Smoke Signals
Quality Improvement iihead For Clinic
Nancy May brings 10 years of experience to the job.
10 SEPTEMBER 1, 2004
By Ron Karten
Nancy May, the Wellness Clinic's
Quality Improvement Coordinator,
wants clinic patients to bring prob
lems to her as soon as they occur, if
possible, and to look at patient sur
veys with fresh eyes.
"It's really important that people
respond with constructive com
ments," she said, "and suggestions
for improvement."
It is easy to blow off surveys and
many do. One day in June, the
clinic served 90 patients who were
then sent follow-up surveys. Only
13 responded and of those, eight
had no name or address for the per
son commenting.
May is bringing back to life the
formal process of quality improve
ment at the clinic. She comes to the
job with some 10 years of experi
ence as a Registered Nurse, Qual
ity Improvement and Peer Review
Specialist for the Good Samaritan
Regional Medical Center in
Corvallis.
Patient surveys represent one
part of quality improvement. May
also works with clinic physicians
and other staffers to make sure that
the clinic's policies and procedures
"are reflecting the care we give."
Her work takes her into each area
of care to develop "quality improve
ment studies" showing how far the
clinic has come and how far it still
has to go.
The new effort is a way to formal
ize what is too often an anecdotal
process. "If people have concerns,"
she said, "they need to do it in a
formal process."
Making a complaint formal is done
with an incident report in May's
office upstairs at the clinic. Forms
are also available at the windows
of each section in the clinic. "I'll
follow-up with you or just take care
of it," she said. "But it's important
to do it as soon as the incident oc
curs. It makes it more difficult if
we go three weeks down the road
(before a complaint is filed)," she
said.
"If we see a trend," she said, "we
can work more effectively with a
formal complaint (filed right away).
"Since starting in June, the office
has received only a handful of for
mal complaints," said May.
Principle concerns for staffers in
clude customer service, safety is
sues, particularly with equipment,
infection control and patient care.
For patients of the clinic, concerns
should include the other side of cus
tomer service: that is, suc
cessful interactions with
staffers, access to services
needed and cases of poor out
comes from service provided,
said May.
Patients should not expect
solutions overnight. When
May learns of a problem, she
wants to learn how wide
spread it may be, and she
wants to know if others have
different perspectives on the
issue.
A complaint about waiting
too long to see a clinic staffer,
for example, could be an in
dividual problem but May al
ready knows that in many
cases, the system itself plays
a role.
"For example, we know
that emergency cases go be
fore routine cases (sometimes
causing longer waits than
desirable)," she said.
"We may try a few solutions be
fore we find a good one," she said.
"There may not always be a
simple answer," she said, "but if we
hear about it, we can try to improve
it. If we don't, we can't address it."
"Every organization can improve,"
said May. "The main thing is that
we have a process here."
However, she added, success "re
quires the cooperation of the staff
and the community."
For questions or comments, May
can be reached at 503 879-2098.
Nancy May
Health Clinic Administrator Balances Care And Cost
David Foss continues his health care career in Grand Ronde.
By Ron Karten
David Foss, Administrative Of
ficer for the Tribe's Health Clinic,
is an Oregon boy. His great grand
parents homesteaded in Moro, Or
egon - "wheat country." His grand
parents lived along the Siuslaw
River near Florence. His grandfa
ther was a Forest Service Engineer
who designed "a lot of parks and
roads around Mount Hood" includ
ing Eagle Creek Park.
"He used to take me up there," he
said.
So, it should be no surprise that
he looks at his recent life in Oregon
that began again in January when
he started working for the Tribe, as
a homecoming.
He came from a career in hospital
management serving both small,
federally-sponsored clinics and ma
jor hospital corporations. He started
as an orderly at Stanford Univer
sity Hospital in California and has
since worked across California,
Washington and Oregon.
What brought him back to Oregon
this time, however, was his daugh
ter, who was attending George Fox
University in Newberg and decided
to stay in Oregon. "It was a chance
to come home," he said.
He commutes twice as far to work
from his Oregon home in Sandy, but
said that the two-hour commute is
so beautiful that it's easier to take
than the hour he used to struggle
through every day in the Bay area
of California.
Over the years, he has seen over
all health care improve dramati
st
v -' J ....
David Foss
cally, mainly in his view, because
of improved technology and meth
ods, he said. The big issue with
care has always been delivery
that is, how to get care to all who
need it.
"Access is the problem in any sys
tem," said Foss. "I don't know that
that has changed over the years."
In that regard, Foss has lobbied
Congress for improved access for
the poor and in many cases been
successful. His observations over
the years about service have left him
with the impression that health care
in this country is great for those
with money or a job that provides
health insurance and OK
for the very poor.
To a great degree, the
poor have been served by
federally funded clinics,
though he said that access,
again, is spotty. Here in
Oregon, for example, feder
ally funded clinics can ba
sically be found in the ma
jor metropolitan areas of
Portland, Salem, Eugene
and Klamath Falls.
Big gaps can also be
found among those with
too much money for feder
ally funded clinics but no
health insurance and not
enough money to pay cash
for health services.
And likewise, while ser
vices and techniques and
pills are better than they've
ever been for curing or
maintaining patients with many
serious conditions, another big gap
in America's health care system is
prevention. Relatively few dollars
are available for preventive ser
vices, said Foss.
"If you're having a heart attack,"
he said, "they'll take you. If you
want to prevent a heart attack,
that's another story."
But here in Grand Ronde, Tribal
members are participating in a
growing effort to bring preventive
care to the forefront (See "Dog
Days Walk" story on page 7 for one
recent example). The Tribe also of
fers diabetes aquatic classes and
support groups, alcohol, tobacco
and drug education, safety classes
for Pre-school, HeadStart and Af
tercare programs, including such
messages as the importance of
hand washing in preventing colds.
Different programs at the Tribe
offer culturally attuned prevention-type
messages using to
bacco in a sacred way only, for ex
ample as part of what Tribal
Wellness Manager Bonnie Tom
called, "a holistic approach to pre
vention including mind, spirit and
body. You have to use all three to
prevent illness," she said.
As Administrative Officer, Foss
described his goal for the Tribe as
"buying the best care possible with
limited resources."
Put another way, he added, "I'm
basically watching our finances
and I'm available for day-to-day
problems," said Foss.
Foss has been married for 39
years. His wife, Denise, is a
teacher for Clackamas County,
and together, they have three
grown children. Over the years,
the family has enjoyed "a fair
amount of camping, hiking and
water skiing," he said. "I tried
windsurfing but I spent all day try
ing to get back on the board. It's
easier," he supposed, "if you learn
when you're younger."
He has been a scout leader and
a church leader for years, but now,
he is reaping the reward for a life
well lived: "I'm leaving it to the
kids," he said.
c
2