Who Does What in a Community Health Center? Jennifer Genua

 Federally Qualified Health Center (FQHC)  Federally Qualified Health Center Look-Alike (FQHC LAL)  Community Health Centers  Section 330 Grantee  Non-federal entity  HRSA/Bureau of Primary Health Care (Bureau) Special Population Funding  Section 330(g)-Migrant/Seasonal Health Centers  Section 330(h)-Healthcare for the Homeless  Section 330(i)-Public Housing Primary Care Jennifer Genua

 As a recap: ◦ Holding monthly meetings and maintaining records/minutes that verify and document the board’s functioning ◦ Approving applications related to the health center project, including grants/designation applications and other HRSA requests regarding scope of project ◦ Approving the annual health center budget, audit and sliding fee discount program (nominal fee) ◦ Long-term strategic planning, which would include regular updating of the health center’s mission, goals, and plans, as appropriate Jennifer Genua

◦ Evaluating the health center’s progress in meeting its annual and long-term goals ◦ Selecting services, location and mode of delivery of those services (Form 5, A, B, C) ◦ Determining the hours during which services are provided at health center sites that are appropriate and responsive to the community’s needs ◦ Approving the selection/dismissal/evaluation of the health center’s CEO/Executive Director ◦ Establishing general policies and procedures for the health center that are consistent with Health Center Program and applicable grants management requirements ◦ Privileging and Credentialing unless by board resolution delegated (Per PIN ) Jennifer Genua

Board RoleCEO’s Role Develop Mission StatementCommunicate Mission Statement Guide Strategic/Long-Range PlanningImplement Strategic/Long-Range Planning Establish/Approve PolicyImplement Policy Select and Evaluate Qualified Chief Executive Officer Ensure Timely and Accurate Reporting to Board on Achievement of Organizational Goals and Objectives Evaluate Center OperationsManage Center Operations Review Quality of CareMonitor Quality of Care Represent Community InterestRepresent Health Center Needs Jennifer Genua

 Budget and Finance: ◦ Board members approve the budget  Generally prepared by the Chief Financial Officer (CFO), and reviewed by the CEO and Senior Management ◦ Monitoring program expenditures and determine sound fiscal policy and internal control practices  “Stoplight dashboards”; Statement of Operations etc. ◦ Assume the responsibility for the fiscal accountability of the health center  Notice of Award (NoA) is legal document that HRSA provides Jennifer Genua

 Health Center Program Evaluation: ◦ Monitor program effectiveness ◦ Review of program evaluation reports on a regular basis  Reports can come through committees  Trending reports for fiscal and clinical measures  Other goals the board sets through the strategic plan  What did you tell HRSA you would do?  Through the grant application and quarterly calls with Project Officer ◦ Advise staff on the health center’s self-evaluation activities Jennifer Genua

 Planning: ◦ Participation in and approve the strategic plans of the center, including the program’s goals and objectives ◦ Regular monitoring of goals?  “What is the status of the goal? Are there restrictions to achieving this goal?” ◦ May assist staff in the development of these plans and set organizational priorities for action  Through the CEO/Executive Director, allow staff to operationalize priorities Jennifer Genua

 Personnel: ◦ Board of Directors hires the CEO/Executive Director ◦ Monitors the effectiveness of the Director’s performance and removes Director if performance is unsatisfactory  Based on job description and mutually agreed upon objectives ◦ Determining personnel salary ranges (and benefits) and develop personnel policies. ◦ Staff members are hired, evaluated, and, if necessary, removed by the CEO/ED, not the Board  This includes the Chief Medical Officer (CMO) Jennifer Genua

 Board Development: ◦ Determining the structure of the Board and committee membership (Based on PIN ) ◦ Nominate and selects new board members and set standards for its own periodic self-evaluation ◦ Self-evaluation by board members is an important process as it provides feedback to the Board  Can assist to identify potential training opportunities and other opportunities for improvement at the Board level Jennifer Genua

 Public Relations: ◦ When appropriate, the Board of Directors communicates with funders, community leaders, and other interested parties about the health center’s activities  Can include fundraising/board development ◦ More typically, Board members advise the staff in the development of public relations responses to community and/or health center issues as appropriate. Jennifer Genua

 Policy: ◦ Board determines the health center’s policies  Policies: Broad guidelines that provide a framework for future decision making  Procedures: Clarify what steps must be taken, what rules must be followed, and who must be included in the process.  Generally formulated by the staff rather than by the Board ◦ Organizational Policies and Procedures are routinely brought to the Board for review and approval on a regular basis Jennifer Genua

 Planning: ◦ Works with the board to develop and gain Board approval on the goals, objectives and priorities  Usually completed through the strategic plan ◦ Will delegate responsibility to staff to carry out and operationalize the plan ◦ Regular report back to the board on the progress Jennifer Genua

 Budget and Finance: ◦ Works in conjunction with the CFO/Finance Director to prepare the budget  If a health center has a finance committee- all preparation work can be done within the committee ◦ The health center budget is brought before the full board for approval ◦ Monthly financials prepared for the board with discussion  Financial indicators, statement of operations, balance sheet, profit & loss, productivity etc. Jennifer Genua

 Administration & Staff: ◦ Responsible for the day to day administration of the activities of the health center  Duties are clearly defined in the job description and at times health center bylaws ◦ Delegation and supervision of staff in carrying out the plans and programs of the health center ◦ Determines responsibilities and authority among staff and assures that high standards of performance are being met Jennifer Genua

 Program Evaluation: ◦ Assists board in evaluation of the progress and outcomes of health center programs (strategic plan), and recommends revisions of goals/objectives when needed in order to improve organizational performance ◦ Works with the board to secure adequate resources to carry out the center’s programs and monitors the allocation of these resources to insure they are used effectively and efficiently  Report back to the board on the status Jennifer Genua

 Public Relations: ◦ Works with the board to ensure community awareness of the health center’s goals, mission, objectives and programs, and obtaining community support for the Center. ◦ The CEO, or his/her delegate, is the chief spokesperson for the health, unless otherwise directed by the board of directors Jennifer Genua

 Board members must not use their positions to obtain employment in the health center, or for preferential medical treatment for themselves, family members or close associates ◦ Program Requirement #19-Conflict of Interest  Also addressed in the bylaws usually address  Board members should not attempt to resolve staff complaints Jennifer Genua

 When confronted with a staff complaint, Board members will: ◦ Express concern and desire that the complaint be handled appropriately as outlined in the Personnel Policy ◦ Explain that an individual board member has no authority to deal with staff complaints; therefore, the Board member will not attempt to mediate or resolve their complaint ◦ Explain that the Board has delegated staff, including complaints, to administration and the staff person should address their concern with the Chief Executive Officer or his/her delegate Jennifer Genua

atlagreement.html (Updated Health Center Governing Board Workbook) Jennifer Genua

 Jennifer A. Genua-McDaniel, BA (Hons), CHCEF, Consultant   (928) Jennifer Genua