A troubling trend of staff turnover in community health centers in the state, particularly in leadership positions, has occurred over the last eight years. There have been vacancies in at least one of the key leadership positions in each of the community health centers in Texas. Since 1995 there have been 20 Executive Director, 33 Chief Financial Officer, 45 Medical Director, and 30 Clinic Manager vacancies. To address this issue, in 2001, the Texas Association of Community Health Centers (TACHC) was funded by the Bureau of Primary Health Care (BPHC) to implement a leadership program targeting seven community health centers in the state. The major goals of the project were to improve staff satisfaction and lessen turnover by providing training, technical assistance and mentoring to the leadership of community health centers. This pilot program was highly successful and resulted in BPHC's continued support of the TACHC Leadership Initiative. TACHC is in the third year of this project. Currently, 20 centers have participated in the program over the last three years.

A unique component of the project design of the TACHC Leadership Program is to work with the entire leadership team of the community health center instead of only working with one position such as the Executive Director or Medical Director. As a result, the participants have a built in support system and ongoing feedback from their co-workers to continuously improve and enhance their leadership abilities. In this model, the health center's Executive Director, Medical Director, Clinic Manager and Chief Financial Officer are provided with training, technical assistance, individual leadership plans, mentoring with a professional peer, and monthly coaching with the project consultant and TACHC staff. Many of the participating centers have expanded their leadership teams to include Dental Directors, Director of Nursing and Human Resource Directors. In this program, the center's leadership team works together, as well as individually, to improve their leadership and management skills, improve communication among the leadership team and other health center staff, and develop succession plans for each of the leadership positions.

"The TACHC Leadership Program has really helped gel the leadership team at our health center. We are so much more effective now because we have learned how to openly communicate with each other and we all freely contribute ideas and work together. In the past we really got bogged down in the day-to-day hustle and bustle of running a community health center. It was great to be able to get away and focus and work on how to communicate and be more effective leaders in our health center," remarked Emily Alpert, Director of Operations at Brownsville Community Health Centers in Brownsville, Texas.

Each year TACHC staff recruit approximately seven health centers to participate in the program to keep the program to a manageable size and allow for lively interaction and hands on technical support from the project consultant and staff. The 20 health centers that have participated in the project represent both urban and rural health centers as well as large multi-site centers and smaller health centers with one site. The leaders from these health centers also represent the gamut of professional knowledge and experience in the community health center family.

The program design utilizes a variety of mediums to provide ongoing training, support, and technical assistance. Three intensive face-to-face leadership learning sessions are held over the project period to provide information designed to improve communication, leadership and management skills. Prior to the first learning session, a 360 Degree Assessment of each team member's leadership and management skills is conducted. An individual leadership plan for each participant is developed from the feedback received from each team member's peers, direct reports, supervisor, as well as a self assessment. The leadership plan includes areas of strength and weaknesses and the participant's goals for improvement. A post 360 Degree Assessment is also conducted for each team member to determine the participant's progress and areas still in need of improvement. Janie Finical, the Chief Financial Officer of South Plains Health Provider Organization in Plainview, Texas commented, "the 360 Degree Assessments helped me understand my strengths and how they can be plugged in to help the center. The leadership project in general also helped me to appreciate and bring out the best in others for the best possible end result. Now I know how to help my staff thrive and really feel like they are contributing to the mission of the health center." TACHC also offers leadership sessions at regular TACHC conferences and provides other types of resources/information to past participants to support their continued development and progress as leadership teams.

One common trait of successful participants are those who actively work with their mentors throughout the project period. These individuals tend to make even greater strides in improving their leadership competencies. In the program, each participant selects a mentor to work with them on issues identified in their leadership plan as well as other issues facing the leadership within their center. Health Center leaders who have participated in past TACHC Leadership Initiatives in many instances act as the mentors to current leadership program participants from other community health centers in the state. Due to the success of this project and the effectiveness of peer mentoring, TACHC plans to develop mentoring networks for Executive Directors and Medical and Dental Directors. A successful CFO network, implemented by TACHC four years ago, is already in place with active participation among all CFOs in community health centers in the state.

Throughout the project, TACHC staff and the project consultant also provide ongoing support through monthly coaching calls utilizing videoconferencing and teleconferencing to check in with participants on the center's leadership team and track individual progress. Additional information including books, articles, leadership tools, and surveys were also provided to participating leadership staff through email to discuss during coaching calls and mentoring sessions. "Because we met at off-site locations, on the telephone and utilized the videoconference technology, we had an opportunity to learn through various media," noted Joyce Tapley, Chief Executive Officer, MLK Jr. Family Clinic in Dallas, Texas.

Both qualitative and quantitative evaluation techniques were used to assess the effectiveness of the project. Project evaluations are collected from team members and baseline and follow-up data on staff satisfaction were collected from each of the participating centers. The evaluation of the project proved that the pilot program was a resounding success. "Our team showed improvement over the last year, based on staff satisfaction surveys. The leadership team's relationship with the staff improved through open communication as well. As the CEO, I have changed the focus of how we involve our staff in the overall operations of the clinic, resulting in more initiative and ownership in the daily activities by staff members," reported Joyce Tapley, Chief Executive Officer of Martin Luther King Jr. Family Clinic. Sara Ingram, Clinic Manager of La Esperanza Clinic in San Angelo, Texas commented that "the TACHC Leadership Program benefited everyone individually and has made us into a team. The project built the foundation for our center to continue to improve the effectiveness of the leadership team. Now we work together for future planning, to improve present operations and empower clinic managers to make the day-to-day decisions." The data collected from the staff satisfaction survey showed that staff satisfaction among all health centers participating in the project improved significantly and confidence in and trust among staff of their leadership teams increased in each of the health centers. In many instances, participating center staff satisfaction scores increased by an entire point out of a scale of one to five. Succession plans for each of the participating health centers key leadership positions are also developed by the end of each project period.

For more information regarding the TACHC Leadership Initiative, please contact Jana Blasi at TACHC.