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. Author manuscript; available in PMC: 2017 Sep 8.
Published in final edited form as: J Health Care Poor Underserved. 2014 May;25(2):930–947. doi: 10.1353/hpu.2014.0107

Table 4.

Different Pathways for Community Health Center Decision-Making

Dominant Influence Service Decisions Financial Decisions
Governing Board “I think the board is [more influential] because our executive director…generally runs any kind of auxiliary services through us before she implements them.” No examples given.
Executive Director “Actually, the staff initiates that. As the doctors providing the services here, when they see patients they realize what we need here to better serve the patients that they’re seeing….With that in mind, they began to target this, then that brought discussion with the CEO. The CEO then brings that discussion to the board. Then the board, we talk about it and then we assign committees to get a report if that is necessary. Then that committee will come back to us…with their report. Then we make a conclusion of what we should do…and then we make that recommendation to the CEO who then makes the final decision.”

“I think the senior team and the individual clinics director are more involved in those decisions because they’re in a much better position to understand the needs of the different communities…The clinic directors really know, you know, do we need Saturday hours, do we need a late night, do we need childcare at this location… Obviously, it has significant financial implications that go through our financial committee and ends up being considered at that level, but overall I would say that’s more of an operation decision for the senior management team…We aren’t necessarily the initiators.”
“Definitely the CEO would be a bigger influence on the finances. Obviously, the board members are all volunteer members and we meet once a month. We have a full-time CEO and he hired a CFO. Actually, I’m on the finance committee so what we’ll do is we also meet once a month, typically the day before our full board meeting. After the finance meeting the members of the finance committee will hear reports as to what the previous month’s revenues and expense were. If there are any big items we need to talk about or if management has a suggestion that we move money from one CD to another or getting through the issues of us doing some expansion. The question may be, all right, the board has already approved us doing this expansion and now the CFO has put together a couple of options, we can borrow all the money, we can put up some of our money here, we can do this and that, so that’s pretty much how that’s presented to us. As far as actually maintaining the finances, that’s certainly something that management does and really kind of reports back to the board, this is the current state of things and obviously answer questions if we raised them or something doesn’t sound right. That’s pretty much how we’ve operated.”
Shared No examples given. “I think it’s pretty equal. I think our finance committee people are real dedicated and real on top of it. One of the members of the finance committee is a doctor who has been on the board from the very beginning and he’s very conscientious… We’re exceptionally financially healthy now and have been for a few years. I would say that the major credit for that is due to the CEO, but I do think our finance committee is very active and attentive and on top of it.”