There’s no such thing as a typical day in an FQHC. Each patient that walks through the doors brings a unique set of challenges that must be addressed using an ever-changing set of tools, resources, and relationships that may or may not be available exactly when they’re needed.
Clinical and administrative staff have learned to be creative, flexible, and adaptable in these situations, brainstorming workarounds and tenaciously pursuing solutions for patients who often have nowhere else to turn.
This go-go-go approach to constantly putting out fires has become deeply ingrained in the culture and mindset of many FQHCs, leaving staff and executive leaders feeling as if they have little control over what new crisis is looming just over the horizon. But FQHCs don’t have to fully resign themselves to taking whatever the universe throws at them – at least not in every single circumstance.
“A lot of FQHCs feel stuck in this cycle of chaos, where everything is stressful all the time and every organizational attempt to fix the problems is really just an impediment to getting things done on a day-to-day basis,” said Deborah Johnson Ingram, Senior Director of Performance Improvement at the Primary Care Development Corporation (PCDC), which provides practice transformation assistance to FQHCs in New York and elsewhere.
“But that constant sense of urgency and deprivation means something is broken somewhere. Fortunately, broken things can be fixed. FQHCs need to slow down for a moment and think about where they’re experiencing bottlenecks or gaps because there are clear and available solutions for making things better.”
Staff training is at the heart of the solution. Investing in more extensive training may seem like just another drain on the organization’s precious time, but getting staff members on the same page – and keeping them there – is vital for ensuring that workflows are efficient and effective while telling the right story about the FQHC and its performance.
“We’re constantly telling patients that preventive care is essential,” said Ingram. “FQHCs need to apply the same mentality to their operations and their technology. Training, education, and a commitment to continuous improvement will help FQHCs find stability and sustainability in a very challenging environment.”
Breaking free from the negative feedback loop
Advocates for socioeconomic equity have a saying: “it’s expensive to be poor.” People experiencing poverty tend to pay unofficial taxes on goods, services, and opportunities due to their situation, from predatory lenders to higher prices for less healthy meals. Low-wage jobs and a barrage of everyday expenses make it difficult to save up for emergencies, forcing people to make suboptimal short-term decisions that end up costing much more in the long run.
Healthcare organizations serving these populations are often subject to the same patterns. With a shoestring budget, inefficient use of technology, and rapid staff turnover, FQHCs often turn to shortcuts and workarounds to meet the overwhelming needs of their communities.
That puts FQHCs in the middle of a troublesome Catch-22, says Ingram.
“When the organization feels like it’s stuck together with tape and glue, it’s difficult to attract and retain experienced clinical and administrative staff,” she pointed out. “Without high-quality staff, you’re not going to be able to deliver great care and use your technology to appropriately document your successes for payers and regulators.”
“If you’re not tangibly demonstrating value, you’re going to miss out on funding opportunities and partnerships to help you keep improving and retain your best employees. You have to find the off-switch for this feedback loop – most often, that’s going to be at the intersection of your people and your technology.”
Leveraging technology to start owning the quality narrative
Despite the rapid digitization of the healthcare ecosystem, FQHCs still largely struggle to automate their patient-facing processes, collect complete and accurate clinical data, and access actionable insights for population health management.
“The technology gap is one of the biggest issues facing FQHCs right now,” said Ingram. “If you don’t put information into the system correctly, you can’t pull it out correctly. If no one is checking your reporting before it gets sent off to your payers and CMS for quality programs, you don’t know if you’re telling an erroneous story with that data or not.”
“Data is a powerful tool to give you a retrospective view of how you’re performing for your patients,” she said. “You need to have the skills on hand to check if what you’ve captured is accurate, otherwise you’ll be making decisions based on incorrect assumptions. Those decisions are going to affect your financial picture for the next year or next several years, so you’re going to want them to be good ones.”
With more reliable and comprehensive data, FQHCs can develop confidence in their direction and start thinking strategically about longer-term plans for new initiatives, including further digital upgrades and additions to the staff.
Technology can also support the organization by removing time-intensive tasks from clinical and administrative staff members. For example, using population analytics to identify patients due for services, and automating timely outreach to those individuals with text messages or patient portal communications, can dramatically reduce stress on front desk staff, nurses, and care coordinators.
“These are positions that are experiencing very high turnover, especially during the current staffing shortage,” noted Ingram. “If you can make their jobs easier and give them more time for what they’re really good at, you’re more likely to make training for those tools seem like less of an imposition, retain those people for longer, and create more stability in your culture.”
“That’s how you start to break out of that place where everyone is reinventing the wheel as soon as they’re hired because there’s no organizational memory to help them understand the best way to accomplish their tasks. You can’t afford to make one single person the only repository of critical knowledge, because when that person moves on, you’ve got to start from scratch again.”
Collaborating with FQHC advocates and peers to drive shared success
FQHCs aren’t purposely ignoring their training and technology needs, Ingram readily acknowledged. Instead, they are simply doing the best with what they have on hand.
“The key is to empower and equip FQHCs with more tools and more opportunities to learn and improve,” she said. “We have to educate FQHCs about what options are out there for training and support so they can start building momentum and reaching their full potential.”
PCDC offers extensive training and transformation resources to its partners in the community health space, including technical assistance to help FQHCs optimize their existing infrastructure and integrate new capabilities into their digital framework.
But FQHCs can also benefit from partnering with each other in innovative ways, such as through an independent provider association (IPA) that can help community health centers collectively advocate for more advantageous, value-driven contracts with insurance companies.
These arrangements may lead to more robust, data-driven communication, as well as increased financial incentives for high performance, which can then be reinvested into the FQHC and its staff.
“FQHCs have to invest themselves,” Ingram urged. “They have to devote more attention to developing the people-power they need to maximize their technology, their relationships in the community, and their ability to work proactively with patients.”
“It may feel a little painful to spend time and resources on training and technical development at the beginning, but it’s too much of a risk not to do it. Investing in taking ownership of your own story will absolutely pay dividends for you, for your staff, and especially for your patients.”