Key Factors Worksheet *(Sample based on the Arroyo Fresco Case Study)*

To begin the evaluation process, review the applicant's Organizational
Profile and the Additional Information Needed Form. List the key
business/organization factors for this applicant, using the Areas to
Address (Organizational Environment, Organizational Relationships,
Competitive Environment, Strategic Challenges, and Performance
Improvement System) in the order presented in the Preface:
Organizational Profile section of the appropriate *Criteria for
Performance Excellence* booklet.

In a change from the traditional process, please number your key factors
rather than delineate with bullet points.

**P.1a Organizational Environment**

1\. Community health center (CHC) providing primary care and preventive
services

2\. Serves three-county area covering 23,000 square miles with a
population of fewer than 400,000 people

3\. Services to enable care and increase access include transportation,
translation, case management, health education, and home visits

4\. Delivery mechanism for providing health care services is the
Clinical Microsystem (CM)

5\. Organizational culture reflects a commitment to providing health
care to the underserved

6\. Organization's vision is to "the people of Western Arizona will
become the healthiest in the state"

7\. Mission is to provide residents easy and timely access to
high-quality and safe health care services, responsive to diverse
cultural and socioeconomic needs, regardless of ability to pay

8\. Five core organizational values: respect, trust, relationship,
performance, and accountability

9\. 379 FTEs consisting of 62% clinical providers, 33%
administrative/facility/patient support employees, and 5% senior
leaders/managers

10\. 12% of staff are part-time; contract staff are used to fill
critical vacancies; no collective bargaining units

11\. Over 200 current volunteers

12\. 58% of the staff are female, 78% white, 15% mixed race, 5.5% Native
American, and 26% of Hispanic heritage

13\. Special health and safety requirements include exposure to
communicable diseases, exposure to radiation and chemicals, and
ergonomic injuries

14\. Major technologies, equipment, and facilities include 11 clinics
and 4 mobile service vans

15\. One clinic specializes in Women's Health

16\. The mobile vans make regularly scheduled stops at churches,
schools, and other community centers

17\. Electronic health record is integrated with the billing and
scheduling system

18\. Care Connection Kiosks allow staff, patients, and community access
to organizational information

19\. There are multiple legal and regulatory requirements at the
federal, state, and local levels, including specific requirements to be
designated a federally qualified health center (FQHC) and to be
qualified for Section 330 grant funds and Joint Commission of
Accreditation of Healthcare Organizations (JCAHO) accreditation, a
mandatory requirement for CHCs

**P.1b Organizational Relationships**

20\. Voluntary 15-member Board of Directors includes non-voting senior
leaders; more than 51% of the voting members of the Board must be
recipients of organizational services

21\. Key stakeholder groups are patients and their families, the
community, physicians, staff, volunteers, partners, and payors; key
requirements for each of these groups have been identified (Figure
P.1-5) and vary among groups

22\. Key health care market segments for Yuma County include diabetic
patients and young females

23\. Many patients have chronic health problems including asthma,
cardiovascular disease, depression, obesity, and substance
abuse/addiction behavior

24\. Role of suppliers and partners is to support the providing of care
in more innovative ways

25\. Most important types of suppliers and partners are the following:
advocacy providers (State Association of CHCs); group purchasing
suppliers (MedProducts, Inc.); community health care providers
(community hospitals and private physicians); education partners
(Saguaro State University, Schools of Business, Medicine, Dentistry,
Nursing, and Public Health); community partner groups (schools, county
government, churches); and industry/strategic/vendor partners
(CactusCom, Winding River Casinos, Desert Data Solutions, Shiny Clean,
Gil's Garage, and HR Leaders, Inc.)

26\. Important supply chain requirements are low cost/high value,
on-time delivery of supplies and services, and continuity of operations
for providing clinical care

27\. Key suppliers and partners receive annual training related to
ethics, legal obligations, and the vision, mission, and values

28\. The Partners Committee participates in strategic planning

**P.2a Competitive Environment**

29\. Organization has 17% of the market share in its three-county
service area -- with higher percentages in Yuma (21%) and LaPaz (19%),
and a lower percentage in Mohave (12%)

30\. Primary competitive position is to operate in a high-need service
area with guarantee of service regardless of ability to pay

31\. Communities in the Yuma County service area along the border of
Mexico are among the state's fastest growing; LaPaz, one of the state's
most rural counties, is home to the Colorado River Indian tribes, one of
the largest Arizona Native American populations; Mohave and LaPaz
Counties are a destination for vacationers and retirees

32\. Competitors and key collaborations are CHCs in adjacent counties,
community-based private medical/dental/behavioral health providers,
Indian Health Services, Veterans Administration inpatient and outpatient
care, and providers and facilities located in Mexico

33\. Competition for staff members with specific clinical/technical
skills is intense

34\. Factors that determine organizational success are operational
efficiency and productivity, decreased expenses, use of information
technology (IT) to reduce waste and increase productivity, and the
expansion and strengthening of access to capital

35\. Changes taking place affecting the competitive situation include
opportunities for collaboration, funding challenges, staffing, and
patient demand

36\. Key sources of comparative and competitive data within the health
care industry are the following: data from CHCs, JCAHO, Agency for
Healthcare Research and Quality (AHRQ), Bureau of Primary Health Care
(BPHC)/Health Resources and Services Administration (HRSA), Centers for
Disease Control and Prevention (CDC), Centers for Medicare/Medicaid
Services (CMS), Health Plan Employer Data and Information Set (HEDIS);
professional associations; Packer Patient Satisfaction data; Oates Staff
Satisfaction data; Quality and Productivity Group (QPG) and Baldrige
Award recipient data; Healthy Arizona 2010; State Association of CHCs;
and Saguaro State Award program

37\. Benchmarking Consortium created as a forum for state and local
level CHC data

**P.2b Strategic Context**

38\. Strategic Challenges are aligned to the five key performance areas:
F-- Financial Performance, O-- Organizational Learning, C-- Clinical
Excellence, U-- Utilization, S-- Satisfaction

39\. Six key health care service, operational, and human resource
strategic challenges for the organization are: an increase in uninsured
patients and decreased federal and Medicaid funding; the need to address
workforce gaps; low incidence of prevention and screening and high
incidence of chronic and communicable diseases; the need to provide
specialty and unmet service needs, particularly to uninsured patients;
the need to meet staff recruitment and retention challenges; and the
need to maintain/enhance relationships with patients, community, and
external partners

40\. Strategic challenge of sustainability is finding revenue sources,
particularly since federal 330 grant funding has decreased over the last
decade

41\. Current revenue sources are Medicaid (33%); grants, donations,
annuity (49%); Medicare (6%); private insurance (6%); self-pay (6%)

**P.2c Performance Improvement System**

42\. Multiple strategies for performance improvement and organizational
learning include Plan-Do-Check-Act process, OASIS improvement model,
Clinical Microsystems (CMs), Baldrige Criteria, and Saguaro State Award
Program

43\. Systematic evaluation and improvement of key processes achieved
through informal/formal performance reviews, electronic sharing of
organizational knowledge, participation in the State Association of CHCs
improvement activities, and participation in national learning
collaboratives