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By Sarah C. Threnhauser, MPA

Managing a team of clinical professionals in the community is different than managing a team in at a fixed location. And the differences—in culture, technology, and process—are increasingly “must have” skills for health and human service provider organizations. Across all market segments, but particularly with the consumers with the most complex support needs, we’re seeing the growth of the volume of care outside the institutional and clinic settings. Consumer preference, cost pressures, performance requirements, and value-based reimbursement are all contributing to the increase in community-based care.

Boris Vilgorin

This leads to the question—are your staff (and your managers) prepared to serve consumers where they are? This was the focus of The 2018 OPEN MINDS Strategy & Innovation Institute session, How To Manage A Community-Based Workforce, featuring Boris Vilgorin, Healthcare Strategy Officer, NYU McSilver Institute; and Chris Copeland, Chief Operating Officer, The Institute for Community Living (ICL).

Mr. Vilgorin and Mr. Copeland’s advice? Pay particularly close attention to four key areas—attract the staff suitable for working in the field, develop new business practice for community-based settings, leverage mobile technology, and address the unique safety issues of community-based work.

Chris Copeland

Attracting The Right Staff—Staff that are based in the community are often working with the toughest consumers in the toughest communities. They are physically disconnected from their organization and operate with the kind of freedom and self-direction that facility-based staff don’t have. This demands different skill sets—staff in the community need to show more independent initiative, have strong engagement skills, be culturally responsive, and be better communicators with the ability to consistently share information through different channels.

OPEN MINDS Senior Associate, Annie Medina noted that, “Because community-based employees need to be able to operate capably without immediate and direct oversight, they should be comfortable with a fair amount of autonomy and ambiguity. They should also be highly self-aware, and know their own limitations and when they need to consult with someone else. The ‘right’ staff are able to operate successfully as part of a team, even if they don’t necessarily see their team members on a daily basis.”

Developing New Business Practices—Building a community-based service model means determining the geography you will need to cover, including all the budgeting, transportation, mobile tech, and “home base” location needed to serve the territory. Key to succeeding is understanding that some things are the same (the infrastructure it will take, such as human resources, compliance/quality, IT, billing), and some things are different depending on the state and location you are working in (labor laws, compliance, insurance).

Annie Medina

According to Ms. Medina, “policies and procedures may need to be adjusted. One of our speakers specifically pointed out long-standing policies about needing to clock-in and clock-out for shifts. This makes sense when you have an on-site work force. However, it’s not a reasonable expectation to make community-based employees—who may be covering areas 90 minutes away from the home office—come in simply to comply with dogma. Evaluate which practices need to be adjusted in order to support off-site employees.”

Leveraging Mobile Technology—Best practice community-based work requires mobile technology. Key mobile technology functions needed in the field include the ability to connect, as well as supply the necessary security compliance for HIPAA and the security of protected health information. A field-based mobile tech strategy means thinking through who has access to the tech, tracking who is in possession of the tech, and deciding how best to keep the staff and equipment safe. Ms. Medina expanded on the additional mobile tech considerations, noting the importance of “consistently having access in remote areas, and planning for the inevitable loss of access.” She also advised that, “some technology may label your work force as ‘outsiders’, such as a new iPhone when they are serving consumers in a largely impoverished area. Make sure that technology use policies include ‘safeties’, such as location tracking and communicating location ahead of the service, so that if your staff is unable to get to their technology, a plan is in place to check on them.”

Addressing Safety Issues— Organizations need to build a culture of safety, as well as the community connections to address safety concerns. This includes routines that promote safety (information sharing, pre-visit planning, fully charged phone, checking in at end of day), and de-escalation strategies. It also demands greater communication and collaboration with law enforcement/police, hospitals, landlords, and community groups. Ms. Medina explained:

“Staff perceive that safety may be an issue because they are outside of the four walls of a facility. In reality, it may not be. There is inherent risk in going into someone else’s home, regardless of who the other person is. However, there is also risk in serving consumers in clinics and hospitals. The best way to help mitigate the perceived heightened risk of being outside of the facility is to build that culture of safety. Have procedures and check-ins in place, follow through with them, assign teams, etc. One of the wonderful things about the health and human services field is that the work force is typically driven by a need to serve the consumer. In community-based services, we need to be sure that this drive doesn’t overshadow better judgment. Part of the culture of safety is making it clear that the employee can walk away from providing the service if he or she feels unsafe, and never has to face any situation alone.”

To learn more about building new treatment programs, join Annie Medina in Long Beach, California on August 14 for her session, Designing & Implementing Innovative Treatment Programs: An OPEN MINDS Executive Summit & Showcase.

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