Tribe's Joint Venture Application Denied by I.H.S.
By Joe Morey
The LCO Tribe submitted an application in November for the Indian Health Service (I.H.S.) Joint Venture Funding program, which would have paid for operations and payroll for a new tribal health center for the next 20 years. Unfortunately, in mid-December, the Tribal Governing Board (TGB) was notified that LCO was denied.
IHS listed the reason for the denial as being our close proximity to Essentia Health, Northlakes and Marshfield Clinics located only 5 miles away in Hayward. The Division of Facilities Planning and Construction (DFPC) stated the tribes chosen to move on to Phase II in the Joint Venture Construction Program Final Application were selected based on being more rural than LCO currently is. Tribes chosen were from more rural parts of the country.
LCO Secretary-Treasurer Michelle Beaudin added that IHS said no tribe from the Bemidji region of IHS was selected.
In an article printed on October 25, Jason Weaver of the LCO Grants Department, said LCO Health Center was the oldest facility in the Bemidji area, built in 1983.
“It has had many additions and remodeling projects, but it still hasn’t provided a clinic that meets our community health care needs or our growing population,” stated Weaver. “Many Tribal members are using other Tribal and non-Tribal clinics because of the options and shorter wait times. These are areas we can improve with a new facility.”
Weaver explained that if LCO were approved, the program would reimburse the LCO health care facility for operational and maintenance cost for 20 years. This would be about $7 to $8 million in additional funds annually from I.H.S. above and beyond our current funding levels. The Joint Venture program requires the Tribe to pay for and build a new facility with our own funds through non-federal grants, New Market Tax Credits and/or loans. LCO was in discussions with the Shakopee Tribe for the loan.
As part of the TGB’s goal of the new clinic, they retained Blue Stone Strategy Group to do an assessment of the current health facility and make sure a new clinic is feasible for the Tribe.
On Tuesday, Dec. 3, Blue Stone president, John Moors, and founder, Jamie Fullmer, presented their findings to the TGB. They reported there have been a lot of distractions at the clinic and these distractions have had a negative impact on employee morale.
Moors said they asked employees what they believe the clinic does well and 64% of respondents said patient care and compassion topped their list, and 40% said the quality of care.
“Those are the strengths of the clinic,” Moors said. He also added that overall staff perception of how the tribal membership views the clinic is that the clinic is operating below average.
Moors said that 88% of respondents stated there is no open line of communication with the TGB or the Health Advisory Board (HAB) and the staff.
“You have a committed team and they are passionate about what they do,” Moors told the TGB. He added it is important the clinic creates a new image and plan for the future, and that they maximize their current operations.
During the assessment, Blue Stone asked what the clinic needs to be operating at a capacity that provides care for all Tribal members. Answers included;
"Staff is divided and needs help coming together as a team."
"Communication within departments and across departments needs improvement. Our admin and other programs are at a lack of communication as for certain things that need to happen."
"We need a meaningful budget, with direction from an experienced health board."
"We need more qualified medical staff for multiple roles and planned services, however, most professionals in the area are very reluctant about accepting positions at the health clinic because of the past and current reputation of high staff turnover."
"There is a need for additional doctors and staff enrichment (cultural training, team atmosphere, interactive training, increased communication)."
"The health clinic should be run independently from tribal governance."
Moors told the TGB that the current structure at the clinic is part of the problem. As part of their recommendations, Blue Stone advised the current Health Advisory Board be disbanded and a new Medical Board of Directors be established.
“There has to be a medical board with an ability to govern,” Moors said. “We believe for financial stability at the clinic, there has to be a separation.”
Blue Stone recommended in its Action Plan that TGB appoint a new Health Board that will consist of at least a medical professional, a financial professional, a TGB member and other important representations from the community. They also recommended hiring a Chief Executive Officer for the clinic and that the Health Board has oversight over the CEO.
Moors said although the TGB should consider community members first for the CEO, they should not try to minimize the importance of having a qualified person in the position.
“You can’t be half in. We’ve seen compromise and short cuts, and what we've seen is the council doesn’t get what they were hoping for,” Moors said.
As for the Health Board, Blue Stone said the positions should have some form of compensation, most likely, a stipend.
“Ultimately, the Health Board is going to be expected to help move the clinic to a for-profit operation,” Moors added.
Moors concluded by stating, “If you separate, you have to over-communicate. This will set the standard. If you get this right, you’ll have many opportunities.”