1. WAFCC Standards of Excellence – baseline survey results
Staci Young, PhD
Associate Professor, Department of Family & Community Medicine
June 1, 2018

2. Objectives
Describe preliminary findings for WAFCC clinics that completed a baseline assessment of Standards of Excellence
Obtain feedback on the survey findings and elicit recommendations

3. Background
WAFCC Standards Committee finalized the Standards of Excellence in summer 2017
Survey was submitted to MCW for IRB approval
Online survey link distributed to all WAFCC clinics in December 2017
Once opened, up to 2 weeks to complete

4. Survey overview Five sections
Part 1: Clinic and patient characteristics
Part 2: Clinic governance, administration and management
Part 3: Optimizing the patient care experience
Part 4: Fostering community relationships
Part 5: Perceptions of the Standards of Excellence
Time period: January 1, 2016 – December 31, 2016

5. Preliminary findings
20 clinics completed the survey as of April 30, 2018
Average time to complete: 2 hours

6. Part 1: Clinic characteristics

8. Other clinic characteristics
Year opened: 1977 – 2016
60% free-standing clinics
90% open at least 2 days/week
Cash operating budgets ranged from $4,200 - $1.3M
Unduplicated: range from ,185 (mean=1,248)
New patients served: range from 4 – 3,781

9. Patient characteristics
GENDER: 51% male; 49% female
RACE:
26% Hispanic or Latino; 42% white; 20% African American; 3% Asian
AGE:
8% children ages 0-17
85% adults 18-64
6% adults 65+

10. Clinic services provided
90% provide medical care
20% provide dental
70% provide medications
45% provide behavioral health services
60% of clinics have a geographic residency requirement

11. Part 2: Clinic governance, administration and management

12. GAM 1: Governance and administration
The purpose of the Governance, Administration, and Management (GAM) section is to provide a framework of tools by which a Clinic’s Governing Body ensures accountability, fairness, and transparency of the organization. The Standards describe mechanisms which promote a Clinic’s duty to enhance living its mission, monitoring meaningful impact on current and future health care gaps, and ensuring viability of the organization. Additionally, these Standards describe the criteria for directors and managers to efficiently administer a Clinic’s operations.
MISSION
LEGAL DOCUMENTS
GOVERNANCE STANDARDS
FINANCIAL STANDARDS

13. GAM 2: Operational competency
The purpose of the Operational Competency Standards is to identify those organizational functions, which contribute to an efficiently run clinic, meet required legal statutes for employees and show effective volunteer engagement.
EMPLOYEE & VOLUNTEER MANAGEMENT
POLICY AND PROCEDURE MANUAL

14. GAM 3: Risk management
The goal of the Risk Management Standards is to reduce risks to the clinic and ensure individual safety by identifying high risks and defining methods to avoid risk. Sources of risks to organization and individuals include but are not limited to financial viability, liability, organizational practices, and patient sources. All members of the Clinic are responsible to provide safe care and ensure safety processes.
MEDICATION MANAGEMENT
ENVIRONMENTAL SAFETY
TRANSMISSION OF BLOODBORNE PATHOGENS AND COMMUNICABLE DISEASE
LIABILITY
PATIENT INFORMATION SAFETY

15. GAM 4: Performance measurement
The purpose of the Performance Management Standards is to help clinics identify elements of a performance improvement program, which utilizes best practice guidelines to enhance the quality of care delivered to the free or charitable clinic population.
QUALITY IMPROVEMENT

16. Part 3: Optimizing the patient experience

17. OPC 1: Optimal access to care
Meeting the Optimal Access to Care Standards will help FCCs show how their organizations define, provide, and evaluate access to health care services for their target populations. Fulfilling the Optimal Access to Care Standards will facilitate the clinic’s role to bridge a gap in the healthcare system for a population that would otherwise lack access to healthcare.
UNDERSTANDING THE POPULATION
FILLING THE GAP
EXPANDING ACCESS THROUGH COMMUNITY PARTNERSHIPS AND REFERRAL NETWORKS
TRANSITIONING TO PERMANENT HEALTH CARE HOME

18. OPC 2: Care management and support
The purpose of the Care Management and Support Standard is to help clinics systematically identify and address vulnerability or high risk for poor health outcomes in the population they serve. These Standards define measures to provide care coordination using a team-based approach.
FORMING THE PATIENT-CENTERED CARE TEAM
SUPPORTING SELF CARE AND SHARED DECISION MAKING
IDENTIFYING VULNERABLE AND HIGH RISK PATIENTS
FORMULATING THE CARE PLAN

19. Part 4: Fostering community relationships
A close link between a clinic and its larger community can significantly enhance community responsivity to Clinic needs. The Fostering Community Relationships Standards describe means to strengthen a clinic’s connections within the community, and to promote a Clinic’s unique role and responsibility in building a healthier community.

20. FCR 1: Effective collaboration with health systems & community partners

21. FCR 2: Building trusting relationships with the community
A close link between a clinic and its larger community can significantly enhance community responsivity to Clinic needs. The Fostering Community Relationships Standards describe means to strengthen a clinic’s connections within the community, and to promote a Clinic’s unique role and responsibility in building a healthier community.

22. FCR 3: Reducing the cost of health care
By providing healthcare services to the uninsured, underserved, economically and socially disadvantaged, marginalized, or vulnerable populations the clinic reduces the financial burden on local healthcare organizations and the government.
The purpose of the Reducing the Cost of Healthcare standards is to identify best practices of the Clinic that demonstrate cost effective care and to track the impact a Clinic has on reducing healthcare spending in a community.
PROMOTING APPROPRIATE USE OF HEALTHCARE RESOURCES

23. Part 5: Perceptions of the Standards of Excellence

24. % “STRONGLY AGREE” OR “AGREE”
STATEMENT
% “STRONGLY AGREE” OR “AGREE”
Confident we will achieve all SOEs at Required level in 1-5 years
84%
SOEs offer measurable guidance suitable to the WI FCC environment
89%
SOEs allow sufficient flexibility in “Required” and “Optimal” evidence
88%
Achieving the SOE seal will improve the reputation of our FCC
Achieving the SOE seal will help our FCC attract funding
74%
Adopting the SOEs will help our FCC improve the quality of patient care
Our FCC organization has sufficient resources to achieve the SOEs
63%
Our FCC has access to the information and knowledge to implement the SOEs
WAFCC communicates openly with our FCC organization
WAFCC resources help our FCC stay abreast of health care changes and challenges
RR is unknown…how many clinics received the survey?
Would help to know why clinics chose NOT to complete (e.g. time, not generally meeting evidence, standards not a priority, etc.)
Potential for selection bias…i.e. those clinics that generally met the required evidence more likely to complete

25. QUESTIONS