Shared risk management expert guides FUHN clinics to improved processes

Four Federally Qualified Health Center Unified Network member clinics are benefiting from the expertise of Kristie Sams, MBA, CCMP, FMVA, LBBP, ESG, CBCP,  their fractional director of risk management.

For the past several months, Sams has been working closely with the clinics as an extension of their teams, reviewing clinical-related processes and identifying which ones need to be updated and/or assigned an owner to be responsible for their oversight. In partnership with Sams, the clinics have been creating action plans with owners and due dates outlining what they do to mitigate risks to protect patients and give them the best care possible.

Sams is offering insight into how to effectively implement the action plans with limited staff and leaders so committed to their organization that they want to take on everything. One suggestion was to have “a champion” who could be a part-time person who drives the action plan for five hours a month.

“A critical component to change management and effectively executing an action plan is validating that changes hold over time, not just that they were implemented,” says Sams. “We need closed-loop accountability to ensure issues are fully resolved, not just addressed.”

Highest risk clinical areas and centralizing focus

Based on Federal Tort Claims Act (FTCA) Deeming Requirements, the highest risk clinical areas for HRSA-funded health centers, which require targeted risk management and staff training, include obstetrics, medication management, infection control, and diagnostic errors. Other high-risk areas include dental care, behavioral health, and emergency, urgent, or chronic care management.

According to Sams, at the clinic level in a large health care system, risk stays decentralized in the specific clinical areas. But at the network level, it is centralized. FUHN exists to bring cost-savings, shared service agreements, value-based care arrangements, and best practices to its member clinics.

By Q4 2026, Sams and FUHN Executive Director Mary Maertens, RN, PHN, MHA, FACHE, aim to have a central dashboard for all FUHN member clinics to review risk management processes, develop templates, and build best practices. This approach has worked well for FUHN’s Quality Committee, which adopted a shared quality calendar across the member clinics in 2025 to align and focus on specific quality improvement topics and efforts such as cancer and depression screenings, childhood immunizations and well-child visits, diabetes care, and hypertension treatment.

“A collaborative, network-level approach helps FUHN member clinics learn from one another, as they share best practices and key learnings,” says Maertens. “Over the past several years, clinic leaders have leaned into each other and built a strong sense of shared responsibility and commitment to their collective success because their success means better patient care and more efficient operations in a demanding, ever-changing, and complicated health care dynamic.”

“You are only as good as your documentation.”

As a consultant and fractional director of risk management, Sams has the benefit of a third-party perspective of examining reporting processes, determining what they’re specifically communicating, and identifying the gaps and potential risks. Then, with her expertise in change management (she has a certification in this area), she brings teams together around improvement processes and solutions.

“What stands out to me about the clinics' staff is the level of buy-in. Even with competing demands, staff are actively engaging in improving processes and strengthening patient care,” says Sams. “They believe in what they’re doing and are committed to continuously improving so they can be better for their patients and communities.”

Increasingly, HRSA and FTCA want more than a narrative description of the risk management methodology. According to Sams, the agencies are not looking for more processes per se; they want to see more structure and processes that are measurable and defensible when negative incidents occur, as they inevitably do despite a clinic’s best efforts.

“In this environment, what matters is what is documented and consistently followed, not what was intended,” says Sams. 

Areas of improvement to date

In a short time, Sams has made a difference for the clinics. 

One center executive director shared, "Kristie helped us shape an examination of our new after-hours phone answering solution with Octiva Healthcare, identifying risks and closing any gaps. From a patient perspective, we wanted to confirm we were doing what we could to ensure the patients receive the care information they need and that we could review the calls and processes. Having Kristie’s guidance was critical, and now we can roll out the AI-driven solution with confidence.” 

In addition to the above example, here are several other improvements since Kristie Sams joined the FUHN clinics:

Increased diagnostic follow-up reliability: At one clinic, gaps were identified in how diagnostic results were tracked and closed out. There wasn’t consistent visibility into whether abnormal results were reviewed and communicated. The clinic focused on standardizing follow-up expectations, improving tracking mechanisms, and reinforcing documentation so there’s a clear audit trail.

Improved patient information handling: At another clinic, inconsistencies were observed in how patient information was handled within daily workflows, particularly around shared workspaces.  The clinic addressed that by tightening process controls, reinforcing expectations with staff, and implementing simple end-of-day accountability checks.

Better referral continuity: For another clinic, the opportunity to improve was around referral management. The process existed, but execution wasn’t always consistent. The clinic worked on strengthening tracking, improving visibility into completion, and aligning expectations so providers have clear feedback on outcomes.

More program structure and visibility: At another clinic, the gap wasn’t a single process but rather overall visibility into risk. The clinic focused on implementing a more structured risk framework, improving reporting consistency, and ensuring leadership had clearer insight into where risks exist.

“The FUHN leadership team is looking forward to seeing the continued improvements in risk management under Kristie’s guidance,” says Maertens. “The more FUHN member clinics can collaborate and learn from each other and experts like Kristie, the better positioned they will be to persevere through changes in health care and continue to serve their patients and communities with the care and talent their teams exhibit every day.”