Nurse Practitioner Brings Leadership to Community Health Care

On the wall across from Margaret Flinter’s desk, an old photo reveals a lot about her relationship with Connecticut’s Community Health Center, Inc. (CHC), of which she is vice president and clinical director. In it, Flinter’s 4-year-old son, now a college student, is standing next to her and the health center’s CEO, Mark Maselli, along with a few other friends—the whole group with shovels in hand, ready to work hard. “That was back in the days before we could hire a landscaper,” she says with a smile.

A lot has changed since that photo was taken, and yet the convictions behind it have remained the same. What began with 5 marginally paid employees working in a 4-room flat has grown to fill more than 100,000 square feet of space in 7 cities throughout Connecticut, with a staff of close to 300 and more than 190,000 patient visits every year. CHC now provides services that go beyond medical, dental, and mental health, including pharmacies, dance therapy, meditation classes, and a battered-women’s shelter. They even transformed an old parking lot into a community herb garden.

While Flinter didn’t act alone, much of this progress is due to her leadership. “Margaret is very much into community and into building community,” says Masselli. “She views this health center as a vehicle for changing the way that people think about their health care and their community. She’s really been a transformational force within our agency.”

Flinter grew up in Waterbury, Connecticut, 40 miles away from Middletown, where she now works. She has fond memories of her culturally diverse neighborhood and notes that it was very similar to the communities where CHC’s seven facilities are based.

“Nursing was not something that I knew I wanted to do from childhood,” she says. “But I always had a truly deep enjoyment of people, compassion for their daily struggle with life, and a fascination for how communities support families. It was definitely the social nature of health care that appealed to me.”

Before earning her graduate nursing degree with an NHSC scholarship at Yale University, Flinter earned her bachelors degree in nursing from the University of Connecticut and went into community health practice in a town called Putnam. It was in Putnam that she had her first taste of leadership, securing a March of Dimes grant to set up the area’s first prenatal health center. Soon thereafter, she was recruited to work on a large-scale genetic and public health education project in rural Georgia, in conjunction with Emory University and the State’s health department.

When it came time to fulfill her NHSC scholarship commitment, Flinter anticipated returning to Georgia. “I actually had a nice little place in the hills there, and quite a nice life,” she says. In a twist of fate, however, she was contacted about a job in a tiny health center in Middletown, Connecticut. Flinter scheduled an interview and drove up the next day. That was in 1980. She recalls showing up at 8:00 a.m., dressed in “the most conservative, preppy dress one could find at that time,” and meeting Masselli, who had hair down to his waist. “It took me only a few minutes to realize that I had found an absolute comrade in him,” she says. “I felt immediately, in a way that I’m not sure too many people do, that this was just…great.” She says that feeling, as well as the convictions the two of them shared during their interview, have remained with the organization, even as it has grown and flourished.

“We believe that health care is a right, not a privilege,” Flinter says. “And we believe that the clinic mentality—line them up, let them wait, let them sit in rows on end, let them have the doctor or student of the week—is not how you should take care of people.” Staff at the center’s sites are trained, in fact, not to refer to their offices as a clinic, but as a practice. This formula seems to work well for patients—nearly 20 percent of them could opt for care at a private practice but choose CHC instead.

Flinter has implemented numerous other tenets at the center during her 25 years working there. Perhaps most important among these is her belief that nurses can be leaders in community health care. “Margaret has a certain allegiance to both nurse practitioners and nurses, and she has built that into how the Community Health Center operates,” says her husband, Paul Freundlich. “They’re not just adjuncts to doctors; they have their own critical role in the organization, because that’s the best way to leverage their capabilities and serve the patients.”

In fact, Flinter believes that anyone involved in community health care should understand every aspect of how their health center works and take a leadership role of some sort. “You can’t be in health care and not have an understanding of the fundamental issues of running a health center,” she says. “At the same time, you can’t be a clinical person and say, ‘I don’t have anything to do with the money.’ That’s old language, and people should just bag it.”

Flinter will admit—and those who know her corroborate—that she’s something of a workaholic. In addition to steering this $25-million-a-year organization, she’s pursuing a Ph.D., is a recipient of the Robert Wood Johnson Executive Nursing Fellowship, and is the president-elect of the Connecticut State Nurses Association. In addition, she still sees patients every Monday and Wednesday. Flinter doesn’t complain, however. On the contrary, her busy schedule energizes her. “I find it so rewarding and enjoy it so much,” she says. “I really feel that it contributes to my abilities and effectiveness as a leader in this organization.”

She provides words of wisdom to those considering a career working with underserved communities by saying, “It’s almost a cliché, but if you’re interested in providing the highest quality primary care and, increasingly, specialty care to boot, there’s no more interesting, challenging, and rewarding place to work than a community health center.”