It wasn’t that long ago that even their colleagues inside HRSA weren’t sure what the analysts in the Office of Performance Review were up to. Who were these people snooping around their programs, bugging their grantees and getting underfoot?

For the agency’s project officers — those responsible for supervising HRSA’s grant portfolios — the calls from anxious clients started coming in almost from the moment OPR was launched in 2002:

“You run into a lot of people in this job who get nervous at the sound of the word, ‘federal’," said CDR Dale Bates of OPR’s Seattle office, “much less the idea that somebody from Washington is coming to visit them, personally. They don’t exactly consider it their Lucky Day.”

Six years later, thanks in large part to an emerging culture of cooperation between project officers and OPR reviewers, that anxiety has begun to dissipate. Where OPR once might have struggled to get a toe in the door of a clinic or program director’s office, bureau project managers are helping them gain increasing access.

The result for many grantees has been a windfall of technical support, consulting services and recognition for their business practices.

In other instances, OPR has arrived in the nick of time to inject critical expertise that has kept less-established clinics afloat.

Recalls Nisha Patel, a senior project officer in the Office of Rural Health Policy: “Tell you the truth, we weren’t sure ourselves what this was about in the beginning...but we’ve heard from so many grantees by now, telling us what a great experience it is, that it’s obvious OPR isn’t this big, scary thing they were so worried about.”

“Not that they expect everything to be all ‘Kumbaya’ or anything,” added Nicole Coles of the Bureau of Primary Health Care, “but the grantees are now telling us they’d like these reviews to be the beginning of something longer-lasting...they want to have a relationship with OPR, because they’ve seen the benefits.”

Those benefits have been a matter of life and death for some clinics.

CDR David de la Cruz, then a project officer for the Maternal and Child Health Bureau, described one such scenario at last month’s All-Hands Conference:

For months, he had been hearing rumors and isolated reports that one of his grantees was experiencing management problems. High staff turnover. Late paychecks. Clinical and administrative operations were “a mess.”

Enter Tom Thomas, public health analyst in OPR’s Dallas office, who had experienced resistance from grantees in prior reviews. He checked in with de la Cruz early on to get a briefing on the clinic before a planned visit.

De la Cruz laid out his concerns about the clinic’s stability, and agreed to make some introductory calls for Thomas.

“A lot of site visits go wrong because the project reviewer is not getting to the people at the level where the care is actually being provided,” de la Cruz said. “Instead, you’re getting the CEO or the Chief Financial Officer, where the outlook might be rosier than what is really going on.”

“One of the things you want to get across very early on is that this is not the type of review where HRSA is looking for problems so we can ding you for it and restrict your funding. There are very tangible benefits — especially the technology assistance part, which OPR has the ability to affect in ways that the bureaus can’t.”

Jeffrey Beard, OPR-Boston Regional Coordinator, and Nicole Coles, BPHC Project Officer

CDR Dale Bates, OPR-Seattle Analyst, and Nisha Patel, ORHP Project Officer

Jeff Jordan, OPR-Dallas Regional Coordinator; Lauren Spears and Tom Thomas, OPR-Dallas Analysts

Dr. Duke and Becky Spitzgo, OPR associate administrator