• Duke Receives Surgeon General’s Top Honor
• OPR - Office of Performance Review: Out to Make a Difference
• OPR - Pictures from 2008 OPR All Hands Meeting
• OPR - Project Officers and OPR Analysts: Doing a Tough Job Better... Together
• What's Up on the Web
• HRSA Grants Official Makes Unexpectedly Long Visit to Alaska Health Center
• Omaha Health Center Lends Dental Van to Help Iowa Flood Victims
• HRSA Employees On the Move
• News and Events
• An Election Season Reminder to All HRSA Employees

Office of Performance Review: Out to Make a Difference

“We really had to get better at the business part of what we do,” Duke told OPR staff last month at their 2008 All Hands Meeting, held over two days in July at the Hilton Hotel and Conference Center in Rockville, Md. “It wasn’t enough anymore to give a grant to a responsible party, and just send them off on their own with our best wishes that they ‘do a good job for us.’

“The times were changing. We were in an environment of tightening budgets and increasing demands from the President and Congress for more accountability and objective reviews” of HRSA’s 7,144 grants.

Describing the mission, however, would prove much easier than actually carrying it out. Accustomed to decades of relative autonomy, many grantees had quietly accumulated records of accomplishment that would be the envy of any government program manager. Not everyone was enthusiastic to suddenly receive visitors from the Home Office.

HRSA-funded health clinics and programs had helped slash the U.S. infant mortality rate by more than 70 percent; boosted childhood vaccinations; fielded 28,000 physicians, dentists and nurses to isolated communities; intervened in the HIV/AIDS crisis; and brought health care to more than 15 million Americans living on the fringes of mainstream society.

Could they do better? That’s what Duke wanted to find out, and OPR got the assignment.

Doing it all

From Day One, Duke said, it was clear that there was no better source of know-how than HRSA’s grantees. Among health centers, some had evolved from street corner “free clinics” in the 1970s into some of the biggest health care providers in their states, with multiple outreach offices.

To carry out a job for which no clear precedent existed within the agency, OPR’s analysts would have to boldly go where no one had gone before — gathering real-time, ground-level data from hundreds of individual HRSA-funded health centers, state agencies and institutions.

Charged not only with the traditional job of ‘checking the books’ on 3,000 separate grantee organizations involved in 80 different programs, the office also would seek to meet larger philosophical and managerial ends that might best be described as “winning friends and influencing people.” Convincing successful grantees to share their business models and “best practices” is a big part of the job.

“We needed somebody to tell us what was really going on out there,” as Dr. Duke put it, “and you at OPR are the ones who drove that.”

Still, six years later, hardly a day goes by when the question doesn’t come up in one of the office’s 10 regional branches — usually from a nervous grantee who just found out it’s their turn for a site visit: “Why are you bothering us when we haven’t done anything wrong?”

“They’re worried that we’re coming to flip over rocks to see what crawls out,” said Kimberly Patton of OPR’s Denver office. “Even though that’s not really what we do, we’re just naturally set up for conflict a lot of the time. The grantee hears that HRSA is on the line, and their first reaction is to... freak out!”

Such is life for those inside the small hybrid office with the big mandate. Describing how their jobs have evolved over the past six years, analysts at the All Hands Conference said they have found themselves in the role of watch-dogs, efficiency experts, trouble shooters, crisis managers and goodwill envoys.

Although many a grantee sees them as HRSA’s “enforcement arm,” OPR is more likely to come bearing gifts of technical support for clinics struggling with outmoded or overloaded records systems, or consultancy services from an outside expert.

Mediating senior-level staff disputes, taking complaints, convening statewide conferences of public health agencies and grantees to identify emerging trends? All in a day’s work.

“We do wear many hats,” OPR Associate Administrator Rebecca Spitzgo acknowledged to her staff at the conference. “But the first one we put on every morning is our HRSA hat. Making sure the agency is well represented is our first responsibility.”

Level heads & a sense of humor

The conference was only the second time that the entire group had met since the office was established in 2002 — and for HRSA’s youngest and smallest field operations division, it was a chance to review their charter, share tales from the trenches, and redefine their varied and often competing missions. Dr. Duke reminded everyone of OPR’s special status.

“You are helping us be One Agency,” she told the staff. “You’re helping us answer the question of quality. How do we make things better? How do we make a difference for our grantees?”

In the beginning, Duke told the OPR staff, “we had no feedback loop. People inside HRSA, our own bureau people, didn’t know each other. Our grantees had never met each other. They had no idea what other grantees were doing — even people who were doing the same work as them...sometimes in the same town!”

Six years and hundreds of performance reviews later, she confessed to being pleasantly surprised that OPR has managed to garner better than an 80 percent satisfaction rating — well above the government-wide average of 68 — given the reluctance of many long-time grantees to adopt new ways of doing business, much less routine oversight.

“The more you talk to people, the more you realize that a lot of them have been out there alone for years, doing this work with very little support. They’re obviously very passionate about their programs and the systems they’ve been able to create — and all the good things they’ve been able to do for their communities...and they’re all worried about losing their (grant) money.”

In their case study, Jordan and Spears walked their fellow analysts through the months of negotiations they undertook with their “Reluctant Grantee” before finally deciding to commission a consultant who was able to offer immediate advice on how to improve the grantee’s clinical and administrative operations.

Ron Moss, director of OPR’s New York Division, added that some clinics are cash-strapped — especially those serving large populations of uninsured patients. So they may be years behind in their management and information systems.

“You can generate a lot of good will in a situation like that,” Moss said, by offering outside consulting services or other technical assistance that can lay the groundwork for future modernization of grant applications.

“Sometimes,” he added, “simply putting a grantee in touch with another clinic operator who benefited from the review process is all it takes. Get people talking to each other, right? Make things better. Once they realize that’s why we’re there, that’s when we can make a difference.”

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