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Management in Practice

Navigating a New Now: Prioritizing a Vulnerable Community

A community health center in New Haven knocked on 5,246 doors to ensure patients had access to vaccines and accurate information. Dr. Suzanne Lagarde ’14, CEO of Fair Haven Community Health Care, explains how she adapted the organization’s approach to meet the needs of the community even as the unrelenting pandemic took a toll on her staff. In this series, we talk with Yale SOM alumni about how they are leading their organizations through the uncertainty, optimism, and fear of the new now.

Last fall, Dr. Suzanne Lagarde ’14, CEO of Fair Haven Community Health Care, talked with Yale Insights about how COVID-19 was affecting Fair Haven’s largely Hispanic population and how the organization was responding. With increased food insecurity in the area, FHCHC was extending its services beyond healthcare, partnering with a food bank and a taxi company to safely deliver groceries to Fair Haven’s patients. Masks, social distancing, and testing had brought down cases in the area but winter was approaching and vaccines were still months off. We checked back in to hear about how the organization experienced the hope and uncertainty of the last year, and what the future looks like.

Q: How has the pandemic impacted Fair Haven Community Health Care since we last spoke?

It’s been a rough year and a half. I remember talking with you last year about my fear of losing a staff member to COVID. Unfortunately, that was realized in January. We lost a much-beloved physician to COVID. That was the lowest low. It had an incredibly sobering impact on the entire staff.

Now, from a COVID perspective, things are better. The vaccines were a game changer. They’re safe and so highly protective. It’s a very different scenario. If you’re vaccinated and you still get COVID, odds are that you’re not going to get horribly ill. That’s unequivocally made a huge difference.

Even so, the need in the community is still there. We continue to get food to people who we see during the course of a regular day. Once a month, we work with M7 Taxi to deliver two huge shopping bags of food, a lot of it fresh produce that we get through the Connecticut Food bank, to about 250 homes. That’s possible because we’ve developed these collaborations and partnerships.

Our program with another nonprofit, BH Care, at our facility which is right over the East Haven line in Branford, is going extremely well. Delivering integrated mental health care is a top priority because there’s a huge need out there.

Q: How much of the adaptation to the pandemic is temporary and how much is a new normal?

That’s a fascinating question. We know COVID is not just going to suddenly disappear. I think we’re going to see some variations of the state we’re in now for a number of years. When I see somebody I haven’t seen in a long time and who I might normally go over and hug, I hold back. I think that’s the new norm, at least for a while.

After so many challenges, this is a moment when I really want to bring my staff together to rally the troops. But everybody’s still a little cautious. People don’t want to gather. At work, we’re, appropriately, all masked all the time; it’s just hard to keep up spirits in that environment.

I’m hoping that we get to a point where we’re able to gradually, cautiously, return to more social interactions. I’ve learned how much of work is a social thing. It’s an opportunity to interact with people that you like being around. I think we will gradually get back to close to where we were, but I think it’s going to take a very long time.

In June I thought things were getting better; then Delta surged. Even with high vaccination rates in Connecticut, with our COVID testing, we were seeing positivity rates in August and early September as high as 10%. That has come down. I want to hope that things are going to stay better. But, along with everybody else, I’m concerned about the colder weather, the impact of flu, etc.

Q: How has Fair Haven approached vaccinations?

We gave our first vaccine dose on Christmas Eve. By Martin Luther King Day we realized we were vaccinating people from all over Connecticut; 80% were white. I didn’t want to deny anybody access to the vaccine, but my mission, my focus, had to be on my community.

At that time, to get a vaccine appointment online through the state’s Vaccine Administration Management System (VAMS), you needed an email address, you needed a smartphone or computer, you needed access to the internet, and you needed to speak English because it wasn’t available in any other language. That meant many of our patients were being left out.

It took a lot of time and was complicated for us to leave VAMS because we needed another mechanism for delivering our vaccine administration data into Connecticut’s vaccine database, but we managed to do it.

In early March, we started knocking on every single door in Fair Haven, all 5,246 of them. With 300 volunteers, always working in pairs and always with at least one bilingual person, we did outreach for seven weeks. Our community needed that approach. At this point, 60% of the people we’ve vaccinated are either Hispanic or African American.

We serve neighborhoods that are very vulnerable, according to the social determinants of health. These are folks who don’t have easy access to services. By focusing on them, we were able to do a phenomenal campaign. We coordinated with a community van. We got funds to provide taxi rides back and forth for those who needed it. We did some in-home vaccines, which is very time-consuming, but obviously there are people who just are home bound.

At this point, we’ve administered over 25,000 doses. Demand has significantly diminished, but we’re still vaccinating about 200 people a week.

In terms of staff, we got to about 80% vaccinated, and then we had the diehards. We made COVID vaccination mandatory back in August with a deadline of October 1. A few people left rather than get vaccinated. But at this point everybody’s gotten at least one dose of vaccine and the vast majority are fully vaccinated.

Q: How are your staff handling this ongoing extraordinary situation?

As a Federally Qualified Health Center (FQHC), we’re a nonprofit that receives some federal funding in order to deliver healthcare to underserved and vulnerable populations. For those working here, everyone wears many hats because we have such limited resources. Everybody’s called on to do more than they would in another environment. You do your best because the stakes are high—the lives of 29,000 people depend on us. It’s important stuff. It’s meaningful.

Even so, burnout is real. The Health Resources and Services Administration (HRSA), our regulatory agency, put out grants to help facilities like mine work on burnout. This has been accelerated and accentuated by COVID, but it started pre-COVID.

I’d be lying if I didn’t say it’s a challenge. We try to make it a good work environment. We want people to want to go to work. Now that we’re going back in person more, we want that to be a positive experience. Like everybody else, we’re seeing significant turnover.

I don’t think people are leaving our sector more than they’re leaving other sectors. Still, the impact of the lack of workforce is unbelievable. I have to say, I don’t really understand the why, but we are just so challenged in getting positions filled, particularly nurses and medical assistants.

It’s not the pay. There was a time when people thought that the government paying a generous subsidy to those who were unemployed was an incentive to remain on unemployment, but that ended, and I don’t see any great improvements. In fact, if anything, it seems to be getting worse. I don’t know the resolution of this. I’ve got to hope that it’s somehow related to it having been a tough year and a half emotionally for a lot of people.

Q: Leading Fair Haven has meant steeping away from treating patients. How has that shifted your perspective?

Thirty years of boots on the ground experience as a doctor informs everything I do. But these days I spend a great deal of my time trying to educate our state and national leaders. It’s a fight. I’ve been fighting for a rate increase from Medicaid for five years. We receive one of the lowest rates among the 17 FQHCs in Connecticut. I’ll keep fighting because I think we’re in the right.

Fifty-eight percent of our patients have Medicaid. Twenty-seven percent are uninsured. We provide one level of care; there aren’t different levels of care provided based on ability to pay. For the business, when that many patients are paying pennies on the dollar, it has an impact on what we’re able to do overall.

“I don’t know if I’m idealistic, because the things we’re trying to do are achievable. So I think it’s realism. Some of them are hard and will take time. But I believe we can get there.” 

Q: The work seems to require a mix of idealism and pragmatism. Is that accurate?

I don’t know if I’m being idealistic, because the things we’re trying to do are achievable. So I think it’s realism. Some of them are hard and will take time. They may take months or years. But I believe we can get there.

Q: Are you drawing on skills you learned at Yale SOM?

My daughter is a second-year SOM student. It’s been fascinating because she brings up courses that I was taking just eight years ago, and we have conversations about them.

There’s no question what I learned at SOM made a huge difference. Do I think of, every day, “For this I’m going to pull out what I learned in Daylian Cain’s class on negotiation”? Or “For this, I need to know the net present value to be sure these projections make sense”? No. It just becomes integrated in how you function.

That said, there’s no way I would be here today if it wasn’t for SOM. I would’ve never taken the job in the first place; I would’ve never felt competent to do it. The single most important thing that SOM gave me was confidence. The confidence that whatever comes up, I’ve heard of it, I’ve seen it before, there are resources that I can tap into. That, for me, was invaluable.

I know that many people go to Yale SOM with the idea of joining a multi-billion- or trillion-dollar company. Most people who do that necessarily end up somewhere in the hierarchy. I get to run my organization. I lead a $32 million a year business with about 240 employees. It’s a nonprofit FQHC, but at the end of the day, it’s a business. I need to invoke all of the lessons I learned at SOM to make it successful.

If your goal is to make humongous amounts of money, you’re not going to do that in the nonprofit sector. But, if your goal is to make a very respectable salary and have a very rewarding life and do a lot of what we talked about during those two years at SOM, the nonprofit sector can be really exciting.

Some days it drives me nuts. But my husband keeps saying, “When are you going to retire?” I can’t fathom it. I really would miss what I do.