The Primary Care Clinic
Michelle N. Thomas
Prof. Johnette Simmons
April 29, 2018
The Primary Care Clinic
The Healthcare profession is quite rewarding in terms of perks, benefits and recognition, but it is
not without its challenges. The role of a Manager is an intricate and critical part of the
organization and its success. Managers are faced with making sure the right staff is in place,
terminations, damage control, and proper organizational directives to name a few. A manager
must be confident to know the ins and outs or the pros and cons of his or her facility and the
community where the facility presides. A manager cannot have tunnel vision as this will affect
proper development and organizational functions from a team structured position.
As a manager of a new Primary Care Clinic, located outside of a small city, my immediate
mission would be to promote and deliver the highest quality services to the surrounding
community both near and far with empathy and professionalism and build a health network
through continuous teaching, caring, healing and follow up.
The main objectives to accomplish this would be the following:
Create a clear development of performance objectives through structure, regulations, and accountability.
Productivity-ensure Physicians and related medical personnel are up to date on current procedures to improve or enhance quality of care.
Partner and Network with other healthcare systems to procure newer technological innovations to meet the increased requirements for patient care.
This is easier said than done, however it is not an impossible task. A manager must have an alliance
with her team in order to function properly. This is not just in an HCO, but any business.
I have a friend who has been performing countless research regarding Primary Care Clinics/Urgent
Care Facilities and hospitals for the last 2 years. Figuring that he would give me some great insight,
I decided to ask him about his views on key social, political, and economic factors that have led to
the proliferation of Urgent Care facilities and Primary Care Practices and his response was quite
unexpected. According to R. Terry (personal communication, April 24, 2018), Urgent Care
facilities have nothing to do with health care, absolutely nothing! It is simply a way to steal
money out of a broken healthcare system. He describes Urgent care facilities as a “great smelling
pie in the oven but, doesn’t fill the stomach”. Exorbitant prices of healthcare are able to be
absorbed in larger cities because of the amount of people that had private insurance. In rural
areas, private insurance was able to assist in the cost as well as Medicaid and Medicare assisted
because the State and local governments always pay their bills. Terry went on to say that rural
hospitals were the piggy bank for towns to offset their budgets. It became a way for the
government to subsidize a town without officially doing it. Once jobs in rural areas left, the
healthcare costs were not divided equally among the Medicare and Medicaid private insurance.
Mr. Terry feels strongly that urgent care facilities do nothing more than refer a patient to a
hospital or to the pharmacy. The tort issue has not helped the cost of doctors to operate, and thus
have decided to have large practices pay for their insurance that leads to the increase in the
amount of patient visits that doctors see each day. Mr. Terry also asked me to research the
political red tape within the VA in order to see what he is talking about.
The other aspect of this issue is his definition of a “hospital”. “Hospitals do not make money,
they lose money in the ER, which is also the biggest to operate”. I was not expecting the rant that
he gave me, though it was interesting and engaging. My Response to him was that, the
proliferation of urgent care facilities has been essential because there has been a greater patient
demand and need for fast services as well as economically affordable. There is also a sense of
peace and calm when a nurse or doctor can communicate with a patient in their own language.
An article in the Kaiser Health News (2009) stated that according to the Wall Street Journal
“urgent care clinics fill the gap between the need for the care and an increasingly limited supply
of primary care physicians and crowded emergency departments”.
Between 1995 and 2005, there has been an influx of Urgent Care Centers nationwide,
but the number of Primary Care Clinics have decreased. Emergency room visits have also
“increased by 20 percent or more during this period”. Today there are over 9,000 urgent care
In the United States, people are very fortunate to have so many locations of urgent care and Primary
clinics. This is not the case in many other parts of the world such as, third world countries. Medical
treatments are not so readily attainable because of the lack of staff or financial capability to seek
medical treatments. There is also an issue of salaries for the medical staff.
Giving back to the community is greatly needed because for some, humanitarian efforts is the only
resource to opportunity for free healthcare.
Connaught Hospital, is one of 4 primary hospitals in Freetown, Sierra Leone provides medical
and surgical services for patients with TB, Leprosy, HIV/AIDS and other serious medical ailments.
They also have a fully functionable an Emergency department.
Connaught Hospital’s ER department spend a lot of time treating patients with minor ailments that
should be treated by a primary care clinic this is scarcely available to the people.
In addition, patients admitted to Connaught Hospital, must pay for their own food and medical
supplies because there is no insurance to help them. Many people have family members who are
in the States and this serves as a savior for many people. For those who do not have that privilege,
one thing is for certain, people will typically self-diagnose and medicate themselves.
Malaria is very common in Sierra Leone, and it is sad that a lot of these 3rd world countries have
not been able to acquire suitable technology to network with other healthcare networks overseas.
The Sierra Leonean war which lasted for 10 years (ended in 2002), is grossly responsible for the
damage to the countries health care system and thus, availability to treatments as well as
accessibility. In more recent years, Sierra Leone adapted the Free Healthcare plan which is offered
to Pregnant women and women who are lactating.
The Six Lesson Care approach consisted of the following:
Implementation of a “Systemic Approach”
Build a better system with predictable shocks
Plan and collect data in terms of making advance assessments
Focus on “quality”
Create long term Functional Institutions
Create a “supportive environment” that will ensure accountability
Unlike Connaught Hospital, we have formidable technology in the United States and do not have
to worry about the ominous backlash that people are often faced with in third world countries.
A person is treated regardless of whether you can pay up front or not and hospitalization do not
require you to pay your food and medical supply cost up front.
Canada is another country whose healthcare system is funded through government revenues. The
Average person in Canada of a single home with a salary range in the low $40’s pays
approximately $4,200 in health insurance taxes. Whilst a family of four ranging in salary topping
the low $120, 000 combined, will pay approximately $12,000 in health insurance taxes. Low
income families will pay somewhere around $477, thus healthcare in Canada is not “free”. Many
people claim it’s free because physician or medical staff visits are free at the time of visit. They
are not required to pay out of pocket costs at time of visit as we are in the United States.
There are many directions that a clinic can put in place to make sure that care is extended to
everyone regardless of whether they can afford care or not. As a manager of a Primary Clinic, I
would gather all essential personnel and have regular meetings with them regarding the Clinic’s
mission and purpose. The main topics that we would address to make sure that our clinic is
functioning at optimum levels are:
Make sure that every patient completes a detailed survey after every visit.
Make sure that the follow up team, calls and checks in with every patient no matter the condition treated to ensure that everything is ok.
Visit and familiarize myself as a Manager with the residents and businesses in the area paying close attention to any homeless shelters or veteran shelters or association in need.
Make a Charitable donation to the shelters or Food Banks.
Familiarize myself with the patient demographics that are coming into the clinic to determine any additional services that we can provide to make them more comfortable such as language barriers, etc.
Set up a wellness event and encourage patients and their families to come and participate continuously. This would also be a time to get continued feedback from the community on any additional services that would benefit the community.
Set up or negotiate partnership with other health facilities to aide in transportation of patients needing severe treatments.
Make sure that patient coding/billing is correct.
This is helpful to determine what factors to consider when deciding what services to provide in-
house and which ones to refer to other institutions. For conditions such as major surgeries, life
support, organ transplantation, etc.
With continuous outreach to the community and neighboring areas, we can facilitate partnerships
with our colleagues both near and far.
In order to determine any opportunities for improvement, I would have to cite the PDSA Model
(Plan-Do-Study-Act). This is a “simple, yet powerful tool for accelerating quality improvement.
Plan-Know your brand, its mission and project that to the surrounding community.
Do- Conduct surveys, follow ups and other types of patient engagement
Study-Analyze survey results/suggestions and implement
Make changes based on feedback from patients, and stay abreast of policy changes
Primary Care is constantly evolving. Technology advancement is being introduced every day.
Primary care is critical to the medical infrastructure because of the physician/patient
relationships. Seeing a primary care provider regularly helps to cut down some of the cost of
visiting the emergency room or even visits to see a specialist. Primary Care staffers, to include
Nurses, CNA’s or LPN’s are not exempt from this. They are constantly in danger of being over
stressed or burnout. If this happens, it leads to changes in specialty care, or quitting a profession
that they worked so hard for. Physicians are noticeably stressed or burnt out when they start
emitting signs of lack of interest in a patient, being argumentative and sarcastic. Late, emotional
issues are also symptoms of Physician burnout. As a Manager of a facility, I believe that it is a
team effort to create, balance with the staff. Some of the ways of continuing in this role would be
to seek a positive balance with the staff daily through morning meetings in hopes of addressing
any pertinent or urgent matters ahead of time. Seek out initiatives and make sure that physicians
are sharing the load with the lower staff. Make sure that there are checklists in place to assist the
RN, LPN or CNA, to properly assess a patient and review them constantly for accuracy.
Make sure that billing and coding department are up to date on certifications and that the proper
codes are being billed in accordance with patient diagnosis.
Continue to enforce, and ensure that quality care is being given to every patient in accordance
with its mission and policy
Baribault ; Cloyd. (1999, July 26). Health Care Systems: Three International Comparisons. Retrieved from https://web.stanford.edu/class/e297c/poverty_prejudice/soc_sec/health.htm
Klasko, S. (2014, November 17). What healthcare will look like in 2020 | Stephen Klasko | TEDxPhiladelphia Video file. Retrieved from https://www.youtube.com/watch?v=esugL07XANg
Plan-Do-Study-Act Cycle. (2013). Retrieved from https://innovations.ahrq.gov/qualitytools/plan-do-study-act-pdsa-cycle
Urgent Care vs. Emergency Rooms – What’s the Difference? Video file. (2014, October 3). Retrieved from https://www.youtube.com/watch?v=G5E3uNv6eKA
Witter, S. (2016, May 31). The Free Health Care Initiative in Sierra Leone: six years on, six lessons | The Lancet Global Health Blog. Retrieved from http://globalhealth.thelancet.com/2016/05/31/free-health-care-initiative-sierra-leone-six-years-six-lessons