SampleCommunity Health Center

Strategic Plan

(Edited to Remove Name and Other Identifying Information)

Written and Edited byTom Martorelli

Boston, MassachusettsJune, 2012

Table of Contents

Executive Summary................................................................................3

Introduction............................................................................................6

Clinical Services......................................................................................10Key Elements of the Clinical Services Strategic Plan....................................................11Five-Year Goals for the Clinical Services 2012 Strategic Plan......................................11Conclusion...................................................................................................................17

the Research Department......................................................................18Key Elements of the Research Department’s Strategic Plan........................................19Five-Year Goals for Research Department’s 2012 Strategic Plan.................................21Conclusion...................................................................................................................22

Development and Communications........................................................23Key Elements of the Development and Communications Strategic Plan......................24Five-Year Goals for the Development Department’s 2012 Strategic Plan....................25Five-Year Goals for the Communications Department’s 2012 Strategic Plan...............27Conclusion...................................................................................................................28

Resources and Organization...................................................................29Key Elements of The Resources and Organization Strategic Plan................................31Five-Year Goals for the Resources and Organization 2012 Strategic Plan....................32Conclusion...................................................................................................................33

Appendix 1: 2004 Strategic Plan and Related Accomplishments...........352004 Clinical Services Strategic Plan and Related Accomplishments...........................36Research Department 2004 Strategic Plan and Related Accomplishments..................412004 Development Strategic Plan and Related Accomplishments...............................432004 Communications Strategic Plan and Related Accomplishments..........................452004 Resources and Organization Strategic Plan and Related Accomplishments........46

Appendix 2: SWOT Analyses...................................................................52Clinical Services...........................................................................................................53the Research Department............................................................................................55Development and Communications.............................................................................57Resources and Organization........................................................................................59

Appendix 3: Agenda, Annual Strategic Reports to the Board.................61

Appendix 4: Organizational Chart, Major Boston Area Health Center Departments...........................................................................................63

Appendix 5: Statement of Ethics............................................................65

Appendix 6: Strategic Planning Teams...................................................70

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Executive Summary

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Executive SummaryThis strategic plan is the result of an extraordinary effort across the entirety of an organization that has accomplished a great deal since our last plan was written in 2004. The scope of Boston Area Health Center as a model “Academic Community Health Center” in Massachusetts, and its Research Department as the home of our growing international leadership in community health research, education, and policy development, has required a team approach to planning – four separate organizational units, each taking the same disciplined look at our past and present in order to chart a course for Boston Area Health Center’s continued success in the future.

Organizing Our Strategic GoalsBoston Area Health Center’s 2012 strategic plan has been written in four chapters by four planning teams – Clinical Services; the Research Department; our Development and Communications Department; and a Resources and Organization team representing the financial, administrative, and senior leadership hub in Boston Area Health Center’s “hub and spoke” organizational model. To varying degrees, each team focused their goals into five broad categories.

Excellence The quality of Boston Area Health Center’s health care, research, education, and policy efforts has long been at the core of our success. Maintaining this quality, and supporting it with development, communications, and managerial leadership of equal caliber, is a key priority. Customer service – the intersection of quality and communication – is an example of where Boston Area Health Center will develop its excellence in the next five years.

GrowthSince its founding in 1971, Boston Area Health Center has experienced a number of periods of extraordinary growth, most notably in its response to the need for community health services as doctors left the city’s urban areas. Our most recent growth – the conceptualization, building, and deployment of programs at our local headquarters – differs from some of our historic growth in that it is mission-driven, and planned. Given our full occupancy of all ten floors of local address in 2012 – three years ahead of schedule – continuing to manage growth in an increasingly uncertain environment is another priority.

InnovationBoston Area Health Center is unique in our delivery of quality health care to patients in our neighborhood and Eastern Massachusetts while also becoming an international leader in clinical research, consumer and provider education programs, and health policy development. Creative thinking, and a willingness to become a “learning organization” in addition to our collection of services and programs, must remain at our core.

Community healthBoston Area Health Center’s commitment to the provision of services to underserved populations began with our commitment to geriatric and local resident health nights in the 1970s. Our pioneering various diseases and specialty care and research developed in parallel to Boston Area Health Center’s alternative women’s health programs in the 1970s. Today’s Specialty Care Health Programs and the Research Department’s Population Center research on broad epidemiological issues are evidence of how this commitment has grown, and will continue to grow in Boston Area Health Center’s future. Today, we are shaping our approach to community health with the perspective that our population is every bit as diverse as the American population at large. There is no single community but an assortment of communities, each requiring its own culturally competent care.

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ImpactIt is understandable how Boston Area Health Center’s pioneering efforts in community health have helped us earn a national and international position in this field. But Boston Area Health Center has also developed other skills, experience, and capabilities that are the basis for leadership in research, provider training, and policy development – defined more broadly than their applications in responding to community health, or in community health. Collaboration with Boston’s teaching hospitals on provider training, or establishing a community-based clinical research program, or successfully influencing state health policies and reimbursements for innovative care are all examples of the broad impact we can have on health care in general. We will maintain these and similar efforts in the future.

A Guide to this PlanBoston Area Health Center’s four planning teams each took a similar approach in writing this strategic plan. We began with a look at Boston Area Health Center’s 2004 strategic plan, and reviewed our success and shortcomings in achieving goals identified in that document. We continued with a SWOT (strengths, weaknesses, opportunities, and threats) analysis of our current situation.

Based on these analyses, we created a planning framework for our strategic goals, using the five broad categories outlined in this executive summary. Within that framework, we wrote broad strategic goals to guide Boston Area Health Center during the next five years.

Finally, in order to achieve these broad goals, we developed a methodology for translating these broad goals into achievable and measurable objectives in the years to come. Each planning team will make an annual presentation to Boston Area Health Center’s Board of Directors in which it will propose programs and initiatives for the coming year based on its strategic goals, outline the ways in which that team and the board can measure success, and report on its success since its last annual presentation. As this process continues and plans are refined based on each team’s results, we will achieve two important goals: we will benefit from a disciplined approach to strategic planning and the translation of these plans into action; and we will also provide a baseline of shared knowledge for the development of Boston Area Health Center’s next strategic plan.

The documentation of our 2012 strategic plan follows with an introduction that summarizes Boston Area Health Center’s mission statement, and our vision and values. Next, the plan summarizes the planning framework and strategic goals for each of our four planning themes.

Reference documents in the appendix include a summary of each team’s progress toward Boston Area Health Center’s 2004 strategic goals, and a summary of each team’s SWOT analysis. An outline of the agenda for each team’s annual strategic planning presentation to Boston Area Health Center’s Board of Directors follows. A high-level organizational chart for Boston Area Health Center is next, followed by the organization’s statement of ethics. Last but not least, there is a roster of all the individuals who contributed their time and energy to our 2012 strategic plan, to whom Boston Area Health Center owes much thanks.

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Introduction

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Introduction

Forty years ago, the Greater Downtown Boston Area Community Health Center was the smallest in Boston, occupying less than 5,000 square feet of basement space, with an annual operating budget of $250,000. As the organization’s name shortened, first to Downtown Boston Area Community Health Center and now to just Boston Area Community Health Center, it has grown to become one of Boston’s largest health care organizations, fully occupying its three-year old ten story headquarters building at local address, with three additional facilities providing health care to Boston’s community, to young adults, and to people in the New Neighborhood community.

Boston Area Health Center is still a community health center at its core, but it is also so much more in 2012. Services have expanded beyond clinical care to include behavioral health, vision and dental care, and a broad range of services designed for the 16,000 individuals who come to Boston Area Health Center for care. In addition to providing these clinical services to people in Boston, Eastern Massachusetts, and New England, the organization and its Research Department have earned a national and international reputation for excellence in research, education, and health policy development based on its historic leadership in the delivery of care to people with various diseases, the community in its entirety, and Boston Area Health Center’s growing neighborhoods. The organization and its Research Department have earned a national and international reputation for excellence in research, education, and health policy development based on its historic leadership in the delivery of care to people with various diseases, the community in its entirety, and Boston Area Health Center’s growing patient base. Today, Boston Area Health Center and the Research Department are a model of what a community-based organization can do to increase both access to, and the quality of health care throughout the world.

Much of Boston Area Health Center’s dramatic growth has occurred since its most recent strategic plan was completed in 2004. In Boston, Boston Area Health Center has seen a doubling of patient visits for both medical and behavioral health services; the planning and construction of a 10-story, $60 million headquarters facility at local address, Boston; the addition of new services such as dental care and eye care; acquisition of the City Youth Health Center and its programs for young adults ages 19 through 29; expansion of New Neighborhood Health Associates (now Boston Area Health Center: New Neighborhood ) with space for a pharmacy and behavioral health services in addition to primary care; and the creation of a Communications Department to enhance Boston Area Health Center’s dialogue with patients, partners, and the community in print, on site, and on line.

Nationally, Boston Area Health Center has established the first-of-its-kind Center for Population Research in community Health at the Research Department; published The Boston Area Health Center Guide to Specialty Population Health Care, a groundbreaking training resource for health care professionals in all institutions of care; and participated in a growing number of national coalitions successfully influencing federal, state, and local government health policies.

Internationally, the Research Department’s leadership in community health research and treatment have made real contributions in Asia, South America, Europe, and Africa, through capacity building and collaborative research projects with local agencies. Additionally, the Research Department’s researchers have presented on innovative various diseases prevention interventions at numerous global conferences. Since 2009, the Research Department has hosted 2-3 meetings per year of researchers, policy makers and funders to discuss critical issues surrounding various disease prevention and care strategies.

In drafting Boston Area Health Center’s 2012 strategic plan, our discussion began with three critical questions that framed the organization’s previous plans: what do we want

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Boston Area Health Center to be in the future, how can we get there, and what resources will be required to achieve this shared vision?

A larger Boston Area Health Center in 2012 approaches its strategic plan along four related paths: one for its clinical services; a second for the Research Department and its research, training, and policy programs; a third for its combined development and communications departments; and a fourth with an eye on the resources and organization that will support Boston Area Health Center’s multiple departments, programs, employees, and volunteers as we grow.

Along with Boston Area Health Center’s excellence, innovation, impact, and community health, growth is a theme that recurs throughout this plan. The previous decade saw unprecedented growth in all areas of Boston Area Health Center, symbolized by the successful planning, construction, and opening of the New Headquarters Building, the “hub” in Boston Area Health Center’s “hub and spoke” organizational model. Physical expansion beyond this hub, at Boston Area Health Center: New Neighborhood, and the City Youth Health Center, provide two different examples of how we can achieve similar growth in the future. And the development of new programs in clinical care, research, provider education, prevention, and policy will continue as Boston Area Health Center maintains its leadership in community health care and the care we provide to all people in our communities and neighborhoods. In short, mission-driven growth is and will remain a key element in our organizational philosophy while concurrently honoring our commitment to provide care regardless of the socioeconomic status of those who choose to be our patients.

With so much that is new, however, we will always do well in planning for our future by remembering the mission, vision, and values that have guided Boston Area Health Center throughout its more than forty-year history.

Mission, Vision and ValuesMission

The mission of Boston Area Health Center Community Health is to enhance the wellbeing of the local population, other individual, and specialty care communities and all people in our neighborhoods and beyond through access to the highest quality health care, education, research, and policy.

Vision

Care & Providing. A national leader in providing integrated, interdisciplinary, community based health care - primary medical, mental health, substance abuse treatment and health promotion and disease prevention services - to the diverse populations of the local population and to other individuals requiring specialty care.

Discovering & Learning. A national and international leader in community based research on various diseases and the health needs of our local population, aging men and women, and the specialty care communities.

Education & Teaching. A national center to enhance the understanding of our local population, and other specialty care health issues.

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Growth & Development. A financially secure and robust organization that includes a healthy endowment & broad base of donor support.

Values

Demonstrate commitment to our clients by providing the highest quality of care and responding to client needs by providing innovative, state-of-the-art services delivered with care and respect.

Reduce barriers and improve access to medical and behavioral health care and research and health education for the local population, other individuals requring specialty care..

Respond to the catastrophic illnesses affecting the local population, other individuals requring specialty care..

Establish and maintain an organization that reflects the ethnic, racial, socio-economic and general diversity of the community and manifest an acceptance and understanding of all people.

Maintain a workplace that values our employees and encourages their commitment, creativity, contributions, excellence and professional growth and development.

Accept and value the responsibility of being a good neighbor wherever we provide services.

Ensure a fiscally healthy, well-managed organization that implements sound financial practices so that contributors and funders can be assured that we are “faithfully” carrying out our purpose with integrity and without extravagance or waste.

Encourage and support collaboration between not-for-profit, public sector and private health providers to fund and assure adequate services for the local population and other individuals requring specialty care..

Encourage the development of expertise through care and treatment, research, policy and training that results in national recognition in local population, other individuals, and specialty care health concerns.

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Chapter One: Clinical Services

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Clinical ServicesBoston Area Health Center is committed to providing innovative, culturally sensitive, evidence-based medical and behavioral health care to local resident, geriatric, and other individual patients, their families, and all people in the surrounding Boston Area Health Center neighborhood.  Our vision for clinical services in the future consists of the following fundamental characteristics:

• Care will include ethnically-diverse pediatric, adult and geriatric care with a special emphasis on community health, women’s health, and specialty care. 

• Clinical programs will be inter-disciplinary, integrated and team-based and will

include all ancillary services to provide comprehensive care including behavioral health, adolescent and senior care, dental, optometry, nurse case management, and other community-focused programs to create a patient-centered medical home. 

• Clinical departments, in collaboration with the Research Department and other academic institutions, will continue to innovate and research more effective ways to care for patients.

• Boston Area Health Center’s clinical departments will sustain, if not increase, their commitment to educate and train other health care providers in culturally diverse community care.

Key Elements of the Clinical Services Strategic PlanBoston Area Health Center’s Clinical Services Department is broad in size and scope, and its strategic plan is organized to include services ranging from medical and behavioral health through community health care, women’s and children’s health, senior health, and other clinical services. The strategic goals we have created for the next five years are similarly broad, and are the result of a process that includes a review of our progress vs. the goals in our 2004 strategic plan, and a SWOT analysis conducted when we began our work late in 2011. Details for both steps in the development of our strategic plan are included in the Appendix of this document

The Clinical Departments’ strategic goals are organized by four themes that affect all of Boston Area Health Center’s clinical services: quality, innovation, training, and growth.

Five Year Goals for the Clinical Services 2012 Strategic PlanWe have arranged the many long-term goals and objectives for the Clinical Services Strategic Plan into four broad themes: (1) quality, as the degree of excellence in something; (2) innovation, as the process of making a new method, idea, or product; (3) training, or the act of teaching a particular skill, and (4) growth, the process of developing, maturing, or increasing in size. These goals are listed below, along with a brief qualitative or aspirational discussion of each of our four organizing themes.

QualityA 2001 Research Department publication set forth a new paradigm for thinking about health care excellence in the new millennium. The book defines quality care as possessing six different characteristics:

• Safe: patients should not be harmed by the care that is intended to help them.• Effective: care should be based on sound scientific knowledge.• Patient-Centered: care should be responsive to individual preferences, needs, and

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values.• Timely: unnecessary waits and harmful delays should be reduced.• Efficient: care should not be wasteful.• Equitable: care should not vary in quality because of patient characteristics.

This decade-old paradigm has attained wide acceptance in the health care field. Boston Area Health Center has built its quality plan around these concepts, and we believe it is essential for the organization to continue to focus on them in order to succeed. Examples of objectives that help us actualize the Research Department’s vision of care include the following:

• Maintaining Joint Commission accreditation: Boston Area Health Center was one of the first community health centers in the country to obtain Joint Commission accreditation. The Joint Commission survey process allows health care organizations, through a combination of self-assessment exercises and unannounced surveys, to identify and improve quality gaps that, if ignored, can lead to patient harm. It is also the means by which the U.S. Department of Health and Human Services, Bureau of Primary Health Care certifies that a federally qualified health center is compliant with federal standards. The upcoming 2012 survey will mark the first time ever that the City Youth Health Center will participate in the Joint Commission accreditation process.

• Implementing Lean management training: Lean management refers to a philosophy, popularized by the Toyota Production System, of maximizing customer value while minimizing waste. Lean’s main tools and tenets include mapping entire value streams, empowering individuals within an organization to identify waste and suggest ways of eliminating it, acknowledging that an organization’s employees are its greatest resource, and ensuring that each worker functions at the top of his/her level of training. Lean’s applications in health care are many. A well-implemented Lean management program at Boston Area Health Center can lead to improvements in customer and staff satisfaction and a reduction in errors.

• Commitment to Staff Training Program: Boston Area Health Center will continue to offer professional development opportunities to its staff, be they through an internal curriculum of in-service lectures or by subsidizing participation in external trainings.

• Clinical leaders will help drive quality improvement efforts by maintaining and revising policies and procedures. They will monitor these efforts through their participation in the Quality Council, the Clinical Committee, and the Board Quality and Compliance Committee.

We have two “quality” goals in Boston Area Health Center’s Clinical Strategic Plan for 2012.

Quality Goal One: We will strive to provide care at Boston Area Health Center that follows the principles defined by the Research Department.

We will continually monitor clinical dashboards on the board and staff level.

We will specifically measure access to timely care and continually assess and implement potential actions for improvement.

We will prioritize customer service by developing quality improvement goals and annual plans that specifically measures patient satisfaction and solicits patient feedback. This will be used to identify quality improvement initiatives and continuous staff training.

Joint Commission Accreditation process will continue and will be ongoing. The

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City Youth Health Center will achieve Joint Commission Accreditation through quality improvement initiatives.

Policies and Procedures will continually be reviewed, revised and created as new areas are identified.

Quality Council and Clinical Committee will continue as effective working groups within the health center with representation from all clinical services and the Research Department.

We will meet the “Meaningful Use” objectives set by federal regulation for our EMR.

Lean Principles will be applied to management training throughout the organization.

There will be a commitment to the professional training of our staff in the form of consistent training plans that include in-service training series, seminars, forums and rounds as well as participation in external training opportunities as a high priority.

We will achieve NCQA (National Committee of Quality Assurance) Recognition as a PCMH (Patient Centered Medical Home).

Quality Goal Two: We will establish quality metrics to sustain and improve quality outcomes.

We will assess the need for new or revised measures and we will expand our dashboard to measure clinical quality and clinical outcomes in all areas of clinical services.

InnovationWhile there is much uncertainty about the future direction of health care reform, there is, without a doubt, a dire need for new ideas about how to deliver care that is effective. Several of these ideas are currently the object of much attention and deserve mention in this report.

• Patient Centered Medical Home (PCMH): this idea focuses on an approach to providing comprehensive primary care to individuals in a health care setting that facilitates partnerships and allows for interdisciplinary team-based care, an emphasis on preventive population-based outreach, and care management of individuals with chronic diseases. Boston Area Health Center aims to attain Level 3 Medical Home status from the National Committee for Quality Assurance (NCQA) in 2012.

• Accountable Care Organizations (ACO): The ACO is a type of payment and delivery reform model that seeks to tie provider reimbursements to coordination of care across health care settings; the level of reimbursements are determined by quality metrics and reductions in the total cost of care for an assigned population of patients. Many health care policy forecasts suggest that ACO’s will emerge as a predominant payment model in the years to come. It will be important for Boston Area Health Center’s clinical leaders, together with the Board of Directors and the Management Team, to become familiar with ACO structure and function and to determine the necessary steps for ensuring success for the organization should alignment with such a structure occur.

• Integrated Behavioral Health in Primary Care: At Boston Area Health Center, as in most of the country, the demand for outpatient behavioral health services far

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outweighs our ability to provide these services to everyone. One potential solution to this problem is to embed behavioral health specialists within the primary care setting to allow for less structured but more timely assessment, intervention, follow-up, and linkage to more intensive care as needed. Boston Area Health Center looks to implement such a program by formalizing the work of its Medical Social Workers who are already co-located in the primary care clinics, and are active participants in the Primary Care Teams.

• Care for Seniors and Children: In an effort to offer cradle-to-grave care to its patients, clinical leaders will, with the guidance of the Management Team and Board of Directors, explore the feasibility of initiating additional programs at Boston Area Health Center that focus on both ends of the age spectrum. Such efforts will require identifying and collaborating with community partners to create a care system that is seamless and thoughtfully designed.

We have three “innovation” goals in our 2012 Clinical Strategic Plan.

Innovation Goal One: We will create the Patient Centered Medical Home model of care. Clinical services will be integrated and team-based and will include ancillary services to provide comprehensive care including behavioral health, pediatric, adolescent and senior care, dental, optometry, nurse case management, psychosocial case management, and other programs.

Examples of How we will Achieve this Goal

We will continue to assess the feasibility of bringing additional clinical and support services on-site to better integrate care, lower costs and ensure quality.

We will evaluate and make strategic decisions regarding Boston Area Health Center’s role within Accountable Care Organizations.

We will evaluate the feasibility of adding new programs to reach seniors and youth such as home visits, day care and drop in centers.

Innovation Goal Two: We will use advanced clinical information technologies to integrate patient care between all Boston Area Health Center departments and affiliates to serve our patients at the highest level of quality.

We will implement a new Practice Management system

We will implement electronic billing

We will meet the “Meaningful Use” objectives set by federal regulation for our EMR through upgrades.

Innovation Goal Three: We will continue to strengthen the integration with the Research Department and collaborate with other academic institutions to research more effective ways to care for patients.

TrainingBoston Area Health Center recognizes in its mission statement the importance of playing a lead role in educating tomorrow’s minority-sensitive and community health oriented providers. Therefore, it is vital that Boston Area Health Center maintain, and even increase, its commitment to educating and training health care providers of various disciplines in the delivery of culturally diverse care. Examples of current

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affiliations that we wish to continue include:

• Behavioral Health Department: Massachusetts School of Professional Psychology, Simmons/UMass-Boston/Northeastern/Leslie/Boston College Schools of Social Work, Suffolk University Clinical Psychology Program.

• Dental Department: Boston University School of Dentistry, Lutheran Medical Center.• Medical Department: BIDMC Internal Medicine Residency Program – Boston Area

Health Center community Health Track, Harvard Medical School.• Optometry Department: New England College of Optometry.• Pharmacy Department: Massachusetts College of Pharmacy, Northeastern University

School of Pharmacy.

We have two “training” goals in this year’s strategic plan.

Training Goal One: Boston Area Health Center’s clinical departments will sustain, and increase, their commitment to educate and train other health care providers in culturally diverse community care.

We will seek funding to support our clinical providers to respond to requests from outside organizations to provide workshops, seminars and trainings off site at other institutions or at conferences and events

We will provide internal training support for our providers as “train the trainers.”

Training Goal Two: Current Academic relationships will be maintained and new opportunities will be developed for graduate internships within Behavioral Health, residency medical programs, graduate RN/NP programs, and dental students

We will continue to support our affiliation with DHSS/HRSA funded BIDMC Primary Care Boston Area Health Center Track – the first community focused residency training program in the country

We will continue to work with local graduate schools of social work, psychology and counseling to place master’s and doctoral level graduate interns at Boston Area Health Center, such as Massachusetts School of Professional Psychology, Simmons School of Social Work, Suffolk University Clinical Psychology, Boston College, UMass, Leslie, Northeastern

We will continue our relationship with dental schools such as Boston University and the Lutheran Medical Center.

GrowthBoston Area Health Center will most likely continue to see marked increases in patient visits in all clinical departments and at all clinical sites. Conversion of one of the two vacant floors in the New Headquarters Building to a clinical space for primary care, specialty care, and imaging services (X-ray, mammography, ultrasound, bone mineral density) will take place in the next year. During this time, the Dental Department will also expand on the sixth floor. Upon the expiration of its lease in 2014, the City Youth Health Center will need to find a new home elsewhere. Lastly, continued success in practice growth at Boston Area Health Center:New Neighborhood will eventually necessitate an expansion at that site as well. With all this in mind, it will be important to remember the following values as we pursue Boston Area Health Center’s goals for growth:

• Growth must continue to be sustainable and smart: Developing a model of optimal practice support will be helpful in enabling the organization to anticipate staffing and space needs and maintain an optimum health support staff to provider ratio.

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• The growth of pharmacy services must continue to be a priority, given the Pharmacy Department’s impact on Boston Area Health Center’s overall financial health.

• To the extent that it allows us to better fulfill our mission of serving the community and better reaching those affected by various diseases whom we have not succeeded in reaching before, we will continue to seek opportunities to expand to new sites.

• We must continue to expand access to care – by adding more weekend/evening hours, by implementing walk-in services, or by utilizing standard orders for nurse driven care.

• In addition to creating new programs aimed at children and seniors mentioned above, we must continue to develop our care programs for these special populations: o Women: Through our partnership with BIDMC, we will explore the feasibility of

adding obstetric care within the next 5 years; as mentioned above, we will add women’s health imaging in the next year. Moreover, we will continue to support key services to women (2 outreach staff, a team program assistant, the Women’s Health Brunch) that do not directly generate revenue but that create significant value and context among patients.

o Specialty care people: Having worked diligently to create a solid framework for specialty care primary care, the Specialty Care Health Team will now require the assistance of the Board of Directors and the Management Team in advocating for the provision of surgical services to Trans patients in the Boston area.

We have two “growth” goals in Boston Area Health Center’s clinical strategic plan for 2012.

Growth Goal One: We will continue to grow our current services including dentistry, optometry, pharmacy, Women’s Health, and community primary and behavioral health care.

We will grow wisely and smartly, adding appropriate support staff when required.

We will develop a model of optimal practice support so that we can anticipate staffing needs and keep pace with our growth.

We will continue to support the growth of our pharmacy services recognizing the overall impact on Boston Area Health Center’s financial health.

We will seek opportunities to expand to new sites and new neighborhoods to provide clinical services that best fulfill our mission to serve community communities and those at high risk of various diseases infection.

We will expand services and potentially seek new sites to provide services to youth through the City Youth Health Center.

We will expand at our current sites, specifically the build out of the 6th floor for expanded dentistry and the 4th floor of our headquarters building for primary care. We will pursue the potential for new and additional rental space.

Growth Goal Two: We will broaden the scope of care that we provide to develop a Patient Centered Medical Home.

We will expand our Women’s health care, through mammography, ultrasound, and OB.

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We will develop appropriate clinical services and possible new locations to reach seniors.

We will advocate for improved specialty care services including policy for improved surgical services, pediatric specialty care, and integration of behavioral health.

ConclusionBoston Area Health Center’s clinical successes over the last ten years have placed the organization in a very advantageous position. The preceding growth has created a favorable environment that now allows us to focus on resource allocation, further staff training, and exploration of new opportunities as they present themselves.

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Chapter Two: the Research Department

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the Research Department

Since Boston Area Health Center’s 2004 strategic planning process, the Research Department of Boston Area Health Center has developed into a thriving multi-disciplinary center branded as the Research Department. In 2006, a process began to incorporate all research, educational programs and health policy work under the umbrella of the Research Department. It is the Research Department’s integration with the organization’s clinical services that support and define Boston Area Health Center as one of the only academic community health centers in the country. This unique model has become an example for other health organizations serving community and other communities.

Key Elements of the Research Department’s Strategic Plan

Strategic planning for the Research Department began with documentation of our accomplishments against the goals included in Boston Area Health Center’s 2004 plan. A summary of these accomplishments, along with a SWOT analysis conducted at the start of our planning process, are included in the Appendix of this document. Broad strategic goals for the next five years, based on our work since the process began in 2011, are organized into three themes: growth, broadening our work in community health, and our growing national and international impact.

the Research Department’s Strategic Planning Themes

the Research Department’s major accomplishments over the past several years can be summarized in three categories: (1) the growth of the Research Department over that time, in terms of increased faculty, budget, and research programs; (2) the broadening of the Research Department’s work beyond community health research to include community population science, and the creation of training and professional development textbooks and other resources; and (3) the expansion of Boston Area Health Center’s international leadership role in community health research and policy, community health studies and policy, and publication of several first-of-their-kind textbooks and training resources for community health care professionals worldwide.

Growth:the Research Department has seen immense growth since 2004. Revenue for the Research Department has steadily grown from $3.3 million in FY 04 to $8.5 million for FY 12. During that same time period, the the Research Department faculty grew from 4 to 15 members and the total staff (including faculty) grew from 28 to 85 employees. Much of this growth is attributable to an expansion of our community health research efforts, including doubling the number of NIH-funded research networks from two to four, being one of only two domestic sites with expertise in implementing pre-exposure prophylaxis studies, and expanding research work in areas of behavioral health, epidemiological methods and health informatics. We have also expanded our education, training and professional development work by bringing on senior faculty to oversee our clinical training, and by centralizing all community education efforts within the Research Department. Our Center for Population Research in community Health, the first center of its kind funded by NIH in the country, has expanded our capacity to work with pre- and post-doctoral students from about 5 per year in FY 04 to about 40 per year in FY 12. In FY 12, we recruited a new faculty member to oversee our groundbreaking health policy research work in this area.

Broadening of effort to all aspects of community healthBoston Area Health Center has been a leader in community health research since 1982, when we began longitudinal studies to follow the natural progression of the disease. The concept of a multidisciplinary center was formed in 2000 when we used our strong various diseases research infrastructure to support the development of an

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international community health research institute. Since 2004, we have made great strides to do exactly this. One of the Research Department’s biggest accomplishments in this area was supported by an infrastructure grant from NIH to develop the Center for Population Research in community Health. This “center without walls” brings together over 50 researchers from throughout the country to engage in community health population science. As part of its mission to develop the next generation of community researchers, the Center matches students from around the country with Center-affiliated faculty to provide mentorships on community health research. The Center also offers an intensive 4-week summer course on research methods for population research applicable to community health. Finally, the Center acts as a resource to affiliated faculty, students and others interested in community health research by creating a central repository of data sets that can be used for community health research.

Our training and professional development work has focused on community health, including the 2007 publishing of the first medical textbook focused on community health, and an on-going series of grand rounds lectures in Boston’s leading teaching hospitals (50 from 2009 – 2011). Given the highly visible nature of these efforts and our partnership with two national medical organizations to implement them (The American College of Physicians and the American Medical Association), the Research Department has become more widely known as a national leader in the community health movement.

As a direct result of our national community health efforts, the Research Department had two faculty members appointed to a Research Department committee, which published a report identifying gaps in community health research. the Research Department was also publicly acknowledged for our part in ensuring inclusion of community populations in Healthy People 2020. The IOM Report and Healthy People 2020 are two tools that support the importance of community health in the US as elements of national health policy. Our participation in these efforts secures the Research Department’s place in the national community health movement.

Impactthe Research Department has a national and international impact on the health of people affected by community health, the community and others who face health disparities. We participate in at least fifty local, national and international meetings and conferences each year. We participate in three local coalitions, including groups focused on the needs of the youngest and oldest in the community. We act as conveners of the local, national and international communities, hosting at least three conferences a year since Boston Area Health Center’s new conference center was opened in 2009. Our policy work has led to community health becoming a priority health issue, both nationally and internationally. In 2005, the community Health Equity Network, a community-driven network of advocates and professionals looking to enhance community health by eliminating tobacco use and other health disparities, joined the Research Department. Since that date, the community Health Equity Network has trained over 150 health departments and other groups on community cultural competency. Since 2006, we have received research funding to work in Asia and Europe and have provided consult on community health in Asia, Europe, Africa and South America. The Boston Area Health Center Guide to Community Health remains the only medical textbook in community health. Our Guide to Providing STI Service to the Community: What Every Provider Should Know was translated to Spanish and distributed throughout a network of 6 Central and South American countries. Our publication of a resource book on other individuals remains one of the only such publications in the country and has been distributed widely. We have become a model for community based research and were recognized by HRSA in 2010, which named the Research Department as one of four Community Health Applied Research Networks which focuses on research capacity building within community health centers.

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Five Year Goals for the Research Department’s 2012 Strategic PlanOur overall goal for the Research Department is to be regarded as one of the top community health research, training, education, and policy organizations in the world. We have made great strides over the past decade toward this overall goal, and have developed the following strategic goals with this in mind.

the Research Department’s Overall Goals

1. We will develop and adopt a business model for data center operations that is self-sustaining. We will also review and re-vamp how the data center is designed, managed, and resourced to facilitate and support all research and health center data management, reporting, and analysis needs within a secure environment.

2. In partnership with the Development Department, we will create and implement a funding plan that will further diversify funding sources for the Research Department infrastructure and divisions and work towards more solid long term funding such as the creation of an endowment.

3. We will make the Research Department the international source for health and wellness information and resources for community people through a robust communications plan, an enhanced web presence, and continued participation in the national and international community health movement.

4. We will continue to coordinate, both within Boston Area Health Center and the Research Department, to ensure maximal synergy and effectiveness.

5. We will maintain adequate dedicated space for the Research Department staff and projects, and continue to invest in technology that supports and enhances our work.

6. We will continue to recruit and retain a diverse and highly skilled work force.7. We will seek opportunities to develop new and expand existing academic

partnerships to support attaining our goals.8. We will seek to better fulfill our mission and expand our scope of work by

continuing to evaluate and enhance our community partnerships.9. We will seek funding for a translational research center which will produce

briefing papers and state-of-the-art conferences.10. We will strengthen our infrastructure to ensure that contract, budget,

compliance and administrative needs are met for all of the Research Department.

11. We will expand our portfolio to better represent all of the populations we serve, especially individuals requiring specialty care people and minority women.

Research and Evaluation

1. We will build efforts in health services research, program evaluation, and global community health. To accomplish this, we will recruit additional faculty and expand our collaborations to continue to grow our research and evaluation efforts.

2. We will develop research on the health priorities of minority women.

Professional Development and Training

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1. We will further establish a primary care residency program focused on community health, develop a pool of trained clinicians available to provide on-site training in community health and cross-cultural competence, and expand upon the Population Center’s Summer Research Department. We will accomplish this by recruiting additional faculty and expanding our collaborations to continue to grow our professional development and training efforts.

2. We will become a leader in providing training for providers in specialty care health care.

Community Education Programs

1. We will broaden our audience for the Research Department’s programming to include all members of the community, and be more national in scope. We will develop strategies for program development based on a matrix of target populations, methods, desired outcomes, and conceptual frames for planning.

Health Policy Research and Advocacy

1. We will maintain a mission-driven policy advocacy plan which is based on our research.

2. We will clarify internal decision-making and organizational relationships to ensure that policy goals are consistent across the Research Department/Boston Area Health Center.

3. We will produce high-quality, data-based publications to support our policy work.

4. We will exert a positive influence on global standards of care for community people.

Conclusionthe Research Department, from its early days as Boston Area Health Center’s Research Department, has long been an integral part in the overall organization’s success. The coordinated progress toward research, clinical, policy, and education/training goals that has contributed to Boston Area Health Center’s success will be even more important in a future that includes both expanding opportunities for international leadership and likely challenges in maintaining the levels of financial support required for continued community health research. The goals identified in this strategic plan are intended to guide the Research Department’s future growth in a way that benefits the entire Boston Area Health Center organization.

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Chapter Three: Development and Communications

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Development & Communications

Although closely aligned and connected, Development and Communications play separate and distinct roles in the success of an organization. And while communicating doesn’t always involve direct fundraising, it is a prerequisite for a successful development program.

The umbrella of a strong and strategic communications program covers far more than fundraising. It is the systematic planning and realization of information flow, communication, media development, and image care, managed within a long-term horizon.

Concurrently, fundraising couldn’t exist without communications to tell the organization’s story and show why donors should give. But a well-synchronized development plan requires much more than a broad delivery of the organization’s message. It also requires the active and participatory involvement of senior executives within the organization and a strong culture of philanthropy among the Board of Directors.

Recent changes have made the relationship between Development and Communications even more critical. The communications methods used by fundraisers have become more sophisticated than ever. Reaching and keeping donors now requires multiple communications channels. This requires familiarity with new and evolving technologies such as social media, e-mail, web advertising, and so on. But it also calls for increased personal attention to individual donors to deepen their relationship with Boston Area Health Center.

During the next few years, we will seek to amalgamate the relationship between Development and Communications to an even greater extent, and will reap the benefits of a well-integrated strategy.

Key Elements of the Development and Communications Strategic Plan

The Development and Communications Department has evolved since Boston Area Health Center’s last strategic plan was completed in 2004. At that time, there was a Development Department, but not a Communications Department (communications were then the responsibility of the Development Department). Looking back at our accomplishments therefore requires two separate perspectives: one that reviews our progress toward then-identified development goals, and a second that discusses the accomplishments of Boston Area Health Center’s communications efforts since that time without any prior benchmarks.

The Development and Communications Departments’ 2012 strategic plan includes a review of our progress since the completion of Boston Area Health Center’s last strategic plan in 2004, the SWOT analysis conducted by all participating departments (both of these are included with the others in the appendix of this plan), and a presentation of strategic goals for the next five or more years, separated into goals for development, and for communications, to better articulate our specific plans, and to express them in a way that facilitates the measurement of our success against these goals.

Five-Year Goals for Development’s 2012 Strategic Plan

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After reviewing a snapshot of where we currently are and how we got here over the past several years, our group identified several specific goals for both Development and Communications that, when successfully executed, will deliver powerful results for Boston Area Health Center. Below are the goals for Boston Area Health Center’s Development Department, followed by a second set of goals for Communications.

1. We will find more ways to engage and involve the Board of Directors in philanthropy

Considerable growth in Boston Area Health Center’s fundraising will depend on the example set by Boston Area Health Center’s Board of Directors.  Only if board members are willing to make a significant financial investment in their organization can we expect the wider community to do so.

Members of Boston Area Health Center’s Board of Directors will actively make Boston Area Health Center a philanthropic priority, and their top community philanthropic priority. They will make meaningful annual gifts that reflect this priority.

Development will be much more intimately involved in collaboration with the Membership Committee in proposing candidates, and in communicating and strategizing with them.

Special emphasis will be put on identifying new board members with the capacity to make significant five and six figure annual fund gifts an to connect us with others who can support Boston Area Health Center in a similar manner.

Board members will meet regularly with Development staff to assist and support the leadership giving of Boston Area Health Center.

We will update the guidelines for Board membership and make sure all Board members are clear on the role of philanthropy at Boston Area Health Center.

We will make annual fund participation and support of Boston Area Health Center’s development efforts a requirement for re-nomination for each two-year term.

2. We will move our leadership giving levels up at all gift amounts

Our current leadership giving levels range from $1,340 to $50,000.  However, of the more than 225 gifts at this level, 80% are at $2,500 or below.  While $1,340 is a good entry point for a “major” gift, we need to move the higher end range up to have significant annual fund gifts at the $50,000, $100,000, $250,000, $500,000 level and above.  This will include a strategy of moving donors from one level to the next ($1,340 to $2,500 and $10,000 to $25,000 for example) as well as engaging new donors to Boston Area Health Center at $50,000 level and higher.   

This will require time, consistency, and help from outside consultants. The results of success will make Boston Area Health Center a major player in the local and national philanthropic arena.

We will require additional support from development professionals with a proven track record of closing six figure gifts.

We will explore the establishment of a recognition vehicle for our most active supporters who have left the Boards of Directors and Visitors. Our goal will be to keep our most loyal supporters engaged (and thus financially supportive) of Boston Area Health Center.

3. We will build our donor base outside of Boston

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We will capitalize on the tremendous opportunity to build donors outside of Boston, specifically in areas like New York, Chicago, south Florida, San Francisco and Los Angeles.

We will build on the work of the Research Department as a primary connection for this effort.

We will maintain significant investment in this program even as results will not likely be immediately evident.

We will develop improved and more consistent communication about the work of the Research Department in the national media.

We will build collaborative and supportive relationships with community organizations in these cities/areas.

4. Boston Area Health Center will be the leading planned giving choice for the community in New England

Planned giving will be an important part of our long-term revenue stream and endowment growth.

We will build the infrastructure to support and grow an extensive planned giving program and hire the expertise to manage it.

Planned giving is a long term strategy. We will not likely see any return on our investment for at least 5-7 years. Within 20 years, we should be able to predict with a high level of accuracy an annual amount of anticipated revenue from planned giving.

A new giving society for long-time, consistent donors at any level will be implemented to identify logical targets for planned giving.

5. We will determine a longer term plan for Boston Area Health Center’s events

The current event structure has worked well for many years. Is there an opportunity to significantly increase revenue or attendance? If so, how will we go about realizing these increases? If not, what are the implications for our future events strategy? The Development team will lay out a separate SWOT analysis for the current events.

The events are becoming more mixed as time passes. Is it possible that at some point they may naturally morph onto one single event? We’ll need to analyze what the actual mix is…from a community perspective, or from an organizational perspective, or both.

6. We will build the endowment for Boston Area Health Center and the Research Department

Boston Area Health Center’s current endowment stands at about $2,000,000.

We will develop a clear and meaningful plan for growing the endowment. We will prepare a roster of specific opportunities, such as endowed

chairs or endowed programs. Planned giving will be a key to growing the endowment. We will build the endowment to $10,000,000 by 2020.

7. We will position Boston Area Health Center as an organization that's here to stay.

Successful organizations with mature fund raising programs have an aura of perpetuity about them.

Donors and prospective donors know that organizations like Harvard University, Mass General Hospital and the Boston Museum of Fine Arts

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will be here today, and tomorrow. Donors are more likely to support organizations that will be around for

the long term. Development will work closely with the Communications department to

build the Boston Area Health Center brand toward the concept of long-term sustainability for the organization.

Successful implementation of these development goals will result in several significant accomplishments:

We will have an engaged, active and philanthropically-driven Board of Directors. We will have a planned giving program that will deliver significant resources to

the organization on an annual basis, and will provide healthy growth in our endowment.

Our donor base will grow significantly in both diversity of donors and reach of influence.

We will see a healthy, consistent, and steady growth in the annual fund in the range of 8 – 10% per year.

Five-Year Goals for Communication’s 2012 Strategic Plan1. Articulate a clear mandate for the Communications Department

The Communications Department will own the communications process for the entire organization, including but not limited to patient acquisition communications, employee communications, etc.

The goals and purpose of the Communications Department will be clearly understood throughout the organization.

The organization will look to the Communications Department as a critical resource for assisting in departmental initiatives and programs.

2. Acquire and maintain up-to-date demo- and psycho-graphics on our key audiences

Key audiences will include patients, volunteers, donors, the media, event attendees, members of the community and other allied communities not familiar with Boston Area Health Center, and others.

We will acquire and manage the data that is necessary to better understand our audiences and how to communicate to their individual and specific needs.

3. Take an organization-wide, integrated approach to marketing and communications

This approach must be centralized for the entire organization, with dedicated resources adequate to establish a stronger marketing and communications effort that is both consistent for branding purposes and flexible enough to adapt to the individual needs of each operating unit.

We will address the need for a centralized marketing function at Boston Area Health Center, and will develop an integrated approach to marketing communications that will help manage customer relationships, drive brand value, and ensure consistency of our message across all media.

4. Foster an environment of two-way communications

We will make sure our communities and stakeholders have the ability and to communicate with us, and encourage them to do so.

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We will use input from key constituents to help shape and reshape the communication process.

We will make sure we can communicate with each other about us. We will develop effective cross-departmental communication systems to

provide truly integrated marketing communication. We will keep abreast of and utilize the latest technology (i.e.: social

media) to foster an environment of collaborative communication.

5. Dedicate the staffing resources necessary to achieve excellence

We will hire additional staff needed to achieve our goals of integrated marketing communications. These resources will enable us to focus on promotion/marketing of our ancillary services, national publicity, data management, target marketing, etc.

We will train current staff on new skill sets when necessary and possible. We will bring in additional skills and knowledge by hiring new staff or

using consultants.

6. Create reasonable metrics for measuring performance and ROI

We will invest in tools to help us establish a benchmark of our current position in key communication measurements.

Once we’ve established these measurements, we will determine where we want to be within a specified time period.

We will dedicate the resources necessary to achieve desired goals in the desired timeframe.

We will continue to measure standards in a consistent way to measure progress and determine the value of resources invested.

Successful implementation of these communications goals will result in several significant accomplishments:

Boston Area Health Center will become the thought leader for community health issues, both locally and nationally.

We will expand the national and international profile of Boston Area Health Center and the Research Department.

We will motivate and inspire the community and allied communities. There will be increased financial support for Boston Area Health Center and the

Research Department. We will create a personal/individual connection between each stakeholder and

Boston Area Health Center that will stand the test of time.

Conclusion

We’ve seen solid growth and accomplishments for both the Development and Communications groups over the past several years. We’re well positioned for continued growth and excellence in the coming years. With the proper investment in both of these areas, we will be able to capitalize on the favorable environment Boston Area Health Center has created to better spread the word about the tremendous work we do to broaden our level of support and the spectrum of those individuals and organizations who support us.

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Chapter Four: Resources and Organization

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Resources and OrganizationThis chapter of Boston Area Health Center’s 2012 strategic plan combines two broad terms: “resources,” and “organization.” Resources is a term that references the financial and physical assets required for Boston Area Health Center’s continuing operations and the operating systems that configure these assets into efficient support programs such as IT, data management, customer service, etc. Organization is shorthand for Boston Area Health Center’s human resources – the staff and volunteers who work within the organization, the structure in which they collaborate and communicate with each other, along with personnel-related systems such as succession planning, recruitment, staff training, etc.

Organizational elements of Boston Area Health Center participating in this chapter of the strategic plan include its finance and administration department, human resources, senior management, and the board of directors. Our plan begins with a look a four planning themes that apply to the entire organization, but which have a distinct priority for the people and systems represented in this chapter.

National and International LeadershipBoston Area Health Center is an increasingly important player in the national and international fields of health care, clinical research, provider education, and policy development. With this expanding leadership come new challenges and opportunities, many of which rise beyond the scope of individual departments such as clinical services, the Research Department, or development and communications. The entire organization must be poised for this role, and both senior staff and Boston Area Health Center’s central infrastructure people and systems will have important new responsibilities associated with our growing global responsibilities. “Hub and Spoke”The 2004 plan identified a “hub and spoke” conceptual organization structure for Boston Area Health Center, in which a central facility would include primary care, behavioral health, research, policy development, provider education, and the health center’s institutional infrastructure. This “hub” is home to the finance and administration department, which is responsible for much of the central infrastructure that must be responsive to the “spokes” where primary care and other direct services are provided to Boston Area Health Center’s patient population. Today, these spokes include such physical locations as the City Youth Health Center, Boston Area Health Center: New Neighborhood , and Boston Area Health Center: Sixteen. Conceptually, these spokes also include the Research Department’s clinical research, provider education, and policy development programs. In the future, Boston Area Health Center’s spokes may include other communities where community people and other communities needing Boston Area Health Center’s care call home, along with the expanding network of organizations and individuals collaborating with the Research Department and Boston Area Health Center throughout the world.

A Commitment to GrowthAs noted in the introduction to this 2012 strategic plan, growth will clearly be a part of Boston Area Health Center’s future. We may not know today the specifics of when or how this growth will evolve. We may not yet know whether it will begin with geographic expansion through more spokes, or the addition of new clinical services needed by our communities, or the addition of new research, education and policy programs at the Research Department. But in a world in which community people are aging along with the American population, where there are more community families with children, and where there is still a need for better understanding of various diseases, specialty care health, and geriatric health, it is clear that the need for new and expanded Boston Area Health Center services will continue.

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Managing UncertaintyExternal pressures on Boston Area Health Center will be unavoidable even as the organization seeks to fulfill its mission. Uncertainties about health care reform, federal funding for health care in general and various diseases services in particular, the national economy, and the future of the medical care system in Massachusetts must be evaluated, anticipated, and managed.

Planning for the next three to five years leads us to an expansive view of the central organizational core required for continued growth. Therefore, this chapter of the plan defines that core infrastructure to include senior staff, the board, and key outside advisors. Strategic planning for Boston Area Health Center’s resources and organization will involve succession planning for key staff; board development, recruitment, and engagement; and staff training and promotion programs to ensure bench strength for the future.

Key Elements of the Resources and Organization Strategic PlanGiven the context of the 2012 Boston Area Health Center Strategic Plan, the Resources and Organization chapter’s goals can be divided into three parts:

First is the completion of Boston Area Health Center’s historic expansion as it was envisioned in the 2004 strategic plan. This includes building out the final two floors of local, for expanded clinical services and the Research Department; completing the integration of the City Youth Health Center, Boston Area Health Center: New Neighborhood , and Boston Area Health Center: 16 into the larger organization; supporting the success of the Research Department; and expanding the physical and managerial infrastructure required for successful operation of dental and eye care services.

Second is a conceptual framework to guide Boston Area Health Center’s future growth. This includes staying on top of changes in the external environment; expanding both the hub and spokes of our organization structure when necessary; developing new services required by Boston Area Health Center’s target populations, including pediatrics for community families and elder care for an aging population; and supporting the growth of the Research Department and its unique research, education, and policy programs.

The third set of goals focus on how Boston Area Health Center adapts and expands its infrastructure to ensure continued success in a changing world. We must respond to change by changing our organizational structure in the right way, and at the right time. We must also define succession plans for the CEO, senior staff, and the board; assess and realign Boston Area Health Center's relationship with strategic partners; and prepare for growth that might be strategically planned, or a response to new opportunities. Specific issues such as staff training, customer service, IT, and recruitment will be part of this section.

Along with the other organizational units participating in Boston Area Health Center’s current strategic planning effort, the Resources and Organization team began with a review of its progress since the last strategic plan, and a SWOT analysis of our current situation. Documents summarizing these two processes are included in the Appendix of this plan. Because there was no formal Resources and Organization section of the 2004 strategic plan, our team organized its review of the past several years of our operations into six planning themes. These include:

Mission-driven growth: how Boston Area Health Center has expanded its services, its geographic footprint in Greater Boston, and its national and international leadership as a health care organization.

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Facilities: the specifics of Boston Area Health Center’s construction and acquisition of physical space, and how this space has been developed to house a growing Boston Area Health Center.

External influences on Boston Area Health Center’s growth: a look at the local, regional, national, and international trends in health care knowledge, practices, policy, funding, and other aspects of our industry that have and will affect our operations.

Internal systems to support Boston Area Health Center’s operations: an assessment of the infrastructure we will need to create and nurture in order to remain in our leadership position as a community health center and a global health care organization.

Organization structure: a review of Boston Area Health Center’s management and communications systems with an eye toward how these may need adjustment as growth continues.

Succession plans: a specific look at Boston Area Health Center’s senior leadership, on both a staff and board level, to ensure that effective leadership will remain as a key organizational asset in a rapidly changing world.

These planning themes are discussed in more detail in the Resources and Organization team’s summary of our progress since 2004.

Five-Year Goals for the Resources and Organization 2012 Strategic Plan Based on our analysis of Boston Area Health Center’s current situation, and a review of the six major themes within the finance and administration department’s span of control, we have identified the following goals for the next five years.

1. Continuing Boston Area Health Center’s Historic Expansion We will nurture the programs and services that are at the core of Boston

Area Health Center’s and the Research Department’s international leadership in care, research, education, and policy development.

We will maximize use of our current space through rational staffing and infrastructure development, and will market the use of this space to current and future consumers.

We will continue to inform Boston Area Health Center staff about the capabilities of our expanding infrastructure, and will train them to use these systems to their maximum advantage.

We will develop an organization-wide methodology for assessing the need for, and for the planning and management of future expansion.

2. Guiding Future Growth We will always know our target populations and will use this knowledge to guide

service and program development. This will include the addition of new clinical services, geographic expansion, and the development of strategic alliances.

We are committed to our “hub and spoke” conceptual organization structure and will use it to manage a growing Boston Area Health Center.

We will be flexible and ready for unforeseen opportunities.32

3. An Infrastructure for Future Success We will examine Boston Area Health Center’s staff organizational structure and

adjust it when required to continue the organization’s continued success.

We will develop succession planning for key individuals in staff and board leadership.

We will maintain and grow our strategic alliances in Boston, Massachusetts, the nation, and beyond to help achieve Boston Area Health Center’s goals.

We will continue to invest in Boston Area Health Center’s infrastructure systems – staff training, recruitment, customer service, IT, public relations, marketing, etc. – so that they will be capable of supporting Boston Area Health Center’s strategic growth. This includes systems that are located at the organization’s hub and its spokes.

We will ensure that our infrastructure for success is not only an organizational asset, but includes an understanding of our mission, vision, and values that live within each employee and volunteer.

ConclusionSuccess in achieving Boston Area Health Center’s strategic goals for its financial and managerial infrastructure will be measured in two important ways:

Tangible MilestonesThe implementation or improvement of specific systems and procedures designed to benefit the entire organization. One example of this type of success would be the expansion of training programs to help staff make the best use of Boston Area Health Center’s IT systems. Another might be the adoption of succession plans for the CEO and other key leaders. A third might be the formalization of customer service standards that are a consistent element of every interaction between Boston Area Health Center and its patients, partners, and volunteers.

Tangible milestones might also include the development of new service programs that are carefully considered, developed, and implemented as part of a long-term growth strategy. Examples of these services might include elder care for community people and pediatrics for children of younger patient couples. Other milestones in the fields of research, education, and policy development will also serve to measure Boston Area Health Center’s continuing success as a leading international health care organization.

A Constant Readiness for New OpportunitiesBoston Area Health Center’s leadership and core managerial team will succeed in guiding the health center through future challenges and opportunities if we are always well-informed about both the internal state of our organization and the external world in which we operate. More important, we will succeed if we are able to identify the opportunities that present themselves both internally and externally, and develop sound plans and programs to make the most of them.

Managing uncertainty will almost surely be a constant presence in Boston Area Health Center’s next five years, and maintaining our organization’s strong track record of not only seeing around the curve, but steering our health care organization through both good and difficult times, will always be a key element in Boston Area Health Center’s future success.

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Appendix 1: 2004 Strategic Plan Goals and Related Accomplishments

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2004 Clinical Strategic Plan and Related AccomplishmentsA list of Boston Area Health Center 2004 Strategic Plan goals and their outcomes demonstrates that this last period of Boston Area Health Center’s history has been one of marked growth in all clinical departments and partnerships. Highlights include the physical expansion of clinical spaces at Boston Area Health Center: New Neighborhood, the building of Boston Area Health Center’s new main health center in 2009 and the acquisition of the City Youth Health Center in 2010.

This expansion in physical capacity drove a significant increase both in total visits and in the number of patients served by the health center. In both the Medical and Behavioral Health Departments, for example, patient visits increased by approximately 50% in the last decade

New clinical services – including eye care and dentistry in 2009 and pulmonary care in 2011 – were introduced, and existing services – including gynecology, podiatry, anal colposcopy, psychopharmacology, and group behavioral health therapy – expanded significantly. Growth in clinical and retail pharmacy services has been, by far the strongest driver of financial growth at Boston Area Health Center, accounting for 50% of total revenue in the last fiscal year.

The addition of nonclinical and clinical support staff to clinical departments has greatly increased Boston Area Health Center’s capacity to interface with new communities and to strengthen existing ties through more vigorous outreach efforts, health education events, and marketing materials advertising the services Boston Area Health Center offers.

Boston Area Health Center has strengthened its relationship with Beth Israel Deaconess Medical Center over the last decade, and this has resulted in both a more seamless care connection between the two institutions with respect to patient care transitions, and a robust academic partnership aimed at training tomorrow’s community and community health providers.

Despite these achievements, several goals from the 2004 Strategic Plan have not yet been actualized. For example, despite Boston Area Health Center’s acquisition of the City Youth Health Center (which specializes in adolescent care) in 2010, a feasibility study and a plan for initiating a pediatrics program are still lacking. At the other end of the age spectrum, a comprehensive effort aimed at assessing the needs of seniors in our communities, and then implementing a multidisciplinary approach to meeting these needs has not yet begun.

Detail Strategic Plan 2004 Clinical Services Goals & Outcomes Organized by ten service-related sub-departments, following are the goals from our last strategic plan, with a brief summary of accomplishments for each goal.

Medical DepartmentThe medical department had three goals in Boston Area Health Center’s 2004 strategic plan.

Goal One: Increase number of visits 7% per year.Outcomes:

Visits increased from approximately 30,000 in FY2002 to 45,000 in FY 2010, matching the 7% growth rate forecast in the 2004 plan.

This growth was due to both increased demand and the expansion of Boston Area Health Center’s facilities during these years.

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Goal Two: Explore the feasibility of initiating a pediatrics program.Outcomes:

In FY2010, Boston Area Health Center acquired the City Youth Health Center. Children can be served in Boston Area Health Center’s dental and vision care

programs.

Goal Three: Increase the number of procedures performed by providers and expand specialty care services available on site.Outcomes:

Boston Area Health Center added multiple services over the past several years, including:

o FY2005: added anal colposcopy services (2005 and expansions in 2008 and 2011).

o Lumbar puncture service (2009). o Expanded cervical colposcopy and podiatry services (2010).o Contraception and pulmonary clinics (2010).

Behavioral Health DepartmentThe Behavioral Health Department had three goals in Boston Area Health Center’s 2004 strategic plan.

Goal One: Grow by 3% annually.Outcomes:

Visits increased from 20,000 in FY 2002 to over 29,000 in FY 2011, exceeding the target growth rate identified in the 2004 plan.

Accomplishments related to this increase include: o The beginning of behavioral health services at Boston Area Health

Center: New Neighborhood in 2008. o A significant increase in group visits, evidenced by a 53% increase in

such visits in 2010 vs. 2009.

Goal Two: Expand hours of psychopharmacology service.Outcomes:

Boston Area Health Center has doubled its psychiatry staff from 1.5 FTEs in 2002 to 3.0 FTEs in 2011.

Goal Three: Additional service expansion, including youth services, substance abuse services, medical social work, and victim recovery services. Outcomes:

In FY 2010, Boston Area Health Center acquired The City Youth Health Center, and also implemented a suboxone/opiate addiction program.

In 2011, two social work positions were added, a 50% increase since 2002. The victim recovery program also expanded by one FTE in 2011 for the first

time in ten years, due to new funding.

community health CareBoston Area Health Center’s community health Care program had one goal in Boston Area Health Center’s 2004 strategic plan.

Goal One: Identify and expand resources to respond to the community health epidemic in Outcomes:

In Greater Boston, Boston Area Health Center increased its various diseases patients from 1,000 in FY 2002 to 1,500 in FY 2011, an average increase of approximately 7% per year.

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Women’s HealthBoston Area Health Center’s Women’s Health programs had four goals in the 2004 plan.

Goal One: Provide key, unreimbursed services to women: AI Program related parent training programs, geriatric cancer support group, and geriatric health promotion series.Outcomes:

In FY 2008, we named a new Director of Women’s Health, and a Women’s Health Program Assistant was added, increasing Women’s Health support staff to 2.0 FTE.

In FY 2009, a Minority Outreach Assistant was added, increasing women’s health support staff to 3.0 FTE.

In FY 2010, a Women’s Health Education and Outreach Coordinator was added, increasing Women’s Health support staff to 4.0 FTE.

Goal Two: Develop a cohesive presentation of available services, programs, and projects; Enhance coordination across services and programs dealing with women’s health.Outcomes:

The Women's Health Team has thoroughly catalogued all of Boston Area Health Center's women's health services; this information is available in binder form on the clinical floors, and also in electronic form on the Boston Area Health Center webpage.

Boston Area Health Center now holds a semimonthly, multidisciplinary Women's Health Team meeting, which allows for better coordination of women's health services across the organization.

Goal Three: Identify and establish mechanisms to annually identify emerging health needs in the women’s communities in order to anticipate and guide resource development initiatives in underserved communitiesOutcomes:

Boston Area Health Center created a new Women's Health Outreach Coordinator position within the Women's Health Team in 2009, which has allowed the organization to create a larger presence at numerous outreach events in the community, and to better assess the needs of women through better dialoguing at these events. Thanks to the input obtained by the Women's Health Outreach Coordinator, we have been able to successfully implement new Women's Health programs at Boston Area Health Center, such as the initiation of free or low cost family planning services at the headquarters building and the delivery of a free wellness curriculum to female patients.

Goal Four: Present health promotion programs that offer prevention education addressing health issues confronting women of color.Outcomes:

Boston Area Health Center has increased its support of the annual Women’s Health Cancer Awareness Brunch, an event that seeks to gather women and their friends who have been affected by cancer. The event is now in its thirteenth year and moved from the campus of Simmons College to the headquarters building in 2009. Numerous educational and healing sessions take place in conjunction with the brunch, offering an opportunity for Boston Area Health Center to hear from women of color in particular.

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Men’s HealthBoston Area Health Center’s 2004 strategic plan included two goals for its MEN’S Health programs.

Goal One: Expand awareness and increase recognition of Boston Area Health Center’s prevention and wellness services for men and identify new resources for men’s health.Outcomes:

Boston Area Health Center has continued to increase patient volume, mostly through word of mouth in the communities we serve, but also through a greater presence in community outreach activities. Boston Area Health Center has partnered with organizations like Americorps to create outreach positions in the clinical departments. This has enabled Boston Area Health Center to, for example, set up information tables at more events serving the community. Boston Area Health Center clinical providers have also continued to support community outreach efforts by volunteering to give talks on health issues at numerous events.

Boston Area Health Center has worked closely with the Department of Public Health's Division of STD Prevention, in response to recent increases in syphilis and other STD incidence rates among people of color, to institute one of only three comprehensive STD clinics in the city of Boston. At these clinics, clients can receive various diseases testing, STD testing and treatment, immunizations against hepatitis, and counseling regarding safer sex and harm reduction -- all free of charge.

Goal Two: Develop a cohesive presentation of available men’s health services, programs, and projects.Outcomes:

Boston Area Health Center's clinical departments have worked closely with the Communications Department to create a comprehensive listing of services for men on the Boston Area Health Center webpage.

Specialty care HealthBoston Area Health Center’s Specialty care Health program had one goal in the FY 2004 strategic plan.

Goal One: Seek foundation and/or public funds to support multidisciplinary efforts to meet emerging needs of clients, and identify training resources re: specialty care health for the provider community.Outcomes:

Boston Area Health Center’s specialty care patient population grew from about 140 in FY 2002 to 600 in FY 2011.

This growth was supported by the formation of a multidisciplinary specialty care clinical team in FY 2006, including the hiring of a Specialty care Program Manager, and a revision of Boston Area Health Center’s specialty care health protocols in 2007.

Senior HeathThere was one goal for Boston Area Health Center’s Senior Health programs in the 2004 strategic plan.

Goal One: Seek foundation and/or public funds to support multidisciplinary efforts to meet emerging needs of clients, and identify training resources re: senior health for the provider communityOutcomes:

In FY 2002, a Senior Support Group was started.

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In FY 2011, Boston Area Health Center began to offer the senior support group as a free service when it no longer reimbursable through Medicare.

PharmacyThere was one pharmacy goal in Boston Area Health Center’s 2004 strategic plan.

Goal One: Utilize the pharmacy to meet patient needs, contribute to the organization’s financial health, and more readily participate in research studies.

Outcomes: Boston Area Health Center opened its first pharmacy in 2003, followed by a

second at Boston Area Health Center: New Neighborhood . By FY 2010, there were over $21 million in pharmacy sales, with two pharmacy

sites including retail and clinical pharmacy services.

LaboratoryBoston Area Health Center’s Laboratory had one goal in the 2004 strategic plan.

Goal One: Determine whether or not Boston Area Health Center will offer laboratory services.Outcomes:

In FY 2002, lab services were outsourced to Quest Diagnostics. In FY 2006, Boston Area Health Center’s then-headquarters outsourced lab

services to BIDMC. Lab services for Boston Area Health Center: New Neighborhood continues to be

outsourced to Quest.

Clinical PartnersThere was one goal in Boston Area Health Center’s 2004 strategic plan related to its clinical partners.

Goal One: Evaluate the current relationship with BIDMC and explore potential alternatives.Outcomes:

Today, Boston Area Health Center remains closely allied with BIDMC and BID Provider Organization for contracting, specialist and inpatient care, and the provision of laboratory and other diagnostic services.

Clinical TrainingThere was one clinical training goal in Boston Area Health Center’s 2004 strategic plan.

Goal One: Explore the development of an community focused community based primary care training program in collaboration with an academic medical center.Outcome:

Funded by the Health Resources and Services Administration (HRSA), FY 2010 saw the inauguration of BIDMC’s Primary Care Boston Area Health Center Track – the first community-focused residency training program in the country.

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The Research Department’s 2004 Strategic Plan and Related AccomplishmentsThe Research Department’s progress against its 2004 Strategic Goals is summarized below. Each of the nine goals from that plan is written in italics, followed by a summary of what has been accomplished and what remains to be done for that goal.

Goal One: We will need to attract new faculty, post-doc’s, and fellows through collaborations with Harvard Medical School and Brown University.Outcomes:

the Research Department faculty has expanded from 4 to 15 members. In 2010, the Research Department began a 4-week Summer Research

Department to train 18 pre and post-doctoral students in community health population research methods per year.

the Research Department works with an additional 20 pre and post-doctoral medical and public health interns per year through Harvard Medical School, Brown University and local, national and international academic centers.

Goal Two: Based on Boston Area Health Center’s long-history of health-related research (primarily various diseases-related), we wish to extend our research activities to community health issues.Outcomes:

the Research Department was awarded a 5-year infrastructure grant from NICHD in 2007 to establish the Center for Population Research in community Health.

Goal Three: We intend to expand federal and foundation support over the next several years.Outcomes:

Grant revenue for the Research Department grew from $3.3 million in FY 04 to a projected $8 million budget for FY 12.

The majority of funding continues to be from government sources. the Research Department has not successfully expanded foundation support.

Goal Four: We will need to seek philanthropic support for some of these efforts in order to fund cutting-edge research that would be less likely to receive government or foundation funding.Outcomes:

the Research Department has used general funds to support developing cutting-edge research in the following areas:

o STI intervention development with sex workerso Formative qualitative interviews with specialty care men and womeno Chart review studies of our local population and other patient chartso Infrastructure and pilot development with collaborators serving

disadvantaged individuals in India. o Developmental work on systematically capturing important health

information in electronic health records.o Developmental work addressing community aging research needs.o Developmental work addressing community youth research needs.

Goal Five: So that Boston Area Health Center Community Health can improve and expand its important role in training health care professionals, Boston Area Health Center Community Health will seek dedicated support for this purpose.

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Approximately $350,000 per year has been raised to support these efforts since 2006 resulting in the first medical text book focused on community health, companion lecture notes and slides for the text and a grand round series for 15 teaching hospitals throughout the country.

Goal Six: Boston Area Health Center intends to explore the development of an community focused community based primary care training program in collaboration with an area academic medical center.Outcomes:

Residency program with BI was expanded in 2008 from 3 to 6 residents. Weekly didactic sessions focused on various diseases and community health also began.

Additional funding was secured to develop an various diseases/community curriculum for the residency program in collaboration with Beth-Israel Deaconess (BI) in 2010.

Goal Seven: We will ensure the National Coalition for Community Health’s capacity to maintain a strong policy effort targeting Congress and the Administration focused on Healthy People 2010.”Outcomes:

Boston Area Health Center has continued to participate on and support the National Coalition for Community Health.

Goal Eight: We will also create successful programs that address specific problems – such as anti-minority community violence or teen suicide -- that can be replicated within other community-based organizations nationwide.Outcomes:

the Research Department has successfully adapted health navigation for various diseases prevention (2004- present), crystal meth prevention (2007-2010) and connecting people with various diseases to care (2001 – 2005).

From 2004 – 2008 and 2010 to present, the Research Department has worked with CDC to adapt and evaluate Disease Prevention interventions to better serve people of color.

the Research Department has not created new programs for anti-minority community violence or teen suicide.

Goal Nine: Appropriate consideration will be given to adding staff in a timely manner to deal with billing, compliance and data workloads.”Outcomes:

the Research Department staffing for compliance and data have expanded since 2004 from 3 to 10 full time staff members.

Dedicated contract and budget staffing for the Research Department has remained at 1 FTE.

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The Development Department’s 2004 Strategic Plan and Related AccomplishmentsThe Development Department participated in Boston Area Health Center’s 2004 Strategic Plan, and during that process, several goals were established. These most specifically focused around the need to prepare for a Capital Campaign to raise funds to support the construction of local, and to cover increased needs for operating programs and services. Development goals in Boston Area Health Center’s 2004 strategic plan are listed below, along with an analysis of how the organization fared in achieving them:

Goal One: Build Boston Area Health Center’s Development InfrastructureOutcomes:

Additional professional and support staff was hired, fundraising software was acquired and implemented, and consultants were used to help upgrade and professionalize the department.

The Boston Area Health Center Leadership Circle was launched, resulting in significant growth in gifts from major donors.

Boston Area Health Center optimized its use of events by increasing the net revenues from explicit sponsors, and creating more intimate cultivation and stewardship events, with a special focus on house parties.

We enhanced donor communications and recognition procedures, including disseminating a periodic letter from the Executive Director, publishing an annual report that includes donor lists and corporate financials, and redesigning our website.

Goal Two: Prepare Boston Area Health Center’s Development Team Outcomes:

Support the Board of Directors to optimize their own efforts to give and get on Boston Area Health Center’s behalf, and to provide overall philanthropic leadership to those inside and outside Boston Area Health Center.

Establish a Board of Visitors as a means to involve more volunteers in the life of Boston Area Health Center, groom a next generation of leaders, and expand the base of volunteers who will help support and guide the organization in the future.

Support, train, and build Development staff to work collaboratively with all of our constituents to achieve increasing levels of support and provide top quality service.

Engage a development consultant to provide strategic and operational advice to advance our readiness to both build our annual program and stage a successful capital campaign.

Goal Three: Instill a Culture of Philanthropy throughout Boston Area Health CenterOutcomes:

Develop a clear and compelling case for support of Boston Area Health Center that demonstrates why we are worthy of collaboration and financial contributions in a region with abundant other health care facilities and a range of important organizations serving various needs of the community.

Attract top volunteers and give them high-value-added opportunities to serve by governing, fundraising, sharpening and communicating our mission and vision, and more.

Make it easy for people to contribute what they want, when they want, and how they want. Additionally, we will make them feel appreciated for their support and comfortable in the knowledge of how we have used their philanthropy.

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During the years since the previous strategic plan, the Development Department has seen significant growth in the annual fund, from approximately $1,000,000 in revenue in 2004 to almost $2,100,000 in 2011. Donor numbers grew from 1,600 in 2004 to more than 2,100 in 2011. Growth in the Boston Area Health Center Leadership Circle program was impressive, growing from under 80 at the $1,000+ level in 2004 to more than 225 at the $1,340+ level in 2011. The Development Department oversaw a successful Capital Campaign, exceeding goals by raising more than $18.5 million to provide capital for the local building project. And defying industry trends, the annual fund showed steady and consistent growth during the Capital Campaign despite a very challenging economy.

The strong growth in the annual fund can in part, be attributed to the foundation provided in the 2004 strategic plan, but also to a successful communication program which significantly increased the visibility of Boston Area Health Center and the work done here.

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The Communication Department’s 2004 Strategic Plan and Related AccomplishmentsBecause the Communications Department was not part of the most recent strategic plan, there were no specific goals established for this function. However, significant progress has been made on many fronts.

In late 2004, Boston Area Health Center created a separate Communications Department and hired two staff people. Prior to that, the organization’s communications function was part of the Development Department. Since then, two additional staff people, a web designer and communications and design associate have been hired to enhance our online communications, graphic design, and social media capacity. However, in 2005, the Director of Communications was asked to also manage the Development Department, and much of the director’s time has been spent on growing the development efforts for Boston Area Health Center, with significantly less time dedicated to communications.

Boston Area Health Center’s web site was static and difficult to update in 2004. We redesigned the site and enhanced its interactivity, moved most of our event ticket sales online, created a robust e-mail communications program that includes two external e-mail newsletters, one staff newsletter and regular donor and event communications. We now oversee five separate web sites, including those for Boston Area Health Center and The City Youth Health Center, and have an active social media engagement program that operates across multiple platforms, including Facebook, Twitter and Foursquare. Monthly unique visitors to our main web site, www.Boston Area Health Centerhealth.org, have grown from 6,000 – 7,000 in 2005 to 16,000 – 18,000 in 2011.

A new graphic identity was introduced for the organization at the end of 2008, which included new logo treatments, signage, and a new graphic standards manual. Boston Area Health Center’s media profile has grown considerably since 2004, and we received widespread coverage around several events, including a number of research study results release in 2010 and the Research Department’s community health report in 2011. Our advertising and sponsorship program has also grown, allowing us to further increase our organizational visibility.

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The Resources and Organization 2004 Strategic Plan and Related AccomplishmentsThere was no separate chapter of Boston Area Health Center’s 2004 strategic plan for its Resources and Organization “departments.” Instead, centralized goals to support the mission-driven goals for the entire organization were included throughout the plan. In thinking about Boston Area Health Center’s centralized support goals for the 2012 plan, our team assessed Resources and Organization’s accomplishments over the past several years and its current status in terms of six central issues.

1. Mission-Driven GrowthThe delivery of health care to patients will always be at the core of Boston Area Health Center’s mission, vision, and values. As the organization grows in the coming years, questions about how that growth will take place, and whom Boston Area Health Center will serve, are paramount.

How will Boston Area Health Center choose to expand to new communities? Boston Area Health Center is recognized for the quality of its care in medicine, behavioral health, and health education and prevention. It is also known for the environment it has created for neighborhood residents and the community communities of Boston and the surrounding towns and cities. This geographic distribution of our patients provides an opportunity to explore establishing “spokes” where concentrations reside.

The Research Department continues to expand its international leadership in research, training, education, and policy work focused on various diseases, community health, and other clinical studies of our patient population. Its Center for Population Research in community Health; the HRSA funded National Collaborative Community Training Program that will train other community health centers; and its continuing global role in various diseases treatment and prevention research are just a few of the programs that will both deliver and require substantial resources in the coming years.

How will Boston Area Health Center add new clinical services to serve the changing needs of its target populations? Along with American society in general, the Boston community is aging, and senior care for this population is a need we anticipate meeting in the future. In addition, with more community families having children, Boston Area Health Center will add pediatric care to its clinical services. Through the Research Department, we will be uniquely positioned to identify what specialty services will be needed by community people in the future. Working with strategic partners, Boston Area Health Center can be a central actor in the development of a continuum of culturally competent care for them.

There is a substantial and growing need for behavioral health services in the community. Does this represent a “gateway” for Boston Area Health Center’s other clinical services, leading these patients to more fully utilize us as their medical home? Does the large and increasing demand for these services require careful planning and managerial efforts to guide Boston Area Health Center’s clinical growth?

While mission-driven objectives remain primary in our growth strategy, revenue concerns will always be involved in decisions about how, where, and when Boston Area Health Center will grow. Certain services are better in generating income than others, and balancing these competing needs will be increasingly important in a world where resources for health care may become more difficult to obtain.

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2. FacilitiesIn 2012, Boston Area Health Center is completing the build-out of its local headquarters, with the two final floors slated for occupancy by the Research Department and additional medical providers. Three years after its formal opening, our headquarters location is completely occupied, and additional space is required. Moving some non-clinical functions (the billing department, other finance and administration) to nearby leased office space has begun.

Other facilities-related issues that will need to be addressed in the next three to five years include further expansion of Boston Area Health Center: New Neighborhood to include expanded medical and behavioral health services and a larger pharmacy. The City Youth Health Center will need to be relocated as its lease expires, a situation that may be repeated at other locations shortly thereafter.

Boston Area Health Center’s first new building became too small for the organization within two months of its opening in 1991. We should remember this, and learn from the more successful example of local, which has handled Boston Area Health Center’s space needs for three years and will continue to do so for some time, the next time growth requires more physical space.

Boston Area Health Center’s hub-and-spoke conceptual organization structure is a fundamental consideration in planning for geographic expansion. Acquiring other organizations means taking on their space issues, as is now the case with The City Youth Health Center. Critical decisions about future locations will always be a priority at Boston Area Health Center’s central managerial hub.

Opportunistic expansion might take new shape in the future. In addition to outright acquisition of an existing organization, Boston Area Health Center might consider collaboration with another organization as another way to grow.

the Research Department is growing significantly, and will continue to do so. Due to the unique needs for in-person collaboration among clinical researchers, it may always be a requirement that the entire Research Department be located in a single building. This may inform the need for new Boston Area Health Center facilities in the future.

“We need a ten-story hub.” This comment from a current board member serves to illustrate the importance of getting it right when expanding Boston Area Health Center’s physical space. Our hub will always need to include specialty services that cannot be located in several spokes (mammography, bone density, other diagnostic procedures), and of course the health center’s administration, and senior leadership. Conversely, we will need to examine the optimal practice size for each of Boston Area Health Center’s spokes, and we may also learn that the needs of diverse populations within the community may require different locations to serve some of them.

3. External Influences on Boston Area Health Center’s GrowthManaging uncertainty is a primary responsibility for the leadership of any health care organization, and health care is facing a great deal of uncertainty in the next decade. Changing demographic trends and resulting new needs for health care services are one reason for this; shifts in government support for and regulation of our services are another; the actions of partner organizations such as Boston’s large teaching hospitals and other care providers are a third. Over the years, Boston Area Health Center has seen more than its share of these influences, and its ability to respond to them is a key factor in its success. Every era brings its own unique challenges and opportunities, and 2012 is no exception.

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Our population is aging. Along with American society in general, the local community is growing older, and with this shift, the need for medical services is increasing. Specialty care for individuals from all of our communities who are in their 60s, 70s, 80s, and beyond will be a larger component of future demand. Boston Area Health Center’s possible participation in assisted living programs or residential care for community people will be an opportunity to be considered. Along with its clinical department and the Research Department, Boston Area Health Center’s finance and administration department will be a key player in how we develop these new programs.

In addition to responding to the needs for pediatric health care in Boston Area Health Center’s growing neighborhoods, there are also more younger families with children. The needs for additional programs targeting young families, children, and youth will surely follow these demographic trends. With its long history of supporting community families dating back to one of America’s first community health center-based family health education programs in 1983, Boston Area Health Center is uniquely positioned to deliver and expand these services. The way in which these new services are introduced, managed, and funded will be a challenge for Boston Area Health Center’s institutional core.

Health care reform is likely to change the economics of health care in fundamental ways. As this plan is written, the future of the Affordable Care Act is unknown. Whether and how it is enacted will create a new environment for both government and individual payments for care. Like every other community health center, hospital, and doctor’s office, Boston Area Health Center will need to monitor these changes and respond to them in a way that will best preserve its financial security.

Government funding for health care will be increasingly strained over the next several years. Regardless of health care reform, future support from federal, state, and local agencies is likely to decrease. With many programs at risk, Boston Area Health Center’s various disease services may need to be financed in new ways. Boston Area Health Center has a long history of proactively addressing health care policy issues at the national level, including the Center for Population Research in Community Health, but this initiative may need to be augmented by other efforts to maintain support for Boston Area Health Center’s mission.

The Massachusetts health care system is changing. As other organizations wrestle with uncertainties in government funding and regulations, their degree of success may change. Boston Area Health Center will always need to maintain the strongest possible partnerships with allied clinical and community care institutions and managing the risk of our partners’ success will be increasingly important. Fortunately, Boston Area Health Center is and will continue to be an attractive partner for other health care organizations, and we may need to rely on this strength over the next several years.

Unknown opportunities and threats will always exist. We have referenced the acquisition of the City Youth Health Center in 2010 as an example of how Boston Area Health Center must be aware of the community around us, and nimble enough to act when such opportunities present themselves. As we manage the development of new services and programs based on our own vision of the future, we must always be ready to act quickly when our environment changes, for better or worse. This will require even stronger communication and collaboration among Boston Area Health Center’s departments, its senior staff, and the board in the future, as outlined in the communications chapter of this plan.

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4. Internal Systems to Develop as Boston Area Health Center GrowsBoston Area Health Center’s finance and administration department is responsible for much of the infrastructure that keeps the organization going on a daily basis – and maintaining this daily pace as growth accelerates in the future is a strategic priority. While the number and nature of its internal systems may change over time – ranging from IT to telephony, staff recruitment and training, marketing, and customer service – the way in which Boston Area Health Center approaches the challenge of maintaining them at the highest level of quality does not. We will always review them with three key questions: Is there room for improvement? When will be the best time to change or review existing systems? And, how do we systematically manage each as we grow?

Customer service –a key companion with the delivery of high-quality care – will be a priority. Maintaining high standards across multiple departments in an increasing number of geographically dispersed locations will test all systems. Customer service – where Boston Area Health Center meets consumers and the community every day – is an important success factor for continued growth, and must be managed to achieve organization-wide standards. To do this, we will need to define those standards in a systematic way, while at the same time instilling customer service as a value for every individual staff member and volunteer. While other departments move forward with new programs and services, the finance and administration department will need to keep everyone’s focus on this important core value.

All internal systems will need to be managed in a way that supports Boston Area Health Center’s “hub and spoke” organizational model. Constant review of each of them, with an eye for the support finance and administration can provide to ensure their successful operation, will be our department’s mission. We will do this by exploring the meaning of various metrics – patient satisfaction on one end of a spectrum, with organizational efficiency on the other – and using this information to develop and adjust systems for sharing data, insight, and resources from spoke to hub, and from hub to spoke.

Systems exist across the entire organization, but they also live within each of us. Customer service only works when everyone delivers it, on a personal level – to our consumers, to employees of allied organizations, to members of the community, and to our fellow staff and volunteers at Boston Area Health Center. The greatest IT system will not reach its maximum potential until staff members are trained in how to use it. The finance and administration department understands the importance of delivering services on both a macro and very personal level, and will continue to develop and maintain them with an eye on both of these priorities. Boston Area Health Center will never become a de-motivating bureaucracy, no matter how large we become in the future.

5. Organization StructureBoston Area Health Center’s significant growth in size has resulted in its staff more than doubling since 2004. With over 300 full-time equivalent employees, the issue of how to continue managing the organization in a way that ensures consistent quality of services, financial stability, and its historic entrepreneurial values is often raised, along with several corollaries. What drives the need for organizational change – dollar value of Boston Area Health Center’s annual budget, employee head count, or some other factor? What are the signals that organizational change might be needed, and how can senior management and the board monitor Boston Area Health Center’s operations to receive those signals in time to act? Further down the line, how do we balance a theoretical look at Boston Area Health Center’s organizational chart with a recognition of the strengths of the individuals who hold key positions in leadership and management? How equipped are others on our management team for advancement? What is the right time to promote them?

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Boston Area Health Center has long operated with the belief that there is more than one right answer to many of these questions. The important element in designing Boston Area Health Center’s organization structure is to accurately understand and describe the challenge. The finance and administration department will provide key information to support these strategic adjustments in the coming years.

Growth will continue, and it will have an impact. Other chapters of this plan describe how Boston Area Health Center will grow, in terms of patient visits for existing services, the development of new programs, and geographic expansion. Each of these will test our organization and the continued successful balance of systematic efficiency and entrepreneurial creativity.

Growth will occur at different rates throughout the organization, and with different demands for managerial effort. the Research Department is growing rapidly, and much of its growth comes through the addition of large new initiatives requiring significant additions of staff. The pharmacies may dramatically increase their revenue contributions to Boston Area Health Center, but these increases may not need the same degree of attention from our core management infrastructure. In planning for growth and how to guide it, we must pay attention to where and how growth is occurring throughout the organization. One size will not fit all.

Monitoring and communications systems will be key. Boston Area Health Center’s hub and spoke model will require increasingly sophisticated managerial effort, and paying attention to the ways in which senior leadership and the board maintain an accurate picture of Boston Area Health Center’s overall functionality is a primary challenge for the finance and administration department. Deciding what can be managed within an individual department, what needs the attention of Boston Area Health Center’s central finance and administrative staff, and what requires the attention of senior management and the board will be a priority for everyone, but it will require discussions based on information the finance and administration department will supply.

Growth will require expanding leadership and professional talent. The need for more entrepreneurial energy at Boston Area Health Center’s spokes is one reason to increase efforts to recruit, train, and retain managerial talent. The development of “bench strength” prepared to lead the organization in the future is another.

Growth and bureaucracy can also put pressures on a mission-driven organization – sometimes diluting the value employees find in the mission. Boston Area Health Center will remain focused on its mission and on motivating the entire organization with that mission – avoiding this potential bureaucratic trap.

6. Succession PlanningBroadly defined, succession planning includes three different priorities: emergency succession planning for the chief executive, other senior staff, and board members; developing procedures for managing transitions as staff in additional key positions retire or leave the organization; and planning for the promotion and related training of junior managers and volunteer committee members as they assume more senior positions in the organization. These are all important responsibilities for Boston Area Health Center’s human resources professionals, and the finance and administration department is committed to working with senior staff and the board on development of procedures, guidelines, and contingency plans to handle each situation.

Emergency planning begins with the chief executive. Boston Area Health Center must have plans in place for the unplanned departure of this key leader, and

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these plans need to cover a number of important priorities to assure the continued successful operations of the organization. An interim CEO must be named to assume leadership and manage Boston Area Health Center through the transition period. Key partners and other organizations must be notified to maintain their confidence and support during this sensitive time. The board must be engaged to lend their skills and energy to interim management and the search for a permanent CEO. The search process for a new CEO can be planned in advance to minimize disruptions. And finally, institutional records the interim and new CEO will need to manage Boston Area Health Center can be maintained so that they are easily accessed when needed, and the board will schedule an annual review of these plans to make sure they are up-to-date.

Succession planning goes beyond the CEO to include other key staff and board members. As Boston Area Health Center grows, other leadership positions may require similar emergency succession planning. However, these plans must not become so detailed as to remove Boston Area Health Center’s ability to be flexible and entrepreneurial, particularly at sensitive times. The plan developed for the CEO can be used as a model for these other plans.

Board succession and board training are responsibilities that include recruiting new leaders to the board, defining their responsibilities in terms of governance, planning, and philanthropy, and educating them about the organization and its many programs and services. Board training must also provide a mechanism for understanding how their responsibilities will change over time. Board succession involves the identification of future board members from the board of visitors and other sources, and planning for leadership development once new members join the board itself. Senior staff and the development department can facilitate these activities and provide information when needed, although other departments may be more active in identifying candidates for board membership.

Staff development is primarily the responsibility of Boston Area Health Center’s human resources department, and as such will be managed by the finance and administration department, where human resources is currently located.

Departure-related succession plans are already in place and can be documented for review when required; staff training and development are addressed in this chapter of the plan under “systems.” One addition to these plans includes planning for the transition time as one employee leaves and his/her successor arrives, including “on boarding” and mentoring programs.

Senior management will develop reporting tools to inform the board of these plans on a regular basis so that there is appropriate understanding of all these succession planning strategies by the volunteer leadership of the organization.

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Appendix 2: SWOT Analyses for Each Department

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Clinical Services: Strengths, Weaknesses, Opportunities and Threats (SWOT) AnalysisFollowing is a summary of the Clinical Departments’ SWOT analysis, conducted in late 2011 as part of the strategic planning process.

Strengths

Boston Area Health Center’s clinical strengths are many. Our clinical staff is mission driven, well-trained, and experienced. A low staff turnover rate allows for incremental skill-building and continuous improvement, both in quality of care and in levels of customer service. The presence of a well-established electronic medical record (EMR) and other health information technologies translates into greater patient safety and communication enhancements. The ability to serve patients at three clinical sites affords Boston Area Health Center the opportunity to reach more communities than ever. Having onsite pharmacy and lab services is a convenience to patients and providers that also allows us to provide life-saving medication and diagnostic testing to the neediest members of our community. Expanded access of clinical services – including evening and weekend hours and a focus on same-day appointment availability – means more patients are able to get the appointment that they want when they want it. Finally, Boston Area Health Center’s contractual alignment with the Beth Israel Deaconess Provider Organization (BIDPO) has resulted in more favorable reimbursement rates for care involving commercially insured patients. These clinical strengths have helped to boost Boston Area Health Center’s clinical reputation as a leader in community health and various diseases care.

Weaknesses

Despite these strengths, there are key weaknesses that require attention and improvement. Some of these – such as the high workload, high administrative burden, and low reimbursements attached to primary care and behavioral health fields relative to other clinical specialties – are external to Boston Area Health Center and very difficult to control. Other weaknesses are less external but still require input and cooperation from outside sources. A good example of this is our current technological interface with BIDMC’s many clinical information systems – an interface that we have continued to strengthen but which still falls short of our goal of having completely bidirectional flow of patient data. Our most key internal weaknesses are almost all tied to the unprecedented growth of the health center over the past few years; these include excess demand for behavioral health and dental care, and a lack of adequate support staffing and middle management in some clinical departments. Some 2004 Strategic Plan goals that have not yet been met – such as the lack of a plan for adding pediatric care and strengthening senior care – represent other weaknesses that are worth noting in this analysis.

Opportunities

Still, there are several promising opportunities that lie ahead for Boston Area Health Center’s clinical departments. Our new practice management system, slated for implementation in Winter 2010, will facilitate appointment scheduling, recording of demographic data, and population-based care via registries. The telephony system that was implemented in 2009 will continue to allow for better monitoring of, and improvements in, customer service. Health information technology upgrades slated for fiscal year 2010-11 will usher in e-prescribing, electronic billing and lab ordering, and dashboard-style care management of chronic illnesses like diabetes and various diseases at the provider panel level. The dearth of primary care services relative to the demand for them in our community suggests that there will continue to be a favorable environment for physical and service expansion. Current national and state health care

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reform efforts focusing on the development of patient centered medical homes and alternative payment models may ultimately lead to the prioritization and incentivizing of preventive care, early intervention, and population based care programs that Boston Area Health Center has already engendered.

Threats

Several significant challenges exist today that stand in the way of realizing our vision for clinical services at Boston Area Health Center. The soaring cost of health care, and the response of key entities to these cost increased, (including federal/state/local governments, commercial payors, hospital systems, and professional organizations), has the potential to significantly alter the entire health care landscape in unpredictable ways over the next decade. Looming federal and state budget cuts driven by current deficit reduction efforts constitute an additional financial obstacle to Boston Area Health Center, which received over $11 million in contract and grant revenue this past fiscal year. Health services currently receiving these funds include but are not limited to various diseases testing, treatment, and prevention programs; public immunization clinics; substance abuse treatment programs; dental programs for people living with community health; our pharmacy’s 340b program; and our Violence Recovery Program.

At the local level, still more key challenges exist. Metropolitan Boston has among the highest health care costs in the country. The Massachusetts State Attorney General’s Office has, for the last two years, investigated these high costs and aims to continue to study the drivers for health care price increases. Future study results may lead to legal action on the state level that has the potential to significantly change the way that health care entities work with each other and even provide care to patients.

In short, there are multiple external threats to Boston Area Health Center’s stability. Clinical department directors will need to work closely with our Executive Team and Board of Directors to anticipate funding and policy trends and inform policy efforts.

In addition to the extrinsic challenges that await us, Boston Area Health Center must also be mindful of its own internal threats. These include the potential for problems with our technology implementation and maintenance plans, with a subsequent negative impact on our ability to prepare, provide, and bill for services. The consequences of growth that is too quick can include gaps in quality/customer service or relative staffing shortages. Finally, there is always the possibility that Boston Area Health Center will not continue to attract a diverse applicant base, with a resulting inability to reach out to, among others, communities of color.

As we grow and expand it will be an ongoing challenge to maintain a balance in our mission to serve the community populations and neighborhoods within which we are located, in order to preserve our unique identity as a leader in community care.  The community aspect of our mission has been one of the driving forces behind the recruitment and retention of many of our highly skilled providers, and changes in our populations could affect both staff recruitment and retention as well as Boston Area Health Center leadership position in community health care.  We will need to consciously plan strategies that address our growth while maintaining our "niche" identity.

The Research Department:Strengths, Weaknesses, Opportunities and Threats (SWOT) AnalysisFollowing are summaries of the SWOT analysis conducted at the beginning of the

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Research Department’s strategic planning process in 2011.

Strengths Internal capabilities: the Research Department has strong administrative and

scientific leadership, an enthusiastic, diverse and committed staff, an ability to develop sophisticated grant proposals, and the capability to implement complex projects. the Research Department is made up of a multidisciplinary team with a can-do attitude, who can be nimble and flexible enough to take advantage of opportunities that are both planned and unforeseen. Our close relationship with the clinical departments is a key asset in our work. We value and provide strong mentorship of the next generation of researchers, health professionals and advocates. We have recently expanded our program evaluation capacity.

Nature of the work product: the Research Department has the ability to translate research into clinical training and community education quite seamlessly. We produce and disseminate high quality, cutting edge texts, papers and other products. We have a strong compliance program and our own IRB, which closely monitors our research work and ensures it is of the highest quality.

the Research Department’s reputation: We have an existing national and international presence. the Research Department has a reputation for doing high quality work and has developed unique research capacities, especially around various diseases prevention and community health research. Students seek opportunities to train with us as they develop into community and various diseases researchers, clinicians and advocates.

Weaknesses Infrastructure support for the Research Department: the Research

Department’s growth has been rapid and this continued growth may test Boston Area Health Center’s ability to provide the necessary support at the same speed. This was especially noted around IS/IT support, communication/marketing and workspace. Data security limitations could also put us at risk for serious violations which could impact our reputation and work.

Communication: the Research Department is Boston Area Health Center’s best-kept secret. We lack a clear way to communicate with the media, our donor base, internal staff and volunteers, and to the broader community about the Research Department’s work.

Diversification of funding: the Research Department has developed expertise in preparing successful grant proposals for federal funding. However, little work has been done to solicit foundation and private philanthropic funding for the Research Department. As a result, the Research Department is susceptible to the ups and downs of government funding priorities.

Diversification of the Research Department’s faculty: the Research Department has little racial/ethnic diversity among its faculty.

Strategic planning: the Research Department has been quite opportunistic and should be thinking more strategically about where we are headed with 5-year goals and a method to evaluate progress along the way.

Opportunities

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New areas of work: Despite all of the Research Department’s growth, areas for continued expansion remain. They include research and clinical training grants; work in strengths-based various diseases prevention; diversification of study populations, especially among people of color and minority women; creating replicable program models; and developing a bio-statistical core to help with dissemination of study findings.

Global Leader: the Research Department has developed a reputation for doing high-quality work that directly benefits the health of people in the community and others in need. We can better communicate these accomplishments to broader audiences, leading to new development opportunities. Our reputation also provides us with the opportunity to attract additional faculty to further diversify our work. With all of this going for us, the Research Department has the chance to develop into the leading community health organization in the world.

ThreatsChange in landscape: Federal funding continues to shrink in areas where the Research Department has historically received the most support. Additionally, changes in political leadership at the state and national level could affect the priority community health are given. Also, the field is becoming more competitive, with other academic institutions beginning to develop community health programs that will compete for similar resources.

Integration: As the Research Department grows, there is concern that the divisions within the Research Department may become more segregated versus more integrated. Similarly, the different departments of Boston Area Health Center are so busy that it is harder to integrate work efforts toward common goals.

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Development and CommunicationsStrengths, Weaknesses, Opportunities, and Threats AnalysisSeparate analyses were conducted for each of the Development and Communications Departments. They are summarized in this section of the appendix.

Strengths, Weaknesses, Opportunities, and Threats for DevelopmentStrengths:

We have a strong focus on donors and the growth of the major gift program. Boston Area Health Center’s revenue stream has diversified across categories

such as government support, individual donors, event revenue, and other sources.

There has been steady growth of the annual fund in recent years.

Weaknesses: There is still limited participation by the Board of Directors in support for the

organization’s philanthropic activities. We need to develop a specific community and Boston-area donor base for

Boston Area Health Center. We have little or no demographic information about many donors and

prospects. Our focus on Boston Area Health Center’s major fundraising events, while

successful, is also a drain on the organization’s staff resources.

Opportunities: Boston Area Health Center needs to further engage the Board of Directors and

Board of Visitors in its philanthropic efforts. The Planned Giving program can be significantly expanded. With national messaging, Boston Area Health Center can broaden its base for

support. We can broaden our engagement with former Board of Directors and Board of

Visitors members who have shown an extraordinary level of support for Boston Area Health Center.

Threats: The current economic climate and legislation potentially affecting tax laws for

charitable contributions may lead to decreased individual support. Health care reform is a major uncertainty. Competition from other community groups and a growing national focus on

healthcare-related political activity may divert some potential supporters from Boston Area Health Center to other organizations.

Strengths, Weaknesses, Opportunities and Threats for CommunicationsStrengths:

We have developed a strong website and online communications. Boston Area Health Center has embraced the trend of increased sophistication

of its overall communications program and the support this program can provide to development and other organizational units.

Boston Area Health Center has capitalized on its long-standing brand equity with efforts to further brand the overall organization and many of its operating units.

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Weaknesses: As a new and growing department, communications has yet to develop a clear

mandate for its efforts within the larger organization. There are inadequate staffing and other resources for such specific functions as

media relations and coordination with Boston Area Health Center’s growing operational units.

We still lack of data on stakeholders and audiences.

Opportunities: Boston Area Health Center is in an excellent position to provide thought

leadership on messaging for a broad range of community health issues. We can integrate our messages to specific and diverse populations, leveraging

the notion of Boston Area Health Center as a key part of these larger “communities.”

We can increase our use of technology for more powerful and effective communications initiatives.

Threats: There is increasing competition for people’s attention, particularly in the

community. As Boston Area Health Center grows, the complexity of our message increases,

requiring more efforts on focusing and targeting our communications efforts. Is there a growing “post-local resident” mentality in America, and, if there is,

how will it affect Boston Area Health Center, given our clear identity as a primarily local community organization?

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Resources and OrganizationStrengths, Weaknesses, Opportunities, and Threats (SWOT) AnalysisStrengthsBoston Area Health Center’s organizational core has a number of key strengths, among them a clearly-defined mission, and the fact that this mission is supported by the entire board and staff. A high percentage of our employees rank Boston Area Health Center as a great work environment, not only because of our mission and service programs, but also due to Boston Area Health Center’s commitment to our employees, evidenced by a competitive pay and benefit package, and efforts to maintain a strong staff team. Boston Area Health Center also commits resources to maintaining up-to-date systems and equipment, including electronic medical records, IT, and telephony, and long-standing efforts to diversity both inside the workplace and in the community. Boston Area Health Center’s strong financial position is also a key asset, and is the result of consistent support from individual donors; and organizational partners including hospitals, associations, government agencies, foundations, and businesses throughout Boston, Massachusetts, and the United States. Boston Area Health Center has also long enjoyed a loyal following in many of these communities.

WeaknessesChallenges related to Boston Area Health Center’s current organization include the work required to manage multiple geographic sites in a rapidly-growing organization. There is also a need for more training in the development of a team approach among clinical staff. Boston Area Health Center’s rapid growth in facilities has outpaced some staff’s ability to utilize it to its maximum potential, and training is also needed in IT, telephony, and other systems. Maintaining consistency across the entire organization, including continued commitment to our mission; development of paths for career growth among our staff (and the attendant training to accomplish this goal); and a focus on customer service will also be among Boston Area Health Center’s challenges over the next five years. Finally, there is a need to address succession planning for the chief executive, senior management, and the board, to ensure continued and consistent guidance of Boston Area Health Center’s future growth.

OpportunitiesKeeping up with demand is perhaps the best way to describe the opportunities before Boston Area Health Center in the coming years. This includes an ever-increasing number of patients at all locations, the growth of the Research Department’s many programs, the continuing evolution of Boston Area Health Center’s Patient-centered Medical Home model of care, and the local impact of health care reform. For example, our patient population is aging, and there is also growth in the number of younger patients with children; both of these demographic trends will provide opportunities for service development. Having a diverse staff is also important to us; expanding diversity among the board, senior management, researchers, and providers requires consistent effort. Boston Area Health Center has an opportunity to build its endowment as a buffer for future financial requirements. The finance and administration department and senior staff are in the best position within the organization to assist Boston Area Health Center in developing training programs at all levels, from staff and board development to customer service and software utilization. Boston Area Health Center can also cultivate stronger relationships with government, not just for funding, but in the regulatory and political arenas.

Threats58

The same outside environment that brings so many opportunities to Boston Area Health Center may also be the source of roadblocks in the way of continued success. Health care reform may falter, and other reliable sources of funding in the past may no longer be available, even beyond the impact of a sluggish economy, should that continue. In addition, changes in health care reimbursements may put significant pressure on the leading hospitals in Boston, which could add additional uncertainties to the delivery of patient care. Shortages of clinicians at our partner hospitals and other health care institutions in Boston may bring new challenges in referring our patients for specialty and institutional care. Regulatory requirements may place additional burdens on our medical providers and on Boston Area Health Center’s financial office in terms of reporting and other staff-intensive procedures. Boston’s highly competitive market for health care professionals and its high cost of living may make the recruitment of future clinical staff challenging. Customers also have a choice, and people can increasingly go elsewhere for services in today’s competitive health care market. Finally, growth itself could present a threat to Boston Area Health Center if the organization does not manage growth-related challenges in a clear and effective manner.

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Appendix 3: Agenda, Annual Department Strategic Plan Updates to the Board of Directors

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Agenda: Planning Teams’ Annual Reports to the Board of Directors

At our June 2, 2012, Strategic Planning Retreat, participants agreed on a method for translating each team’s broad goals into action. Every year, each of the five teams will report to the Board of Directors on the progress toward its strategic goals. This report will include a review of progress to date, and plans for the next year. There will be an emphasis on specific and measurable accomplishments, and these measurable results will be used to shape future plans.

The benefits of this approach will be twofold. First, it will encourage active pursuit of Boston Area Health Center’s strategic goals in a practical way, so that our collective progress can be understood in measurable terms. Second, by the time Boston Area Health Center embarks on its next strategic plan, each team’s series of annual reports will form a strong foundation for that process.

The five teams reporting to the board will be: Clinical Services the Research Department Development Communications Resources and Organization

Reports will be structured to follow the goals included in this strategic plan, and will begin with two broad questions:

Are these goals still applicable to our team? If not, what changes are needed and why?

What has been our progress toward these goals? What is the plan for achieving our goals in the coming year?

Specific measurements will be developed by each team and shared with the board. At our June 2 retreat, we discussed a range of what these measurements might be. Possibilities included specific numbers, such as a target growth rate, or number of patient visits, or dollars raised. Alternatives might be letter grades for a team’s relative success, or colors – green for “well under way,” yellow for “some concerns,” and red for flagging problem areas.

It was noted that much of this discipline is now used by the board in the annual budget process, so the agendas for these planning reports can draw on that experience. As the board discusses the reports made by our planning teams, there may be a need to revise the monthly dashboard included in management reports based on these discussions.

Additional topics discussed in our strategic planning process, including leadership succession for staff and board leaders, and customer service, will also be brought to the board for further development.

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Appendix 4: Summary Organization Chart

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Boston Area Health Center Organizational Chart by Major Departments

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Appendix 5: Statement of Ethics

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Boston Area Health Center Community Health Center, Inc.Statement of Conduct and Ethics

This Statement of Conduct and Ethics has been adopted by the Board of Directors of Boston Area Health Center Community Health Center, Inc. (“Boston Area Health Center” or “Boston Area Health Center”) in recognition of Boston Area Health Center’s legal and ethical responsibilities to its patients, clinicians and other employees, its funders and the communities we serve. It is the responsibility of those affiliated with Boston Area Health Center - directors, administration, clinical staff and other employees - to act in a manner that is consistent with this Statement. Because this Statement cannot answer all questions raised in the context of furthering Boston Area Health Center’s charitable mission, the directors, officers and employees of Boston Area Health Center must take responsibility for recognizing and responding appropriately to specific situations as they arise. If an employee has any question about the requirements of this Statement or the appropriateness of a relationship or action, he or she should consult with his or her supervisor; or in the case of a director or officer, he or she should consult with the President or a member of the Executive Committee.

Compliance With Laws, Regulations and Professional Codes of ConductAs a non-profit entity, Boston Area Health Center has a legal and ethical obligation to act in compliance with applicable laws, to engage in activities in furtherance of its charitable purpose, and to ensure that its resources are used in a manner which furthers its mission. All directors, officers and employees must comply with, and must endeavor to ensure that Boston Area Health Center complies with, all federal, state and local laws and regulations applicable to Boston Area Health Center. Directors, officers and employees are expected to use good judgment and common sense in seeking to so comply and to ask for advice when they are uncertain about what is required.

In addition to the policies set forth in this Statement, professional employees of Boston Area Health Center are obligated to perform their duties in full compliance with the codes of conduct and ethics that apply to their professions.

Integrity and Fair DealingBoston Area Health Center requires candor, honesty and cooperation from its directors, officers and employees in the performance of their responsibilities. We are committed to act with integrity in all of our activities and to treat Boston Area Health Center’s patients and the many other constituencies that we serve with the utmost respect. Directors, officers and employees should endeavor to deal honestly, ethically and fairly with any patient receiving care at Boston Area Health Center and with entities doing business with Boston Area Health Center.

Ethical Responsibilities to PatientsWe will treat all patients with dignity, respect, and courtesy. All patients (and/or their significant others or designees) will be involved - to the extent that it is feasible - in decisions regarding the care that we deliver. We will inform patients about treatment options and the risks associated with these treatments. We will constantly seek to understand and respect their objectives for care.

We respect the dignity of our patients, regardless of the nature of their health problem, gender, race, ethnicity, national status, or social status. In all circumstances, we will attempt to treat patients in a manner appropriate to their backgrounds, cultures, religions, and heritages.

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Regardless of the settings in which this organization provides patient services, we will follow well-designed standards of care based upon patient needs and the best available scientific evidence. We will provide services only to those patients for whom this organization can safely provide care. As we strive to provide care that meets the highest standards of quality, we will work to provide it in the most cost-effective manner.

Transfers of patients to other facilities due to a medical condition requiring treatment beyond Boston Area Health Center’s capabilities are done only with agreement of the receiving facility and with careful attention to accurate and complete communication regarding such transfers.

Clinical decision-making is based on patient need without regard to how Boston Area Health Center compensates its officers, clinical staff and other employees and licensed independent practitioners. Boston Area Health Center and its clinical staff will invoice patients or third parties only for services actually provided to patients, and will provide assistance to patients seeking to understand the cost of their care. We will attempt to resolve questions and objections to patients’ satisfaction.

Services are provided based on patient needs, regardless of payer source. Patients in need of our services will not be turned away due to inability to pay. The organization will take steps to assist patients in securing health care benefits for which they are eligible.

Ethical Responsibilities to EmployeesWe treat employees respectfully and fairly. We are guided in our relationship with our employees by several key principles. These include:

We provide equal employment opportunities irrespective of a person’s race, color, religion, sex, age, national origin, sexual orientation, gender identity, or disability.

We provide a work environment that fosters open communication and employee participation.

We strive to provide a work environment that ensures employee safety and well-being.

We provide equity in compensation and benefits.

ConfidentialityBoston Area Health Center recognizes the critical nature of maintaining the confidentiality of patient-related information. As such, patient information will not be shared in an unauthorized manner, and sensitive information concerning personnel and management issues will be maintained in the strictest confidence and accessible only to those individuals authorized to review and act upon such information. Directors, officers, clinical staff and other employees will comply with all laws, regulations and policies in regards to the management of protected health information.

Resolution Of Conflicts In Patient Care DecisionsWe recognize that conflicts may arise among those who participate in patient care decisions. Whether this conflict is between members of administration, clinical staff, employees or directors, or between patient caregivers and the patient, family, or significant other, we will seek to fairly and objectively resolve all conflicts. In cases

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where mutual satisfaction cannot be achieved, it is Boston Area Health Center’s policy to involve the patient advocate or the administrator on call to oversee resolution of the conflict. Other staff and second opinions will be involved as needed to pursue a mutually satisfactory resolution.

Relationships with Outside Organizations and AgenciesBoston Area Health Center works with many organizations and agencies as it strives to meet its mission. We search for opportunities for collaboration with community agencies and organizations, educational institutions, and other health care facilities to promote medical research and education, and improve the community’s health and wellness.

Boston Area Health Center makes legally required and appropriate disclosures to government agencies that regulate Boston Area Health Center, to Boston Area Health Center’s auditors and to others as appropriate to their duties in relation to Boston Area Health Center. We cooperate with proper authorities by meeting our public health reporting requirements. These include reporting cases of suspected abuse and violence, infectious diseases and reportable events.

Books, records and accounts are maintained in accordance with all applicable regulations and standards and accurately reflect the true nature of the transactions they record. Directors, officers, clinical staff and other employees are responsible for the accuracy of their records and reports. Information disclosed to outside organizations and agencies will be complete, fair, and accurate.

Marketing and FundraisingWe will fairly and accurately represent Boston Area Health Center in all our communications in accordance with all applicable state and federal laws. Boston Area Health Center’s marketing and public affairs programs are designed to inform interested parties about our physicians, programs, and services. Marketing and public affairs programs include, but are not limited to, advertising, direct mail, media relations, publications, sales promotion, public policy advocacy, speaking engagements, events, and seminars.

Statements by directors, officers and employees about Boston Area Health Center’s services should not be misleading. We are committed to promoting truthful and accurate information at all times to all audiences. Our marketing and public affairs programs shall comply with the ethical standards of leading industry and professional associations, including the American Hospital Association, American Association of Advertising Agencies, Direct Marketing Association, Public Relations Society of America, American Marketing Association, and Foundation for Public Affairs.Boston Area Health Center raises funds for its programs and services. We recognize our responsibility to ensure that needed resources are vigorously and ethically sought and that the intent of the donor is honestly fulfilled. Boston Area Health Center embraces the national Society of Fundraising Executives Code of Ethical Principles and Standards of Professional Practice, which guide the solicitation and use of charitable funds in manners that comply with all applicable local, state, provincial, federal, civil, and criminal laws.

Avoidance of Conflicts Of InterestWe understand that the potential for conflict of interest exists for decision makers at all levels within an organization - including directors, administration, clinical staff and other employees. It is our policy to request the disclosure of potential conflicts of

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interest so that appropriate action may be taken to ensure that the conflict does not inappropriately influence important decisions.

Directors, administration and clinical staff leaders are required to submit an annual disclosure form and to disclose potential conflicts related to decisions that arise during the course of a year. The Executive Committee of the Board or administrative officers, as appropriate, will review potential conflicts and assist in the resolution of the issues. In the event a potential conflict of interest has a direct impact on patient care or the administration of Boston Area Health Center, the Executive Committee or the Board will take appropriate action.

Waivers Any employee who believes that an exception to any of the policies contained in this Statement is appropriate in his or her case should first contact his or her immediate supervisor. If such supervisor agrees that an exception is appropriate, the approval of the President must be obtained. Any director or officer who seeks an exception to any of these policies should contact any member of the Executive Committee of the Board. Any waiver of the policies set forth in this Statement for a director or officer may be made only by a majority vote of the disinterested members of the Executive Committee.

Violations of this Statement of Conduct and EthicsThe Executive Committee of the Board has the responsibility to investigate suspected violations of the policies set forth in this Statement by officers and members of the Board. Detailed instructions for the reporting and investigation of suspected violations of such policies by employees, and corrective actions for a confirmed breach of such policies, can be found in Boston Area Health Center’s employee handbook. Every director, officer and employee has the responsibility to ask questions, seek guidance, report suspected violations and express concerns regarding compliance with the policies set forth in this Statement. Anyone who believes that any director, officer and employee has engaged or is engaging in conduct that violates the policies set forth in this Statement should promptly report such information to his supervisor or to a member of the Executive Committee of the Board as appropriate. Boston Area Health Center will not discipline, discriminate against or retaliate against any individual making a good faith report of a suspected violation of such policies or who cooperates in any investigation or inquiry regarding such conduct.

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