BROOKSVILLE — One day last month, Phil Spence brainstormed over pizza with staffers at the Hernando County Health Department's dental clinic.
Spence, the department's new administrator, provided the pies; employees served up the ideas.
"How could they help me and help the organization by offering up suggestions on how to improve and be more efficient?" Spence recalled.
The lunch is an example of what Spence calls walkabout leadership. Employees at every level needed to meet the new guy, but they must also be part of an ongoing effort to get the department's finances in order, the retired Army colonel and veteran health administrator told the Tampa Bay Times last week after about 2 1/2 months on the job.
Tapped by Michael Sentman, the state's assistant deputy secretary for health, to replace retiring longtime leader Elizabeth Callaghan, Spence recently submitted to his bosses in Tallahassee a three-pronged fiscal corrective action plan.
The first strategy has nothing to do with numbers. The goal, he wrote, is to build a "culture of team work, collaboration, trust and program ownership." That's especially important in the wake of last fall's round of layoffs at the department, Spence said.
"If your employees feel you're hiding things from them, if they don't understand the big picture, then you can't really expect them to jump onto the bus," he said.
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Shortly after arriving, Spence formed a "productivity committee" comprised of employees from all levels of the department. The committee meets once a week, and the minutes are distributed to the entire staff.
Success means striking a tricky balance between two seemingly conflicting missions: provide as many services as possible to an increasingly needy population, and keep a business-minded eye on the bottom line to remain viable and build up the department's reserves.
The administrator and his charges have work ahead of them. The state wants departments the size of Hernando's to keep reserves of about 7.5 percent of the total budget. By the time Spence arrived, the $7 million budget had dipped into the red by a little more than 3 percent.
Spence has set a goal to have the reserve figure up to 4 percent by June 30, and to 7.5 percent by the end of the calendar year. He said he is still optimistic that the department can avoid layoffs and cuts to services if the state doesn't slash funding and the current legislative session doesn't produce major changes to the Medicaid program.
There are already initial signs of improvement. By the end of January, the rainy day fund had crept into the black by about one-half of 1 percent. That was due in part to an easy fix. The department had been running nearly a month behind in processing billing slips, so a team of staffers attacked the problem.
The long-term health of any department, however, has much to do with the volume of clients that come through the doors and how they pay, so that's another component of Spence's recovery plan.
Some patients have insurance, some are covered by Medicare or Medicaid, and some are under-insured or uninsured. Fees for that last category are levied according to a seven-tier sliding scale based on income. Indigent patients pay nothing. No one needing care is turned away.
The problem in the dental clinic, where roughly 65 percent of current patients are eligible for free services, shows how important a balanced payer mix is to the overall operation.
"You just cannot maintain an operation where you don't have enough revenue being generated to pay for the cost of doing business, and that is what has happened with our dental program," Spence said. "The revenues we receive from the other 35 percent do not sustain the program."
The solution is not to cut the program or deny service to the needy, especially since the department's new 57,000-square-foot building on Forest Oaks Boulevard in Spring Hill features a dental suite with room to grow. The goal is to bring in more patients who can pay or have insurance, and that revenue subsidizes services for poorer patients. Ideally, the money could even cover the cost to expand services.
With that in mind, Spence has tasked the staff with promoting the department's dental services for children who are covered by Medicaid.
The department will seek potential clients in places such as pediatricians' and obstetricians' offices, and in Head Start programs. There is also a contest among the staff to come up with a new name that captures a family-friendly mission. Spence has ponied up a $20 gift card for the winning name.
Bringing in more children for dental services is a good business call, but it's also a sound health policy, said Dr. Pedro Lense, the department's senior dentist.
"We can prevent future problems," Lense said. "It saves a lot of heartache later."
Spence is convinced there are ways to get clients in and out more efficiently. He acknowledges, though, that encouraging physicians to see more patients can be a touchy prospect.
"That's a delicate balance between practicing good medicine and getting enough people through the door to be cost effective," he said. "There's definitely room for improvement, but I can't just walk in and make an edict that we're going to see five more patients a day than what we're seeing. It has to be us working as a team."
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One employee-driven success story involves the HIV/AIDS program.
Through an inter-local contract, Hillsborough County uses grant money to reimburse the Hernando department for providing HIV/AIDS services to clients in this area. There is a waiting list for those services, but even with the grant money, the program wasn't cost effective, Spence said.
Staffers were able to negotiate with Hillsborough to increase the reimbursement rate by some 50 percent. The local department will also be able to see more patients by working with the lab to accommodate their blood work.
The open lines of communication and Spence's accessible style have helped to somewhat settle the nerves of workers doing more with less, employees told the Times.
"He has stated and restated to the staff that he really values input concerning how we might be able to streamline services, and I think he's stayed true to his word," said Kathleen Sauskojus, organizational development manager and a member of the new committee, who started at the department in 1982.
As a clerk specialist who sets appointments from the Brooksville office, Charlene Luke is on the front lines of the patient flow. She has already emailed to Spence some suggestions and observations.
"You can't just step into a position and snap your fingers and make everything work," Luke said. "It will eventually come together."
Tony Marrero can be reached at (352) 848-1431 or firstname.lastname@example.org.