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The objective of this research is to synthesize evidence on the relationship between context, strategies and performance in the context of federally qualified health centers (FQHCs), a core safety net health services provider in the United States. The research also identifies prior approaches to measure contextual factors, FQHC strategy and performance. Gaps in the research are identified, and directions for future research are provided.

A systematic review of peer-reviewed journal articles published between the years 1997 and 2017 was conducted using a bibliographic search of PubMed, Business Source Premier and ABI/Inform databases.

28 studies were selected for the analysis. Results supported associations among contextual factors (organizational and environmental) and FQHC strategy and FQHC performance. The research also indicates that previous research was primarily emphasized on clinical performance with less focus on other types of FQHC performance. In addition, there exists a wide variability in terms of measuring context, FQHC strategy and performance.

Operating in resource-scarce and highly constraining environments, FQHCs have demonstrated the ability to stay innovative and competent as serving often unhealthier and costlier patient populations. To date, there has been no study that reviewed the relationships between context, FQHC strategy and FQHC performance. In addition, there is an absence of consensus on how context, FQHC strategy and FQHC performance are measured. This study is the first that examined context–strategy–performance relationships in the context of FQHCs.

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.

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.

The purpose of this paper is to evaluate a collaborative effort between a health care organization and academic institution to strengthen organizational health literacy.

The intervention took place at a rural, federally qualified health clinic in Missouri between May 2009 and April 2011. Qualitative interviews of key informants were conducted before (n=35) and after (n=23) the intervention to examine program implementation and success in effecting organizational change.

Intervention activities helped establish a comprehensive understanding of health literacy. The project achieved moderate, fundamental and sustainable organizational change. The program successfully integrated health literacy practices into clinic systems and garnered leadership and organizational commitment, helped the workforce improve interpersonal communication and embedded practices making health education materials more accessible.

The study points to programmatic, conceptual and methodological challenges that must be addressed for organizations to improve health literacy practices, and suggests change management strategies to advance organizational health literacy.

Community health clinics serving the poor and underserved are geographically expanding due to changes in U.S. health care policy. This paper describes the experience of a collaborative alliance of health care providers in a large metropolitan area who develop a conceptual and mathematical decision model to guide decisions on expanding its network of community health clinics.

Community stakeholders participated in a collaborative process that defined constructs they deemed important in guiding decisions on the location of community health clinics. This collaboration also defined key variables within each construct. Scores for variables within each construct were then totaled and weighted into a community-specific optimal space planning equation. This analysis relied entirely on secondary data available from published sources.

The model built from this collaboration revolved around the constructs of demand, sustainability, and competition. It used publicly available data defining variables within each construct to arrive at an optimal location that maximized demand and sustainability and minimized competition.

This is a model that safety net clinic planners and community stakeholders can use to analyze demographic and utilization data to optimize capacity expansion to serve uninsured and Medicaid populations.

Communities can use this innovative model to develop a locally relevant clinic location-planning framework.

The recent Childhood Immunization Initiative of the Clinton Administration was a dramatic and ambitious policy response to what we will show is a case of significant management and implementation failure. Interpreted by the Administration as a policy failure, low rates of early childhood immunization met with an aggressive and targeted policy response which ultimately diverted attention away from significant evidence of fundamental problems of service delivery, infrastructure, and parental knowledge and behavior. Analyzes and seeks to evaluate the reasons for the poor fit between the diagnosis of the problem of existing childhood immunization policy and the ultimate policy prescription of the Clinton Administration which relies almost exclusively on reducing the price of vaccines.

In an effort to address health care disparities, U.S. laws mandate that health care organizations provide free language interpreting and translation anytime a patient and health care provider cannot communicate in the same language. The heretofore absence of legislative and professional oversight in health care interpreting allows for anyone to interpret. A qualitative study was conducted to understand the conditions and practices of bilingual staff who interpret as a secondary part of their job in community health clinics.

Four focus groups were conducted as part of a study on shared decision-making during interpreted medical visits in a busy, urban clinic serving a large number of limited English proficient (LEP) patients. The focus groups were designed to understand the process of interpreting and how interpreters influence medical decisions between LEP patients and their health care providers. To understand the interpreting process from multiple perspectives, one focus group was conducted with users of interpreters – monolingual health care providers (N=6), two with Spanish speaking men (N=10) who were experienced with interpreted health visits, and one with bilingual staff (N=5) who interpret as an ad hoc feature of their job, also known as dual-role medical interpreters.

Dual-role interpreters use different styles while interpreting what is communicated between health care providers and patients. In some cases, they provide near word-for-word interpretation of what is said. In other cases, they summarize and or paraphrase multiple sentences, seek clarity through questions, and deconstruct culturally laden and technical terms. In still other cases, dual-role interpreters combine interpretation styles within a single interactional exchange. Each of the three major styles of interpreting has advantages in medical settings. Specific style is influenced by health care provider preference, interpreter–health care provider trust and familiarity, and interpreter medical knowledge. Interpreters are challenged by the patients’ dialects, educational level, provider personalities, gender issues, and out of clinic relationships with the patients. Contextual conditions and contingencies of reinforcement contributed to varying methods of interpretation. These conditions included organizational policies, language and bilingual communication, and social relations with both the health care providers and the patients.

These findings demonstrate the complexity of medical interpretation and the critical involvement of health care providers and bilingual staff in facilitating interpreted encounters. Findings suggest the need for training both health care providers and interpreters and possible change in reimbursement for services.

The purpose of this paper is to provide a case study of a multifaceted institutional approach to minimizing cancer health disparities, presenting a novel organizational framework entitled, “A.C.C.E.S.S.” to guide those efforts.

This paper presents a case study of an organization that operates under the theory that cancer health disparities are a result of the cumulative incongruence of differences that exist between people in various contexts and interactions over time. Consequently, the A.C.C.E.S.S. framework is used to demonstrate the range of opportunities within an organization to intervene and mitigate gaps that result in inequality.

Addressing A.C.C.E.S.S. in various interactions and contexts over a sustained period of time results in a continuous improvement cycle that attenuates cancer health disparity.

The antecedents and impacts of cancer health disparities are well documented. However, there is a dearth of directionality for institutions and organizations in achieving equality in cancer treatment and care. This paper provides a framework to consider in organizing such endeavors.

The purpose of this paper is to identify ways for organizationally complex, community‐based health improvement initiatives to avoid “failures” with regard to client outcomes.

Organizational research on errors, failures and high reliability organizations led Weick and Sutcliffe to articulate five strategies for organizational mindfulness: preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience, and deference to expertise. Using this framework, one US federally funded health initiative to reduce infant mortality and pre‐term birth and a corresponding locally implemented program are analyzed. Experience with both over a five year period is the basis for this case study.

Mindlessness actions were found to occur at both the federal and local levels, despite the possibility of enacting mindfulness strategies at federal and local levels.

To create health care initiatives and programs in ways that prevent disastrous outcomes, such as infant death and preterm births, can be achieved through application of the mindfulness strategies.

The evidence‐based approach of organizational mindfulness previously has not been applied to health programs. Yet, this analysis demonstrates its usefulness in identifying ways in which these semi‐autonomous organizations could avoid “failures” for their program clients.

Purpose – This chapter explores the use of adaptive and disruptive change strategies to create an integrated health care delivery system that is both economically sustainable and patient-centered.

Design/methodology – This case study of Montefiore Medical Center is based on a year of research that included focus-group interviews; individual interviews with executives, frontline staff, and union leaders; site visits; analysis of internal data; and a literature review.

Findings – Montefiore Medical Center is using both adaptive and disruptive strategies to develop an integrated delivery system driven by capitated payments from health insurance companies, a focus on primary care and chronic disease management programs, and community outreach. The growth of these delivery system components in conjunction with Montefiore's Care Management Corporation (to help manage the health plan contracts) has contributed to an affordable cost of care, improved clinical outcomes, and proactive patient and community engagement.

Originality and value – There is a paucity of case studies describing how safety-net hospitals – and health systems in general – can integrate the services they provide to create a positive, seamless, and economical patient experience. The story of Montefiore Medical Center offers an overview of how health care infrastructure and payment methods can be transformed to align financial and clinical incentives and to better serve a patient population that largely depends on government health insurance.