Featured Articles: NWRPCA Programs

Capstone Projects: Mid-Level Management Training

Thursday, November 15, 2012   (0 Comments)
Posted by: Joy Ingram
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Hiring HealthCorps Navigators, Wolf

Billing Department Transition Project, Taylor

Improving Team Communication in the PCMH with Team Times, Edwards

Improving Employee Morale, Baron

The Patient Experience at Westside Pediatric & Adolescent Clinic, Tomcho

An Employee Volunteer Program, Cantwell

Via Salud! Transportation for Healthcare, Supinski & Whitfield

Pod Lead Program, Photos

Improvement of Customer Service & Employee Satisfaction at a Call Center, Ortiz

Launching a Foundation for our Health Center, Metcalf & York

Behavioral Interviewing, Huezo

Coalescing the Medical Support Managers into an Effective, Accountable Team, Supinski

Patient-Centered Medical Home Recognition: Getting Started, Trevizo & Carmona

Hiring HealthCorps Navigators

Rachel Wolf, Salud Family Health Centers


I fill two distinct but overlapping roles at Salud Family Health Centers: Program Manager for Transitions of Care, a program that aims to reduce hospital readmissions of Salud patients, and Coordinator for the HealthCorps Program, a type of AmeriCorps program that aims to improve healthcare access to the underserved and enhance workforce development for community health centers. Our organization hosts ten Community HealthCorps Navigators who staff the Transitions of Care Program while serving with Salud.

I took over the role of Community HealthCorps Program Coordinator in June 2012, shortly after receiving this training. As such, I was able to translate the training directly into action.

The Problem: Imperfect hiring process for temporary employees

I decided to target two areas for the capstone project – the hiring process for Community HealthCorps Navigators and the Orientation those Navigators would receive upon joining our team. These seemed to be the two most critical aspects to ensure success for my first program year.

I learned in this course that effective hiring, meaning hiring the best person for the position and organization, can be a huge determinant of success in the workplace. I wanted to update the hiring process for Community HealthCorps Navigators so that we could confidently select the best candidates for the position and the team.            

In the past, HealthCorps Navigators have felt as if they were not well integrated into the organization, due partly to the fact that Navigators stay for only an 11-month contract and fall outside the normal operational structure. I wanted to use the Navigator’s orientation as an opportunity to introduce them to the organization, not just their specific program. I also wanted it to be as organized and seamless as possible, to set the expectations for the upcoming year. 

The Solution

One of the first steps taken was creating two versions of the job description – one that was given to the applicants and one internal version that was not shown to applicants, but served as a reference point for the type of qualities we wanted applicants to have. Then, I increased advertising for the HealthCorps positions to reach a wider applicant pool. We began posting our positions on job listing websites like Craigslist, Idealist, and college and university career centers in Colorado. I added additional steps to the screening process so that we could begin weeding out unqualified applicants before the in-depth interview. 

After receiving applications (all applicants must submit the AmeriCorps application through the AmeriCorps portal), I emailed the full job description to applicants and then scheduled a preliminary phone call.  It was an opportunity to clarify any outstanding questions about the position and get a better sense of the applicant’s qualifications for the position. If the applicant was unsuitable for the position, they were not offered an in-depth interview.

The rest of the changes surround the format of the in-depth interview. We began interviewing applicants by a team of three people – the previous Community HealthCorps Coordinator, a current Community HealthCorps Navigator, and me. The Navigators rotated throughout the hiring process so they each were able to interview candidates. They offered invaluable insight into what qualities they thought their successors needed, based on their experiences, and expressed gratitude at having been invited into the hiring process.

Finally, I incorporated behavioral interviewing techniques and questions into the interview to get a sense of the applicant’s past actions. After the other interviewers became familiar with this style, we alternated asking questions and documenting the applicant’s responses. From our notes, we were able to evaluate and compare candidates’ performances afterwards.

Next I focused on orientation. I identified the essential components of a successful orientation that would leave the Navigators not only informed about the organization and their role, but also excited to begin their service because of the impact they would have.

We began each day of orientation with a team building activity. We had different speakers from within the organization present to the group on various topics.  During orientation, we completed the majority of the training required to prepare the Navigators for their role. Finally, all Navigators shadowed multiple roles within their clinic to get an understanding of clinic operations.

We ran into a few challenges when implementing our new hiring process. The first was becoming accustomed to “reaching for a STAR.” At first, it felt unnatural to probe deeply into an applicant’s initial response, but it nearly becomes an instinctual response once you know what you’re looking for in their answer. 

Secondly, there was a minor logistical challenge in setting up interviews, given that we had three schedules to work around, but this proved very manageable.

The biggest challenge when updating the orientation for Navigators was scheduling! We had to consider the schedules of all the presenters who came during orientation. This year, it was further complicated by the fact that orientation fell during our HRSA site visit. Another challenge was finding other people within our organization to give trainings. Ultimately, I had help from the executive team, client services department, IT, and some alumni of the Community HealthCorps program.  

I still have many goals I’d like to accomplish in the upcoming year. Beginning next week, I plan to start my individual check-ins with each Navigator to ensure they have good understanding of their role and the expectations of their position. I also want to hear their feedback, so I am creating a survey that they will be able to complete anonymously. 

Some of my longer-term goals include: setting goals for each placement site to increase productivity; fostering a supportive environment through bi-weekly meetings; and finally having both a mid-term celebration and end-of-program graduation ceremony where each Navigator will get recognition for their service.



Billing Department Transition Project

Diane Taylor, Valley View Health Center


Our community health center was struggling with billing burn out, out of control A/R days, internal misconception of job duties and some staff without adequate “can do” and “will do” work styles to allow the changes necessary to get the job done. My mentor (Sonja Cox) and I met nearly every day for hours and mapped and planned out a way to change the billing department to be a successful and fully operational office, with what the office employees then thought could never happen without hiring more staff. Over the past nine months, Sonja and I have recreated a billing office that functions beyond its predicted capacity - with the same number of employees. The duties have been redistributed and proportioned out to a capacity that is logical and fundamental in the success of the company. 

The Problem: Billers with unique, unshared skills and methods

We began by measuring our employee’s knowledge of billing. We had them take a test to determine where they stood. Each biller had his/her own expertise, and it was specific to that person alone; no one else knew how to do their job. We had four billers all doing something differently; we have 8 clinics, 23 providers and over 100 employees. 

The Solution

Once we measured the employee knowledge we decided to even out the workload among the four employees. We would split the billing office alphabetically and evenly for both dental and medical. I would take over the IT work. 

How did we train everyone at little to no cost?  Because everyone had their own expertise, each employee was to write up their own training sessions for the subjects they knew how to do, and then they were required and scheduled to have classes twice a day in order to teach the other employees how to do the job that they were doing. The dental biller created a slide presentation and posted it on the company shared drive for training purposes, allowing all billers to know how to bill dental. Another biller was doing IT work along with electronic claims submissions and downloads, which was quite overwhelming. The problem was that the process was impossible for anyone else to comprehend and needed to be fixed.

Unfortunately, some employees just did not want the change and eventually three employees left.

A Second Problem Identified: Noisy workplace

I found that, in this billing department, all the billers sat in one room with no dividers. It was a small room next to a noisy delivery hallway, and we could hear the dental drill noises and children crying in patient rooms. This made it very difficult to concentrate or hear on the phone. Other staff and providers interrupted constantly with questions or chitchat. 

A Second Solution

We moved the billing office across the street where we all split up into three different offices. It is very quiet, so we can concentrate; the production numbers speak for themselves. In addition, the billing office had one set of ICD9 and CPT coding books for training (only one person was using them previously). So we bought the Encoder Pro Professional for medical and dental, coding not to mention the ICD-10 crosswalk. All the billers including myself can access this and get up-to-date information on any code, the RVUs, the most current Medicare and Medicaid information and updates and some other payers. It’s been a great training tool that every billing office needs!

The employees that left caused a delay in our project, but that was anticipated. This was my chance to do somebehavioral interviewing, obviously my greatest focus at this point, considering that the three employees that left did so because they were unwilling to change. I needed people willing to work with a “can do” attitude. We interviewed many people and hired based on willingness to learn and capabilities of learning. We understood our hiring needs and asked the questions necessary to see what those people would be “willing” to do, not “whether” they could do them. 

This was an enormous success and today we are proud to say that we have one of the greatest billing teams ever. They work hard, all doing the same thing. They all are learning medical and dental and every day they are learning more. All billers work their individual alpha split A/R and collections. Patients statements have their individual billers’ phone number listed so that each biller is familiar with most of their patients’ situations and can easily help them. We have an enormous white board in the hall with everyone’s name and duty for each date, based on a rotation for all electronic billing duties.

On September 11th, we went live with the Electronic Dental Record. Since I am on the core team, I needed to be a liaison between billing and education for this piece. On the same day we went live with our new clearinghouse Claim Remedi. But it was too much to do both the eligibility and the claims portion, so we are now working on the claims submission. This takes an enormous amount of time and energy for the IT work and training.

During these past few months we had to identify our clinics with their separate NPI numbers and match to the PTANS (obviously a huge project in itself), as we could not send claims to the clearing house until the NPIs were all evenly distributed. In addition, as providers come and go, we found that we need to change to a group contract with our insurances rather than individual.

Another training tool during this transition was the “essential learning” program that our company purchased for the purpose of training employees at their leisure. It is an online tool by which supervisors in the hierarchy designate which classes they want their employees to accomplish and by what date. The employee can take the class at home if they choose. Some employees have expressed interest in some of the learning programs that are not required; I am using this in my evaluations in setting goals for the staff. 

Since my last visit to Denver for Part 1 of the Critical Skills for Mid-Level Managers training, I have used the communication style information provided by June Ramos. I found her to be invigorating and helpful, so I thought I would give my employees a chance to learn about their own communication styles and keep them encouraged during these tough times of constant change. 

This process has been a lot of hard work, long hours and a lot of emotional stress for all involved as we all know, change is hard to do, but it is absolutely necessary in order to be successful in anything.



Improving Team Communication in the Patient-Centered Medical Home with Team Times

William Edwards, M.D., Denver Health 


Our clinic is in the initial stages of starting the transition to a Patient-Centered Medical Home (PCMH).  The PCMH model is based on the formation of patient-specific Care Teams.  A Care Team usually consists of providers, nurses, health-care partners, clerks, and additional staff to help meet all the medical/social needs of the patients.  This model also allows patients to establish ongoing relationships with their teams, which allows for improved consistency of care and patient satisfaction. 

 The Problem: Need for Care Team Communication

The most important aspect of maintaining a well-run team is establishing methods of good communication.  

The focus of my project was the establishment of “Team Times.”  Team Time is a 30-minute meeting among all the members of individual Care Teams.  The time was established so that individuals within the care team can better manage the needs of their patients.  We used a template from Westside clinic (which has a better established PCMH model) as a guide for what each individual might do to make better use of the time.  Despite having these guidelines, we initially had a lot of difficulty establishing consistent Team Times due to scheduling difficulties and getting teams acclimated to the new process. 

The Solution

While trying to better establish team times, I was also transitioning into a leadership position at Eastside.  The person helping me with this transition is my mentor Dr. Lora Melnicoe.  We met 2-3hours per week, discussing many administrative topics including PCMH and provider scheduling.  We established team time for six providers with the following goals in mind: 1) To have three team-times per week and 2) For each provider to have team time approximately every two weeks.   

While learning how to do provider scheduling for our clinic, I thought of a way for us to consistently implement the Team Times at Eastside. I decided to schedule Team Times into the provider schedule, which is made two months in advance.  I did this by communicating with all groups involved to find out optimal scheduling times. 

The optimal times in our clinic were at the end of a session (11:30a-12p or 4:30p-5p).  This allowed for better cross-coverage for clerks and HCPs.  Scheduling two months in advanced allowed providers to be better prepared for their times and gave the Nurse Practice Manager more time to plan for coverage.  The meetings were set typically during times when the providers weren’t also seeing patients.  In situations where that wasn’t possible, we adjusted that provider’s schedule so that they could attend. We are still adjusting to a new process, but we will work on this with continued enforcement over time.  Our Team Times went from being frequently cancelled and not schedule to 86% attendance rate.



Improving Employee Morale

Linamaria Baron, Salud Family Health Centers


I think it is important to train every employee on the significance of their daily activities and to teach them how they ultimately impact the community where they live. In my experience Salud has been much more than a place to make money or find a career; it has been an opportunity to help and understand my community. This is why it is important to me to find employees that abide by the same ideas, and I think that sometimes employees lack that understanding because they lack the necessary training.  When employees learn the goal they are trying to attain they will be more engaged in their daily activities because they will know exactly what it is that Salud is trying to attain, and they will also love what they do much more, because they will understand how much difference they are making in the world we live.

 The Problem: Employee morale unconnected to Salud’s strategic goals

I set out to show employees the importance of their daily activities in the accomplishment of our health center’s strategic goals.

The Solution

I created a very colorful and straightforward presentation that outlines our Mission, Vision and Strategic Goals and includes an existing video in which a member of upper management explains in detail Salud’s mission and composition. I also created a chart with Salud’s Mission, Vision and strategic goals for this year, which I expect to relate to each position at a later date. In addition, I plan to have Dr Virgilio Licona come in to every site to do the same presentation he did at our training.

So far, I have done the presentation at my site, where it was received with a lot of interest. They understood the point and many of them heard for the first time the goals of our organization. Time has been a major setback on my project, but I have tried to do as much as I can with what I have. Communication has not been easy because of the great distance between our administrative center and the nine clinics. 

I have tried to communicate as much as I can, and I am thankful to everyone I have reached, because my co-workers and the executives have been really helpful.



The Patient Experience at Westside Pediatric and Adolescent Clinic

Margaret M. Tomcho, M.D., Denver Health 


Healthcare is a dynamic field.  Healthcare delivery is focusing more and more on the provision of team based care.  An engaged, informed customer is a key member of this team and is an integral part of this delivery.   The patient’s perspective and experience is consequently an important component to measure and study.  However, measuring and quantifying that patient experience is a challenging task. 

Westside Pediatric and Adolescent Clinic is the largest outpatient primary care clinic in Denver Health’s Community Health Services with over 30,000 visits last year. The patient population is primarily low income.  The payer mix includes Managed Care Medicaid, Fee-for-Service Medicaid, CHP+, as well as uninsured and Denver Health discount program recipients.  The population is overwhelmingly Latino, many of whom are monolingual Spanish speaking.  There is a rapidly growing Somali and Somali Bantu refugee population as well as a large Vietnamese refugee population.

The provider group is also diverse.  There are 16 providers both M.D.’s and P.A.’s.  Most are part time and job share in pairs to form Care Teams. 

Problem: Are we meeting patient needs?

At Westside Pediatric and Adolescent Clinic, we experimented with a Patient Walk Through to attempt to gain first hand knowledge about the patient experience.  The knowledge and information gained would hopefully allow us to better meet the needs of our patients and families.  In addition, the observations could begin to educate the health care team on ways to streamline and improve the overall delivery of care using the “Right Person Right Job” philosophy.   

 The Solution

 Denver Health Quality Improvement Coaches followed patients from check-in through the entire visit to check-out.  We developed questions and points of observation using a scale created by Larry Mauksch.  In addition, we created questions as a debriefing with families after the visits.

The Patient Walk Through represents a unique approach to obtaining a window into the patient experience.  The data obtained will help guide future training programs for the staff and provider on adequately addressing the needs of the patients and their families.  Additionally, the observations will stimulate further development and refinement of the primary care pediatric visit.

This project is in the very early stages.  There was a small sample size observed so generalizability of the results is limited.  The QI coaches observed only English-speaking patients so the results may not be equally applicable either.  These challenges will be addressed by increasing the sample size and further refining the process.



An Employee Volunteer Program

Melissa L. Cantwell, MHA, Community Health Center


The initial concept for my project was driven by experience at the Mid-Level Managers Conference in April. Coming out of that I was prepared to focus on an employee retention program. After speaking with my Human Resources Director and mentor, it became obvious that an employee retention program was a very large undertaking that would require more work than might be feasible for the time-frame of this project.


With that in mind I began to think about what really drew me to the concept of the employee retention program – employee satisfaction. In conducting some research and speaking to co-workers, I decided to shift my focus to an employee volunteer program. Research indicates that 96% of Americans believe that volunteering makes people happier (Do Good, Live Well Study (UnitedHealthcare & VolunteerMatch), 2010). This seemed like a logical step to take, because I believe that happy employees lead to happy patients. 


To determine if employees would truly be interested in volunteering, I created a survey asking questions about areas of interest, past volunteer experiences, and barriers to volunteering. Thirty-one out of nearly 100 employees responded. The dominant themes were health, children, mentoring, and teaching.


The Problem: No employee volunteer program

Once the surveys were tabulated I had to determine what scope and involvement Community Health Center would have in the employee volunteer program. A vision statement was created, “to develop and maintain an employee volunteer program that allows our employees to serve their community. We believe that our employees thrive when they have the opportunity to help others and we want to support and provide recognition for those efforts.” At one point the idea of allowing employees to volunteer during work hours was discussed; however, after discussion with my fellow clinic site managers and supervisor, I determined that this might be too destabilizing to the clinics.

The Solution

Instead we decided to focus on in-house volunteer opportunities such as food drives, hygiene drives, Christmas stockings, etc.

 The first food drive began on October 8th and will run to November 9th. Our goal is to collect 500 pounds of food that we can donate to the local food banks to help feed hungry families for Thanksgiving.


In addition to the in-house program, I have also created a volunteer resource directory that is available on our intranet page. This directory features information about local volunteer opportunities, including information about the company, who they serve, volunteer expectations, and hours needed.


Finally, we have created a “Celebration” page on our intranet. On this page we recognize employee volunteer efforts and highlight the good work they are doing.


Although it is still in the early stages, the employee volunteer program has the potential to be a great addition to Community Health Center. Employees have the opportunity to help others, the community benefits from their work, and we strengthen our bonds as a community.




Via Salud!  Transportation for Healthcare

Sue Supinski and Stephanie Whitfield, Salud Family Health Centers


Estes Park is town of approximately 5976 people located in the Colorado Mountains within hours of the Denver area, making it a perfect day-getaway for people on the plains.  It is also a tourist town, a destination wedding location and the gateway to Rocky Mountain National Park.  The drive to Estes Park is a scenic canyon drive from four different directions.

We have 137 Restaurants, including coffee shops, pizza places, bars with grills and ice cream shops.  We have 27 hotels and lodges – and this number does not include cabins and homes that are available for weekly rental.  During tourist season, our population can jump to 50,000 each day.

From these numbers you can see that the majority of the populations we serve are those people who are working in the service industry.

Our clinic, Estes Park Salud, is located on the out skirts of town, in a residential area, making it difficult for some of our patients to make it to an appointment.  Our service area also includes the surrounding towns: 

  • Allenspark – located 12.6 miles from Estes Park
  • Drake – located 13.1 miles from Estes park
  • Pinewood Springs – located 12. 4 miles from Estes Park
  • Glen Haven – located 7.4 miles from Estes Park
  • Lyons – located 16.9 miles from Estes Park.

The Problem: Transportation

Salud’s mission statement says that transportation should not be a barrier for healthcare.  We did a survey of our patient population and the results were:

  •  61% responded that transportation as a whole is a problem
  • 71% responded that they missed an appointment or had to cancel because of lack of transportation
  • 80% responded they would use a mode of transportation that was affordable ($2.50 round trip)
  • 71% responded that during the winter months, transportation is a larger problem.

We took this as sign that we need to do something about transportation for our patients!

Estes Park Salud receives no federal funding due to the date the clinic was started, the location, and the median income at that time.  So a wonderful group of people formed the Estes Park Salud Foundation.  They raise money for us and help us in areas that Salud Administration cannot.  For instance – they raised the money to build our current clinic on donated land – which why it is located where it is. 

Our public transportation here in Estes Park is a company called  Viá Colorado.  We met with one of their information specialist and formed a plan! 

Viá served only the disabled population using a bus with handicap accessibility. Recently, due to the lack of public transportation in Estes Park, Viá has started providing transportation to all community members. This has been a great development; however, the passenger bus incurs high fuel and use cost when many times the larger capacity and handicap accessibility are not needed. 

The Solution

The addition of a small car would allow Viá to serve a larger population more efficiently and would also be more environmentally responsible. 

Our intention is that Viá would own and operate (scheduling, driver, insurance, maintenance) the vehicle with preference made for Salud patients, as they are often the most in need due to poverty status and health issues.  The Salud Foundation would cover the operating costs. We envision both the Viá logo and the Salud logo on the vehicle to highlight this partnership and point of access in the community. Viá would continue to use their bus as needed for handicapped clients, utilizing the new smaller car for most requests, and they would use the same pay model currently in place, $2.50 for a round trip for clients.

We have a unique relationship with Honda Corporation in that we have a school in Estes Park called Eagle Rock.  Honda owns and operates this school for high school students from all over the country that have problems being in “main stream” school systems.  We are the primary care provider for the school.  We have been working with the Director of the school, Robert Burkart, to develop a proposal to submit to Honda Corporation in hopes that they will donate a car for our purpose!  We would love for this vehicle to be a hybrid – but quite frankly – beggars’ can’t be choosers – so we will take whatever they give us!

We are continuing work on this project.  Last week we met with the Director of Operation of Via, Rich, and got him on board with our idea as well.  Our next steps are to do another survey with our patients specific to Via’s services, submit the proposal to Honda, and investigate the possibility of “volunteer drivers” to help lower the operating costs of the vehicle!



Pod Lead Program

Dana Photos, Salud Family Health Centers


Salud Family Health Center in Fort Collins is staffed by a highly qualified and experienced Medical Support Staff. The clinic is split into three Pods that are often isolated and lack formal systems to monitor and improve efficiency. Providing leadership opportunities to MSS in each Pod will improve Pod strength and increase communication with clinic management. I wanted to outline a program that would assign a permanent Pod Lead to each pod. A similar program was previously enacted with positive results.

The Problem: Operational strength and communication

Pods do not operate at optimal strength or communicate optimally with management. 

The Solution

Three MSS members will assume leadership roles in one of three Pods by exhibiting specific skills and work ethic. The Pod Lead will motivate the Pod and enable them to efficiently perform duties as assigned. The Pod Lead will ensure that MSS tasks are efficiently completed and Pod performance is consistent with Salud Policies and Procedures.

The Pod Lead will monitor:

  • MSS tasks: The daily and weekly tasks performed by MSS as indicated on the supplemental form Pod Lead Report and as defined in the MSS Job Description.
  • Pod Efficiencies: The successes observed in each pod that may be used for standardizing current procedures.
  • Pod Inefficiencies: The failures observed in each pod that may be used for recognizing clinic needs for quality assurance and allow for improvements.
  • Professional Conduct: Refers to attendance, inappropriate use of internet, inappropriate language or behavior, inappropriate use of phones, uphold dress code, and ensuring patient confidentiality.
  • General Notes:  The Pod Lead may indicate any general comments concerning the Pod i.e. equipment or facility repairs, medical supply needs, office supply needs, etc.
  • Signature: The Pod Lead will sign and date the Pod Lead report authorizing the information for submission to the Medical Support Manager.

The Pod Lead will meet each week with the Medical Support Manager to review the Pod’s performance, efficiencies, inefficiencies, professional conduct and general information.

The Medical Support Manager will work with each Pod Lead to take appropriate action based on information from the Pod Lead Report. The Medical Support Manager will report directly with the Fort Collins Management Team and Salud Administration as needed.



Improvement of Customer Service and Employee Satisfaction at the Call Center for Salud Family Health Centers

Israel Ortiz, Salud Family Health Centers


The call center for Salud Family Health Centers receives around 2200 calls a day. We have experienced scheduling errors, inappropriate transfers to clinics, some lack of employee satisfaction, and even moments of incivility.

The Problem: A call center that doesn’t represent the health center well

I want to provide world-class customer service to our patients, reduce scheduling errors, ensure transfers are correct, and help our call center employees experience job satisfaction. However, it is really hard to convince others the importance of the change, particularly when they do not realize the importance of their job.

The Solution

I decided to use the eight steps to create successful change as presented by John Kotter:

  • Create a sense of urgency
  • Pull together a guiding team
  • Develop a change vision
  • Communicate the vision for buy-in
  • Empower others to act
  • Produce short-term wins
  • Do not let up
  • Create a new culture

As a former Business Manager (office manager) it was really helpful for me to see the other side of the coin and to bring that knowledge to my staff at the call center, to be able to explain to them the process at the clinics and how their job impacts directly our patients, the clinics and their own satisfaction. I have been able to improve the communication with the clinic managers, which is crucial to success. I have invited managers to visit the call center so they can get a real perspective on what we do. I also visited the sites, bringing along my staff lead so she could get a better perspective on the clinic flow and pass that information to the rest of the staff. These two simple efforts have helped us a lot to improve our daily performance.

I have assembled an internal committee so we can discuss areas that we need to improve. It includes strong staff members able to influence and move the rest of the team toward our goal. I still receive complaints from the clinics, but I have noticed a great improvement. Recent survey results show really good feedback from the management at the clinics. I understand that this is a continuous improvement process, but we are working hard to achieve our goal.

Regarding employee satisfaction, I am happy with the results so far. I also created a survey for my staff, and the results were much better than I anticipated. My staff thinks they can count on their management for any issues, and they now feel their jobs make a difference to our patients and clinics, although I still need to create a better training system as they feel they need more in certain areas.

This project has not been completed yet. We are continuously working on getting better. I do not know how long it will take us to get to be able to say we have accomplished the goals, but I can see improvement now.


Launching a Foundation for our Health Center

Jennifer Metcalf & Cynthia York, Horizon Foundation


Our COO, Jeff Mengenhausen, who served as our mentor, indicated his wish to establish a non-profit foundation for Horizon Health.

The Problem: Inability to reap the benefits of a nonprofit foundation 

The Solution

After some initial Internet research, we began by creating a mission statement, by-laws, policy & procedures guidelines, meeting structuring template, and records-keeping protocol. After our mentor reviews our work, we will present the proposal to our Board of Directors. With their approval we will file with the state for our tax exempt license, apply for an IRS 501 ©(3) tax exempt status form (1023), register with Charities Bureau of the Attorney General Office, prepare a personnel manual, select individual to serve on the Board of Directors, designate officers to serve on the board, establish board committees, volunteer committee, executive committee, finance committee and fundraising committee.

 We will have to have our first meeting to elect corporate directors & officers, retain an accountant for the annual audit and mandatory government filing. Then we will establish a bank account and check writing procedures, and determine which officers have the power to sign off on checks.

 When we first started this project we didn’t know there was so much involved in getting a foundation started. It has been a lesson well learned. We are aware there is a long road ahead of us to complete this project but are looking forward to the outcome.



Behavioral Interviewing

Monica Huezo, Valley View Health Center 


We needed an easier and more efficient selecting and hiring process and the ability to hire the right person.

The Problem: an ineffective hiring system

We needed to save time and money in our hiring processes and end up hiring the right person. 


It was difficult to find the time to complete the work involved. Because we were not currently hiring, it was difficult to test new ideas as I went along. 

The Solution

I created tools that can be used by any interviewer and then shared the tools and my ideas with my coworkers. By doing so I achieved peer buy-in and contributions. The overall hiring process improved.



Coalescing the Medical Support Managers into an Effective, Accountable Team

Sue Supinski, Salud Family Health Centers, Estes Park


Salud Family Health Centers is comprised of 9 Clinics, one Mobile Unit, a Pharmacy, a Call Center, and the Stanley J. Brasher Administrative and Training Center.  Each clinic hosts Medical, Dental and Behavioral Health and the facilities are spread over 8,500 square miles of North Central Colorado.  Each facility has a management team consisting of a Clinic Director (who also is a provider), a Business Manager, and a Medical Support Manager (who also is a Medical Assistant or LPN). 

In 1970 Salud opened its doors with one clinic in Fort Lupton Colorado and over the next 40+ years became the 2nd largest Community Health Organization in Colorado.  The Last 4 years has seen the implementation of the Call Center, the Pharmacy, and Electronic Medical Records.

The Problem: Rapid growth outpaced team coalescence

The rapid growth in both patient numbers and technology has, as one would expect, created more responsibilities, and the trend toward MU and PCMH is rife with mandatory reports, audits, CQI, etc.  Much of this falls to Medical, and most anything in Medical in some manner falls to the MSM and their staff.

The Solution

The first step was realizing that this is more a 6 month project.  With that acknowledged I threw expedience to the winds and started at the ground level:

Before anything can be improved it must be defined.

  1. Define and standardize the Medical Support Manager position
    Review the existing Job Description and update it
    b.  Share this with HR so they can write a new job description
    c.  Make sure we all have the tools and knowledge to do the job
    d.  Use the MSM team to correct the disparities
                     i.  shadow clinics/MSM that excel where others are lacking
                            ii.  Share knowledge and best practices

To be efficient we must have an impeccable means of communication.

2. Communication should be Consistent, Timely and Accessible
      a.  Weekly virtual huddles?
      b.  Share Point?
      c.  Lead Managers?

To succeed we must be accountable.

3.  Accountability
       a.  Clear and measurable expectations
       b.  Audit regularly
       c.  Identify strengths and weaknesses
                             i. Utilize the Team to correct deficiencies

At this juncture we are in the middle of step one.  I have included all the MSM in this project; it is not MY project, it is OUR project.  Working on this has given us (the MSM) a common goal; we have gotten to know one another better and are communicating much more freely than I feel we were before. It has been a challenge getting ‘buy in’; we already have too much on our plate so it has been difficult for everyone to attend our meetings, follow through with our ‘homework’ and get and stay invested.  One of the ways I keep the ball rolling is frequent emails.  I send reminders of what we are working on and updates on progress. 

This is a process.  It will take time and will come to fruition slowly and with many stalls and leaps along the way but we learn and benefit from the process itself.



Patient-Centered Medical Home Recognition: Getting Started

Araceli Trevizo and Margarita Carmona, Salud Family Health Center


In order to accomplish Medicaid and Medicare EHR incentive programs, Meaningful use and PHCMH, Salud staff has to meet a measurement of 80% on certain objectives. In addition to meeting certain objectives/measures, our patients must have records in the certified EHR technology. Of the 15 core measures, our staff needed to apply five to their everyday work flow. The objectives for the staff are to provide clinical summaries for patients for each office visit; drug- drug and drug-allergy interaction checks; record demographics; maintain active medication allergy list; record and chart changes in vital signs. Part of becoming a patient-centered home is to improve the overall geriatric care. Our goal as a clinic was to meet the measures of 80% of the requirements for both Meaningful Use and patient-centered home.

First we had to let staff know what the objectives and goals were, giving them a clear overview of the measures and what they had to do in order to meet the goals. We had to ensure, day by day, they understood the benefits of meeting our goals and the importance of taking responsibility for doing so. 

The Problem: Get from 20% to 80% ASAP

At the beginning of the project we were measuring at 20% of our goal on all of the objectives. At the end of the project we achieved a goal of 95%-100%. At the beginning of the project our staff lacked a clear understanding of the objectives or what had to be done. Management was not informed correctly about how the reports were getting run. Staff was saying they were doing what they were told to do, but our numbers were still low. It was up to management to figure out why the numbers were not matching with the reports. We eventually realized there was a miscommunication on how we were trained to enter data. 

The Solution: Clarification

After clarification we retrained our staff and met our goals. We also reminded staff on a daily basis about our objectives and added notes on patients’ files, and made a do-not-forget-to-do list. We also encouraged staff by sharing the data or measures of where we were at in are staff meeting. 

By the end of our project we saw a big difference in our numbers from 20% to 95-100% measurement. Our staff was recognized by our management team with a lunch and a certificate to encourage them to continue with their hard work.


We are grateful to our course instructor, Lisa Mouscher of Sogence Training, for submitting these capstone project reports for sharing.

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