Many individuals in our society spend a great deal
of time "hand wringing" and "finger pointing." You see it most places
if you choose to look. Some people seem happier if they are victims
and can make something or someone else the "bad guy" or responsible
for their troubles. Practitioners and entire organizations will spend
enormous amounts of time, money and energy to not address a problem.
When all is said and done, the problem still exists and might be even
worse. Facing the problem, analyzing it, coming up with possible
solutions, picking one and implementing it is somehow too much -- too
much effort, time, energy or thought. Or maybe they just like to be
"stuck." In the long run, deciding not to decide or face the issue(s)
is frequently much more costly.
The behavioral healthcare industry seems to have gotten itself into a similar rut. For many years, providers have spent a great deal of time "wringing their hands" and "pointing fingers" about all the negative things that have been happening to the field. This positioning has created a "victim" role for the industry and will do nothing to change the future. There seems to be no insight into the fact that our actions, or lack thereof, have contributed to these negative forces and continue to do so.
A more productive and proactive approach is to look at the problems and analyze the root cause of the situation. I believe there are two primary issues facing the behavioral healthcare industry that have negatively impacted on its very survival:
Competency is an issue that few organizations really want to face. They are afraid they will hurt someone's feelings or make someone mad. But competency is of critical importance because it directly affects the quality of care, quality of documentation and reimbursement. Many organizations are grasping at straws in the form of credentialing companies as the answer to this problem. That only goes to show that they do not understand the issues that face them. Checking credentials is important, but it is only part of the process. We all know individuals who have tons of credentials and yet we would not send anyone we loved to them. We also know people who are extremely competent who do not have the pedigree. Unfortunately, in this world you have to have both to be successful.
The best way to address this issue is to put a process in place that checks credentials, measures demonstrated competency and continues in a regular and ongoing way to monitor both. Somehow some of us have gotten the notion that we are above reproach and review. We have to realize that our clients are customers who have every right to know about our staff's competency and credentials as well as how we assure that they are able to do the job.
As one starts to talk about systems, the discussion about competency begins to merge with the next topic: leadership with little business savvy. Other areas of healthcare, i.e. long-term care and hospitals, have long required individuals in leadership positions to have business administration degrees and leadership experience. Our industry has not taken that approach. Most of the leaders in behavioral health have been promoted from within, having little, if any, business education or experience. This is not a personal attack on them, but rather a factual observation. Behavioral health has had a very difficult time recognizing that running a behavioral healthcare organization takes different skills and a complex knowledge base different from those of a physician, nurse or social worker. These skills and areas of knowledge are not taught in medical or nursing school, nor would you expect them to be.
The first hurdle to get over is to realize that
behavioral healthcare organizations are a business. They must stay in
business to provide care. They have customers. They have a product
that must be delivered by competent employees. They have to plan.
They have to budget. They have to be able to change as the
environment changes. They have to allocate resources. They have to
look for business opportunities and take advantage of the ones that
present themselves. They have to know what laws and regulations apply
to them and adhere to them appropriately. They have to be led by
competent, visionary, ethical, responsible leaders who can make the
right decisions, not the popular ones, based on what is right for the
organization.
Many people who read this will bristle and say that the patient has been forgotten in this scenario. That is not true at all. Because of the type of business we are in, we are very philanthropic by nature. But in order to be generous and giving, you must have a well-run business. A good business person knows there is a balance that has to be achieved between business decisions and philanthropic endeavors. Neither one of them can be excessive, or the balance becomes disrupted and the business fails.
Behavioral healthcare leaders need to understand the nature of the product, but they do not primarily need behavioral healthcare skills to run an organization. Because most behavioral healthcare leaders have little business education and/or business experience to draw from, the leaders draw on what they know and are comfortable with. As a result, their leadership style reflects their emotions (fear, anger, guilt, etc.) or their own patterns of behavior (avoidance, confrontation, etc.). The negative impact is limitless; problem employees are frequently personal "rehab" projects -- even up to the point where they negatively impact on care and the overall operation of the organization; there is often little opportunity and encouragement for change; accountability and consequences for non-compliance are often not addressed; business opportunities are avoided; organizations are not in compliance with laws or regulations that apply to them, and on and on.
The Joint Commission on Accreditation of Healthcare organizations (JCAHO) has recognized the power and critical nature of proactive and responsible leadership for a long time. In 1995, in the "Mental Health Standards," JCAHO combined many of their chapters, including "Governance and Management," "Planning and Evaluation" and pieces of many others, to create a "Leadership" chapter. In this chapter, they make it very clear who they feel is ultimately responsible for decision-making and leadership activities such as planning, budgeting, allocation of resources, compliance with laws, staffing, etc. Technical matters that are cited by JCAHO often have a corresponding Leadership Standard that is also cited. That is appropriate. We all know middle managers can not make necessary changes to improve care or operations without the support of leadership.
Fundamental business practices are of great concern; of that there is no doubt. But as behavioral health gets swept into the arena of "big business," our unprepared leaders frequently have to match wits with experienced business operators who are result oriented and fiscally driven. This lack of business savvy has the potential to be the undoing of many organizations.
As an industry, we need to quickly realize the true "burning" issues and stop pointing fingers and hoping it will all go away. Not only is it not going to go away, it will probably get even more demanding. We need to assume responsibility, be accountable and start making changes to address these deficits. This sounds awfully similar to what we tell our patients on a regular basis. We need to always keep sight of the patient, while remembering we do not serve them well by going out of business. We need to stay viable. Running a business is hard work that takes skill and knowledge. Those who rely on luck and the goodwill of others are always the most surprised and angry when the end comes.
Joan
Betzold is the president and founder of Professional Services
Consultants, Inc., a national healthcare management consulting firm.
She is also a well-known national author and presenter. E-mail:
psc@netgsi.com or visit website:
www.netgsi.com/psc