Clinical Services and Staff
A Tribal health program is ultimately a people organization.
Buildings, equipment, funding, information systems, and policies are important, but patients experience the program through the people who provide care and the people who support that care.
For the Health Director, managing clinical services therefore begins with understanding the workforce, how services fit together, and what is required to provide dependable care to the community.
The people are the health program
A health program depends on much more than physicians and advanced practice providers.
Depending on the size and organization of the program, the workforce may include nurses, medical assistants, behavioral health professionals, dentists and dental staff, pharmacists, laboratory and radiology personnel, public health workers, community health representatives, billing and eligibility staff, reception and administrative personnel, and many others.
Each has a role in the system.
A program can have excellent individual employees and still have serious organizational problems if the pieces do not work together.
Recruitment and retention
Recruiting health professionals is difficult in many communities, particularly in rural and remote areas.
But recruitment is only part of the problem.
A program that continually loses experienced employees has to recruit again, train new staff, and absorb the disruption caused by vacancies. Patients may have difficulty establishing continuing relationships with providers, and remaining employees may become overextended.
Retention therefore deserves as much attention as recruitment.
- Effective supervision.
- A reasonable workload.
- Reliable support from the organization.
- Competitive compensation and benefits.
- Opportunities to develop professionally.
- A respectful workplace.
- Clear expectations.
- Confidence that problems will be addressed.
Sometimes the reason an employee leaves has less to do with salary than with how the organization is managed.
Clinical and administrative staff are one system
Clinical staff cannot provide care effectively without administrative support.
Scheduling, registration, eligibility, billing, purchasing, information systems, facilities, human resources, and finance all affect what happens in the examination room.
Likewise, administrative decisions can have direct clinical consequences.
A Health Director needs to understand both sides of the organization and make sure they work together.
The goal is not to divide the program into “clinical” and “administrative” camps. It is to create one organization with a common purpose: providing effective health services to the community.
The right mix of services
A Tribal health program does not have to provide every possible service itself.
The appropriate scope of services depends on the community, available resources, workforce, facilities, referral options, and the program’s ability to sustain those services.
Adding a new service may require much more than hiring one additional person. It may require equipment, space, administrative support, billing capacity, information systems, laboratory or pharmacy support, and continuing funding.
More services are not necessarily better if the program cannot sustain them.
Sometimes the better management decision is to provide a strong primary service and establish reliable arrangements for services that are better obtained elsewhere.
The Health Director and clinical judgment
The Health Director does not have to be the best clinician in the organization.
The Health Director’s responsibility is to make sure the organization has competent clinical leadership, appropriate professional standards, adequate staffing, and the resources necessary to provide care.
Clinical professionals must be able to exercise appropriate professional judgment.
At the same time, clinical operations are part of the larger Tribal health program and must be managed within the organization’s policies, resources, and accountability structure.
Understanding the difference between clinical judgment and organizational management is essential.
When things are not working
Problems with clinical services often show up first as complaints.
Patients may complain about difficulty getting an appointment, long waits, a provider leaving, difficulty obtaining medication, or problems getting referred for specialty care.
The immediate complaint may be legitimate, but the Health Director needs to look beyond the individual incident.
Is this a staffing problem?
A scheduling problem?
A facilities problem?
A referral problem?
An information problem?
A financing problem?
Or is the program simply trying to provide more services than its resources can support?
Good management looks for the underlying problem rather than treating every complaint as an isolated event.
Questions for Tribal leadership
- Does the health program have the staff it needs to provide the services it promises?
- Are vacancies and turnover being monitored?
- Is the program able to recruit and retain qualified personnel?
- Are employees adequately supervised and supported?
- Is the scope of services realistic given available resources?
- Are clinical and administrative functions working together?
- Does the program have appropriate clinical leadership?
- Are patients able to obtain timely care?
- When services cannot be provided locally, are referral arrangements working?
- What investments in facilities, equipment, workforce, or training are needed?
A practical management principle
The objective is not simply to have a large health program.
It is to have a stable organization capable of providing high-quality services to the community.
That requires the right people, in the right roles, with the resources and support necessary to do their jobs.
The Health Director’s responsibility is to bring those pieces together.