Free clinic

OPEN ARMS FREE CLINIC13 HANDS WAY

BLESSINGS, NC 24681

Providing Free Medical Care to our CommunityHours:

Monday, Wednesday and Friday – 8AM – 5PM

Our Mission: Open Arms Free Clinic is a faith-based non-

profit organization that provides free quality health care in our community for those who lack appropriate alternatives (Advocacy: The Free Medical Clinic of Greater Cleveland, 2009).

It is our intention to develop programs that address the community health needs through collaborative efforts with area hospitals and health care agencies (National Association of Free Clinics, 2009).

We will provide care as an expression of God’s love for all people.

Our vision is to: Deliver quality health care services for

free to those who qualify. Promote health and wellness in our

community through health care education (Ashe County Free Medical Clinic, n.d.)

Provide care in a compassionate environment that will improve the health of our community.

Raise awareness of the need for support from educational, business, medical and faith based communities to help protect the health of our community (Carefree Medical & Dental

Clinics, 2007).

Open Arms Free Clinic Services

Primary Family Medicine Affordable or free prescription services Referral to Medical Specialists when

necessary Access to free laboratory and X-ray

services Durable medical equipment Well child examinations and

immunizations Sports, school and employment physicals

Delivery of Services Services are provided by an all-volunteer staff

of physicians, nurse practitioners, physician assistants, nurses, nursing assistants, pharmacists and various unlicensed personnel (Guidelines for Starting Free Medical Clinics, n.d.)

Hours of operation are: Monday, Wednesday, Friday 8Am – 5PM 25 patients can be seen daily and patients are

seen on a first-come first-serve basis This is a free clinic…there is no charge for

medical exams

Delivery of Services

Prescription medications are provided free or for a nominal fee

No narcotic prescriptions are available on site

Lab work and X-Ray services provided in partnership with area hospitals at no cost to patients

Eligibility Requirements No private health insurance Do not qualify for Medicaid, Medicare, NC

Health Choice or Veterans Benefits (Ashe County Free Medical Clinic, n.d.).

Total household income must not exceed 200% of Federal Poverty Level based on size of your immediate family (Harmony Health Clinic, n.d.).

You must set up an appointment for a one-time interview to apply for and determine eligibility

Resources

(2009, May 06). Retrieved May 24, 2010, from Advocacy: The Free Clinic of Greater Cleveland: http://thefreeclinic.org/advocacy.htm

About ACFMC. (n.d.). Retrieved May 23, 2010, from Ashe County Free Medical Clinic: http://www.acfmc.org/about.php

Care Free Medical Clinic, Inc - Free Medical Clinics in Mason and Lansing, Michigan. (2007). Retrieved May 23, 2010, from Carefree Medical & Dental Clinics: http://www.carefreemedical.com/board.htm

Guidelines for Starting Free Medical Clinics. (n.d.). Retrieved May 24, 2010, from http://members.cox.net/billsisson/Guidelines,htm

Harmony Health Clinic. (n.d.). Retrieved May 24, 2010, from Harmony health Clinic: http://www.harmonyclinicar.lorg/en/services

National Association of Free Clinics-Advocacy and Support for America's Free Clinics. (2009). Retrieved May 27, 2010, from The National Association of Free Clinics(NAFC): http://www.freeclinics.us/membersbenefits.php

PERFORMANCE IMPROVEMENT AND

PATIENT SATISFACTION

Open Arms Free Clinic

Goals for Clinic Improvement

Provide safe care – Avoiding injuries to patients from care that intended to help .

Provide effective care – Services based on evidence and scientific knowledge that avoids underuse and overuse.

Provide patient-centered care – Respectful and responsive to patient preferences, needs and values.

Providing timely care – Reducing waits and harmful delays for those who give and receive care

Methods for Improvement Organize a Process Improvement Team that includes Medical,

Pharmacy, Nursing and Support Staff as well as members from the church sponsor and participating hospitals.

Establish improvement goals –What are we trying to accomplish?

Identify changes that will result in patient and employee/volunteer satisfaction improvement.

Implement changes using the PDSA model (Plan-Do-Study-Act).

Use benchmarking tools to compare/contrast survey results and evaluate changes in care with other clinics (CAHPS Surveys & Tools).

ResourceHow to Improve. (n.d.). IHI.org: A resource from the Institute for Healthcare Improvement.

http://www.ihi.org/IHI/Topics/Improvement/Improvement Methods/HowToImprove/. Downloaded 6/2/1010/

Evaluation

Monitor safety and patient satisfaction with point-of-care surveys.

Evaluate any cost saving programs implemented after a 3 month period and investigate additional partnerships that may result in reduced operating costs.

Monitor and evaluate improvements with employee volunteers, medical partners and participating hospitals and seek additional measures to ensure quality of care delivered to our patient population.

Organizational Structure

Open Arms Free Clinic

Organizational Structure

Executive DirectorMedical Director

PhysicianNP/PA

PharmacistPharmacy Tech

Registered nurseCNA

SecretaryReceptionistBookkeeper

Patient AcuityPatient Acuity Mix

Open Arms Free Clinic

Patient Acuity Mix

As a free clinic we will provide quality medical services to a wide variety of cliental. Patient acuity will be divided into 3 levels: Simple, Moderate and Complex.

Acuity levels will be based on the medical needs and services provided to the patient. The higher the need, the higher the acuity level.

Adequate staff will be available per the acuity mix.

Patient Acuity Levels Simple

Moderate Complex

MD/NP time < 30 minutes

MD/NP time 30-45 minutes

MD/NP time 45-60 minutes

Initial vital signs only Initial vital signs only 2 or more vital signs to be taken

Initial nursing assessment only

Initial nursing assessment only

2 nursing assessments

1 nursing intervention 2 nursing interventions

3 nursing interventions

Finger-stick labs Lab work drawn and processed

Lab work drawn and processed

Education time < 10 minutes

Education time < 15 minutes

Education time 15-30 minutes

Referral for further diagnostics/admission to hospital

Budget

Open Arms Free Clinic Fiscal Year Ending 12/31/2009

Budget Revenue ExpensesPrivate Donations $ 84,500

Salaries, payroll taxes,Employee benefits $ 235,000

Faith Community 150,000

Operating Costs (supplies, utilities) 75,000

Government and Civic Organizations 85,000

Insurances/licensesDues/Subscriptions 45,000

United Way 150,000

Equipment rental andMaintenance 35,000

Fundraising events 45,000

Contract Services 24,000

Grants 122,000

Medications 65,000

Corporate donations 34,500

Medical equipment /supplies 75,000

Fees, Interest and Miscellaneous donations 85,000

MiscellaneousAssistance to clients 30,000

Total $ 756,000

Total $ 584,000

Budget

Resources

Ada Jenkins Free Clinic of Our Towns Financial Summary, (2008). downloaded from http://www.adajenkins.org/services/health/medical Clinic.cfm June 21, 2010.

The Free Medical Clinic of Greater Cleveland Financial Statements, (2009). Downloaded from http://www.thefreeclinic.org.advocacy.htm May 24, 2010.

Job Descriptions

Open Arms Free Clinic

Job Descriptions

Executive Directors – Church Deacons and Pastor, Pharmacist, Physician and Nurse Practitioner/Physician Assistant making up a governmental body that is faith based.

Medical Directors - On-site rotating physicians.

Physicians – Here at Open Arms Free Clinic, we have the highest quality, qualified and caring physicians in the region. They are licensed, Board Certified, ACLS certified, and have local hospital privileges.

Job Descriptions

Physicians will direct patient cre, treatments and medical direction to the interdisciplinary team ensuring standard of care is upheld.

Nurse Practitioner/Physician Assistant – On site at Open arms Free Clinic we have a Nurse Practitioner/Physician Assistant who is licensed and Board Certified. They work directly with the Physician, who co-directs the interdisciplinary team with Physician based assessments, uses standards of care appropriate for our level of acuity, redirects, and refers to appropriate centers those who need a higher level of care than our team can deliver.

Job Descriptions

Pharmacists – Licensed and Board Certified, able to direct the interdisciplinary team when appropriate. They will report directly to the physician or NP/PA to reduce medical errors.

Pharmacy Technician – Person who works directly under the Pharmacist. They are trained to have a basic knowledge of medications, recognize high-risk medications and disperse medications to the nursing staff as directed.

Job Descriptions

Registered Nurse – At Open Arms Clinic we have the finest Nursing Staff who will carry out appropriate assessments and monitoring of labs and vital signs. They are always aware of appreciating the seriousness of the patient’s condition. All Nursing care is highly qualified with BCLS, ACLS, and PALS.

CNA’s – Our CNA’s are highly qualified and caring individuals who are well versed in BCLS and vital signs. They report directly to the physician, nurse practitioner, or nursing staff. All Patient Care will be kind and courteous.

Job Descriptions

Office Personnel – Secretary, Bookkeeper, and Receptionist. Our office staff is trained to be the receptionist, accountant, and the person in charge of ordering supplies simultaneously.

If for any reason we cannot treat you appropriately, we re well capable of stabilizing methods of life support until Emergency Medical Services arrive for transport to an appropriate facility.

Competencies for Open Arms Free Clinic Staff by Profession

All Staff, Physicians, Nurse Practitioners', RN’s, Pharmacists, All Licensed Staff, & Unlicensed

staff

Competencies by Profession All Staff: Must maintain current BCLS Physicians & NP’s: Must maintain current BCLS,

ACLS, & PALS as well as mandated yearly job specific competencies including blood borne pathogens, reading x-rays, and environmental safety procedures. Also other competencies as deemed necessary to maintain a safe practice & patient care.

RN’s: Must maintain current BCLS,ACLS, & PALS as well as mandated yearly job specific competencies for registered nurses including blood borne pathogens, glucose testing, performing EKG’s, environment of care, & others as deemed necessary to perform job specific tasks.

Competencies by Profession

Pharmacists: Must maintain current BCLS, ACLS, & PALS. All yearly job specific competencies must be completed as designated by the state of North Carolina.

All Licensed Staff: Must maintain the required continuing education as set forth by the state licensing board and all governing bodies.

All Unlicensed Staff: Must complete all mandated yearly competencies as determined by the facility & any others as seen needed.

Performance Appraisals

30 Days, 90 Days, 6 Months, & Yearly

Schedule of Performance Appraisals

With every new hire, the employee will receive a 30 day, 90 day, and yearly evaluation from the time of their hire date.

Every employee will have a shortened 6 month review to evaluate any needs or concerns with job specific and organizational specific tasks.

Peer review evaluations were be used as additional appraisal tools at the yearly evaluation of the employee.

6 Month Review Appraisal This is done to assist the employee in

achievement of personal & professional goals/objectives for the yearly appraisal

Goals/objectives from the previous year will be reviewed for areas of improvement.

Review with employee on how they view their work performance in achieving these goals & improvements.

Discuss any issues, needs, concerns, or challenges so the employee may reach their goals.

Yearly Evaluation & Appraisal

Peer reviewed surveys will be obtained and reviewed from 7-8 employees who work in close relation.

Surveys will remain anonymous and used only for performance improvement purposes.

Survey questions will be job specific only and not used for any purpose other than those specified.

Employees will also do self evaluations

Magnet Forces

Open Arms Free Clinic is not eligible to apply for Magnet Status because it is not a hospital and we do not have a Chief Nursing Officer to oversee nursing activities. We will strive to implement the 14 Forces of Magnet to promote quality in an environment that supports and identifies excellence in professional practice and nursing care delivery.

The 14 Forces of Magnetism

Force 1 – Quality of Nursing Leadership – We will strive to be knowledgeable, strong risk-taking leaders who advocate for staff and patients.

Force 2 – Organizational Structure – We shall share decision making and strive to work as a cohesive group for the betterment of the patients and staff.

Force 3 – Management Style – The staff will provide leadership and take the responsibility of providing constructive criticism and support for each other

Magnet Forces (con't)

Force 4 – Personnel Policies and Programs - We are an all volunteer clinic. We provide creative and flexible staffing that supports a safe and healthy work environment. Personnel policies are developed with direct care nurse input.

Force 5 – Professional Models of Care – Our nurses are capable of treating the patient mix and acuity with knowledgeable and competent nursing care using the primary nursing model.

Magnet Forces (con’t) Force 6 – Quality of Care – Quality patient care is the

Mission of our clinic. The entire organization strives to ensure that each patient contact is a positive experience.

Force 7 – Quality improvement – Our process for Quality Improvement will ensure that we provide safe, effective, patient centered care in a timely manner.

Force 8 – Consultation and Resources – We will provide adequate resources, support and opportunity for our staff and patients to utilize the expert opinion of specialists and advanced practice professionals when their assistance is needed.

Magnet Forces (con’t)

Force 9 – Autonomy – Our nursing staff functions autonomously while working with various other professionals to care for our patient population . This self-directed nursing care is consistent with professional standards.

Force 10 – Community and the Healthcare Organization – Our clinic developed out of the partnership with churches, local hospitals, and healthcare providers to provide care to patients in need and in that way improve patient outcomes.

Magnet Forces (con’t)

Force 11 – Nurses as Teachers – The nursing staff will provide education to patients using literature, handouts, and other resources available. We will partner with local educational institutions to provide mentoring opportunities for students.

Force 12 – The Image of Nursing – The nursing staff is essential to the team that provides care to patients and respected for the quality of the care they provide.

Magnet Forces – (con’t)

Force 13 – Interdisciplinary Relationships – Our staff will have mutual respect for one another regardless of their title.

Force 14 – Professional Development – The clinic values and supports the personal and professional growth and development of its nursing staff. Because of the volunteer nature of the staff and the limited resources of the clinic we are not in a position to provide monetary incentive for certification and/or advanced degree education.

Magnet Forces (con’t)

ResourcesTrofino, Joan, (May, June, July 2007), Magnet

recognition: The nobel prize for nursing practice. Nevada Rnformation, 23-25 downloaded from http://www.nvnurses.org on July 18, 2010.