Process Vs Project

Mainstreaming Chiropractic services in Primary Care is a game changer when fully embraced, in the very least it impacts the organization in similar ways it took to expand into Dentistry. Attention to space allocation, structuring an independent Chiropractic Department, refining special credentialing and operational protocols and provider management. Let’s look at the background of this topic.

FQHCs have advanced their mission of improving access and availability of a broader healthcare service delivery system for the poor and marginalized populations in our communities. Decade after decade there are impressive strides made into expanding into medical specialties, followed by a decade focused on the implementation of Dental care; followed by the addition of Optometry and Podiatry and in some centers, the addition of Chiropractic. The most recent decade of advancement has been focused on the integration of behavioral health services. These changes have been challenging to difficult to nearly impossible, depending on the management approach to these additions in scope of services.

To begin with, implementing an integrated care practice is most certainly a process. Where previous efforts to integrate chiropractic have failed is principally because the added service was managed in the manner we take on a project; thinking that there are initial things to do, then make adjustments, then it is done. When the direction taken was project-centered it is no surprise to hear how many times the chiropractic services have not been sustainable; especially when the original starting team is dispersed; when the CEO or the CMO leaves and their project fails.

The unrelenting, hard-headed, committed artist behind a process that integrates new services such as behavioral health or chiropractic is the CEO.  It is not driven by a VP of Clinical Services, or a mid-manager appointed to head-up a task force. It is led by the mission, and the CEO who’s job is to be guardian of that mission, and seeker of talent to fulfill it. The most recent trend in the industry seems to be to hire a “director of integrated care.” Make no mistake, the “director of integrated care” is the CEO. Often the chief responsibility of implementation of chiropractic is typically assigned the chief medical officer. But when it is led and supported by the CEO, and introduced as not just a part of the mission, about part of the essence of how your organization functions, it become everyone’s responsibility as well.

The truism that things go best when it starts at the top and trickles down the line is definitely applicable when FQHCs consider expanding the organization’s scope of services. Where we have been involved with FQHCs in managing their chiropractic programs 10 and 20 years duration, the CEO has always been at the center of the support and guidance needed to create an environment conducive to sustainability, to the mainstreaming of chiropractic in a primary care organization.