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Integrated clinic grew from organizational spirit

August 19, 2015
by Lori Ashcraft
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Lori Ashcraft

For the last few years we’ve been talking about integration as though it were a new idea. In conversations ranging from funding, program structure and content, to blueprints and office space, we come up with plans to reinvent integration of services.  

Occasionally we hear stories about organizations that have had integrated services forever, and we take a closer look at them to see how they work. This is one of those stories.

Earlier this month, after previous attempts, the Sierra Family Medical Clinic (SFMC) was awarded 330 Federally Qualified Health Center (FQHC) status with the full grant amount for two years. It was one of just a few FQHCs in California to receive the maximum amount. But many of its patients might not realize that Sierra Family was once just a small shed and a single physician with a mission.


Peter Van Houten, MD, graduated with honors from UCSF Medical School and finished his residency in 1980. He moved to rural Northern California and quickly became frustrated by the unmet medical needs in his community.  He didn’t have a five year plan. He had a vision and a strong spirit of service, and this is what propelled him to drive a backhoe out of its shed and open a medical clinic.

He wondered if anyone would come, but by the end of the first day, he had seen 10 patients.

From the beginning, Van Houten solicited advice from his patients and used their needs to guide program development. People came to the clinic with multiple issues: physical, emotional, mental and substance use.

“It just made sense to organize ourselves around the person’s needs instead of standard siloed practices,” says Van Houten. 

As staff came on board, they too were included in the conversation.  This spirit of inclusion and collaboration produced services aimed at a whole person approach for the whole community, including services that were easily accessible and delivered by a team that had strong ownership in providing quality services.

It didn’t take long to outgrow the trailer, but raising capital to build a new clinic is a long shot in rural areas. It requires a spirit of possibility and the willingness to stay open to options that may seem remote. In 1997, the state department of agriculture funded the project with a low interest loan. In time, the new comfortable space allowed SFMC to increase capacity significantly and serve not only its own community but surrounding areas as well.

While Van Houten served as the founding owner and medical director, in 1994 he donated the clinic to a newly formed non-profit set up by community members.  By 1999, the clinic had become a FQHC, and three years later it added behavioral health services, followed by dental services. All told, the little trailer in rural California had organically become an integrated clinic.

Today’s spirit

Today, the clinic is near capacity with waiting lists for non-critical situations. Next month, SFMC will add a second site in the adjoining area of Oregon House. This second site will have all the integrated capacity as the primary site. But there is still more unmet need.

At SFMC I don’t see much frustration. Instead,  I see a spirit of joy that sustains them and calls on them to be in the moment with their work.

Connecting with patents in an authentic spirit of partnership provides a flow of communication that allows for early intervention and prevention. Building trust also encourages patients to turn first to SFMC when they experience health challenges instead of emergency rooms. This results in a dramatic per-person reduction in overall health costs for the community.

Over the years, the clinic has faced obstacles, but the management team’s spirit of resilience has preserved their integrity and their commitment to their vision. By resilience, I don’t simply mean that they bounce back when faced with adversity. I mean they gain strength from it.

Your organizational spirit

I don’t pretend to thoroughly understand organizational spirit, but I can recognize it when I see it. In some organizations, it is a dim glimmer that needs to be fanned in order to glow brightly and carry the organization through tough times. In other organizations, there are traces of it, but it has long since been extinguished by the harsh administrative demands placed on programs. And then there are times like this when it glows brightly enough to study so we can all learn from it.

Take a look at your own organizational sprit. As we see in this story, it’s a key element in sustaining and supporting you as you press toward to goals you’ve set.

Lori Ashcraft is director of Resilience Inc., a training and consulting group with a mission of creating new ways to optimize organizational resilience and wellness.