Profiles in Improvement: Paloma Hernandez of Urban Health Plan

This is part of an ongoing series of audio profiles of front-line improvers.

 

February 2006

 

Photo_Hernandez_Paloma.jpg
Paloma Hernandez
CEO and President
Urban Health Plan

 

 

“The health center started as the San Juan Health Center, where Hispanics could really identify with the institution.”
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My name is Paloma Hernandez. I am the CEO and President of Urban Health Plan. Urban Health Plan is a multi-site federally qualified health center that is accredited by JCAHO. We’re located in the South Bronx in New York City. My dad is a physician who grew up in the South Bronx, and opened his first practice on one corner, purchased a building on another corner, converted a group practice into a community health center, and three years ago we moved into a state-of-the-art newly-constructed health center. So I’ve been there all my life, I’ve worked with him since I was a little girl. We serve close to 27,000 patient users, of which the majority are Hispanic, about 85 percent are Hispanic, about another 15 to 20 percent are African-American and a small “other” population. The health center started as the San Juan Health Center, where Hispanics could really identify with the institution, not so much as a role model, individually, but as institutional role model. From there we changed our name to Urban Health Plan. The community still calls it San Juan.  

“The Hunt’s Point community in the South Bronx, it’s probably one of the highest areas in terms of incidents and prevalence of asthma in the country. And we really made a difference.” (0:53)
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In 2001 I became a participant in the National Health Disparities Collaboratives, through the Bureau of Primary Health Care, through the Department of Health and Human Services. We participated through our asthma work, and we became the star team of that cohort of health centers that went through the process. The outcome measures were phenomenal, and all we really did was go through the process. We went through the learning models, so we went through the whole collaborative framework, in terms of timeline. We learned the Model for Improvement and we applied it to the Chronic Care Model. The results we got in our community — we are in the Hunt’s Point community in the South Bronx, it’s probably one of the highest areas in terms of incidence and prevalence of asthma in the country. And we really made a difference. So when I looked at it, I said this really works and this I can do.

“We took on the whole issue of external referrals.”
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We took on the whole issue of external referrals and how to improve the timeliness of consults getting into the patient charts. I think for any ambulatory facility that is an issue. There were no evidence-based, any standards, anything out there that could really guide us, so we kind of made it up. Our outcome measure was that reports would be filed in the patients’ charts within 14 days of the appointment with the specialist. We haven’t gotten there yet, but through it we have defined all kinds of process measures. Up to the point where we have worked with our preferred hospital and when we started, the number of days that it took them for us to get an appointment was 18. So we called in for an appointment and we waited 18 days for a call back with an appointment date. Our goal is 48 hours; we’re now down to 5 days. When you look at it, especially with a hospital which we don’t have direct control of, it is just really phenomenal work.  

“Leadership is really important. Your teams can’t work well unless there are strong leaders.” (1:03)
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As an administrator, you go to work, and you know you are committed to working for the community, you want to make change in the community, but it’s really hard to understand what change you’re really making. And this was an opportunity. When I was involved with the Asthma Collaborative, it was very clear that we were making a difference. As a community-based administrator, it’s real important. Running a community health center is tough, and being able to see the changes that you make is very gratifying. Leadership however is really important. Your teams can’t work well unless there are strong leaders. I think you have to one, be open to change. I think you have to understand that the status quo is no longer acceptable. I think that’s really the key. That the way you’re doing things is not working, and something has to change, and you have to be open to making those changes, and you have to be willing to commit resources to making those changes, and you have to believe deep down inside that what you’re doing is the right thing.

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