Score

A. Developing Key Results

1

2

3

4

5

N/A

1. Supporting community wide outcomes

4

2. Aware of community wide indicators

4

3. Able to describe the key result

4

4. Able to describe how key result was determined

4

5. Identifying program measures

4

6. Using research to achieve results

3.5*

7. Clearly articulating the key result

4

8. Demonstrating that staff is clear in understanding key results

4

Frequencies

1

1

6

Subtotal = 37.5 out of a possible 40

*Item six was averaged as a rating of 3.5; the reviewers gave the program a rating of 5 in its ability to use medical practice research and rating of 2 in using mobile medical care research.

Comments:

The program provides primary care to the needy and provides an unusually high degree of follow-up. This supports the program’s effort to achieve the community-wide outcome of ensuring that adults are physically healthy. Staff knows that this outcome is being achieved by observing the individual patient’s health status.

Improving access to health care by providing quality health care to uninsured, low-income, working poor and homeless in Montgomery County is MobileMed’s key result, which flows from its mission statement. MobileMed is aware that it is achieving its key result through the number of patient visits, new patients, diagnosis of conditions and health maintenance data.

The program complies with its mission statement "to provide primary health care to the needy of Montgomery County and to ensure that patients receive adequate follow-up care."

Program staff members have a very clear understanding of Mobile Med’s succinct mission statement (see above for mission statement).

The program’s mission statement and key result is articulated in MobileMed’s brochures and publications.

Staff is medically knowledgeable and is aware of MobileMed’s patient demographics for hypertension and diabetes, which together account for a large percent of the program’s patient population.

The program has charts for hypertensive and diabetic patients’ outcomes. Staff is planning more evaluations of results of patient care and collaborations.

Staff keeps up with the latest medical practices and patient chart reviews.

Program research on mobile medical care is missing other than what is being done in Maryland.

Score

B. Charting Results

1

2

3

4

5

N/A

1. Working to ensure that program measures are moving in the right direction

4

2. Measuring information concerning outcomes for individuals

4

3. Gathering information concerning collective success of the program

4

4. Using information to clarify strategy

4

5. Incorporating information about progress toward program key results in reports outside DHHS

4

Frequencies

3

2

Subtotal = 22 out of a possible 25

Comments:

The program is measuring individual outcomes for each patient.

Hypertensive and diabetic patients are often seen monthly partly because scarce medications are unavailable for longer periods and partly to allow for close monitoring. Additionally, these patients are seen frequently to ensure compliance with the doctor’s request for taking prescription medication.

Program staff are able to chart early education and treatment that works preventively.

Score

C. Creating and Nurturing Partnerships

1

2

3

4

5

N/A

1. Establishing relationships (other parts of DHHS)

4

2. Establishing relationships (other parts of county government)

4

3. Establishing relationships (other agencies outside of government)

4

4. Using relationships to support the development of key results

4

5. Using relationships to achieve community-wide outcomes

4

6. Identifying additional partnerships

4

Frequencies

6

Subtotal = 30 out of a possible 30

Comments:

The program is outstanding in its ability to work effectively with numerous partners, agencies and organizations. They have established relationships with a number of groups in Montgomery County including Suburban Hospital (where Moby is parked when it is not in use in the community), Holy Cross Hospital, Montgomery Community College and the County’s Department of Health and Human Services and Housing Opportunities Commission.

As part of an ongoing relationship with County government, MobileMed could ask the County to absorb the cost of upkeep and fuel for the mobile van, which would free up funds for more patient care.

The program is particularly effective about following up on patient use of community resources.

More funding and resources such as EKG machines would enhance patient care and would enable the program to reach even more patients County-wide.

The program is seeking numerous grants currently.

The program sustains a long-term positive relationship with organizations/managers of sites where MobileMed provides services.

Score

A. Identifying the Needs of Customers

1

2

3

4

5

N/A

1. Identifying primary and secondary customers

4

2. Aware of how customers come into the program

4

3. Using explanations of eligibility criteria that are clear

4

4. Maintaining information in a variety of formats and languages

4

5. Attempting to identify the needs of customers on an individual basis

4

6. Knowledgeable about how to provide materials for customers with specific needs

4

7. Employing a positive tone

4

8. Ensuring that customers understand access and intake process

4

9. Encouraging staff to make a concentrated effort to please customers

4

10. Able to demonstrate an awareness of whether customers are pleased

4

Frequencies

1

2

1

5

1

Subtotal = 37 out of a possible 45*

*Possible total score was reduced from 50 to 45 because item #3 was not applicable. The program does not advertise eligibility.

Comments on Identifying the Needs of Customers :

The program has identified many needy groups of patients and works with their families and in many cases, with the residents of particular buildings.

MobileMed has a long-term dependable presence in the community; patients often find out about the program through word-of-mouth; the patient intake sheet has a question that asks patients how they heard about MobileMed.

As a non-profit, MobileMed has chosen not to advertise eligibility. Oral explanations at intake are clear; eligibility is flexible and for now, all who walk in are seen. Helpful written explanations could accompany written questions about patients’ finances.

MobileMed has Spanish language materials available and visible. The program has materials available in multiple languages. Program also uses the language hotline run by the County’s language bank for translations when necessary. Most patients, however, bring their own translators who are usually family or friends. In this increasingly diverse County, MobileMed could continuously use more information in different formats and languages.

To identify the individual needs of customers, the program uses a questionnaire, interviews and consultations as well as patient work ups.

The program does not yet have material in Braille or a sign language interpreter. One of the clinic facilities, Kengar, is not wheelchair accessible. All other sites are wheel chair accessible. During telephone contacts, patients are not asked about access needs.

Staff assists patients with filling out intake and other forms as needed.

The review panel heard overwhelmingly positive reactions to questions about the way the program works and the care received.

MobileMed did a survey five years ago on patient satisfaction. The program now gets informal feedback and sees a large number of returnees. The panel recommends having a professional volunteer/board member periodically circulate and discuss customer satisfaction with patients in the waiting areas.

The program is conscious of the need to be effective providers of both medicines and preventive education in ways that are relevant to problems of different ethnic/national backgrounds.

Score

B. Responding to the needs of customers

1

2

3

4

5

N/A

1.Offering services consistent with goals

4

2. Offering services that are readily available

4

3. Easily accessible by phone, TTY, etc.

4

4. Maintaining a waiting list

4

5. Attempting to meet the needs of customers on the waiting list

4

6. Referring customers on the waiting list to appropriate resources in the community

4

7. Delivering services in comfortable facilities

4

8. Delivering services in a sensitive manner in terms of cultural diversity

4

9. Demonstrating that staff work well together to serve customers

4

Frequencies

1

4

3

1

Subtotal = 34 out of a possible 40*

*Possible total score was reduced from 45 to 40 because the program does not have a waiting list per se.

Comments on Responding to the Needs of Customers:

Program staff tell patients where they can be seen sooner if they cannot get an appointment at the closest MobileMed site.

When the program’s appointment process is fully computerized and when laptops that connect to the main office become present at each site, the patient’s records will then appear with a certainty where the patient is being seen. The program has TTY access at the main office. A portable TTY would be helpful for other clinic sites.

The program is working very hard and continuing to resolve problems of both scheduling appointments (new patients may to wait up to three weeks for an appointment, depending on their flexibility in accessing different clinic sites) and acquiring (and being able to dispense) sufficient medicine. The current budget is inadequate for additional needed clinic hours and personnel as well as medicine supplies.

The program is working very hard to locate additional specialists. The program is using County agencies effectively to connect and follow patients.

MobileMed accepts referrals from and makes referrals to other non-profit organizations including Proyecto Salud, Holy Cross Hospital, Archdiocesan Health Care Network, Project Access and Planned Parenthood.

Kengar is not a wheel chair accessible facility (there are 5-6 steps to go down to the clinic). Fixed clinic sites have comfortable waiting areas. The mobile van is accessible for those with disabilities and has a handicap lift. The inside waiting area of the van comfortably holds three waiting patients. In inclement weather, large groups using Moby at the same time will find comfort a challenge. However, if the van is parked near churches or libraries, patients can wait in those facilities.

MobileMed’s new permanent headquarters building at Old Georgetown Road in Bethesda is convenient to public transportation and accessible to people with disabilities.

The program is sensitive to the patients’ needs. Training is given in cultural competency. At times translations are available in different languages. The program would like all of its providers to explain critical diet information related to medical issues in more culturally accessible and acceptable ways.

Staff members are caring and well-versed in connecting patients to needed resources. Staff demonstrates a good team approach when working together.

Insufficiency of medicines that are both current and the best choice hampers the program’s ability to deliver consistent care. When the patient loads increase, the problem with medicines will worsen under the current low budget for purchasing medicines. MobileMed does refer it patients to Community Pharmacy and Pharmacy Assistance for medications.

Score

C. Anticipating and Evaluating the Needs of the Customer

1

2

3

4

5

N/A

1. Gathering information about customer

Satisfaction

4

2. Using Information to Improve customer service

4

3. Using Information to assess impact of services

4

4. Handling complaints/disputes through a clear process

4

5. Making a change in the program because of the dispute process

4

Frequencies

1

3

Subtotal = 10 out of a possible 20*

*Possible total score reduced was reduced from 25 to 20 because item #5 was not observed.

Comments:

The program obtained recommendations from its customers and advocates through a survey done five years ago. Currently, some informal feedback is obtained from customers and advocates. The board also meets regularly and provides recommendations to the program.

No grievance/dispute process is currently in place. Complaints are currently resolved by the nurse practitioner or executive director. A grievance process would be beneficial for providers and patients as the program hopes to implement soon.

The program has revised the scheduling process as a result of complaints.

The panel recommends instituting a regular formal mechanism for acquiring feedback on customer satisfaction.

Score

A. Supporting Outcomes through Personnel

1

2

3

4

5

N/A

1. Program has staff resources that are sufficient to support program goals

4

2. Program utilizes management techniques to ensure that staff are effectively working to meet goals

4

3. Program has staff that is well-matched to program needs

4

4. Program has staff and others that see their jobs in terms of supporting program goals

4

5. Program has job descriptions and evaluations for each staff person.

4

6. Program has job descriptions that reflect the individual’s role in achieving program goals

4

7. Program has performance evaluations that are conducted on a regular basis

4

8. Program has performance evaluations based on employee’s contribution toward meeting program goals

4

9. Program utilizes any other sources of personnel support such as volunteers and consultants

4

10. Program ensures that volunteers and consultants have an understanding of their role in supporting program goals

4

Frequencies

2

7

Subtotal = 41 out of a possible 45*

*Possible total score was reduced from 50 to 45 because item #1 was not ratable (see first comment in this section for reasons).

Comments for Supporting Outcomes Through Personnel:

The program functions in a highly commendable manner for hours when service is available. At present, MobileMed does not have enough staff to serve even a large percent of the needy in Montgomery County. Moby is not in full use due to lack of personnel and operating funds.

The program is providing cross training to give more staff skills in van driving. MobileMed uses other informational trainings by its own team members and by OSHA. The entire team assists patients.

Staff does an excellent job. Within the team, a wide range of experience is available but the program does not have all the specialists it needs. Administrators have experienced difficulty in all the constraints trying to hire several paid staff due to both budget and availability of suitable professionals.

Job descriptions are written and available.

According to the Employee Handbook, a provisional evaluation of staff is done after the first three months after hire, then done annually.

The program has a good and useful evaluation form allowing for discussion and input.

MobileMed is based on utilization of committed, professionally trained and experienced volunteers.

Volunteers and consultants receive training and are observed. Senior staff review volunteers’ patient charts to ensure their completion. Some consultants supplement the program’s resources by bringing students/medical residents to provide services.

Score

B. Supporting Outcomes through Budget

1

2

3

4

5

N/A

1. Budget reflects and supports program goals

4

2. Budget addresses all of the significant needs of the program

4

3. Budget incorporates a process so that program needs not reflected in the budget are addressed in other ways

4

4. Budget incorporates a process that includes a recommendation from customers/advocates of the program

4

Frequencies

1

2

1

Subtotal = 13 out of a possible 20

Comments :

The program needs a larger influx of funding and/or staffing, for its mobile van and/or medicines.

The staff tries to obtain free medicines whenever possible but needs more fundraising and grants to develop an adequate medicine budget. This budget should include appropriate purchases of much needed medicines for indigent patients regularly in need and increased staff hours and van utilization. The program would like to establish a formulary that could meet MobileMed patients’ pharmaceutical needs.

The annual flu shot program has been used in the past as a source of funding to support other MobileMed programs. MobileMed has not been determined yet whether it will continue to offer the flu shot program to the community due to the high cost involved and effort. However, the flu vaccine will continue to be available at no cost to MobileMed’s patients at each clinic.

The program is trying to secure County funds, public and private funding and foundation support to raise the resources necessary to support the personnel needs of the organization. MobileMed seeks funding from various sources including DHHS, the County Council, other government agencies, private foundations and the United Way. Grants from the Maryland Health Care foundation, Montgomery County and the United Way assisted MobileMed in purchasing Moby. The program also requests donations of volunteer support and/or contributions from the public. MobileMed’s volunteers donated 5,750 hours of professional services to patients in FY’99.

The board assists the program with obtaining funding, recruiting volunteers and increasing MobileMed’s name recognition in the community.

Score

C. Supporting Outcomes through Technology

1

2

3

4

5

N/A

1. Program identifies training resources needed

4

2. Program has resources that are easy to access

4

3. Program has appropriate and sufficient technology to support its work

4

4. Program has technology available for work "in the field"

4

5. Program has staff that understand how technology can help them achieve goals

4

6. Program is exploring ways to use technology to make its work more effective

4

Frequencies

1

1

4

Subtotal = 25 out of a possible 30

Comments:

The program could use management training for staff such as basic computer skills, budgeting, bookkeeping, administrative skills, grant proposal writing, etc. Also, as the County and other funders are requiring more detailed reporting on outcomes and data compilation, the program needs assistance with these administrative duties. The orientation for all staff is complete and rigorous. Program updates are shared regularly to keep staff current.

The program uses its own staff for training as well as OSHA and other area resources.

The mobile van is a new and attractive resource with updated equipment. EKG machines are needed for Moby and clinic sites. Laptop computers are needed for Moby and each clinic sites so that files are retrievable and form filing is facilitated. The program needs resuscitation equipment at every site.

The main office has an answering machine. E-mail is also used at the main office for communication.