UIC Alumnus is a True Network Provider
UIC Alumnus is a True Network Provider
By Paul Engleman
After his first year of medical school at UIC, Dr. Lee Francis, MD, (MPH ’00) signed up for a summer program in community health in which he had the option of working near San Diego or in rural Alabama. With visions of sand and surf in his head, Francis opted to head for the Coast. “I thought, ‘The beach, the ocean—that can’t be bad,’” he says.
Francis recalls getting a glimpse of the Pacific as his plane landed. But once he picked up his luggage and boarded the van that would take him to his summer home, he noticed that the ocean was behind him and getting farther and farther away. Home turned out to be a trailer, and Francis only set foot in the sand once. But the experience of helping doctors treat migrant workers in a community health center in a small town started him on a career path that, to hear the enthusiasm in his voice, has been every bit as enjoyable as a day at the beach.
“When I returned to UIC med school that fall, I started thinking about residency programs where I could have exposure to community health and really learn good medicine,” says Francis, now 52. He didn’t have to think too hard or look too far. Just steps away was Chicago’s only public hospital, Cook County (now the John H. Stroger, Jr. Hospital of Cook County), the notoriously underfunded and overcrowded facility where young doctors have the opportunity to learn their craft in the most challenging of circumstances—a medical baptism by fire.
As a youngster, Francis recalls, he would marvel at the imposing edifice while traveling with his parents and sister on the Eisenhower Expressway from their home in the western suburb of Oak Brook to visit relatives on Chicago’s South Side. “My mom and dad told me it was a place where anyone could go to be treated, even if they couldn’t afford it,” he says. “That must have somehow stuck with me. I remember thinking, ‘That’s neat.’”
In addition to enabling Francis to become part of that “neatness” at Cook County, the residency offered him an opportunity to work at Erie Family Health Center—a community health care center in the West Town neighborhood that was started as a volunteer clinic by doctors from Northwestern Memorial Hospital in 1957. In 1991, after completing his residency, Francis signed on as a clinician at Erie. Over the next decade, he also taught medicine at Cook County and Northwestern. Along the way, he found time to return to UIC and earn a master’s degree at the School of Public Health.
Today, Erie Family Health Center is a network of community health centers serving more than 43,000 patients at 13 Chicago locations and one in Evanston. Francis is Erie’s president and CEO. He and Erie share the same philosophy of health care: “Health care is a right, not a privilege,” he says. “Every human being has a right to the best health care that modern medicine can provide.”
To qualify for the designation of “health center,” a health care provider has to meet several federal guidelines. By definition, a health center must serve a high-need community; it must provide comprehensive primary care, as well as secondary support services such as education, language translation and transportation; a majority of the organization’s board members must be patients of the center; and its service fees must be based on a patient’s ability to pay.
More than three-quarters of Erie’s patients are Hispanic, and nearly half are age 19 or younger. Nearly a third do not have health insurance, and four in five have a household income below the federal poverty line. With a patient base such as that, one might expect that Erie would be a struggling institution.
Since 2007, when Francis became its president and CEO, Erie has added eight locations, including four in public schools, and doubled the number of patients it serves. Francis downplays his role in the expansion, saying that he has been implementing a plan that was put in place by the organization’s board in 2006. He credits much of the institution’s success to the generosity of its donors, creative grant-making and efficient use of resources by Erie’s staff, and the cooperation of its partners in developing cost-effective programs.
Iliana Mora, Erie’s chief operating officer, points to Francis’ leadership as a critical factor. “Lee is really a type of leader who thinks of others and his staff before himself,” says Mora, who has worked with Francis for 11 years. “I have never seen him put himself before others. One of the qualities that makes him stand apart is his ability to connect with the staff at all levels. His priority is relationships—with the staff, with partners, with partner hospitals. He just has an amazing ability to connect with people and to establish trust. That has been a huge contributor to Erie’s success.”
Mora recalls the morning of a blizzard two years ago when “a few brave souls on staff weathered the storm and made it to work in case patients were able to visit the health center. Lee stood outside at the door and gave every staff member a silver dollar as he or she arrived. That may seem like a small gesture to some, but it speaks to his humility and caring nature toward staff.”
It also may explain in part why Erie has been named one of the city’s “100 top workplaces” by the Chicago Tribune for the last three years.
Francis says that salaries for the Erie staff are “on a par with other similar institutions. They should be, because it’s hard work. My job as CEO is probably a lot easier than being a full-time doctor or nurse. But I do think our staff takes into account the value of what we are doing. For many of them, their compensation is not the primary reason they work at Erie.”
Although the majority of his work is now administrative, Francis still sees patients one afternoon a week and one Saturday every month. “I feel it’s important as a clinician to do that,” he says. “Plus, it gives me a wonderful window into what’s going on in the clinic and community. If I’m a leader of the Center, I should be on the front lines, so I can experience the successes and stay current understanding the challenges.”
Patient-Friendly Environments ?
On a scorching hot morning in June of this year, Francis is beaming as he and a group of Erie staffers cut the ceremonial ribbon at the grand opening of a new facility. If the idea of a community health center conjures up an image of a drab clinic where design takes a backseat to function, think again.
This new center is on the seventh floor of a brand-new building on the campus of Swedish Covenant Hospital near the Albany Park neighborhood on Chicago’s North Side. The waiting room is a warm, airy, sunlit space, with floor-to-ceiling windows that afford views of Lake Michigan. The interior offices are stocked with state-of-the-art medical equipment. The center provides a wide range of services, including primary medical care, diagnostic testing, dental services for children, women’s health services and prenatal care, and immediate access to hospital care, if necessary. It also will serve as a training facility for Swedish Covenant medical residents, giving them an opportunity to learn in a community health setting.
Although this center benefits from being brand new and featuring the latest technology, Francis is emphatic that all Erie health centers be warm, clean environments with comforting pastel color schemes. “We design all of our facilities so that they are places you would want to take your family to,” he says. “Our patients, although they may have little means for other aspects of their lives, receive a quality of health care that is equal to what people get on the city’s Gold Coast—and, in some cases, better.”
Paul Brandt-Rauf has known Francis since 2008, when he became Dean of the UIC School of Public Health after a long career at Columbia University. Francis serves on the SPH’s Executive Advisory Board and plays an important role in advising the school on what direction the instruction of future students should take.
“Lee is one of those truly dedicated people who right from the start comes with a moral imperative,” Brandt-Rauf says. “He projects his caring. He’s a true professional who understands the privilege as well as the responsibility of being a physician. He is clearly dedicated to helping underserved and vulnerable populations. He believes it, and he lives it.”
Beyond those personal qualities, Brandt-Rauf offers an explanation for why Francis has been effective as Erie’s top administrator. “There are a lot of dedicated professionals who are not good business people,” he says. “But Lee is both. He’s an idealist, but he’s also pragmatic. That’s a very unusual—and valuable—combination.
“Most doctors are trained to fix the broken problem, not to address the root cause of it,” Brandt-Rauf continues. “Lee’s approach goes much deeper than that. He understands that the root causes of disease are deep in society.”
To that point, Francis explains that, in providing health care to underserved populations, “There are so many layers to deal with, in addition to physical health. The direction we’ve tried to go at Erie is to build in wraparound services that address these other issues.”
One such program is a partnership with the law health program at Loyola University, which can initiate legal aid during a medical appointment. If a patient is suffering from asthma related to housing conditions, for example, a doctor at Erie can arrange for a health law consultation through the electronic medical record. This could result in a landlord receiving a letter from a lawyer requesting mold remediation, to help address the patient’s asthma.
“We adopt models that can work,” Francis says. One “fantastic model” of health care that Erie has adopted is health centers in public schools. Erie has five of them—two in elementary schools, which are open to everyone in the community, and three in high schools, which are restricted to serve only students and their families, due to safety concerns expressed by principals. Four of those centers have opened since Francis took charge.
Erie’s partnership with local hospitals is another important component of its success. Hospitals have been critical in helping us “expand, and we appreciate that very much,” Francis says. “We understand the power of a hospital and a community health center working together. We’ve had a decade-long relationship with Northwestern Memorial, and we have collaborated to develop some model projects in diabetes and breast health care.”
One such project addressed the vision problems of diabetic patients by opening a suite of eye-care exam rooms. “Northwestern helped kick-start that with eye-care professionals to staff it,” he says. “That eye-care suite now provides hundreds of vision screenings.”
Francis expects that Erie’s programs will be put to the test when more provisions of the Affordable Care Act, a.k.a. Obamacare, take effect next year. One challenge will be that health organizations will be evaluated and reimbursed based on how effectively they perform their service, not on how many patients they serve. That rating is based on the Healthcare Effectiveness Data and Information Set, a widely accepted evaluation tool that considers 75 measures across eight different domains of health care.
Francis concurs with COO Mora, who believes Erie may have a leg up on other providers. “Evaluating by performance—that’s how we’ve been doing it since I’ve been at Erie,” she says. “When your margins are slim, you have to be creative about the way you use your resources.”
For instance, she points out that the ACA’s required conversion to an electronic system of medical records shouldn’t present a problem. “We’ve been converting slowly but surely since 2006.” Francis thinks that Erie may even see some benefit from the ACA if more of its patients receive health insurance coverage.
Championship Swimmer ?
Although Francis made it to the beach only once during that summer when he first got his feet wet in public health, he has spent plenty of time in the water since, as part of a commitment to private health—his own. A competitive swimmer during high school in Hinsdale and college in Amherst, Mass., Francis belongs to U.S. Masters Swimming, a national non-profit organization that encourages physical fitness through swimming. Francis swims five mornings each week. Last year, he finished seventh in the national championship for his age group, swimming a mile in just under 20 minutes.
Francis says he greatly enjoys the camaraderie of training with the other master swimmers and makes note of another benefit that seems especially useful to someone with his level of responsibility: “It’s a great stress reliever.”