Audit finds overwhelmed providers at Multnomah County clinics
Multnomah County's health clinics suffer from significant provider turnover, sometimes-overwhelming workloads and rules that may discourage quality care — especially for non-English speakers, according to a new audit.
Last year, about 66,000 residents used the county's network of seven primary care clinics, which also includes eight student health centers for medical and dental care. But even though nearly half of those patients were best served in a language other than English, the county's system does not fully ensure providers can deal with a high number of visits in which an interpreter is necessary. Nor does its call center greeting fully accommodate the many languages its patients speak, the audit found.
Auditors also reported room for improvement in financial management of the division overseeing the clinics, noting an outside federal review and internal consultant had questioned the division's financial practices in 2017, and two of the county's primary care clinics lost money last year.
In a response, Chair Deborah Kafoury and Health Department Director Patricia Charles-Heathers defended management and quality of care at the county's clinics, noting it had passed its most recent inspection, and drew high marks from patients, among other things. They agreed with many of the audit's recommendations and said that, with the help of a consultant, work is under way to address most of the specific concerns raised by the auditor.
"Providing high-quality care is a top priority for the Health Department's leadership, the dedicated staff who work in primary care ... and the county," they wrote.
Vanetta Abdellatif, who oversees the clinics for the county, said turnover is a reality for safety-net providers like the county, calling it " a really tough job." She said she's proud of the quality of care in county clinics, but her division would welcome a new, high-level financial manager. "Some additional financial support would definitely be welcome."
Stressed by communication gaps
Among the audit's findings: doctors, nurses and other providers typically allotted only 20 minutes per patient visit — but often are intentionally overbooked in case some patients don't show up. But because interpreted visits can take much longer to allow for clarification and follow-up questions, providers are under particular pressure in clinics where patients and providers don't speak the same language.
The audit paid particular attention to the Mid-County Health Center clinic at 12710 S.E. Division St. It said the clinic serves a larger number of refugees, has a higher usage of interpreters, serves a high number of patients with complex needs, averages more patient visits than other clinics and loses a third of its providers each year — far above the turnover rate of other clinics.
One provider told auditors she was spending 60 hours per week on work though she was scheduled to work only 32 hours per week.
The audit paraphrased providers as indicating the workload is "unsustainable" and "overwhelming." One complained that management did not take staff concerns seriously.
While some county providers expressed concerns about the quality of patient care as a result of turnover, auditors "found few specific instances of poor quality of care resulting from provider turnover."
The audit noted that patients of the county speak more than 100 languages, and raised concerns of customer service and patient care for patients who do not speak English, saying "The Call Center greeting is in English during hours of operation and in English and Spanish after hours. When we talked to patients during our survey, we learned that non-English speakers have trouble navigating the Call Center. For those who do not understand English, this can be confusing and frustrating. Further, we learned that some patients have had to wait as long as 45 minutes for an interpreter or to speak with someone."
Other concerns raised by patients had nothing to do with language, according to the audit:
"Several patients were frustrated by the wait time and the limited access to their primary care provider ... patients may have to call repeatedly several days in a row to get an appointment with their primary care provider."
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