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We initiated a new program called Farm to Clinic which provided farm fresh, locally grown produce to our patients in a farmer’s market in our waiting room. Vegetables are provided free through “produce prescriptions” earned by attending appointments. Its a great program, but labor intensive involving vegetable pick-up, sorting, storage and staffing of the market booth, preparation of a newsletter with information on the vegetables and recipes, assuring providers have the “produce prescriptions” to hand out to patients, and oversight of students. We decided to split the duties of the position and use community volunteers for coordination. The challenge was finding enough volunteers and back-up for volunteers, then the time to train the volunteers. We also use college students as interns since we’re in a college town, but this also involved time to train and these interns change every semester. After about six months working on our new model for this program we have “permanent volunteers,” a retired couple, that pick-up, sort and store the vegetables. We have another “permanent volunteer” in charge of orienting students and assuring the market booth is staffed. We only occasionally have to fill in to staff the booth and have never had to do vegetable pick-up since we started with these volunteers. Our role is now oversight of the program — purchasing vegetables, working with the community for donations, printing newsletters, etc, Our success came in meeting with staff, working with, meeting with, and training volunteers, development of a Farm to Clinic Market Training Manual for volunteers and student interns, and appointing a staff member as volunteer/intern point of contact.
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Our organization has grown from 25 employees to over 70 in less than four years. Originally, I was responsible for supervising all of our support staff, which was less than 20 people. As the organization grew, so did the need for additional management support. I was unable to give each staff person the level of support that they needed. Initially we created Lead positions for each of our three main support staff areas, Front Office, Medical Assistants, and Care Coordination. We selected the leader for each area from the current staff that worked in these roles and who demonstrated an interest and ability to lead their respective teams. We have since added additional lead roles for other support areas. I have worked very closely with this entire group to help them become what we call our Middle Mangers. They are the liaisons between the entire support staff and the Executive Team.
Challenges – 1)staff found it difficult to change who they reported to; 2) selecting a manager from the department, who was technically skilled in the position, but didn’t have any management experience; 3) added one more layer between the Executive Team and the support staff; 4) as our organization continues to grow we need additional management support.
Overcoming the Challenges – 1) continue to work with the Middle Managers to help them gain the trust and respect of their staff 2) continue to coach the Middle Managers as we work to develop a strong workforce 3) work to make sure that the Executive Team is available and visible to all staff and try to make sure that the Executive Team is not making decisions without the input of the staff that are affected by the decisions; 4) we are currently developing assistant manager positions and working to figure out how to incorporate these staff into the leadership role.
Results – The creation of the Middle Manager positions have allowed us to grow employees who have an interest in leadership who we might have lost to other employers if we weren’t able to give them growth opportunities. We have also been able to hire staff for entry level positions who have very little professional experience and help them be successful because they have more support from their manager. We were also able to create Standards of Behavior and as a group we work to help hold all staff accountable to these standards.
Successful Outcome – I act as the liaison between the Middle Managers and the Executive Team. I am responsible for bringing information back and forth between the two teams. I get to spend lots of time working the the Middle Managers as a group and individually as they face new and/or challenging management situations. We talk through the conversations that they need to have with their staff. We are currently working on a team building project to help the Middle Managers and the Executive Team work together better. We are all learning/relearning Lean practices and working on projects to improve efficiencies within our organization. -
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Reading Jessie’s post is very similar to what I found when I reported exactly one year ago. I “heard” and recognized the need for additional levels of staff to limit the overwhelming administrative requirements placed on our clinical support staff. I first shared my expectations with my 5 nurse managers with the promise that I would critically look at the functions across the organization and the staff who fell under my purview. I found the need to hire additional clinical secretaries with defined PDs and separate a lot of blurred functions that crossed over to business assistants, medical records and nursing duties. All changes were made with input from staff themselves who performed the work with time studies so I can have data linked with financial impact to go to Senior Leader Team (CFO/HR) for additional staff. Another area similar to Jessie was having assistant nurse managers and assistant center managers added to our staffing mix.
when it comes to accountability, this comes from leadership and HR to enforce it at every level. Having clear goals and ability to run reports and track met outcomes is key. I also teach team accountability so peers can hold each other accountable- some on board and others not so much but that’s where training comes in.
we have a designated multi-disciplinary team working on how to best manage uncontrolled diabetics who were pumped up at the beginning to get started but then team lost steam, another director and I set up a coaching time and for the past 2 month they’ve been meeting bi-weekly to focus on goals and reporting out. they now establish setting bi weekly goals to meet as a team. -
Our organization also grew from 45 employees and 2 locations to now over 250 employees and 7 locations. We added the middle management team a couple years ago and now the new executive team is redistributing their duties to give them more time to spend with each employee on goals and training. We are working on retention which is proving to be difficult due to CHC’s rate of pay. We believe that working one on one with employees to answer questions and provide detailed training we will be able to retain employees.
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Looks like we are all thinking along the same lines. Our CHC did the same 2 years ago. One year after becoming an FQHC and growing, we definitely saw the need to have middle managers more engaged. We developed what we call a Joint Leadership Team. Once per month for 90 min this group meets with Senior Leadership. We have a standing agenda then add agenda items as needed. We engage them by teaching them more about the clinic. Agenda items include: deep dive into monthly financials; updates on strategic plan / goals; Quality updates; other training on policy development. We spent several months reviewing a few chapters of the OSV & Compliance Guide to help them be better prepared for the OSV site visit. Some of the challenges we encountered early on what how they disseminate information to their depts/associates as it was not being done. We had to set clear expectations and this seemed to help.
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We have also grown in leaps and bound in the last 4 years. We decided to add two operations manager one for each department Medical and Dental.
They have site meetings at all locations and that has allowed us to roll out polices, procedures, talk about events and engage the staff in more active participation. The office managers meet with the senior team once a month to report back on what is working, what is not. I am currently working with them to update Job descriptions, so that we align them to match our mission, vision and values. It will be a big roll out to the staff to include a new Excellence pledge. I have attached it for all to see. -
The Billing Manager position was new to PHC in 2017. After several months of observing and settling into the position, it was evident that we needed better training for new staff, whether that be temporary or regular FTE. I made a significant effort to learn the various postions on a high level and requested the help of the billing staff to outline the various workflows they encounter during their day and cataloging those into binders for each position. This proved to be very effective and is expected to help minimize turnover in the department by having the correct tools/education for job performance. Throughout the process, it helped me to identify the strong leaders of the group and we now have a Billing Representative II in place to facilitate training in the department and provide additional direction. Staff members do not always have to wait for my direction as they now have a subject matter expert to turn to when I am not available and questions arise.
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