ASPIN Recruitment and Retention Consortium (ARRC): Partnering to improve behavioral health in rural Indiana
Written by Angie LaFlamme, Senior Program Coordinator, National Rural Health Resource Center/Rural Health Innovations
Rural Health Innovations (RHI) worked with ASPIN and their member health care organizations on collaboration in their behavioral health technician recruitment and retention efforts during an on-site visit on June 15, 2017. Clockwise from top left: Paul Conrad, Director of Training and Workforce Development, ASPIN; Robb Backmeyer, COO of Recovery Services, Centerstone; Ben Hall, Senior Talent Acquisition Business Partner, Centerstone; Chris Morrison, ARRC Project Coordinator, ASPIN; Eric McCray, Recruitment Coordinator, Bowen Center; Angie LaFlamme, Senior Program Coordinator, Rural Health Innovations; Kathy Cook, CEO, ASPIN; Amy Coplen, Employment Coordinator, Four County Counseling Center.
Affiliated Service Providers of Indiana (ASPIN) is a 501(c)(3) nonprofit behavioral health provider and education network offering access to clinical providers in over 50 locations throughout the state of Indiana. As a result of being awarded a Health Resources and Services Administration (HRSA) Rural Network Allied Health Training grant, the network formed the ASPIN Recruitment and Retention Consortium (ARRC) in September 2015. ARRC brings key partners together to improve behavioral health and well-being among Indiana’s rural communities that experience health professional shortages.
This June, Debra Laine and I traveled to Indianapolis for an on-site technical assistance (TA) visit with ARCC staff and partners, where we asked them to share information on their network’s best practices, lessons learned, challenges, significant outcomes and achievements, sustainability, and evaluation. Below are the accomplished and motivating responses we received from Kathy Cook, CEO/President, Paul Conrad, Director of Training and Workforce Development, and Chris Morrison, ARRC Program Coordinator.
Q: What are some of the accomplishments you’ve seen during this grant project?
A: There has been notable impact having stemmed from the Employee Satisfaction Surveys feedback activities and the Health Care Organization’s Recruitment and Retention plan strategies that have been implemented.
We have also had great success in our social media campaigns as well as alternative student recruitment strategies we’ve used for behavioral health student and employee recruitment. Our target marketing has been quite effective.
Our executive leadership expressed buy-in from the beginning and has been very enthusiastic about the work we’ve done in bringing key partners together to improve behavioral health and well-being among Indiana’s rural HPSA [Health Professional Shortage Area] communities.
Q: What challenges or barriers has your program encountered?
A: Student recruitment has been a challenge of ours. The level of follow-through from the applicants can minimal at times.
Navigating the many advertising/marketing mediums took some time. There was a lot of trial and error in ultimately determining which venues worked best for us in reaching our target markets.
Our rural geography has also been a challenge. We target schools in rural areas to promote the awareness of Behavioral Health Technicians. Our hope is to recruit students into the educational training programs for this profession and upon graduation, placing them into the rural area clinics and hospitals.
Q: How have ASPIN’s collaborations helped your program succeed?
Q: What lessons have you learned throughout the project?
Q: What have been some of ASPIN’s most significant outcomes?
Q: How is ASPIN approaching sustainability?
Q: On a scale of 1 (low) to 5 (high), how do you rate your network for sustainability following the grant program?
A: We rate our sustainability at a five, by expanding the ARRC Network for continued collaborative work.
Q: How are you implementing your evaluation plan?
Q: What are your major activities or initiatives for this year?
Q: What are a few of ASPIN’s best practices that you would like to share with other networks?
Why Communication Planning is Different for Networks: How your network can re-learn communication to make it successful
This article was written by Lydia Hooper of Fountain Visual Communications for the August 2017 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
Networks are able to solve problems that individuals and organizations cannot on their own. Often when we think of them, we think about coordinated resources and activities, but we also need to think about the coordinated flow of information and ideas.
After all, the reason networks are more effective at addressing large-scale issues is that multiple clusters of expertise can inform one another in order to be both more efficient and more responsive to needs. Just as human organs are composed of cells and tissues, networks are made up of individuals and organizations working together to perform various functions simultaneously. To do so, they need to be in consistent communication with one another.
Communication in networks is different than in organizations. When we understand this, we can recognize and capitalize upon the incredible opportunities they present. Here are four ways communication is different for networks and four strategies for success.
1. Communication is multi-directional. In contrast to networks, the hierarchical organizations and systems we are accustomed to seek to maximize control and stability by having leaders decide what and how to share information, both inside and outside the organization. Unfortunately, these systems are breeding grounds for miscommunication and poor strategy because those who aren’t leaders also have valuable information that may not be fully utilized.
Networks have an incredible opportunity to re-think how information and resources are used. Instead of looking to an executive, we can look to one another and assess what our goals are and how we might each contribute to get there. Organizations that participate in networks may find that it takes considerable effort to break habits based on organizational norms such as looking for clear directions to follow. Networks that use a collective impact framework may have a backbone organization leading coordination, but this can carry with it a risk that the other organizations will easily revert to the habits of traditional hierarchies that they are accustomed to.
The solution: Develop an internal communications strategy. Sometimes networks put the cart before the horse by thinking about marketing or branding before they’ve focused on group clarity and coordination. Establishing group identity and an internal narrative will help your network progress, and it will also help those outside the network better understand what you are doing and why. A strategy should include your network’s shared goals and their coordinated plan for reaching it. A discussion about how resources will be shared should also include how external communication will be supported and executed, preparing the cart for when the horse is really to run.
It is important to remember that communication both reflects and drives culture. One network I’ve worked with developed their strategic plan together, but then months later when the network was getting disorganized and losing focus, the plan was sitting on the shelf. A different one continues to reference their shared vision, even sharing best practices with other networks.
2. More people need to reach consensus internally. The strength and potency of networks is not measured by the number of people or organizations involved, but rather by whether there is sufficient diversity of thought and experience to create new solutions and maximize their potential for success. Having many different voices at the table can invite unique challenges such as:
Knowledge-based networks are all about leveraging what “who you know” knows, but before we can do that, we must first know what each of us knows. Sharing with other network members isn’t always easy, especially because our individual need to belong often eclipses our group need to accomplish tasks. But once many voices can learn to harmonize in unison, their volume will be difficult for anyone to ignore.
The solution: Invest in building trust. Building trust takes considerable time. Networks may have to ask themselves, “Is it more important to accomplish specific tasks within a given timeframe, or is it more important to reach our goal?” Doing the latter may require sacrificing the former.
Building trust also requires leaning into discomfort and conflict, which generally we try to avoid. I have found that the simplest, most effortless way to do this is to use a visual communication tool known as graphic recording to support group members in real-time with understanding complexity and feeling included. Graphic recording is real-time illustration that organizes information during group meetings, supporting members so they can share, understand, and retain more information.
For example, one graphic recording I’ve created visually captured a meeting that was a turning point for two networks that had felt in competition with one another. While individuals arrived at the meeting skeptical about engaging in a facilitated process together, they used the visual to work through their conflicts and by the following year recognized the graphically recorded meeting as the one during which they came together as one.
3. External communication is essential. Networks present opportunities to break through former communication barriers that impede progress, but they are still at risk of becoming isolated from the input of information they need to be effective simply because our natural inclination is to associate with those we are most like.
Complex networks in nature demonstrate that long-term sustainability depends upon balancing efficiency and resilience. The hitch is that while efficiency depends upon the minimization of diversity and interconnectivity, resilience depends on the maximization of them. Likewise, communication in social networks must balance strengthening existing relationships in order to use current network knowledge and consistently creating new relationships in order to expand that knowledge.
Whether your network thinks of this as partnership building, community stakeholder engagement, or marketing, keep in mind that communication is never one-way. Networks may provide information, but they can also get the information they need, for example about the effects their activities are having or the effects they could or should.
The solution: Create new ties thoughtfully. Your network will need to apply the same patient, realistic, strategic approach that you practice internally to build relationships with external stakeholders. It is worth the careful consideration this takes in order to ensure that the work of your network stays relevant.
Respect the time and contributions of others by thinking about what matters to them. If you seek to build bridges by empowering individuals to voice their concerns, then plan to address those concerns (or better yet to give them the agency to do so themselves) so those bridges don’t then get burnt.
One network I’ve worked with is really great at using deliberate facilitative processes but is less practiced at producing early wins that keep stakeholders engaged and hopeful. Others I know can get so focused on producing certain outcomes by deadlines set by a funder, such as having a certain number of people attend meetings, that progress toward their primary goal, such as to have those people inform solutions that will work, is stunted.
4. Messaging (including data) is dynamic. While the organizations that comprise them may focus on offers of services or products that solve concrete needs, networks are in the business of sharing ideas that are often complex and sometimes invisible. Furthermore, networks themselves are fluid, and as more information becomes available messages will need to change.
Networks also have to communicate with multiple audiences, which can challenge individual organizations who may relate differently to them (for example, one organization in the network may rely upon a critical partner who is a perceived threat to another organization).
The solution: Create structures for consistent learning and reporting. As their work ebbs and flows, networks need to stay focused on what’s currently happening. Through thoughtful collection and reporting of high-quality data (both quantitative and qualitative), networks can position themselves to be able to intentionally adapt.
I admire the networks I work with who are willing to dedicate adequate thought and resources to this development. I am saddened by those who get distracted by technical tools when they can start now, even with simple paper surveys, ensuring there will be some data to show change over time.
The ones that I know are guaranteed to make a difference are those who are willing to discover what isn’t working and be open to change. That kind of resiliency is the very reason networks are capable of exceptional results.
Lydia Hooper is a consultant who specializes in helping organizations collaborate and communicate about complex topics. She has partnered with more than 40 organizations and networks, offering services and trainings in data storytelling, graphic recording, and communications strategy. You can read more blog articles and get a free copy of her ebook “Using Visuals to Support Collaboration” at www.fountainvisualcommunications.com.
This article was written by Rene S. Cabral-Daniels, JD, MPH, CEO of Community Care Network of Virginia, Inc., for the July 2017 edition of “Networking News.” Isaiah Dolcee and Eliza Singleton, interns at Community Care Network of Virginia, also contributed to the article. The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center
The impact of health information technology (IT) on the healthcare industry is irrefutable. According to the Department of Health and Human Services’ Office of the National Coordinator (ONC), nearly 90% of office-based physicians have adopted an Electronic Health Record (EHR). Moreover, the percentage of hospitals that provide patients the ability to view, download, and transmit their health records online accelerated from 10% in 2013 to 69% in 2015. Patients are likewise availing themselves of this resource in greater numbers. The ONC reports patient use of information technology to interact with their health care provider, view their personal health information, and track their health and wellness grew significantly between 2013 and 2014. Patient use of one or more of the selected types of IT significantly grew between 2013 and 2014, from 39% to 48%.
The growth in EHR utilization by patients and providers alike likely reflects the many benefits of this technology. Providers value the ability to make medical decisions based on the most current information. As patients may receive care in a variety of healthcare settings, the ability to coordinate the most recent medical information in deciding future treatment is an imperative for providers. EHRs also enhance patient safety, particularly by assuring greater reliability in prescribing pharmaceuticals. Patients requesting their medical records through an EHR can expect to receive complete documentation free from handwritten notes that often prove difficult to read.
The significance of interoperability within health care performance
All of these benefits, as well as the benefit of cost reduction, help communities realize health system performance Triple Aim goals:
Interoperability of EHRs has the ability to enhance each of the Triple Aim benefits. The American Hospital Association asserts interoperability progress will support all three Triple Aim goals, each of which has a positive impact on rural communities.
Enhancing the rural patient experience
The challenge each Triple Aim criterion seeks to address is greater in rural communities; interoperability of electronic health records therefore has a greater advantage in rural communities. The first Triple Aim criterion, patient experience of care, may have a geographic correlation. A study of health center patients found urban patients were more satisfied with their physicians than rural patients. This finding is likely influenced by the challenges faced by rural health providers. Rural American communities face substantial healthcare disadvantages compared to urban and suburban communities. The 40 to 45 percent of people who reside in these areas (approximately 150 million people) report higher levels of chronic conditions and a lower per capita income. These factors, combined with the lack of specialists in rural communities, force many patients to travel to more populated areas to find certain providers. Patient care is often solely provided in the few hospitals in these areas, causing most to be overextended and under supplied.
EHR interoperability can play an important role in enhancing patient satisfaction. The Rural Health IT Corporation asserts improving customer satisfaction in healthcare depends on complete data interoperability. The Bipartisan Policy Center report on the role of health IT in transforming healthcare stated studies indicate high levels of patient satisfaction with online consumer tools. Clearly, patient satisfaction can be positively influenced by EHR interoperability. This finding is particularly relevant to rural communities, as rural patients tend to be less satisfied with their care than their urban counterparts.
Improving the health of rural populations
Improving the health of populations is the second goal of the Triple Aim. Population health management includes the methodologies for providers and payers to contain and lower costs, thereby increasing operational efficiencies such as the ability of providers to streamline care and improve treatment outcomes. One of the main benefits of EHRs is increased access to information. Interoperability of EHRs escalates that benefit by assuring the information is comprehensive and not site-specific, a necessary element in improving population health.
This advantage of comprehensive data review by providers is imperative for rural communities, as residents need to travel greater distances to access different points of the health care delivery system. Healthcare facilities in these areas are small and often provide limited services, thereby requiring rural residents to travel to seek care, particularly tertiary care. Often, due to geographic distance, extreme weather conditions, environmental and climatic barriers, lack of public transportation, and challenging roads, rural residents may be limited/ prohibited from accessing healthcare services in their communities.
Utilizing health IT has benefits for rural providers and patients alike. For example, patients can exchange secure messages, have “e-visits” with their physicians and decrease the hassle of traveling to a specialist. Specialty referrals are also made easier, which is valuable since access to them is often limited.
Reducing costs by increasing interoperability
The third criterion of the Triple Aim involves reducing the per capita cost of healthcare. Every year, providers lose millions of dollars due to the amount of time spent searching for paper medical records. In the past, knowledge of a patient’s medical history relied on physical records held by a primary physician and the memory of a patient, both of which were not completely reliable. These inherent discrepancies in health data are even more prevalent in patients from rural areas since most tend to see multiple physicians. By increasing interoperability, time is used more effectively to solve a patient’s concerns and therefore save money for both the practice and the patient. The Office of the National Coordinator’s Connecting Health and Care for the Nation: A Shared Nation Interoperability Roadmap stated interoperability can help reduce care delivery redundancy and cost by allowing test results to be reused while supporting analyses to pinpoint waste.
The per capita cost of healthcare is significantly reduced with the implementation of interoperable EHRs. This is because patients no longer have to pay for both the cost of administering care as well as complex IT systems that are necessary to access health data in siloed information systems to administer effective care. The West Health Institute calculated the aggregate financial benefit to be projected at $30B saved in the healthcare industry per year. Efforts to lower costs will therefore positively benefit rural communities as their local providers will have access to a full panoply of tests if interoperability of EHRs is complete.
The nation as a whole benefits from true interoperability of electronic health records. When these benefits are viewed through the lens of the Triple Aim, the benefit to rural communities is even greater.
Community Care Network of Virginia, Inc. (CCNV), a community health center-owned and governed provider network, was legally incorporated as a statewide network organization in. CCNV has a long, successful history of providing integrated, network-based services and programs to Virginia’s health centers, including the acquisition and implementation of a centralized practice management system, help desk, and support infrastructure commencing in 1999.
With over two decades of experience as a leader in health policy, finance, and law, Rene Cabral-Daniels has been the CEO of CCNV since 2013. She currently serves on the Healthcare Information and Management Systems Society (HIMSS) North America Board of Directors as well as the National Cooperative of Health Networks (NCHN) Board of Directors.
Isaiah Dolcee is a rising senior at Princeton University, and Eliza Singleton is a rising junior at Elon University.
 Quick Stats by healthit.gov
 The IHI Triple Aim by Institute for Healthcare Improvement
 National Alliance for Health Information Technology. “What Is Interoperability?” 2005. Available online at www.nahit.org
 Achieving Interoperability that Supports Care transformation: A Report of the American Association Interoperability Advisory Group
 Influences on patient satisfaction in healthcare centers: a semi-qualitative study over 5 years by Ruth D. Thornton, Nichole Nurse, Laura Snavely, Stacey Hackett-Zahler, Kenice Frank and Robert A. DiTomasso
 Why Health IT Integration Must Assist Rural Healthcare by HIT Infrastructure
81% dissatisfied with healthcare, Interoperability can help by ruralhealthit.com
 Transforming Health Care: The Role of Health IT (fix citation) pg 23
 Jamoom E, Beatty P, Bercovitz A, Woodwell D, Palso K, Rechtsteiner E. “Physician Adoption of Electronic Health Record Systems: United States, 2011.” 2012.
 Healthcare disparities & barriers to healthcare by Stanford eCampus Rural Health
Healthcare Interoperability can reduce costs and improve care by iShare Medical
West Health Institute finds medical device interoperability could save more than $30 billion a year by West Health Institute
This article was written by A. Craig Dixon, MS, and Ashley Vincent Poore, MA, of the Coalfield Regional Healthcare Network, for the June 2017 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
Okay, “big-idea people.” We know. You have a plan that is just what this company needs. It’s radically different, and it could change the way we do business – the way the whole industry does business. But why won’t anybody listen? “Big-idea people” trying to get buy-in for their plans can feel like Sisyphus, condemned to an eternity of rolling a boulder uphill, only to see it roll back to the bottom of the hill at the first sign of resistance. Let us offer some suggestions to overcome organizational inertia to get your project moving.
Suggestion 1: Use data to define the problem. Chances are, the folks you are pitching your idea to are not going to be excited about your idea simply for its intrinsic value. You have to convince them it is going to solve a problem they care about. In fact, you may have to first demonstrate to them that there is a problem. How do you know there is a problem? What data brought you to your conclusion? While quantitative data (i.e., hard numbers) often represent the best way of communicating the problem, don’t underestimate the value of a couple of compelling anecdotes (qualitative data). Sometimes, a particularly bad experience or an incisive quote can be just as effective as a table of figures or a chart.
Your data should answer the questions your audience is likely to have, and do so in a compelling manner. How bad is the problem? Is the problem worse locally than in similar locales elsewhere? How will we know if we have fixed the problem or mitigated its severity? What negative consequences will result if the problem is not addressed, and how bad could they be? What positive outcomes are possible if it is, and how could that benefit your organization? The aim of your data is to provoke emotion in your audience – emotions like empathy (“I have experienced a problem similar to this before”), outrage (“How can this problem exist/be this bad?”), or moral obligation (“It would be wrong to allow this problem to continue”). Once your audience is convinced that there is a problem that absolutely must be solved, they’ll be looking for ideas, and it just so happens that you have one.
Suggestion 2: Leverage your professional relationships. It is usually a good idea to build a core group of supporters around your idea before presenting it widely. When considering recruits for your team, think about who else would benefit from this idea being implemented. Who is also passionate about the issue being addressed? Getting passionate team members on board will broaden your potential impact and improve your credibility, helping your proposal’s chances of being successful. Think about the people you already know. You don’t have to go right to the top of your own or another company’s organizational chart. Reach out to people with whom you already have a good working relationship. You have a better chance to get buy-in from someone you already have a good rapport with.
When you pitch the idea to prospective partners, don’t present them with a fully formed plan. Allowing your colleagues to help in the development gives them more investment in the proposal and increases their engagement. Even if input from others strays a bit from what you originally envisioned, a really good plan formulated by five people will almost always get buy-in faster than a perfect one created by one person. The opportunity to include their own agendas will possibly broaden the project into something more beneficial that you hadn’t previously considered.
Suggestion 3: Promote outcomes, not actions. No matter how elegant or brilliant your idea, far fewer people are likely to be interested in the idea itself as the outcomes it can produce. You should be prepared to talk about the latter at least as much as the former. Be realistic with what you believe you can accomplish. There is seldom one solution that completely solves a problem. You are just trying to take a bite out of the problem. How big will that bite be, realistically? Don’t sandbag so badly that no one gets excited about the idea’s potential, but it is often wise to under-promise and over-deliver. Doing the reverse can really damage your credibility.
This is another place where a mix of quantitative and qualitative information can really help. First, try to quantify the benefits of implementing your idea (e.g., “We could save $10,000 per year” or “We could reduce downtime by 10 percent”). Then try to describe what your department, organization, network, or community would look like if these results were achieved. Who will be affected – within your organization and beyond – and how? What changes will they notice in their day-to-day lives? Seeing this complete picture can really help get people excited about your idea’s potential.
Whether you’re proposing a grant project or working to get a group of partners together to solve a problem locally, we believe you will find these suggestions helpful in considering how to approach the process. By using meaningful data, including colleagues who will also benefit, and promoting the proposal’s potential outcomes, you can get your big-idea boulder “over the hump,” moving quickly and effectively from idea to implementation. Then, you can kick back and enjoy some well-deserved nectar and ambrosia.
A. Craig Dixon is a grants specialist at Madisonville Community College (MCC) in Madisonville, Kentucky. Since transitioning to his current position in 2011, he has secured over $4 million in grant funding for the college from agencies such as the National Science Foundation, the Health Resources and Services Administration, the U.S. Department of Agriculture, and the Delta Regional Authority. He has been selected to present at national conferences hosted by the National Institute for Staff and Organizational Development (NISOD) and the League for Innovation in the Community College, and his work has been published electronically by the Council on Resource Development and the Kentucky Office of Rural Health. He holds a Master of Science in Computer Science from Western Kentucky University in Bowling Green, Kentucky, and a Bachelor of Science degree in Computer Science from Murray State University in Murray, Kentucky.
Ashley Vincent Poore is the Director of Education and Research at Baptist Health Madisonville (BHM) in Madisonville, Kentucky. Her 15-year career in education includes ten years at Madisonville Community College, first as an adult education instructor and later as director of the college’s assessment center. For two and a half years, she coordinated educational programs for the West Area Health Education Center in Madisonville, and in her present position with BHM, she oversees six departments, including a regional medical school campus, a family medicine residency program, a doctoral nurse anesthetist program, and an area health education center. She also serves as Network Director for the Coalfield Regional Healthcare Network – a group of leaders from medical and educational organizations that include a regional medical center, a critical access hospital, two federally qualified health centers, an area health education center, a mental health provider, and the local health department and community college.
Leadership Influence Without Authority: How network leaders can motivate stakeholders and gain credibility
This article was written by Jo Anne Preston, MS, Workforce and Organizational Development Senior Manager at the Rural Wisconsin Health Cooperative (RWHC), for the May 2017 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
The notion of the solitary, forceful leader who makes things happen is outdated for the way we want to do business today. Position power can make us comply – for a while anyway. But when what you really want is people joining your cause and kicking in (think: leading a rural health network), your real power lies in your ability to influence.
Understanding Motivational Styles through Personality Theory
What we can do is “fuel” the motivational needs that others have, and one way to get better at this is through a basic understanding of personality theory. How one is wired in personality reveals unique information about the kind of fuel needed to get him or her motivated, and the conduit is how we communicate. Examine your communication style to see if you meet the needs of those whose motivation requires the following elements:
Increasing your own influence
There are many recipes for gaining influence, but they all have one vital ingredient: the ability to build relationships of trust. This article identifies a few opportunities to reflect on your own trust-building behaviors. Your credibility earned through trust is your secret sauce, and you can’t really influence without it. But trust doesn’t stand alone.
How you handle yourself makes more difference than you might think, and it definitely impacts your ability to influence. We sometimes undermine our own credibility without realizing it. The following small steps can help us self-manage our actions to maintain credibility with stakeholders:
1. Ask for help. When you don’t ask others for help, they don’t get a chance for successful contribution, and then we may wonder why they are not engaged. This can also lead to feeling like you have to do everything yourself. “I could really use your help; would you be willing?” is a great way to influence and gain engagement.
2. Create space for others to lead. Ego can get in the way of effective power when we fail to create space for others to lead too. We need not be threatened by others’ power. Instead, find ways to access others with influential power to help you bring people on board. Take advantage of their relationships to make connections for you.
3. Manage stress. It can truly be said that we are not overwhelmed by life, but that we overwhelm ourselves with our thoughts about life. People sense our overwhelmed demeanor and run the other way. Break your initiatives down into clear milestones you can articulate so that you can “sell” something people can envision (and at the same time, enjoy less stress).
4. Appeal to their needs. Having a great idea is not enough to get people to sign up. There are competing needs for time and energy, and you can’t “should” someone into joining. If you find your frustration is getting the best of you, you may be trying to push a noodle uphill. What would appeal to them? How does it serve a need they have? Find a connecting story rather than a “should.”
5. Never use gossip as influence. If someone upsets you, listen to them instead of talking about it to others. They may have something you need to hear and may be in a position at some point in the future to help you. Gossip comes back like a boomerang. Gossip is influence, but not the kind that helps.
6. Be specific. Get better at specifically estimating the time or financial resource ask you are making, e.g., “This will take about 10 hours over the next 6 weeks.” It helps people discern and decide.
7. Start small. Getting a “yes” doesn’t have to be all or nothing. Take advantage of pilots where you try something out as a study to learn from it. Provide different tiers of what you offer to allow people to see some benefits without having to fully commit before they are ready.
By becoming aware of the motivators of different personality types, building trust in our relationships, and taking manageable steps to maintain credibility, leaders can more effectively influence collaborators to support the work of the network.
Remember you already are having an influence. Is the kind of influence you want to have? List your assets. What do you have to offer as uniquely you? Make use of it, without over-relying on it. Any strength over-used can become a liability.
Jo Anne Preston is the Workforce and Organizational Development Senior Manager at the Rural Wisconsin Health Cooperative (RWHC) in Sauk City, WI. RWHC serves rural hospitals in Wisconsin with a variety of products and services to support and enhance rural healthcare. Jo Anne’s work includes designing and delivering leadership education, leadership coaching, team facilitation and consultation around employee engagement and customer service. She also serves on a variety of workforce-related work groups in Wisconsin to address solutions to rural workforce shortages. She has a M.S. in Educational Psychology/Community Counseling from Eastern Illinois University.
Written by Angie LaFlamme and Bridget Hart, National Rural Health Resource Center. This content originally appeared on the 3RNet website.
The 3RNet’s mission is to connect health care professionals searching for jobs in rural or underserved areas with health care facilities. They strive to find the right job for professionals in areas where they will live and work comfortably. Some health care professionals entering the workforce have come from large, urban areas and have never practiced in a rural community. But, for University of Minnesota medical students participating in the Rural Physician Associate Program (RPAP), this isn’t the case.
RPAP is a nine-month, community-based educational experience for third-year medical students. Not only does it allow them to train in rural communities, RPAP students and their families get to experience all aspects of rural community life by living in their host towns during the training period.
“RPAP was one of the most valuable experiences of my training,” said Maren Anderson, who participated in RPAP in fall 2016. “I've always felt I would be best served by training in the environment I plan to work in and for me that is rural Minnesota. I knew I was in the right place when we walked down the hallway of physician offices and they pointed at nearly every door, identifying that physician as either a University of Minnesota graduate, RPAP alumnus, or both. I was the only medical student there which gave me the benefit of the undivided attention of not just one preceptor or attending, but every practitioner I came into contact with.”
RPAP students experience hands-on learning as they care for patients of all ages. They learn clinical medicine, procedures, community health, and the business of medicine. Students experience the full spectrum of rural medical care as they follow patients and their families through a disease process or pregnancy. “In the course of a day I might start the morning with an early surgery or c-section, then start clinic, possibly see a patient or two in urgent care, get called to the ER to sew up a laceration, finish out clinic and write my notes, visit a patient or two on inpatient, and then wrap up the day with a delivery,” said Maren of her RPAP experience.
“I truly felt like a member of the team and got to know my patients and my fellow health workers. I felt so incredibly valued and supported during my time there. I also felt like I became a part of the community in a way that I haven't found since moving out of my hometown,” said Maren. “My official preceptor would have me over to his house for dinner regularly and I helped his family shear sheep to get ready for the fair. I joined a church choir there and a number of choir members became my patients, eagerly announcing to me during practice, ‘I'm coming to visit you next week!’”
From populations ranging from 350 to 30,000, over 110 Minnesota communities have participated in the program as teaching sites with a majority having at least one RPAP alum. Practices vary from small family medicine clinics to large multi-specialty outpatient centers, and hospitals ranging in size from 15 to 140 beds. Students see patients in clinics, hospitals, emergency rooms, nursing homes, hospice, at home, and in the community. Each student is the only student in a community and therefore has a greater opportunity to gain hands-on experience in a variety of procedures and specialties.
“When the Minnesota legislature sought a solution to the need for more rural physicians – particularly Family Physicians – in the late 1960’s, they were wonderfully wise to fund the establishment of the University of Minnesota Medical School’s Duluth campus program and the Rural Physicians Associate Program,” said Jim Boulger, Ph.D., Distinguished University Teaching Professor from University of Minnesota Medical School. Since RPAP’s inception in 1971, over 1,300 students have participated in the program, resulting in two out of three former students practicing in Minnesota, two out of three practicing in rural locations, and four out of five practicing primary care.
Statistics show that health care professionals with an educational background in rural areas are more likely to practice in these areas once they enter the workforce. “These programs have been extremely successful models for training our rural Minnesota medical workforce. Now having trained more family physicians – many of them RPAP graduates - than any other medical school in the United States, the University is a proud partner with greater Minnesota in providing care for all of us,” quoted Dr. Boulger.
Former RPAP student Maren states, “RPAP solidified my faith in my decision to become a rural physician because, for the first time since starting medical school, I felt that I actually understood what it means to be a rural doctor and how that shapes your life—and now I can't imagine wanting to do anything else.”
University of Minnesota, Duluth and Twin Cities Campus’ medical students with an interest in family medicine, primary care, or rural medicine specialties are strongly encouraged to apply to the Rural Physician Associate Program. Visit the RPAP website to learn more about the Rural Physician Associate Program, or if you have interest in supporting the Program.
Aligning and streamlining your planning efforts for long-term success
This article was written by Bonnie Noble, PhD, RN, Founder of The Ondina Group, for the April 2017 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.
We’ve all heard that familiar quote, “Failing to plan is planning to fail." This is likely a contemporary paraphrase of one of Benjamin Franklin's quotes: "By failing to prepare, you are preparing to fail." And then, of course, Winston Churchill said, "He who fails to plan is planning to fail."
OK. You get it. You know planning is important. But, sometimes it feels as if we can spend so much time planning that we don’t have time to get anything done. And, what about all those plans required when we’re seeking funding? Just the other day, a client commented on how the funding agencies “require an odd collection of similar-looking documents—Strategic Plan, Logic Model, and Action Plan.” She groaned when I replied, “Don’t forget about the Evaluation Plan and the Sustainability Plan.”
This “odd collection of similar-looking documents” each have a specific purpose and make an important contribution to program and organizational success. Moreover, it is helpful to understand how these various plans fit together in a sort of “less is more” approach that provides simplicity, clarity, and good design while streamlining your planning and writing efforts.
First, let’s briefly examine the key purpose for each one of these plans.
So, how do these plans overlap with and link to one another? The following Planning Crosswalk describes, visually, how these various plans are related.
It is important that these plans are aligned and integrated. For example, your three- to five-year program goals and strategies identified in your Strategic Plan align with the program-specific impact and outcomes in your Logic Model(s). Likewise, your Work Plan is a more detailed description of the initiatives outlined in your Strategic Plan and the activities described in your Logic Model.
The usefulness of each of these planning tools is enhanced by regularly consulting and comparing them. Developing, linking, and using these planning tools will help to ensure that your programs, and your organization, remain focused on its core mission and reaches its goals and vision.
Two important Baldridge program concepts are especially useful here—alignment and integration.
Examples of alignment and integration include linking key goals and objectives in your overall organizational Strategic Plan and your program Logic Model(s). Then, the Work Plan provides more detail on how your stated objectives will be achieved and who will be responsible for doing the actual day-to-day work. Likewise, the Evaluation Plan is a drill-down on how you will collect, analyze, and report data to ensure you remain on target towards reaching stated goals. Finally, the Sustainability Plan describes what actions you will take to ensure long-term viability of your program.
There is great value in aligning and integrating this “odd collection of similar-looking documents,” and doing so will enhance the effectiveness of your organization and its various programs. And, of course, you will more efficiently utilize the most precious resource—your time.
Bonnie Noble, PhD, RN, has an extensive background in the healthcare industry, with more than 30 years of experience working in a variety of healthcare organizations. She has expertise in many quality and performance improvement methodologies, is certified in patient safety, and is a certified professional in healthcare quality. Bonnie has served a National Examiner for the Baldrige National Quality Award and also has managed large federal contracts with the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ). She currently serves as the project director for the Mendonoma Health Alliance, a grantee of the Rural Health Network Development Planning Grant Program through the Health Resources and Services Administration (HRSA).
[i] Balanced Scorecard Institute. Retrieved March 1, 2017 at http://www.balancedscorecard.org/Resources/Strategic-Planning-Basics
[ii] W.K. Kellogg Foundation. East Battle Creek, Michigan. 2004. https://ag.purdue.edu/extension/pdehs/Documents/Pub3669.pdf
[iii] Developing an Effective Evaluation Plan. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Division of Nutrition, Physical Activity, and Obesity, 2011.
[iv] The Grant Helpers.com. Five Key Elements of an Effective Sustainability Plan. 2014. Retrieved on March 2, 2017. http://www.thegranthelpers.com/blog/bid/204687/The-Five-Key-Elements-of-an-Effective-Sustainability-Plan-for-Grants
[v] Baldrige Performance Excellence Program. 2017. 2017–2018 Criteria for Performance Excellence.
Gaithersburg, MD: U.S. Department of Commerce, National Institute of Standards and Technology. http://www.nist.gov/baldrige
This article was written by Linda K. Weiss, LCSW, Director of Member Services for the National Cooperative of Health Networks Association (NCHN), for the March 2017 edition of “Networking News.” The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center
We all know that communication is one of the keys to success for many endeavors, including, but not limited to, personal and professional relationships, sports, social events, education and business. In the world of rural health, telling a network’s story and communicating the resulting benefits of its activities should be done early, often and in a variety of formats. This applies to networks of all ages, sizes, stages, compositions and locations. Communicating the impact of the network’s collaborative efforts is an ongoing task and should be a component of a written communication plan.
Different priorities for different audiences
To whom do you need to communicate the impact of your network’s activities? For starters, it’s important to include all of the following:
The network’s members are most likely going to view things from the lens we commonly refer to as, “What’s in it for me?” This does not mean that they are not committed to the network or its collaborative efforts, but that they are held accountable for business decisions and ventures by their own, separate governing body. If the return on investment (ROI) isn’t there, they are less likely to remain engaged and a part of the network.
The board, or governing body, of the network is obligated to make visionary and guiding decisions on how the network operates. In order to do that effectively, they need to rely on solid information supported by data.
All persons filling positions in the network, whether they be paid or volunteer, should also receive regular information regarding the fruits of their efforts. This type of feedback can assist with buy-in, innovation, dedication and morale.
It’s important for community members in the service area to be made aware of the positive ways the network is impacting where they live. Increasing people’s awareness of the collaborative efforts organizations are making may have ripple effects, from increased donations to improved reputation, to becoming a preferred place of employment.
Typically, funders provide applicants information regarding what type of data, reporting format, reporting due dates, and method(s) of reporting in regard to the activities and impact of activities supported with their funds. Capturing and tracking this information from the start makes reporting back to the funders much more efficient and accurate.
As the network grows, additional partners or members may be sought. Being able to quickly and effectively inform potential collaborators about the successes of the organization and how they might contribute to and benefit from the network can expedite their decision. Again, this decision will most likely come down to the potential ROI.
Using visual elements to support your data
How do you effectively communicate the results of the network? Visual aids are commonly used to enhance verbal messages. These tools, which range from bulleted lists, to a variety of pictures, graphs, charts and diagrams, can succinctly highlight information. Adding visual images to verbal communications provides listeners data in two formats, activating different parts of their brain to receive and make use of the information. The key to using visual aids is to make them easy to read and understand. They need to clearly communicate “at a glance.” Having too much information that readers must study defeats the purpose of such a tool. Be sure any key codes (color, shape, symbol, etc.) are clearly identified.
For example, here is a bar chart (Graph 1) that quickly and easily depicts the annual growth of a network’s service volume through the first five years of its inception. A chart such as this effectively communicates the network’s successful growth to funders, members, staff, the board and the community at large. Even if they don’t remember the numbers, the image of the orange bars increasing in height is likely to stick with them.
Graph 1. Annual growth of the network’s service volume through the first five years of its inception
Similarly, the following pie chart (Graph 2) quickly conveys the improved continuity of care resulting from this network’s efforts.
Graph 2. Continuity of care
As the saying goes, a picture is worth a thousand words. And in the hustle, bustle world of rural health networks, communicating the results of the organization’s hard work efficiently and effectively is a skill worth improving.
Linda K. Weiss is a Licensed Clinical Social Worker with over 25 years of direct service, supervision and management experience. As a former network director, Linda was instrumental in the original design and implementation of a 24/365 behavioral health crisis services delivery system. Linda earned an MSW from the University of Illinois at Urbana-Champaign and is a graduate of the Johnson & Johnson/UCLA Health Care Executive Program from UCLA’s Anderson School of Management in Los Angeles, CA. Linda has been Director of Member Services for the National Cooperative of Health Networks Association, Inc. (NCHN), since 2015. NCHN is a national asociation of health networks and strategic partners whose mission is to support and strengthen health networks. Founded in the late 1980s, NCHN was incorporated in 1995.
Written by the staff of MHP Salud. A version of this article originally appeared on the MHP Salud blog.
There is no question that the Community Health Worker (CHW) movement has expanded its profile in recent years. From the front lines of the Ebola fight abroad to the constant changes in health care reform here at home, the profession gained profile, utility and respect.
Less prominent, but equally important, has been the growing role of the CHW supervisor. Supervisors are an indispensable component of the CHW profession that requires as much attention, care and training as the CHWs themselves receive.
With more than 30 years’ experience designing, running, evaluating and improving CHW programs, as well as more than 20 years’ experience spreading that knowledge via technical assistance to other organizations around the country, MHP Salud has gained insight, experience and a deep understanding of CHW supervision.
From all our experience, we collected this list of six tips for supervision success, which includes insights from MHP Salud staff who supervise CHWs every day. These six tips can be used to strengthen, solidify and promote the CHW model through the professional development of their supervisors.
1. Not everyone is right for the role.
Just as CHWs must possess innate qualities and life experiences to be successful, their supervisors need some baseline skills and qualities as well.
First, if a CHW supervisor is working with a population that is multilingual, the supervisor must have the ability to communicate in the language used by the CHWs he or she supervises. Additionally, in order to read the landscape of the community served, he or she should have a strong knowledge, understanding of or experience with its culture.
Solid time management and independent working skills are also vital to serve as an effective CHW supervisor. Much of a program manager’s day is spent juggling CHW supervision, reporting to funders and the organization and attending local meetings in order to maintain community partnerships and relationships. These broad responsibilities are only effectively met through careful planning and an ability to prioritize independent work.
Apart from life experience and skills, MHP Salud’s Chief Programming Officer Colleen Reinert says there are some innate characteristics needed. “In relation to specifically supervising the CHWs,” she said, “I would say the most important thing is to trust the work of the CHWs.”
To maximize their impact, CHWs spend much of their time away from the supervisor out in the field. Because of this, neither role will function if a supervisor constantly checks that the CHWs are doing what they said they would be doing. Regular check-ins and management tools are still necessary in CHW supervision, but without trust, no one will be able to get their work done.
Reinert says flexibility is also key. “The work of CHWs is not necessarily a nine-to-five job,” she said, “so a supervisor has to also be flexible in the work that their CHWs are doing.” For example, CHWs may not be able to come into the office at a set time in the morning if they stayed out late the night before at a health fair event. The CHWs are inherently flexible around the schedule of the community they serve, and the supervisor must mimic this flexibility.
2. It’s different from other supervisory roles.
Apart from the other organizational requirements for employees, Reinert says a good CHW supervisor needs to be able to recruit quality CHWs. This requires an ability to spot those characteristics that make a CHW successful: compassion, trustworthiness, empathy and the abilities to motivate other individuals and navigate the health system and social services. “Identifying these things isn’t something you can learn at school or receive training on,” said Reinert.
Once hired, measuring and understanding the CHWs’ performance requires additional specialized skills and experience. Good supervision might include holding team and individual meetings to grasp the realities on the ground in the communities served and the CHWs’ impact on it.
“In another position, effective work might be monitored via sales, or number of phone calls, but in CHW programs, there might not be something so concrete,” said Reinert. “It’s more of an art and less of a science.”
CHW supervision hinges on the supervisor understanding that even though a CHW’s impact may not be as clearly legible as other roles in the health care field, a good supervisor will seek to understand this impact through trust and the ability to listen. “Something I have seen over the years is, as much as CHWs appreciate support and seek support, they’re also generally not very willing to express concern when they’re not receiving the support that’s needed,” said Reinert.
She says it is important for managers and upper managers to remember to ensure that there is that time or environment to allow the CHWs to express their needs or concerns that they have within the community and within their organization.
3. Good CHW supervisors champion the work of their staff.
As the CHW movement is expanding and being applied in a larger variety of organizations, health care systems and federal governments, it will be key to find ways for both CHWs and their supervisors to maintain the integrity of the CHW profession. “I don’t want to see it turn into something that it’s not,” said Reinert. “Supervisors have a huge role in ensuring that that doesn’t happen.”
To successfully do this, the supervisor must understand the work of a CHW. They may have been a CHW themselves. If not, they need to have spent enough time getting to know the work of a CHW so that they can appreciate the unique role CHWs play and the challenges and successes that come with that role.
It is also important that supervisors advocate for their CHWs—both internally and externally. Within some organizations, like MHP Salud, who are wholly focused on and invested in the CHW model, advocating for the role of their staff may not be a challenge. In others, such as hospital systems, CHW program services may be a small component of the organization’s work. In these cases, the rest of the employees may lack a full understanding of what a CHW is actually doing, and it is often up to the supervisor to educate them.
Supervisors are also key in promoting the CHW professional movement outside of their own organization. “It is important to have CHWs participate in conferences, whether to present on their own program, to network or to gain more professional development,” said Capacity-Building Assistance Program Director Anne Lee.
Experienced supervisors who understand the CHW point of view can also amplify that viewpoint in group-settings to ensure that the CHW voice is heard.
Instinto Maternal Program Director Randi McCallian says she has learned that supervising CHWs is about more than simply ensuring a job gets accomplished.
“As a supervisor, I try to remember that my role is two-fold,” said McCallian, “to reach program goals and ensure fidelity to the program plan, but to also allow for the professional growth and experience of those I supervise.”
4. There is more than one way to run and supervise a program.
As the profession grows, it is increasingly common for programs to employ CHWs with varying levels of responsibilities. A multi-tiered model is used to distribute the responsibilities of CHWs based on the time commitment and expectations of their position, which can range from a part-time volunteer to a full-time staff member.
When used effectively, this model allows a program to maximize resources, extend the reach of CHWs and create a greater program impact. “Regardless of the CHW tier,” said Reinert, “what’s important to remember is that all CHWs still require a supervisor, coach or mentor—somebody providing support.”
Just as program form can vary, so can the communication between supervisors and their CHWs. With recent advances in technology, it is easy to have proper communication with the CHWs if they receive appropriate tools. “Several years ago, it could have been that a supervisor sends an email a CHW, and it took a week for the CHW to get access to the email in order to respond,” said Reinert.
These days, especially if an organization can provide proper communication to a CHW, such as a smartphone and internet services, it’s possible for a CHW to remain in the field and communicate with their supervisor remotely a majority of the time.
Though Colonia Community Project Program Director Moises Arjona, Jr. spends the majority of his time supervising CHWs remotely while they provide door-to-door outreach in the field, he finds it invaluable to change up his supervisory style occasionally and shadow his staff in the field in order to understand the realities of their work up close. “Once you actually work alongside the CHWs, you can appreciate the work that they do and see the barriers they encounter,” he said. “For example, I saw what it was like to go along door-to-door and have the door closed in my face constantly.”
5. Initial plans don’t always pan out, and that’s okay.
With more and more health agencies adopting CHW programs of their own as a way to address social determinants of health, lofty program objectives are sometimes hampered by realities on the ground.
“Often, a development team has designed a program with goals and expectations,” said Reinert, “but when the program begins, and the CHWs are out on the ground doing their work, the numbers that the development team originally identified are unrealistic.”
Supervisor flexibility comes into play in these instances. Otherwise, if a supervisor
continues to push a team of CHWs to meet those goals without making accommodations for the reality of the situation, the CHWs could burn out.
To prevent this, supervisors must be able to listen to their staff to understand the barriers they encounter in the community, so that they can adapt their goals, bring on more staffing or work together to find a solution to a problem.
Instinto Maternal Program Director Randi McCallian says she’s learned that listening is key to revising expectations and solving problems.
“Listen to the CHWs and through them, the community,” she said. “CHWs have a close relationship and understanding of the strengths and needs of a community, so if anything needs to be addressed, their input on strategies that will work is invaluable.”
6. Support is out there.
Currently, there are more opportunities than ever for CHW supervisors to develop their work. Local, state and national CHW associations, conferences and other meetings provide supervisors a chance to network with others in the field in order to receive peer support and learn from best practices.
In 2015, MHP Salud developed several materials and trainings geared toward supporting the work of CHW supervisors, all of which are released on our Resource Portfolio. These tools assist managers in their hiring, supervision, evaluation and greater professional development.
The new Supervision Manual for Promotor(a) de Salud Programs is an 88-page resource available for free download from MHP Salud’s Resource Portfolio. It covers everything from recruiting CHWs to resolving programmatic challenges as they arise, and the Manual’s appendix includes nine tools ready to be personalized for any CHW program. MHP Salud also offers personalized trainings for supervisors across a wide set of managerial topics.
MHP Salud is a national nonprofit organization that implements and runs Community Health Worker programs. These programs provide peer health education, increase access to health resources and bring community members closer. MHP Salud also has extensive experience offering health organizations training and technical assistance on Community Health Worker programming tailored to their specific needs
Rhonda Barcus, Program Specialist
For the past three years, I had the opportunity to work with the Kansas Department of Health and Environment (KDHE) and Sara Roberts, Director of Kansas Office of Primary Care and Rural Health and more recently with Jennifer Findley from Kansas Hospital Association on a Revenue Cycle Management (RCM) project. We supported 19 hospitals in Kansas with technical assistance to assess their current practices and benchmark those against best practices in RCM.
For all the 13 hospitals participating in years one and two, I had the opportunity to talk with their leadership teams at six and nine months about their progress of implementing the best practice recommendations. The progress and outcomes for most of them were astonishing! What really stood out to me were the common themes from the most successful projects. I wanted to share the top three themes with you.
Revenue Cycle Management (RCM) involves the process of patient charge capture from beginning to end, from creation to payment. It includes a number of steps that begins with patient registration and continues through the delivery of care to billing and to eventual payment. It is a process that involves a number of hospital departments: business office, clinical providers, registration, utilization review and coding to name a few. Because of its complexity and the number of staff that “touch” this process and the reliance on detailed, specific and accurate information at each step, hospitals may find that small errors can result in big financial losses, wasted staff time and decreased staff morale. A well-run RCM impacts patient satisfaction while a fragmented process results in frustration and patient dis-satisfaction.
The first step that every team took was to create a revenue cycle team. The team included business office folks, yes, but also included staff from clinical areas, registration, health information management (HIM) and information technology (IT). This team met weekly. Every leader said the success of this project was dependent on frequent meetings so that RCM issues could be addressed quickly and as close to real time as possible. The team looked at any issue or problem involving RCM over the last week and took immediate steps to remedy it. This kept them focused and they were all aware of the need for constant and consistent attention to make steady progress.
A second factor in their success was the focus on pre-registration. Patient information, coverage for upcoming procedures, co-pays and deductibles were all identified prior to a patient coming for their scheduled procedure when possible. Checks and balances were put in place to ensure accurate collection of information since one small error could impact the success of the entire revenue process. Staff were included in discussions about this so that they were very aware how they affected the success of the process.
A final theme, and was the hardest for many hospitals, was requesting payment from the patient! The hospitals were very transparent with the patient prior to coming for services about their financial responsibility at the time of service. Great care was taken to make sure all staff involved had the right education, training and re-education to do this effectively and with sensitivity. The hospitals also talked openly with patients about needing to pay prior balances and some future scheduled procedures were contingent on something being paid on previous balances. More than one hospital noted that this is part of their culture now and the community and patients just accept it. One CEO noted that almost all patients now come prepared with some type of payment. They noted that while many hospitals fear losing patients if they take this step, when done with sensitivity and skill by staff, that fear has been unfounded.
In addition to the common themes in implementation of best practices, all the hospitals were able to identify measurable outcomes. These outcomes included a decrease in accounts receivable, decrease in claim rejection, and an increase in collections. Also significant were the “non-measurable” outcomes. The hospitals all reported that there was better teamwork within and among departments, staff pride in the success of their work and more accountability across the organization!
The National Rural Health Resource Center (The Center) is a nonprofit organization dedicated to sustaining and improving health care in rural communities. Rural Health Innovations, LLC is a subsidiary of the National Rural Health Resource Center.