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This paper seeks to identify strategies that promote the development and sustainability of a successful comprehensive community health center located in a rural Mid‐western state.

The authors used a qualitative case study methodology, using a purposive sample of 15 employees and board members of a rural community health center. Semi‐structured interviews were conducted, transcribed, and analyzed for common themes and sub‐themes that would describe the strategies used to develop and sustain the successful center.

Leading with Consideration was identified as the dominant theme in the interviews, field notes and archival data. Four sub‐themes: Living the Mission, Fostering Individual Growth, Building a Community, and Encouraging Innovation, emerged from the narratives. Leadership was the most important theme that emerged from the data, resulting in a workforce culture that upholds the mission of the center, leadership that seeks to inspire the growth of both employees and clients. As a result, there is a sense of community and innovative health care endeavours that have created a sustainable holistic health care model.

The themes that emerged from the narratives of the participants may not be transferable to other community health centers. The case selected for this study was located in a rural, primarily Caucasian setting, so the findings may not be transferable to urban or more racially diverse settings.

Transformational leadership may be an important concept for safety net clinics to promote a positive work environment that continually addresses the important mission of the organization, promotes retention of staff, and promotes staff to provide quality, continuity of care to clients to promote their health. Within current safety net organizations, the findings from this research may affirm leaders' servant leadership styles and how they positively impact their organization. Healthy work environments guided by transformational leaders promote retention of quality health care professionals, who in turn, provide quality care in medically underserved communities.

This study is one of the first qualitative studies to describe concepts that support the development of a successful, sustainable community health center.

This article is a descriptive revenue profile of Community and Migrant Health Centers providing preventive and primary health care services to underserved rural and urban populations throughout the United States. The study is a secondary data analysis of the 1994 Bureau Common Reporting Requirements (BCRR) reports of the 626 Community and Migrant Health Centers to the Bureau of Primary Health Care. The purpose of the analysis is to examine the sources of revenue of the centers and consider the implications for public policy. In 1994, the 626 centers generated more than $2 billion from all payment sources to care for more than 7 million users. The findings should guide and assist policy makers at the state and federal levels in first deciding the role of C/MHCs in developing managed health care strategies for underserved rural and urban populations and developing the appropriate funding policies to support these decisions.

This article compares the processes of community verification (CV) and user satisfaction surveys during the implementation of performance-based financing (PBF) in Mali and Burkina Faso.

The authors adopted a qualitative approach based on a multiple-case study design. Data were collected from August 10 to 25, 2017, in Mali, and from January to May 2016 in Burkina Faso. In Mali, 191 semi-structured interviews were conducted with investigators (people who collect information from health centre users in the communities, using survey tools), users, users' relatives, and health workers in three of the 10 health districts in the Koulikoro region. In Burkina Faso, 241 non-participatory observation sessions were recorded in a research diary, and 92 semi-structured interviews and informal discussions were conducted with investigators, community verifiers, users, PBF support staff at the national level, and administrative staff in one of the 15 health districts involved in PBF. The data were analysed inductively.

In both Mali and Burkina Faso, the delayed availability of survey forms led to a delay in starting the surveys. In Mali, to get off to a quick start, some investigators went to health centres to conduct the sampling with their supervisors. In both countries, investigators reported difficulties in finding certain users in the community due to incorrect spelling of names, lack of telephone details, incomplete information on the forms, common or similar sounding names within the community, and user mobility. There was little interference from health workers during user selection and surveys in both countries. In both countries, many surveys were conducted in the presence of the user's family (husband, father-in-law, brother, uncle, etc.) and the person accompanying the investigator. Also in both countries, some investigators filled in forms without investigating. They justified this data fabrication by the inadequate time available for the survey and the difficulty or impossibility of finding certain users. In both countries, the results were not communicated to health centre staff or users in either country.

CV and user satisfaction surveys are important components of PBF implementation. However, their implementation and evaluation remain complex. The instruments for CV and user satisfaction surveys for PBF need to be adapted and simplified to the local context. Emphasis should be placed on data analysis and the use of CV results.

There are similarities and differences in the CV process and user satisfaction surveys in Mali and Burkina Faso. In Mali, the data from the user satisfaction survey was not analyzed, while in Burkina Faso, the analysis did not allow for feedback. The local non-governmental organisations (NGOs) that carried out the CV were pre-financed for 50% of the amount in Mali. In Burkina Faso, community-based organisations (CBOs) were not pre-financed. The lack of financing negatively impacted the conduction of the surveys. In Mali, fraudulent completion of survey forms by interviewers was more common in urban than in rural areas. In Burkina Faso, the frauds concerned consultations for children under five years of age. In Burkina Faso, the survey form was not adapted to collect data on the level of satisfaction of the indigent.

1. There were similarities and differences in the community verification (CV) processes in Mali and Burkina Faso.

2. In both Mali and Burkina Faso, tracing users within their community was difficult for several reasons, including incorrect or incomplete information on forms, common or similar names, and user mobility.

3. In both countries, there was no feedback on the results of the CV process to health centre staff or users.

4. Survey forms were falsified by investigators in both countries. In Mali, falsification was more common in urban than in rural areas. In Burkina Faso, falsification was more often observed for consultations for children under five years of age.

There were similarities and differences in the community verification (CV) processes in Mali and Burkina Faso.

In both Mali and Burkina Faso, tracing users within their community was difficult for several reasons, including incorrect or incomplete information on forms, common or similar names, and user mobility.

In both countries, there was no feedback on the results of the CV process to health centre staff or users.

Survey forms were falsified by investigators in both countries. In Mali, falsification was more common in urban than in rural areas. In Burkina Faso, falsification was more often observed for consultations for children under five years of age.

In an increasing trend, clients are being moved from tertiary and secondary care to primary care. This “downloading”, accompanied by the increasingly complex needs of clients, has forced providers and policy makers to acknowledge the importance of primary care. In exploring options for the reorganization of primary care, the characteristics of community health centres are often promoted as the model with the best potential. This article outlines a descriptive overview of community health centres (CHCs) across Canada.

An analysis of community health, its history, successes and failures, depends on an understanding of its scope, but there is little consensus as to precisely what the discipline entails. Some view it as a strict scientific discipline, others see it as a social movement, and still others conceive of it as a conglomerate of various disciplines. It is useful initially to identify the medical components of community health, and then to approach its interdisciplinary aspects. Community health, strictly defined, includes such fields as disease control, environmental sanitation, maternal and child care, dental health, nutrition, school health, geriatrics, occupational health, and the treatment of drug and alcohol abuse. This limited definition, though accurate, does not differentiate the field from the much older area of public health. Within community health, the disease focus of traditional public health epidemiology, the total health focus of community medicine, and the outcome focus of health services research are interconnected. Community health combines the public health concern for health issues of defined populations with the preventive therapeutic approach of clinical medicine. An emphasis on personal health care is the result of this combination. Robert Kane describes the field accurately and succinctly: “We envision community medicine as a general organizational framework which draws upon a number of disciplines for its tools. In this sense, it is an applied discipline which adopts the knowledge and skills of other areas in its effort to solve community health problems. The tools described here include community diagnosis (which draws upon such diverse fields as sociology, political science, economics, biostatistics, and epidemiology), epidemiology itself, and health services research (the application of epidemiologic techniques on analyzing the effects of medical care on health).”

In 2010 the Patient Protection and Affordable Care Act boosted the expansion of community health centers (CHCs) with $11 billion in mandatory funding from 2011 to 2015. This study used data from the Medical Expenditure Panel Survey (MEPS) and the North Carolina Behavioral Risk Factor Surveillance System (BRFSS) to assess the cost savings associated with the use of community health centers compared to other primary care providers. After controlling for various demographic, socioeconomic characteristics and health conditions, we found savings at an average of $3,437 in total expenditures and $1,211 in ambulatory care expenditures. These results suggest that continuing investment in health centers are important during times of budget cuts in order to improve access to care and to generate cost savings to the healthcare system.

Aims to confirm that societal changes and access to the internet have heightened interest in health information by the general public. Patients/consumers are more involved in their health care. Patients’ rights to make informed health‐care decisions are more recognised by the medical community. Approximately 27 percent of the entire US adult population has visited a web site for health‐care purposes. Increasingly, hospitals in the USA and other countries are providing consumer health information centers for patients and their families.

In February 2002, a patient/consumer health information service opened at Virginia Commonwealth University (VCU) in Richmond, Virginia. This article will discuss the partnership that was forged to create the Community Health Education Center (CHEC) and the role VCU Libraries has in the partnership.

Apart from the obvious value of having The Community Health Education Center, its existence has opened new doors to the three partners for networking, community outreach and obtaining extramural funding.

The health system's visibility in the community has increased because of CHEC's involvement in community events. The strategy and marketing department has come to rely on CHEC staff to represent the health system at exhibits as a result, whilst other VCUHS departments have learned about CHEC's mission and see CHEC staff as part of the patient care team.

The purpose of this paper is to describe and assess the process undertaken by Capital Health responsible for planning and developing a new primary care centre in an older urban, and demographically mixed neighbourhood in Edmonton, Alberta, Canada.

The approach to the paper is to describe how health centres, if they are to be fully effective in terms of meeting community needs, need more than technical excellence; they also need to fit into the community where they are to be located. Primary care centres, through helping people stay healthy and manage their own health in their own communities, can be an essential antidote to the challenges presented by an aging population. The paper uses the Capital Health initiative as a means of demonstrating how a primary care centre can achieve this objective, in terms of design and physical location, as well as planning process.

The paper describes the process the project planners have developed to enter into dialogue with representatives of the community. The proposed site selected for the clinic was met with some resistance because it was formerly a school built in the 1930s in the middle of a large area of green space and surrounded by mature elms in the midst of a mixed urban residential area. Through an intense two‐way communication process with residents of the area, the plans for the centre are iterative, evolving in such a way that the clinic will not only integrate architecturally and structurally, but better meet the needs of the community it serves.

The paper has practical implications for anyone interested in designing and locating new health centres in already existing urban communities.

Discusses the issues of building a new primary care centre, while preserving precious green space and considering opinions of local residents.

This paper examines the impact of the Kansas Mental Health Reform Act of 1990 on the mental health care system, on the budget of the state, and on the budgets of the Community Mental Health Centers. Both the successes and the failures of Mental Health Reform suggest that coordination of institutional and financial arrangements are needed to improve the outcomes of care. From a budgetary perspective, Mental Health Reform demonstrates the central role of Medicare and Medicaid in financing services for vulnerable populations. The reform also demonstrates that shifting costs to Medicare and Medicaid is a component of prudent financial management by the states.

The purpose of this paper was to develop deeper insights into the practices enacted by entrepreneurial healthcare managers to enhance the implementation of a partnership logic in integrated care models for older adults.

A multiple case study design in two urban centres in two jurisdictions in Canada, Ontario and Quebec. Data collection included 65 semi-structured interviews with policymakers, managers and providers and analysis of key policy documents. The institutional entrepreneur theory provided the theoretical lens and informed a reflexive iterative data analysis.

While each case faced unique challenges, there were similarities and differences in how managers enhanced a partnership’s institutional logic. In both cases, entrepreneurial healthcare managers created new roles, negotiated mutually beneficial agreements and co-located staff to foster inter-organisational partnerships between public, private and community organisations in the continuum of care for older adults. In addition, managers in Ontario secured additional funding, while managers in Quebec organised biannual meetings and joint training to enhance inter-organisational partnerships.

This study has two main implications. First, efforts to enhance inter-organisational partnerships should strategically include institutional entrepreneurs. Second, successful institutional changes may be supported by investing in integrated implementation strategies that target roles of staff, co-location and inter-organisational agreements.