Applying the EFQM Excellence Model for Practice

Improvement at Free Medical Clinics

Erin Apodaca | Laura Maxwell | OHSU School of Nursing

Methods
Methods

Aim
Aim
To identify gaps in the healthcare delivery process at a local free
medical clinic in order to introduce process changes to improve the
quality of a service to better match the needs of the populations that
they serve.

Conclusion
Conclusion
By utilizing this framework as a process reference, a series of actions
were taken to identify, analyze, and create recommendation based on
the strengths and limitations of free medical clinics in order to meet
new goals and objectives.

This project has the potential to impact the business due to the fact that
it will help to define current standards and develop guidance on the
best approach to delivery of services in order to improve health
services and outcomes.

Recommendations include:
Recruiting/employing more bilingual/bicultural staff
Employing a Promotores de Salud (Community Health Worker)
Advertising with local Spanish radio stations to recruit volunteers
Exploring local retirement communities to enlist retirees as
possible volunteer interpreters

Background
Background

The EFQM Excellence Model was identified as a systematic approach

to identify underlying principles that form the foundation for achieving
sustainable excellence.

The passage of the Affordable Care Act in 2010 caused a shift in the
need and relevancy of free medical clinics nationally because it was
projected that because health insurance coverage would be more
affordable, more would receive coverage.
Unfortunately, the reality did not match this conceptualization; there
exists inequity in regards to access to the insurance marketplace,
employers refusing to offer insurance coverage, socioeconomic status
and coverage affordability are intertwined, and certain populations do
not qualify for coverage.

Uninsured by Race Alone, Percent

A survey was created and implemented from June 1 st September 1st

2015
The survey contained 14 questions including demographics (i.e.,
race, age, and gender), employment status, insurance status,
language spoken, and barriers to accessing care.

Partnering with local Food Banks to recruit interpreters in

community
Utilizing the Registry of Certified Medical Interpreters for
Marion and Polk counties to recruit volunteers

Personal interviews were conducted with the executive director, the

head of interpretive services, and clinic coordinator at the free medical
clinic.
Several hours of direct observation of the clinic processes were
performed.

Uninsured by Ethnicity Alone, Percent

50.00%
40.00%
40.00%
30.00%

30.00%

Analysis
Analysis

20.00%
20.00%

10.00%
0.00%

10.00%

0.00%
Marion County

Oregon

U.S.

Marion County
Hispanic/Latino

Oregon

U.S.

Non-Hispanic/Latino

The functioning of free medical clinics are based on a complex

network of volunteers and community partnerships and while they
provide free medical and dental services to their communities, there
exists opportunities for practice improvements in order to better meet
the needs of their diverse patient population, inclusive of the cultural
context.

While analyzing the data results from the survey and compiling
information from the person interviews, themes emerged in practice
improvement areas of medical interpretive services, womens services,
and marketing.
A shift in demographics from English speakers to non-English
speakers indicates an increased need for medical interpretive services.
There is a growing need for more bicultural/bilingual staff at free
medical clinics to meet the demands of a growing, culturally diverse
population.

Within the EFQM Excellence Model exists the RADAR (Results,

Approach, Deployment, Assessment and Review) tool which serves
to assist organizations with implementing and analyzing the
effectiveness of systematic improvements.
This dynamic assessment tool provides a structured approach to
assessing the performance of an organization over time. Therefore, it
can be used to assess current capabilities, as well as assess the efficacy
of the implementations of new processes.