Where I was trying to help the group leader with her draft, because she is unable to come up with an introduction, she turns around to slander me with plagiarizing the introduction to the case. Ashley Ricker with a dubious name for Ashley Heffelfinger should be doubted for not believable and as a slander for being inept.

1. Runninghead:GROUP 2 PROJECT
Group 2 Project: Arroyo Fresco Community Center (AFCC) Case Study Analysis
Modupe Sarratt Helping the Group with Introduction, Abstract & Reformat APA Style
University of Maryland University College
HCAD 660 9041
April 10, 2018

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Abstract
The Arroyo Fresco Community Health Center Case Study was prepared for use in the 2006
Malcom Baldrige National Quality Award Examiner Preparation Course to describe a fictitious
nonprofit organization in the health care sector, the case study is based on the excellence
framework of healthcare The purpose is to demonstrate a fact-based, systematic evaluation and
improvement process for the effectiveness and efficiency as the criteria of analyzing the case for
strengths, weakness, and performance of community health care center for their mission, vision,
and value. Arroyo Fresco mission is to serve all patients regardless of their ability to pay against
tight fiscal environment at Federal, state and local level to include an increasing percentage of
uninsured patients in their financial model for performance is by providing health services to all
patients in Arizona, especially for the people of western Arizona to become the healthiest people
in the state (Scott, 2017). The expressed purpose of the assignment analyze the case study for
current concerns of leadership and management principles, the organization structure of the
ownership as well the organization financial performance for profitability.

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Group 2 Project: Arroyo Fresco Community Center (AFCC) Case Study Analysis
Introduction: Background to the case study
The Arroyo Fresco Community Health Center Case Study was prepared for use in the
2006 Malcom Baldrige National Quality Award Examiner Preparation Course to describe a
fictitious nonprofit organization in the health care sector, the case study is based on the
excellence framework of healthcare The purpose is to demonstrate a fact-based, systematic
evaluation and improvement process for the effectiveness and efficiency as the criteria of
analyzing the case for strengths, weakness, and performance of community health care center for
their mission, vision, and value. Arroyo Fresco mission is to serve all patients regardless of their
ability to pay against tight fiscal environment at Federal, state and local level to include an
increasing percentage of uninsured patients in their financial model for performance is by
providing health services to all patients in Arizona, especially for the people of western Arizona
to become the healthiest people in the state (Scott, 2017). This project review the case study
analysis, current concerns and leadership, analysis of new organization of ownership, specific
goal and recommendation of the future, as well describe how strategy will be executed and
measured for financing, revenue, and expenses.
Case Study Analysis
Ramon Gonzalez is the CEO of the Arroyo Fresco Community Center and has been since
1996. Mr Gonzalez believes that the senior leaders have “two roles in the organization and they
are to “manage and present” and to “shape the future.” Since the senior leaders are an active part
of the Community Center, the task of presenting an organizational strategy will be a very

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detailed and convincing one. This strategy is not only presented to Mr. Gonzalez (CEO), but to
the other areas of he AFCC such as Judy Jackson-Gomez, Director of Development, George
Hughes, Medical Director, and Tony Joachin, Director of Human Resources, just to name a few.
Also with assistance from community representatives, which is the state and local regulatory
departments and also the health department helps to present the strategy to the board and also to
reach out to communities in which some of the board serves on committees, support groups,
etc… We know that in order for a company to proceed and grow, the future must be outlined or
“road mapped” in order to evaluate the best opportunities and make the best decisions and where
to allocate resources that will mold these future plans. Some major factors that we must consider
are the things that will affect and impact change and they are current markets, new technology,
various suppliers, and regulations.
We must ask the questions of “where are we now, where are we going, and how will we
get there?” Look at the mission and value of the AFCC. Has any of this changed over the past
few years? The mission statement describes the organization’s purpose, so we do not want this
to change for the AFCC. The mission includes the business of the center and other can also
include the services provided to patients. Since senior leaders review the organization’s progress
through the use of the FOCUS scorecard, and the OASIS method to correct any issues, we must
keep this in mind and continue to use this in the performance strategy. The SWOT method could
also be used which means we must check the strengths, weaknesses, opportunities, and threats
which is a “crucial assessment in the strategic planning position” of the AFCC. The centers
strengths must be recognized, weaknesses strengthened, and know and recognize the threats that
affect your daily progression to being a leader in the healthcare community. FOCUS is Financial
Performance, Organizational Learning, Clinical Excellence, Utilization and Satisfaction. This

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allows AFCC to use “key strategic analyses” and align with the mandates that also allow the
facility to operate to its full potential.
Short term goals also “convert strategic objectives into specific performance targets.”
Effective goals are the things we want to accomplish. How will we accomplish these goals and
who is responsible to help to achieve them? We need to have start and end dates to our short
term goals. We cannot state our goals and not follow them through.
Organizational and educational staff learning will continue to operate through the annual
workforce plan and also continue to educate staff through various educational programs and
Work to Learn seminars. Staff Handbook updates are also an important part of the
organizational process. The employee will have direct access to this handbook through the
human resources department of AFCC.
Current Concerns and Leadership & Management Principles
Arroyo Fresco Community Health Center or AF is a non-profit, community owned health
center and because of the non-profit status, they rely on Federal, state and community based
funding. In order to receive federal funding AF has to meet the needs of the community it
services (the tri county area), specific fees based on a scaling measure and establish a program to
receive grant related funding under The Public Service Act Section 330 (NIST, 2006). As a non-
for profit organization, AF also considers the medical services provided as the largest assets they
have when discussing economic and market values.
Just as other states across the nation, Arizona faces adversities as the populations they
serve age. Arizona has a much older population with 13% being 65 or older and 16% is between
the ages of 54-64 and many are without healthcare insurance at all due to the high costs of

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coverage (AARP, 2009) AF provides services to the tri county area to everyone, regardless of
their ability to pay which, may be problematic unless healthcare reform is successful. There is
also a concern for Medicare spending, Arizona spends approximately 60% of Medicaid funding
on long term care services that are primarily in nursing homes and facilities and 40% of the
spending on in home care (AARP, 2009).
In 1982, the Arizona Cost Containment System or AHCCSS was established operating
under section 1115 under the Social Security Act or SSA. The AHCCSS is the Medicaid
program of the state. With the enactment and implementation of the Affordable Care Act or
ACA of 2010 the AHCCSS has suffered detrimental financial impacts causing freeze
enrollments due to funding deficiencies due to the Medicaid expansion with the total financial
impact being nearly 7 billion by 2026 (AZ Chamber Foundation, 2017). In 2012, the US
Supreme court decided that states did not have to go along with the Medicaid expansion
however; Governor Brewer thought that it was in the states best interest to abide by this
expansion. At this point Arizona can repeal the expansion, continue on or come up with an
alternative solution all of which have pros and cons (AZ Chamber Foundation, 2017).
If Arizona decides to not continue with the Medicaid expansion the state will lose both
expansions funding as well as tax credits. These loses will create a downstream effect on the
healthcare industry in Arizona due to major budget cuts across the healthcare continuum (AZ
Chamber Foundation, 2017). Some of the leadership and management principles that the AF
leaders need to focus on during a time of change is; change management, creating a positive
organizational climate that fosters the mission, vision and the objectives or goals of the
organization (Sharma, M. K., & Jain, S. 2013).

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Analysis of a new organizational structure or ownership
The organizational structure of Arroyo Fresco is currently a strong system that has shown
improvements over the years. Senior leaders created a sustainable organization by using the
FOCUS framework. “Arroyo Fresco identifies any strategic challenges during the annual
strategic planning process by using this framework to establish performance measures in a series
of linked aligned scorecards for the organization, care delivery sites, and functions” (NIST,
2006). Through five key performance areas Financial Performance, Organizational learning,
Clinical excellence, Utilization, and Satisfaction, senior leaders can:
 Focus on fiscal responsibility and innovation in the ways that additional resources are
leveraged (Financial performance)
 Facilitate Organizational learning through benchmarking and by identifying best
practices, and they provide both personal and organizational development and knowledge
sharing (Organizational learning)
 Increase Arroyo Fresco’s ability to adopt to rapid changes in the clinical environment
(Clinical excellence)
 Expand partnerships to increase the services offered to patients, their families, and staff
(Utilization)
 Address the needs and desires of today for staff and volunteers while building longer-
term loyalty through developmental plans and succession plans (Satisfaction)

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Arroyo Fresco’s CEO, Ramon Gonzales wanted to improve the organization’s access and
outreach to the surrounding counties of Western Arizona by achieving “organization-wide,
patient-centered performance excellence and the highest standard of culturally competent care”
(NIST, 2006). The senior leaders adopted the Plan-
Do-Check-Act model and integrated it with the
Baldrige framework, the use of CMs (Clinical
Microsystems), and the OASIS Improvement
model to create a customized improvement system.
The Plan-Do-Check-Act model carries out change in four steps by recognizing an
opportunity to change (plan), testing the change by conducting a small study (do), review the
results of the study (check), and take action based on the results of the study (act). The Baldrige
framework has a “simple purpose to provide the framework to help an organization no matter its
size or type of business to manage the performance of an organization” (Hobcraft, 2017).
Through seven categories such as (1) leadership, (2) strategic planning, (3) customer focus, (4)
measurement, analysis, and knowledge management, (5) workforce focus, (6) process
management, and (7) results, the Baldrige framework is consistent and continuously evolving in
the criteria for performance excellence. OASIS is a “role-based access control architecture for
achieving secure interoperation of services in an open, distributed environment” (Bacon et. al,
2002). OASIS has five steps such as opportunity identification, assess or analyze opportunities,
sets targets and time lines, improves action plans, and shares and sustains plans. The CMs of this
improvement model are defined as Clinical Microsystems. CMs develop “an understanding of
their patient populations using a practice profile, a map, and standardized care processes built on
evidence-based or widely accepted best practices” (NIST, 2006).

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While Arroyo Fresco’s organizational structure is currently strong, the CEO had a desire for
the organization to have the highest standards of culturally competent care. Adopting a cultural
competent model will only further enhance Arroyo Fresco’s organizational structure to achieve
cultural excellence. The Purnell Model for cultural competence is designed as a “holistic
organizing framework with specific questions and a format for assessing culture that could be
used across disciplines and practice settings” (Purnell, 2005). The model consists of twelve
domains, constructs, and concepts that are common to all cultures. These twelve domains are:
 Overview/Heritage
 Communication
 Family Roles and
Organization
 Workforce Issues
 Biocultural Ecology
 High-risk Behaviors
 Nutrition
 Pregnancy
 Death Rituals
 Spirituality
 Healthcare Practices
 Healthcare Practitioners
Purnell described the model as a circle with an outlying rim representing global society, a
second rim representing community, a third rim representing family, and an inner rim
representing the person. The interior of the circle is divided into twelve pie-shaped wedges

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depicting the domains and the dark center represents the unknown phenomena (2005). An
advantage of the Purnell model is that flexibility is one of the strongest features. “This model can
be used by all healthcare professionals in both their practice and academic development. As a
result, the model represents an organizing framework that utilizes precise questions and provides
a helpful format for assessing culture in clinical settings” (Albougami, Pounds, & Alotaibi,
2016). A disadvantage of this model would be that it has a broader perspective of culture
knowledge. A provider cannot possibly know every world culture and the characteristics. The
best practice of this model would be for an organization to strive for individualized care of each
patient.
Specific goals and recommendations for the future, new and unique ideas or
research supported rationale for continuing or changing current practices
The new strategy is to balance the mission to serve against tight fiscal environments at
federal, state, and local levels. The strategy has difficulties in it being financially viable. The
strategy has two approaches. One is to decrease overall cost-to-serve and indirect patient costs as
well as to increase net income. This proposal is difficult because a large number of patients are to
be served. Another aspect of the new strategy is to address workforce gaps. The strategy is to
provide clinical and other staff with technical skills. This strategy is also not financially viable
because employee training costs are high. Training staff with specific technical skills can also be
costly. The third part of the strategy is to increase prevention care and avoid the occurrence of
chronic and communicable disease in service areas. The weakness in this strategy is that it seeks
to develop internal and external resources to address the unmet health care needs in the service
area. The problem with this strategy is that developing resources requires further financial
resources that may be difficult to obtain. The fourth objective of the strategy is to provide unmet

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service needs to uninsured patients. The partnerships with state and local governments can
increase the number of uninsured patients served. However, these patients will increase the costs
and will create a further financial strain. These objectives do not appear to be financially viable.
The fifth component of the strategy is to increase the satisfaction of employees, volunteers, and
patients. The drawback of this strategy is that increasing satisfaction of employees may require
an increase in compensation package of the staff. This is not financially viable.
Recommendations for the future is related to Patient Satisfaction and Retention. Items to
think about for the future to satisfy patients include extended appointment availability, increase
throughput/decrease wait times, improve explanation of medications, improve consistency of
answering patient’s questions, improve consistency of including patient’s preferences in care
decisions, and consider implementing patient advocates, case managers, translators, and/or social
work to help address these concerns and bridge the gaps. Some other recommendations include
re-organization to ensure consistency. Convert volunteers to employees and extend offers of
employment, even if part time. Expand health benefits and decrease employee’s cost for said
benefits.
Financial recommendations are increase grant funding, develop political capital,
partnerships and lucrative investment practices including endowment
portfolios/diversifications, investment in securities market, accounts receivable, and sweep
accounts. Some recommendations for Organization learning include reduce variance in
processes through improved work flow and standardization, leadership and staff training
across county lines. Strengthen grants and process for work-to-learn programs across the
board to develop work skills and competencies across county lines. Ensure knowledge
integration into work to increase efficiency and effectiveness. Ensure robust processes for

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scheduling appointments, responding to employees, communicating with patients and
recording of medical incidents and errors.
Services offered by AF include ambulatory medical, family and pediatric care, and
dental services. AF also offers laboratory services, X- rays, vision and hearing screening,
behavioral health, drug screening, and pharmacy services. The center ensures access to
services by its patients by managing mobile operations six days a week, making stops at
churches, schools, and community centers. Population growth now makes it necessary to
expand access to surrounding counties.
Description of how strategy will be executed and measured for financing, revenue, and
expenses
Financing is the process for sustaining and re-engineering an organization for
profitability with creating a model of OASIS to measure gap in a service for an improvement.
Arroyo Fresco (AF) OASIS includes the opportunity identify gap in the service to analyze a need
to improve a service for operating budgets for the establishment of a financial goal. According
to Bacon et al (2002), the aim of OASIS “is to allow autonomous management domains for
achieving financial security in the interoperation of new services. Reason to measure financing is
because it represents the organization performance for loss (Net loss) or profit (Net income).
According to Cengage Learning, financial performance analysis is the process of determining the
operating and financial characteristics of a firm from accounting and financial statements. The
goal of such analysis is to determine the efficiency and performance of firm’s management, as
reflected in the financial records and reports (Cengage Learning, 2015).
Measuring revenue is by identified the organization asset. The revenue of AF for the
fiscal year remains constant for the five past years. As well AF uses RVUs/$1,000 net asset value

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as a measure of return on assets. Since 2005, AF’s performance on this measure has been the
best—or near the best—among state to consistent with its mission to serve patients regardless of
their ability to pay, AF holds a higher market share in Yuma and La Paz counties which have a
higher percentage of the Medicare Medicaid Private Self-Pay. AF assesses this value in terms of
Relative Value Units (RVUs) per $1,000 of budgeted expenditures in each of the units or
departments (Scot, 2017). Measuring revenue is identified the organization asset (Appendix for
Arroyo Financial Snapshot).
Measuring expense is by budgeting. The expense helps to analyze a new service for a
problem identifiable by cost of a new project or a new service for financing resources. That may
include reducing financial risk for projecting revenue. This include identifying sources for
profitability with opportunities cost of innovation and the use of technology to communicates
idea to others businesses for selling tool for administrative marketing as well as a financing
proposal. The strategic goals that include the “supply chain” of the businesses, McGuinn (2016),
describe supply chain of a business as “marketing demand for the project and how much the
organization can sell to make a profit” are part of the management skill of staffs and recruiters
for the promotion of new service. The cost-cutting is also an improvement strategy for
opportunity cost to make an assessment for gap analysis and to come up with brainstorming
ideas and views of the actual cost.
Financial Statement
Estimated Revenues + Estimated Expenses = Budgeted Operating Statement
Revenues:
Net patient service revenue: $169,013
Operating revenue: 7,079
Non-operating income: 10,000
Total Revenues: 186,092
Expenses:
Salaries and benefits: $126,223
Supplies: 20,568

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Insurance: 4,518
Lease: 3,189
Depreciation: 6,405
Provision for bad debts: 2,000
Interest: 5,329
Total Expenses: $168,232
Net Income: (total revenues minus total expenses) $17,860
A net income is profit and surplus that can be use as operating budget for a new service or can be
reinvested into to the organization financial portfolio.
Recommendation for a new service
With a Net Income for a budget projected of a new patient service to yield a profit for
$17,860 will not hurt an organization with more than million in revenues.
The strategy has difficulties in it being financially viable. The strategy has two approaches. One
is to decrease overall cost-to-serve and indirect patient costs as well as to increase net income.
This strategy is also financially viable because employee training costs are high. The healthcare
organization can then analyze the changes in these components and determine what needs to be
done to improve operations and profitability going forward.
Businesses that maintain growth do so for having different dimensions for business plan, and a
business cannot just operate on long-term goal or plan.
However, with a good foundation of revenues, costs are not the issues. We can use this
information to perform variance analysis checklist, there are three main components to variance
analysis; the revenue variance, the cost variance, and the profit variance. The analysis variances
are the financial management tools for improving an organization performance with operating
budget.

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References
Albougami, A., Pound, K., & Alotaibi, J. (2016). Comparison of Four Cultural Competence
Models in Transcultural Nursing: A Discussion Paper. International Archives of Nursing
and Health Care. doi: 10.23937/2469-5823/1510053
Bacon, J., Moody, K., & Yao, W. (2002). A Model of OASIS Role-Based Access Control and its
Support for Active Security. ACM Transaction on Information and System Security
(TSSEC) 5(4), 492-540
Cengage Learning. (2015). Case Studies. Retrieved from
http://college.cengage.com/business/resources/casestudies/students/overview.htm
Hertz, H. (2006). Arroyo Fresco Community Health Center Feedback Report. Baldridge
National Quality Program.
Hobcraft, P. (2017). The Baldrige Framework: In Pursuit of Excellence. Hype Innovation.
Retrieved from https://blog.hypeinnovation.com/the-baldrige-framework-in-pursuit-of-
excellence
Federal Health Care Reform Potential Impacts on Arizona’s Families, State Budget and
Economy. (2017, June). Retrieved April 2, 2018, from
http://azchamberfoundation.org/wp-content/uploads/2017/06/Federal-Health-Care-
Reform-Impacts-on-Arizona-FINAL.pdf
McGuinn, J. (2016). Compliance is supply chain’s business too: Building a more secure chain.
Management in Healthcare, 1(3), 276-285.

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McLean, R.A. (2003). Financial Management in Healthcare Organizations. Clifton Park, NY:
Delmar Learning.
National Institute of Standards and Technology (2006). Arroyo Fresco Community
Health Center Case Study. NIST. Retrieved from
https://www.nist.gov/baldrige/publications/baldrige-case-study
Purnell, L. (2005). The Purnell Model for Cultural Competence. The Journal of Multicultural
Nursing & Health. 11(2), 7-15. Retrieved from
https://www.researchgate.net/profile/Larry_Purnell/publication/11265758_The_Purnell
Model_for_Cultural_Competence/links/00b495330173a7096d000000/The-Purnell
Model-for-Cultural-Competence.pdf
Scott, L. (2017). 2017 Arroyo Fresco Community Health Center Case Study.
Sharma, M. K., & Jain, S. (2013). Leadership Management: Principles, Models and
Theories. Global Journal of Management and Business Studies, 3(3), 309-318. Retrieved
April 1, 2018, from https://www.ripublication.com/gjmbs_spl/gjmbsv3n3spl_14.pdf.
Shi, L. and Singh, D. (2008). Delivering health care in America: a systems approach. Sudbury,
MA. Jones and Barlett Publishers.
Trial Scorecard: FOCUS. (2014, October). Retrieved April 06, 2018, from
https://www.healio.com/cardiology/chd-prevention/news/print/cardiology-today/{4ad8b4ca-fcef-
4b04-8be7-0a1710273660}/trial-scorecard-focus
What is strategic planning? (n.d.). Balanced Scorecard Institute. Retrieved from
https://www.balancescorecard.org

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Why Healthcare Reform is Important in Arizona. (2009). Retrieved March 31, 2018, from
https://assets.aarp.org/rgcenter/health/state_hcb_09_az.pdf

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Appendix