SEPTEMBER 2022
With 25 years of experience running a healthcare clinic for people in need, April Cook succeeded Randy Jordan as CEO of the North Carolina Association of Free and Charitable Clinics on Aug. 1. As co-founder and former executive director of the Lake Norman Community Health Clinic in Huntersville, she brings a deep appreciation for the value that free and charitable clinics deliver to the communities they serve, and she’s lived the day-to-day challenges of operating a successful clinic. She previously served on the NCAFCC board of directors for a decade. April sat down recently to talk about her new role and opportunities ahead for the Association and its member clinics.
Q: After two decades running your own clinic, what motivated you to go to work for the Association?
A: Everybody involved in free and charitable clinics is looking for ways to increase their impact on the lives of the people they serve. We want to expand access to health care for people who have no insurance. These are good people who serve all of us as essential workers. But clinics have to be creative and beat the bushes for funding to serve as many people as we can.
I remember when we started the Lake Norman Community Health Clinic, we were open only one day a week and that eventually grew to five days. Since 2001, we provided 98,000 appointments and currently serve as the medical home to nearly 9,000 of our neighbors. I remember one farmer in particular who couldn’t afford a car and had to drive his John Deere tractor to the clinic. People like that really stick with you and fuel you to do more. There are so many people in North Carolina who are sick and hurting and managing chronic conditions. It is gratifying to see how just one clinic can make a difference in so many lives – so the opportunity to lead the Association and work with all of our 72 clinics is truly a dream assignment for me.
Q: How do you think your background will influence your leadership of the Association?
A: Everybody brings different strengths and skillsets to any job. Randy has done an amazing job building and strengthening relationships with key stakeholders and raising awareness of free and charitable clinics as a vital component of North Carolina’s healthcare safety net. I think my experience gives me perspective on what our member clinics need and what their leaders need. I know what clinic leaders go through every day and the many hats they are expected to wear: They are chief executive, HR director, fundraiser, accountant, IT director and more. At my clinic, I was often the person mowing the grass or pulling weeds in the parking lot. As CEO of the Association, having walked in those shoes will keep me grounded and focused on how we can move the needle for our members by helping them meet those day-to-day challenges.
Q: What’s your vision for the Association?
A: Clinics have always looked to the Association as a resource for funding, and we all have seen the incredible job Randy and his team have done in securing more than $27 million in COVID relief funding over the past two years. But the Association over the past several years has also become more focused on supporting member clinics on a deeper level, with the ultimate goal of lifting them up by elevating the quality of patient care across our clinics and advancing our mission of expanding access to healthcare to all North Carolinians who need it. The way to do that is to make each of our clinics part of something bigger – a statewide network of independent clinics working together to share resources and best practices and collaborate rather than competing or operating in silos. Regionalization of our clinics is something I am really interested in. I’m a firm believer that clinics are stronger and better able to serve their patients when they work together. We have seen the value of this approach in some of the multi-clinic grant applications that have been successful in gaining funding for important initiatives such as reducing health disparities and improving access to behavioral health services and dental care. In short, my goal is to continue the great work Randy and the team have been doing and explore new ways to live that “stronger together” philosophy.
Q: What do you see as the key challenges facing North Carolina’s free and charitable clinics?
A: Like so many other organizations, the pandemic hit us hard. Our clinics saw a surge in patients, many as they lost their jobs, and our costs soared at the same time our healthcare providers, volunteer force and fundraising declined. Fortunately, the North Carolina General Assembly recognized this crisis, and were already well acquainted with the critical role our clinics play in the safety net – so the Association was able to secure significant COVID relief funding. Nevertheless, the impact of the pandemic will continue to be a challenge for all of our clinics.
Another challenge is to make people aware of the critical need for free and charitable clinics. Most people don’t understand that poor people don’t automatically qualify for Medicaid, or that even if Medicaid expansion is approved, we will still have 700,000 North Carolinians who have no health insurance. Imagine not being able to go to the doctor when you need to – it’s frightening. We need to tell our story so that people have an accurate picture of our clinics and the people we serve. Most patients are essential workers, providing for the needs of others, many of them holding down two or more jobs to support their families. Without consistent access to the high-quality care provided by free and charitable clinics, these folks would be going without treatment or turning to hospital emergency departments, raising the cost of healthcare for everyone.
Q: What are the Association’s priorities over the next year?
A: We will continue to strengthen our clinics by facilitating collaboration among clinics, advocating on their behalf, securing funding, offering research and educational resources, and partnering with clinics on issues that impact them and their patients. Oral health is a great example. The Association has been working with clinics and funding partners on a major initiative to address what is truly an oral health crisis in our state. Parts of every county in North Carolina are federally designated areas with a shortage of dental health professionals. This is a problem even for those of us fortunate enough to have dental coverage, but for the uninsured, particularly in rural North Carolina, access to dental care is severely limited and contributes to broader health issues.
We also will continue “Our Journey Toward Health Equity” that we launched in 2021 and recently took a huge step forward on with the addition of Alice Mae Britt Jackson to our staff. Alice Mae will be leading our equity initiative to help clinics address the social determinants of health that represent roadblocks to better health for the uninsured and underserved communities. These roadblocks lead to disparities in health outcomes, so to have effective change we have to go to the root of the problem.
Personally, my priority is to get to know our clinics and their directors and staff even better than I have over my last 20 years in this business. These folks are the heart and soul of the free and charitable clinic network, and it’s remarkable what they achieve day in and day out. They simply want to help their fellow North Carolinians, like my farmer who drove his tractor to our clinic, who is just as deserving of good health as anyone else.
The COVID-19 pandemic drove home two critical lessons for North Carolina’s free and charitable clinics: Clinics are positioned to play a larger role in addressing the social determinants of health that lead to health disparities and a wider health equity gap. And we all learned firsthand the value of resilience in managing the stress, burnout and fatigue that come with operating under adverse circumstances. Join us Sept. 21 for the 2022 annual members’ meeting of the Association to hear from two of North Carolina’s leading experts on these topics.
Kicking off the discussion on health equity will be Victor Armstrong, who will deliver a keynote presentation on “Creating a Culture of Equity.”
Armstrong served as North Carolina’s first chief health equity officer before taking on his current role as chief diversity officer for Recovery International in Charlotte, a provider of self-help training for mental health and wellness. Earlier this year, he was named the recipient of the 2022 Social Worker of the Year Award by the N.C. chapter of the National Association of Social Workers.
While equity has become a major topic of discussion as the pandemic turned the spotlight on glaring gaps in access to health care, Armstrong cautions an intentional approach is needed to prevent equity from becoming nothing more than a trendy topic. In this presentation, he will discuss the importance of embedding equity into the work of human services, including defining the objective, identifying the essential elements, and exploring the challenges and pitfalls in applying the “lens of equity” to everyday activities.
Armstrong outlined three objectives for his presentation:
The second half of our keynote double-header will feature Patrick Jeffs, founder and CEO of The Resiliency Solution (TRS) in Chapel Hill. TRS is an organizational and resiliency consulting services company with a special focus on healthcare systems as well as individual healthcare workers. Jeffs describes himself as a “social entrepreneur, consultant, trainer and keynote speaker who teaches organizations how to build systemic resiliency.”
TRS provides resiliency training that enables groups and individuals of organizations such as hospitals and government municipalities to better address and overcome adversity and ultimately enhance overall performance. Over the last two years, Jeffs says his clients have become increasingly focused on how they can increase resilience and agility and help their employees feel safer.
Chronic stress in the workplace has itself become a pandemic that leads to burnout, turnover, and fatigue. Jeffs’ program trains executives, healthcare leaders, physicians and staff to apply a “lens of resilience” that helps them not only bounce back after current challenges but focus on expanding the organization’s capacity for the future. Resilience at work drives more innovation and creativity, optimizes collaboration, and increases focus on opportunities.
As part of his keynote, Jeffs will outline his “Six Pillars of Resiliency,” which include self-awareness, self-regulation, mental agility, strength of character, connection and optimism.
Just a year after launching its “Journey Toward Health Equity,” the Association marked an important milestone in August with the addition of Alice Britt Jackson as the organization’s first director of development and health equity.
Alice Mae joined the staff August 15 in a role that will be 50% devoted to helping member clinics improve the patient experience and reduce barriers to better health for all who need care. The other half of Alice Mae’s role will be split evenly between development work for the Association and fundraising on behalf of member clinics.
She brings to the Association her experience in Texas as the executive director of Hope Clinic of Garland and chief executive officer of Network Inc.’s Adolescent and Children’s Clinic in Richardson. Alice Mae also recently completed a three-year tenure on the Texas Association of Charitable Clinics’ Board of Directors.
“It’s wonderful to be back home in North Carolina, where I grew up, and to join this remarkable association of clinics who are devoted to the cause of good health and equitable health for all,” Alice Mae says. “I’ll do everything I can to support our member clinics and bring new strategies and data to help them better serve their patients.”
Hiring Alice Mae caps a year of significant progress since the Association joined healthcare organizations across the country in recognizing the need for actionable strategies to address health disparities.
The Association’s Health Equity Task Force, formed last fall with 29 leaders from member clinics and independent health equity experts, conducted a series of convenings in June, including adding staff resources devoted to health equity.
The task force developed a definition to guide the Association’s efforts: “NCAFCC affirms health equity is the opportunity for all of us to attain full health potential.” A separate value statement further details required actions: “To achieve health equity, we must address root causes of health inequities by (1) valuing everyone equally; (2) acknowledging historical and contemporary injustices; and (3) eliminating health disparities, intentionally advancing societal efforts to prevent inequities.”
In her health equity role, Alice Mae will assist clinics with tools, training and consultation that help instill the values that eliminate unjust health differences. She will also lead efforts to develop practices and policies for the Association and member clinics to advance health equity goals, assist Association leadership with the implementation of a sustainable Health Equity Task Force, and seek member clinics’ participation to strengthen patient care.
Alice Mae’s responsibilities also will include reviewing, analyzing and providing to the Association and membership research from across the state related to special populations and the social determinants impacting their quality of life and barriers to receiving quality healthcare.
The Association staff is further solidifying health equity strategies for the coming fiscal year at a staff planning session this week.
Alice Mae is a native of North Carolina from Murfreesboro in Hertford County, and currently resides in Greensboro. Reach out to her at alicemae@ncafcc.org