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  • Writer's pictureCatherine Nguyen

Closing the Health Gap

Updated: Jul 12, 2022

Why Consumer Voice Matters

The following is a doctoral Op-Ed authored by our Principal, Katie Strautman. Recent events in our nation have provoked our thoughts about the inclusion of underrepresented voices, and GBA is taking this opportunity to present ideas for developing impactful consumer voices on nonprofit boards of directors, especially those of community health centers.

Consumer voice matters. Federally Qualified Health Centers (FQHCs) are required to have a consumer-majority board of directors; however, many consumers that volunteer for these positions are not sufficiently prepared for meaningful participation or fully included in decision-making. Consumer participation and input in health care decision-making and policy development are integral to connecting marginalized, underserved populations to accessible, affordable, and high-quality health care services in their communities.

FQHCs, which are community-based, non-profit health centers, authorized under the Public Health Services Act of 1944, must have a consumer-majority board of directors; meaning that more than one-half of board members need to be patients of the health center. In other words, if the FQHC met the minimum of nine (9) required board members, at least five (5) board members would need to be patients of the health center. Their participation can inform the organization structure and delivery of care services, thus ensuring that decisions like services provided, or sites, and hours of operation, are meeting the needs of the community served. Consumer voice gives health centers a broad perspective and encourages dialogue among members that collectively have the values, competencies, and commitment to respond to the health care gap in their communities.

While the intent of the FQHC model supports consumer majority leadership, all too often there is a lack of support and resources for the onboarding of consumer board members that undermine the potential for consumer-majority leadership. For example, while there might be a learning curve for anyone who is joining a board of directors, consumer board members may be experiencing economic hardship that makes it challenging to participate in a volunteer role, much less without sufficient orientation voting on financial decisions for a multi-million-dollar corporation. Furthermore, some consumers have limited formal education, speak limited English, and/or are unaccustomed to being in peer situations where their voice is as important as any other member. In its essence, it becomes a question of whether consumer board members are fully included and are valued.

In response to this, we, that are involved in supporting the important work of health centers, need to ask ourselves these questions:

  • Do ALL board members feel that they are encouraged to contribute their perspectives at board meetings?

  • Do consumer board members feel that their opinions are respected by board members and management staff?

  • Do consumer board members receive sufficient explanation about the items for discussion by the board and in a format/language that they can understand to make well-informed decisions?

  • Do consumer board members have the resources (e.g., transportation, child care) to allow them to fully participate as a board member?

Sometimes there are invisible barriers that unintentionally excluded consumer members from meaningful participation and inclusion. It is also important to recognize that these barriers impact the long-term sustainability and viability of the organization — because it is a requirement of the FQHC program, and that the lack of consumer input into the decision-making process may adversely impact health care outcomes and the quality of health care provided. For meaningful participation and inclusion to happen, resources are required to support board member recruitment, which includes engaging, mentoring, and educating members — and health center staff — on the values of diversity, equity, and inclusion that make health centers strong. Without systems to support consumer voice, FQHCs, which are a safety net for more than 28 million low-income and other marginalized Americans, will be missing a key ingredient that ensures the FQHCs are meeting those most in need.

Consumer voice matters. For community health centers to be successful, consumer board members must feel valued and empowered to speak up in their role on behalf of ALL health care consumers and the community at large. This will ensure compliance with FQHC requirements, and ensure that services are offered to the people, for the people, and by the people. It means medical care that meets the needs of individual communities and that narrows the health care gap. Finally, while this concept applies to FQHCs and other health care centers, it is also applicable to organizations whose mission is to serve underrepresented and vulnerable populations.

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