What We’ve Achieved

We aimed to test 75% of our patients by the end of 2017. We didn’t quite achieve this lofty goal, but we nearly doubled our testing, going from 26% tested prior to the grant to 51% tested at the end of 2017. We implemented testing at eight of our nine sites. We did this by:

	Strengthening relationships across the organization, harmonizing efforts, and garnering strong buy-in at all levels
	Conducting extensive staff trainings at all levels and at all sites, including HIV facts, testing logistics, EHR modifications and usage, and approaches to obtaining patient consent
	Providing regular feedback on testing rates at all sites during staff meetings, as well as incorporating results into site leadership dashboards
	Implementing ongoing staff education to ensure sustainability, including required annual video reviews and video onboarding for all new staff

We faced many challenges along the way, some cultural, some systemic, others political, and one even a natural disaster. Competing priorities and ongoing staff turnover made all our training efforts much more important. Despite exploring every angle, we couldn’t make reimbursement in our dental clinic sustainable enough to support testing there. We struggled to collect and use high quality data. Then, in October 2017, our largest site sustained catastrophic damage during a firestorm.

Yet despite these challenges, we managed to normalize HIV throughout our organization with both staff and patients. HIV testing became just one of several conditions on which we focused screening activities. And the project had benefits that went beyond HIV. Our efforts moved Santa Rosa Community Health forward in its approach to quality metrics overall, strengthened our commitment to ongoing training, and enhanced our ability to tackle new organizational changes. We hope this toolkit allows others to benefit from our experiences.