healthmedicinet

Mental health care providers face a Gordian knot: on one hand, they must perform well in terms of traditional business models — meet the numbers, make the financial targets and the margins required for stability, while managing turnover, benefits and overhead.  On the other, they must provide care that meets multiple standards of quality while maintaining relationships that foster recovery in practical ways, for example comprehending and responding in an empathic way to the real impact of traumatic experiences.

Here’s a third hand just to complicate matters: whether the cause is neurological (brain-based from injury, disease, or genetics) or learned (shaped by experiences that overwhelm our capacity), or both, how much we discount what the people who have the experience of mental illness say they need in favor of what we’ve learned?  It’s fundamentally about power, who has it, how it is assigned, and how we wrangle it.

How can mental health providers have their cake and eat it too, or at least have two of the three pieces?

For a decade, I worked as a consultant to J.D. Power and Associates. And during that time, I was immensely impressed by the work Dave Power did in helping multiple sectors reap rewards from customer-centric relationships. Automotive, call center, healthcare, financial — anywhere a unique identifier connected an experience to a customer — his firm demonstrated that focusing on quality and relationships of importance to the customer paid off in a way that has some parallels with mental health care. Here are some of the things that stick with me from that era, including from my training as a “Six Sigma Black Belt”.

1.     Customer-centric organizations that place the customers’ requirements for quality at the top of their concerns do better financially.  Forget the defense “but these aren’t just any customers; they’re people with mental illness!”  Just forget it. At the end of the day, if you don’t place the customers’ concerns first, you don’t successful customers. If you don’t have customers who are successful, you don’t have a business.  How you and your organization behave (which is based on what you believe and even how you think others define success versus how they define it)—from front door to back in all processes—drives satisfaction, and enthusiasm, even creates evangelists.  Measure and meet the attributes of importance as defined by your customer.

2.     Processes that work effectively increase financial performance.  This is more than a couple of people getting together to put up sticky notes—first, it’s having everyone who touches the process review it, and crystalize it AS IS, messes and all, no changes.  Then the bottlenecks, problem areas, redundancies are evident—and changes are easier.  It takes significant commitment and organizational willpower to document a process without fixing it; to include everyone touched by the process and to feel the discomfort of waiting for changes.

3.     Quality and relationships mean different things to different people.  Who defines “quality” for the people generating revenue (the clients or customers)?  Is it the provider? Insurance panels? Standards boards? In my specialty of trauma-informed care and helping organizations become trauma-informed, I think people and corporations think “quality” means “taking more time” or “doing only what people want to do.” But to me, quality is a form of personal influence driven by one’s knowledge about trauma, associated beliefs and one’s level of skill in conscious relationships.  This makes the concerns of quality applicable from macro levels (think organizational self-care) to micro levels (how am I when in the presence of another).

4.     Aligning customer, employee and stakeholder interests is critical.  Now we have a Gordian knot within the Gordian knot. The people served want to feel better.  The people providing the services want them to feel better (while making a living).  But feeling better has specific challenges: it’s hard for a anyone to feel better when coerced, dealing with the effects of medication, or when life is not fulfilling.  It’s hard to feel better when your strongest relationship mandates you perform in certain ways to maintain the access to the relationship.  It’s hard to feel better when the people in an organization providing care may not believe you can. This means that it’s especially hard to feel better when providers believe that mentally ill people need to be managed and controlled. And there is a difficult dance all along the spectrum from simply letting clients and customers do “whatever” to coercive interventions that may be driven by others’ resentments or fear.

5.   Realistic workloads are critical. If an individual has an 8 hour day, minus 30 minutes for lunch and another 30 for breaks, that leaves them with seven hours.  For each hour, do you know—actually have measurements based on formal observation—about how long it takes to (1) welcome and bring someone to the office, deducting time from the session or group?  (2) How much time it takes to document an activity?  (3) How much time must be spent on necessary phone calls and correspondence?  Without any sense of a time-study, it’s hard to see how many people an agency can realistically see at any given time.  Did I mention—fourth—the need for recovery time between sessions that allows a provider to be as present at the end of the day as they were at the beginning? What is the point of scheduling ten clients for a seven-hour workday?  Forget “but they need to be seen!” because after client seven, it’s lip service.  If you want quality (see #3), you simply can’t exceed a reasonable quantity.

These strategies go a long way toward making you and your organization “trauma-responsive.” But they sound expensive, right? In fact, it can be until you realize that in actively trauma-responsive organizations or treatment models, the costs of care are likely to decrease per person: people get better faster. Of course, for a business, this is a disincentive – revenue models are sometimes driven by serving more people, for longer time, bringing in more revenue.  But the fact is, we’ll never run out of people to serve in agencies. Becoming trauma-responsive simply allows us to treat more people in the absolute best way possible.

– Please join me on Facebook to discuss personal and organizational trauma, healing, ethics, and innovation.

Image: Drew Leavy via Compfight

 

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And they are apparently too stupid to realize how easy it is to ensure they are called out for their bad behavior.

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    Last reviewed: 4 Jan 2014