Julie Rosen, chief of govt recruiting agency WittKieffer’s Not-for-Revenue Apply, just lately authored a report about constructing sustainable management in Federally Certified Well being Facilities. She just lately spoke with Healthcare Innovation about a number of the report’s findings and her expertise recruiting FQHC leaders.
Earlier than working at WittKieffer, Rosen served as govt director of the Schwartz Middle for Compassionate Healthcare in Boston, a nationwide not-for-profit group advocating for enhancing the patient-clinician relationship. Previous to the Schwartz Middle, she was assistant vp for public and neighborhood affairs at Tufts Well being Plan and govt director of the Convention of Boston Educating Hospitals. She additionally served in management roles with the Massachusetts Hospital Affiliation, Massachusetts Medical Society, and American Dental Hygienists’ Affiliation.
Along with surveying FQHC leaders for this report, WittKiefer additionally carried out proprietary analysis on the profession paths of greater than 350 FQHC CEOs throughout the nation.
Healthcare Innovation: I feel most of our readers are conscious of what FQHCs do, however what are some key challenges of being within the CEO place of an FQHC?
Rosen: It’s fascinating that you simply say that most individuals know what FQHC businesses are. I do know lots of people in healthcare which have by no means heard of an FQ, which I discover astounding, as a result of so many individuals get their healthcare there now — almost 10 p.c of Individuals.
There are extra challenges round social determinants of well being. Loads of FQHC sufferers are in danger, underserved, they usually have wants together with transportation, financial safety, meals and safety from environmental hazards like lead paint. So along with healthcare, many FQHCs present entry to social helps similar to meals and transportation.
The opposite factor that makes it completely different is that 51% of the board members of FQs need to be sufferers.
Once I do my searches, I insist that there are affected person representatives, as a result of that is nearly all of the board. Board schooling is admittedly necessary — ensuring that everyone is on the identical web page, ensuring that the board has sufficient info, and ensuring that the board is consultant.
HCI: In your analysis, did you discover some widespread themes concerning the CEO demographics and educational backgrounds?
Rosen: It is fascinating. Loads of the FQHC founders who’re retiring are social staff who grew small neighborhood clinics. They began including completely different doctor practices, after which abruptly they’d a $100 million operation. They picked up the enterprise expertise, and now the group’s prepared for one thing completely different. Loads of the FQHCs did very well through the pandemic, as a result of there was plenty of PPE and different cash, however these funds have dried up. So that they’re struggling and in want of robust management.
We place some CEOs who’ve by no means labored in an FQ setting. In California, we simply positioned a lady who was a Kaiser govt from a really massive outpatient apply and who needed to offer again. We’re seeing plenty of our older folks with conventional healthcare careers who now wish to give again.
HCI: Do you see plenty of physicians moving into that CEO function?
Rosen: Sure. The primary two FQ searches we did had been in Massachusetts, they usually had been each MDs. On the FQHCs, there are sometimes main clinician productiveness points. They be part of FQHCs as a result of they wish to do good work. They want extra time with every affected person as a result of their sufferers are extra difficult. And due to the cost incentive system, they have to be extra environment friendly, so there are points about productiveness and scheduling.
HCI: Your report discovered that there is been a 20% CEO turnover charge up to now two years. Are there some the explanation why we’re seeing this excessive turnover charge now?
Rosen: There are some causes which might be associated to FQs, and there are different causes which might be extra associated to demographics. Folks retire, saying they’ve had sufficient. These searches are gratifying however actually exhausting. Getting all people on the identical web page is difficult, as a result of what the FQs need is an impressive, strategic one who’s a visionary, who’s nice at operations and nice on the medical stuff, and nice at finance, and may be an emissary for the group. And, oh, by the best way, raises cash and has a ton of emotional intelligence. And but they don’t have the assets to compensate CEOs the best way hospitals and different healthcare organizations can.
HCI: The report additionally will get into whether or not they have succession planning in place and are beginning to put together folks internally to maneuver up into that CEO place. And it sounds just like the report stated that is not occurring fairly often.
Rosen: That is proper. The Nationwide Affiliation of Group Well being Facilities (NACHC) does have some mentorship packages the place older, retiring FQ CEOs mentor youthful ones.
I come from the hospital business initially, and there’s a lot extra success there when it comes to succession planning. Loads of these FQHC organizations are working by the seat of their pants, so they do not actually have the assets to consider that. I feel out of the 30 positions we’ve been concerned with, possibly six or seven had been crammed by individuals who had been developing by the ranks.
HCI: Are we seeing extra FQHCs getting concerned in value-based care packages? And does that require a further talent set on the a part of the CEO?
Rosen: Each FQ desires the CEOs to grasp what value-based care is. I feel it is determined by the state and what number of FQs there are and the way refined the state is when it comes to its cost. We’ve accomplished a ton of labor in California and Massachusetts, and people are the extra refined states. However when you go to another states, they’re simply not fairly as refined. They’re simply moving into value-based care now.
HCI: Your report, says that workforce challenges embrace expertise, attraction, retention and burnout. Are there some methods you have seen profitable FQHC leaders cope with these points?
Rosen: Normally by versatile scheduling. However coming again to what I stated earlier than about productiveness, it is an enormous concern. It is an actual balancing act. There’s additionally been actual rigidity within the organizations between the executive workers, particularly through the pandemic, and the medical workers, as a result of the executive workers did not have to come back in. They might work at home. That is form of outdated information, however there’s nonetheless a lingering rigidity in a number of the FQs between those that are on the entrance traces and people who are doing the billing and coding.
HCI: Is there anything you wish to point out?
Rosen: Simply that the FQs are nice organizations. There are some actually proficient leaders on the market. There are plenty of FQs which might be moving into joint ventures with hospitals and partnerships round housing. I’ve accomplished searches for homeless shelters which have FQs connected to them. So there are only a lot of various ways in which FQs are arising, and I feel it is actually the wave of the longer term.
