Accomplishing Goals

As I reflect on changes people have made in their lives and the goals they have achieved, whether it was personal or professional, three key factors keep coming to mind: (1) They all had a plan, (2) They remained committed yet open, and (3) They were all willing to sacrifice to accomplish the goal.

Every successful mission, accomplishment or goal starts with a plan. Whether it involves a career change, overcoming a problem, or accomplishing a feat never before even thought possible (like sending a man to the moon), one must start by writing down the goal and spending some time thinking about the steps necessary to attain the goal. By breaking the goal into logical steps, the accomplishment becomes “simpler” as each step can be broken down into specific tasks. Tasks can be shared (and measured) or completed individually, yet lead towards accomplishment of the goal.

Commitment (also referred to as “focus”), the dogged determination to accomplish a goal or task, is the next factor that can easily be identified in the success process. Commitment cannot, however, be blind to the influences of our environment, as we have no control over those factors. One must be open to new ideas, to criticism, and creative and new ways to accomplish goals and tasks (as the Apollo 13 mission crew learned), because we can never be sure of what may stand in our way.

The final factor is sacrifice: the willingness to “give up” something in order to “achieve” something else. This is, in fact, the most difficult factor, in that we all become comfortable in our daily lives. We become unwilling to sacrifice time, energy and money at the risk of potential failure. Human nature, especially as we mature, is to make decisions that result in comfort rather than risk. That is not necessarily a problem, but it certainly can result in failure to attain new goals and accomplishments. If there is no sacrifice, there can ultimately be no improvement or attainment of goals.

The process of accomplishing goals can be simple for some, and arduous for others. But upon reflection at the end of the process, whether the goal as attained or not, one has to agree that the plan, the commitment and the sacrifice were all integral parts of the process. Evaluation of the success of a goal will, if nothing else, bring attention to which of the three facets requires additional improvement before  the next attempt is executed.

Understanding the Mission Statement

With the rapid changes occurring within our organization, there have been many questions arising around our mission statement. By definition, a mission statement should be a summary of “the good” the organization brings to the world. It should contain the organizations purpose, identify stakeholders, and provide responsibilities, products or services offered by the organization.

LMG’s mission statement reads as follows:

” Livingston Medical Group is a non-profit community owned health center providing comprehensive primary and preventive health services to all patients regardless of ability to pay”.

While the mission statement meets the criteria above, questions that arise include:

1. Does the mission statement allow us to survive/thrive through healthcare reform?

2. Does it allow us to assess program needs? Culturally? Linguistically?

3. Does the mission statement allow us to assess quality and governance?

4. Does it address operating efficiently? Getting the most out of everyone? “ability to pay” versus “willingness to pay”?

5. Does the mission statement reflect our ability to collaborate with others while maintaining integrity?

These questions are being debated nation-wide, not just in Livingston, California. Many of the answers are clarified in other documents such as “vision statements”, by-laws, and policies. It does seem, however, that the mission statement rings true and clear, even after 40 years.

CEO Report 10/27/09

I have reached a point where I enjoy having an opportunity to reflect on the activities of the month and measure against the progress of the work plan. The stars seem to align in such a way as to allow us to not only accomplish that we had proposed, but exceed our own expectations. Several members of the management team participated in the CPCA Annual Conference. We were pleased with the quality of the sessions and the expertise made available to us. Even the vendors and suppliers had an amazing understanding of the challenges faced by primary health care providers in California. Other activities worth mentioning this month include:

- An employee donated TWO wheel chairs to LMG in memory of her mother, who recently passed away.

- Our Finance Department continues to make improvements upon our “dashboard” data, used to monitor productivity and cash flow.

- We recently completed an employee satisfaction survey (with 50% response rate). Data will be reviewed by the Board and an action plan created in strategic planning next month.

- I had an opportunity to play golf with the Mayor and City Manager of Livingston. It’s amazing just how much bonding and business opportunity can be developed on a golf course!

- We met with the Department of Agriculture and Premier Valley Bank with respect to a longer term campus project.

- We are working through the challenges of getting the CIP funds released so we may begin some building renovations. -

- We still have not heard on FIP funding for the Delhi project, even though announcements were to be made mid-October.

- Special Thanks to our Board Member, Bob Olson, for coming in last week at 0800 to participate in our Quality Improvement meeting. Staff was pleased to have Board participation and interaction.

- I had an opportunity to speak to students at UC Merced that are interested in health care careers. It’s always rejuvenating to be around young people with so much hope and enthusiasm.

CPCA Committee Meetings and Annual Conference

California Primary Care Association (CPCA) committee meetings were held in South San Francisco on Wednesday, September 30^th. My CFO, Randy King, and I attended Finance Committee, Governance (By-Law) Committee, Workforce Task Force and the 330 Committee meetings in the morning. After lunch, we attended the Legislative Committee, Government Programs, Migrant and Rural Committee meetings.  That evening The Central Valley Health Network (CVHN) Board members took advantage of the collective gathering of our members and had a special board meeting, in person, at a local restaurant.

The actual CPCA annual conference began on October 1^st. The key term that brought meaning to our gathering was “resilience”.  Based upon current budget cuts at the state level, just remaining solvent has proven to be extremely challenging. Based upon current economic trends, the National Association of Community Health Centers (NACHC) expects patients to increase by 20-40 million over the next two years. NACHC expects cuts to state and federal budgets to continue through 2011. That means that leveraging partnerships becomes even more important as we move ahead.

With respect to healthcare reform, changes are occurring “hourly”. A new term (“mushed”) has been coined to describe the process of combining all the different pieces of legislature trying to create a healthcare bill. Most legislators understand that Community Health Centers are “essential community providers” of care and must be an integral part of any solution.

We Have Alternative Choices

Situations arise in our lives that make us want to react quickly, even panic. Changes may occur so drastically that we think we have no choice in the matter. Perhaps we receive a diagnosis about our health or incur a downturn in our finances, and feel or have even been told we have no choice but to accept the outcome. One of the most wonderful things about how LMG staff deal with adversity at work (whether it’s budget cuts or funding changes) , is that  we realize we DO have a choice in what matters to us. We choose how to respond to life’s challenges and step up to build a plan to address the situation and make a difference in the lives of our patients. This response is both admirable and inspiring. I am proud to serve as the CEO for such a fine group of people. Keep up the good work!

CPCA Committee Meetings and Conference

California Primary Care Association (CPCA) committee meetings were held in South San Francisco on Wednesday, September 30^th. My CFO, Randy King, and I attended Finance Committee, Governance (By-Law) Committee, Workforce Task Force and the 330 Committee meetings in the morning. After lunch, we attended the Legislative Committee, Government Programs, Migrant and Rural Committee meetings.  That evening The Central Valley Health Network (CVHN) Board members took advantage of the collective gathering of our members and had a special board meeting, in person, at a local restaurant.

The actual CPCA annual conference began on October 1^st. The key term that brought meaning to our gathering was “resilience”.  Based upon current budget cuts at the state level, just remaining solvent has proven to be extremely challenging. Based upon current economic trends, the National Association of Community Health Centers (NACHC) expects patients to increase by 20-40 million over the next two years. NACHC expects cuts to state and federal budgets to continue through 2011. That means that leveraging partnerships becomes even more important as we move ahead.

With respect to healthcare reform, changes are occurring “hourly”. A new term (“mushed”) has been coined to describe the process of combining all the different pieces of legislature trying to create a healthcare bill. Most legislators understand that Community Health Centers are “essential community providers” of care and must be an integral part of any solution.

CEO Report 9/29/09

This has been another very exciting month, as we pick up momentum and move forward on so many projects. The financial situation is improving and we have developed a simple “dashboard” to track cash flow and encounters. It is just a start,  but it has proven to be a valuable tool for a “weekly/daily” read. Other activities worth mentioning include:

1. Completion of the technical assessment by Jeffrey Zonis.

2. Collaboration with Merced County Human Services Agency on expanding the “All Dads Matter” program by creating a local “Bootcamp for Dads”.

3. Randy and I will be attending the CPCA Quarterly Board Meetings on September 30th. I have been nominated to the CPCA Board and election results will be announced at the CPCA Annual Conference on October 1st. Randy and I will stay over for the conference and Mike Hull will be joining us.

4. PPS rate change request and change of scope documents are reaching final draft. All documents should be completed in a timely manner.

5. We have been proactive with respect to enrolling our Medi-Cal patients in the new managed care product. I will let Senior Staff share the exact numbers.

6. All members of senior staff are creating and integrating 12 and 36 month work plans in response to the technical advisory report.

7. We have interviewed and hired an internal candidate as office manager to provide leadership, training and support to front office and medical records staff. The goal is to improve patient flow through analysis and implementation of consistent processes: Identifying “bottle necks” and resolving challenges as they arise.  This person will work closely with back office staff to ensure improved productivity.

8. We have had two conference calls with our new project officer, Cardora Barnes,  from HRSA. The first was a transition call with our previous project officer, to introduce everyone and discuss current status. The second call was to get updates on specific projects and tasks. Both have proven to be invaluable. It seems like everything is moving forward as planned.

9. The Medi-Care cost report has some additional filing requirements.  I have paperwork that needs to be completed and signed by each Board Member.

10. The “stars are lining up” with respect to the F street property. A new project idea is being crafted, and preliminary discussions with the City of Livingston and the Livingston Unified School District have proven promising.

Management Handbooks Aside…

One of the things I have learned from my staff in these times of economic trouble is that to be a “leader” of such creative and innovative people requires that  I learn to “follow” at times as well. This has allowed me an opportunity to strategically assess employee competence and understanding of our work environment. Together we can run through specific scenarios and “what if” situations around our proposed plans for the future. The difference between this approach and that of a text book is that dedicated people are working from a position of caring: providing passion and a greater sense of urgency and importance in resolving problems and challenges. I believe this gives us the the potential for success.

CEO Report 8/25/09

Some of the tasks I hoped to gradually cover have become more serious since I have assumed the role as CEO. I was hoping to take a little more time to “settle in” before making significant changes in the culture and operations of our business. In the 12-month work plan, I had planned to gather data and begin a methodical analysis of our situation, creating a baseline for systemic change. Budget cuts, and audit results have forced me to move up the timeline and perform some changes while concurrently collecting baseline data. The results have been positive, but we have a long way to go. Some of the activities this month include:

1. Improving the process for collecting co-pays at the time of service.

2. Meeting with providers and medical assistants to ensure buy-in and support of changes.

3. Participating in a listening session for UC Merced Medical School, and requesting resolutions from City Council’s in support of an aggresive timeline for its creation.

4. Meeting with representatives from the Health Plan of San Joaquin, Emanuel Medical Center, Merced Faculty Associates, and Golden Valley Health Centers with respect to our plans for the future.

5. Meeting with Contractors to discuss the renovation of our existing building with CIP funds.

6. Activites around National Health Center Week (see web log), and the employee picnic at Lake Yosemite were very successful.

7. HRSA provided us with some technical assistance. Jeffrey Zonis is here this week reviewing our revenue cycle and financial workplan/budget for FY2010.

8. The RFP is out for the CIP project: deadline is September 14th.

9. The Change in Scope application is complete and requires Board action to support the proposal.

Letter to the Editor

I sent the following letter to the Editor of the Merced Sun Star. I hope they publish it!

“I watch the news and listen to people criticize our political leaders for not having town hall meetings in the community during their congressional break. Until such time as a viable, sustainable solution to health care reform has been crafted, it doesn’t make sense to create a forum for complaining. Everyone knows there is a problem, and there are many people working to create a solution: both Democrats and Republicans. This is a HUGE problem, and the solution will require collaboration and creativity.

In the mean time, I think Sun Star readers should know that Congressman Cardoza is working hard to support the process. He and his “Blue Dog” colleagues will ensure fiscal responsibility and access to care for a maximum number of people. Readers should also know that Congressman Cardoza made a personal stop in Livingston and took time out his schedule to thank all the employees of Livingston Medical Group for their dedication and service. He spent time touring our facility and thanking everyone from receptionists and medical assistants, to providers and referral clerks. As our representative in Washington, DC, Congressman  Cardoza is knowledgeable and influential. He thoroughly understands the problems and challenges that face his constituents. He does not have to have town hall meetings to get the message: he is an expert!”