Coastal Family Undergoes Complete Restructuring of Leadership

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Angel-Greer-thumbMs. Angel S. Greer, MPH, Chief Executive Officer

by Pete Fernbaugh

When HCE last covered Coastal Family Health Center in 2011, we talked with Ms. Angel Greer, MPH, chief executive officer, about the various goals the organization had set with respect to providing care, upgrading technology, and recruiting physicians as an FQHC under healthcare reform.

Since that conversation, the 35-year-old, 230-employee Coastal Family Health Center has pursued a courageous initiative, completely transforming its network that spans 14 different locations, not including administrative sites, in three Gulf Coast counties in Mississippi.

Reorganizing the administrative infrastructure

Greer has been with Coastal Family for 14 years and has served as CEO for the last three. She said the fundamental challenge facing the organization was communication.

“I would consider us a small organization, but because we’re so spread out, we have difficulties with communication and making sure everyone is on the same page,” she said. “Trying to get everyone together in one place at one time is often difficult.”

As Coastal Family was originally structured, each department was run by a director who served as the chain of command for everyone under them. Oftentimes, this meant clerical directors would make decisions that contradicted what the nursing supervisors were doing. And both departments usually clashed with the medical director and the providers. As a practicing physician, the medical director also had difficulty unifying the providers, since he was unable to provide on-site one-on-one contact because of his practice schedule.

At the administrative level existed a centralized decision point where many departmental directors were looking to the CEO to make decisions typically made at the clinic level, Greer said. “Because of the siloed departments, there was no clear-cut go-to person to try to figure out what was the best resolution and not have an affinity for their particular department.”

Realizing the dire implications of this arrangement in light of national reform, Greer and her executive team took several ambitious steps to restructure and reorganize Coastal Family Health Center beginning in the second quarter of 2013.

For one, the team did away with all supervisors. Instead of laying these professionals off, however, they reassessed each person’s strengths and weaknesses to determine where they could better contribute to the organization and its patient-care outcomes. Greer said they developed roles and responsibilities for the former supervisors based upon their unique talents and interests.

Second, Coastal Family brought in masters-level practice managers to replace the position of supervisor. With one practice manager at each location, all ancillary support staff, from lab to nursing to clerical to dental assistants, are now managed and supervised on-site. The practice manager gives direction, coordinating and collaborating with the providers to meet their needs.

Finally, Coastal Family took a look at its administrative infrastructure. For the first time, Greer hired a chief operating officer for the organization. They also created an executive team to support the office of the CEO.

“On a weekly basis, this executive team is looking at productivity, looking at what’s going on inside of the organization as well as outside of the organization,” she said. “The work that we’ve been able to accomplish since we started meeting in September of last year, the amount of projects that we’ve been able to either begin and complete, and in many cases, the improvement in the organizational knowledge, the improvement in the management and leadership decision-making, even at this soon of a time after this change has been made, has been so rewarding. The board has commented on just how significant the change has been in a positive way.”

Seeing improvements after a short time

Immediately before implementing the restructuring initiative, Coastal Family conducted an organization-wide patient-satisfaction survey, and the results were dire, Greer said. In January of this year, another survey was conducted, and the indicators signaled that Coastal Family was moving in the right direction.

“The providers are much happier,” she said. “They get their needs met quickly. They get their issues resolved efficiently. The patient satisfaction has turned around. The morale has improved. Communication has improved.”

When asked for advice to her executive colleagues who are implementing similar initiatives, Greer said, “Admit that you can’t do it all.”

“Honestly, with all of the changes that are coming with healthcare reform, with the changes that will be coming down the pike with reimbursement,” she continued, “we really have to take a look at what we’ve done in the past and what hasn’t worked. We’ve got to figure out how to make it work for the future if we’re going to remain viable. It’s going to really take a team. Each one of us has skills, and along with those skills, we have weaknesses. Creating a knowledgeable and competent team that is open and honest, that’s how we’re going to be successful.”

Transforming the perception of FQHCs

Looking ahead, Greer has another goal in mind: to change the image of the federally qualified health center.

“Largely, community health centers are seen as completely government-funded organizations that aren’t run efficiently or as a feasible and sustainable business model,” she said. “I would like to change that image. With the national budget the way it is and with reimbursement changing the way it is funding, everything is changing. Healthcare in Mississippi doesn’t seem to be getting any better at the moment.

“It’s here we change our mindset about how we’re going to put all these puzzle pieces together—improved outcomes, integrated care, patient satisfaction.”

Through the changes Coastal Family Health Center has been willing to make, Greer wants to be an example of an efficiently run, successful FQHC.

“Without the margin, there’s no mission, and so we must focus on being efficient and achieving success in the way of improved lives and improved outcomes.”

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