Behavioral health care is changing rapidly and our leaders are rushing to catch up. Gone are the days when providers could perform a service, file a claim and get paid. Today’s funders are no longer paying for volume; they are paying for value. In many cases, this requires wholesale transformation of an agency’s administrative, billing and service delivery practices. Organizations unable to meet these new demands are being acquired by high-performing agencies or forced to close their doors. When that happens, continuity of care suffers.
How did we get here and where do we go next? The answers are simple, but the reality can be complex.
Typically, many supervisors in behavioral health organizations are clinicians. They have not had adequate management or leadership training and many have little experience using practice management data to make objective-based decisions. For example, when I ask managers of behavioral health organizations what their no-show rates are, I often hear, “Better than they used to be.” If I ask what they used to be, I hear, “Worse than they are now.” This type of anecdotal information is no longer acceptable in performance-based contracting systems.
Too often, supervisors make decisions by consensus – what I like to call the “committee of the whole” – in which everyone must be okay with any proposed changes in how an organization operates. Supervisors try to push their employees along the discussion-based process and negotiate through their discomfort. This may have worked when changes were incremental and sequential, but in a rapidly evolving transformational change health care environment, managing by consensus brings timely change to a standstill. And those who stand still are at risk of being run over.
From Being Risk Averse to Leading Change
Too many behavioral health supervisors are risk averse, unable or unwilling to accept the authority they have been given. We must provide essential leadership skills training support to help our supervisors step up to become managers. Managers are proactive, solution-focused decision-makers who do not wait for 100 percent of staff to be on board with proposed changes. They make changes when a majority of staff are receptive and they continually evaluate new activities using a plan-do-study-act quality improvement cycle.
We need to encourage our best managers to become leaders, those who see the horizon of where the organization needs to position itself in the health care system and go there every day. Leaders don’t negotiate or push reluctant staff – they pull them forward, generating excitement about the possibilities the planned change will provide. Behavioral health leaders spend time with their staff and listen to their concerns, but in the end, their goals don’t change. And the number one goal is always what’s in the best interest of the individuals and families they serve.
Coaching Up for Success
“We ground all our work with the staff in customer service and what’s best for the client,” said Lorraine Coleman, vice president of social services for Acacia Network, a not-for-profit Latino-led integrated care organization with a mission to partner with the communities, lead change and promote healthy and prosperous individuals and families in a healthy neighborhood environment.
Acacia’s approach supports alignment of behavioral health services with the population health model and transition to value-based payment arrangements. The system must organize around the client and not traditional program needs. For example, access and appointments must be available when a client requests an appointment. For behavioral health organizations to remain relevant, today organizations need to act more like Amazon – always open and ready to serve.
Acacia Network expanded their commitment by ensuring once vibrant Latino community-based organizations facing leadership and financial changes have a renewed path to success as an affiliate. This provides access to the “coach up” for success model.
“Coaching up is about increasing engagement and accountability,” Coleman explained. “Staff develop mutually agreed upon annual professional development plans with strength-based goals, training requirements and performance indicators that are regularly discussed and tracked in supervision. The leaders help staff align with their goals through various means such as assigning mentors and creating whole team partnerships with a shared measurable goal, regardless of position title,” she said.
Directors’ collaboratives meet regularly to discuss staffing issues and acclimate new leaders. Steering committees are being developed to enhance client input into services being received. To Acacia, coaching up begins with the client; staff engagement and accountability means actively seeking out and hearing the client’s voice.
“Coaching out” becomes necessary when staff aren’t performing up to expectations. For staff who are resistant to change, “We empower them to make decisions about their future and help them move on to a position that better aligns with their strengths, matches their skills set and/or temperament or supports their individual career path,” Coleman said.
When leaders step over the threshold of risk to make bold and creative decisions about how to change their service delivery practices and lead their agencies into the 21st century, everyone benefits. Funders are receptive, staff are engaged and patients receive timely access to quality, evidence-based care. But this work is not for the faint of heart and leaders need tools for success.
In addition to metrics to judge their own improvement, behavioral health leaders must learn how to assess and help improve staff performance, behaviors, aptitude and attitude. They must understand how best to lead staff from denial, negotiation and anger, through acceptance of the need to change, to being excited about the opportunities change offers. Only then can they help create a truly client-centered organization able to prove its worth in a value-based, outcomes-oriented health care system.
To find out how to help your organization create effective leaders, contact me at firstname.lastname@example.org. I look forward to hearing from you.
Note: Lorraine Coleman is an alumnus of the National Council’s Executive Leadership Program. She was a member of the 2017 Executive Leadership Class.