Better Patient Care Within a Balanced Organization

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Anna: Welcome Andrew Martin, CEO of Serene Recovery Network, which includes Serene Directory, Serene Connections, Serene Foundation, and Serene Scene Magazine.

Andrew: Thank you.

Anna: Today we are talking about better patient care within a balanced organization. What is a balanced organization?

Andrew: to put it simply, a balanced organization is one in which all business operations function in concert with one another. For example, in a treatment agency you would find business aspects pertaining to the client/patient, which would include the clinical/medical supervision component. Another aspect would include the services/treatment facet of the operation. The sales/enrollment/retention of clients/patients is yet another part of business operations. There are also the operational aspects including accounting, utilization review, food services, purchasing, facilities, etc. and all of these various business aspects are held together by employees/contractors and shareholders/stakeholders which may also include some level of community involvement.
Anna: Can you elaborate on each of the business aspects you have outlined?
Andrew: I would be happy to. Let’s take one at a time beginning with the client/patient aspect of business operation. Addiction treatment agencies are designed to help individuals afflicted with addiction to find wellness and fulfilling lives without the use of drugs, alcohol, and other impulse related disorders. In order to accomplish this, the agency must be client focused and provide a multitude of therapeutic interventions from which they can select the most appropriate for each individual client/patient. This sounds simple enough, but this task is daunting. Not only must the agency find individuals that can implement relevant therapeutic interventions, they must also select the most appropriate treatment modality and package its services in such a way that the client/patient will feel safe to engage and change.

Considering the transient nature of the clients/patients that enter a treatment facility, the population of the agency will be inconsistent at best which requires a great deal of attention by the agency’s program director. There must be a clinical/medical supervision component to the management of the client/patient relationship. Usually this would involve clinical supervision of the clinicians that are working with the client/patient on a daily basis. Sometimes an agency may incorporate the feedback system in which the client/patient provides direct input through a survey or an interview process.

This leads me to the next aspect of business operations that must be addressed in a balanced organization; that being the services/treatment offered by the agency. All addiction treatment agencies are structured differently, some may have a multitude and vast selection of services offered, while others may have a tried-and-true treatment regimen. Regardless of the methodology used within the treatment agency the balanced organization must have a process in place which identifies and measures critical performance areas pertaining to client/patient outcomes. This process will help the agency identify where necessary changes should be implemented within the services/treatment provided to the clients/patients.

It is possible to have a world-class service/treatment offering yet still have poor client/patient treatment outcomes. This is because the agency is focused on the services and treatments and has lost sight of the client/patient needs. In a balanced organization there is a system in place to connect the two aspects of business together.

Of course, even with an outstanding system that links clients/patients together with services/treatment and agency cannot exist without functional sales, enrollment, and retention systems in place. In a balanced organization the sales effort is coordinated to attract treatment candidates that fit within the desired client/patient definition. Once those clients/patients are attracted to the agency, the enrollment process must verify that the client/patient is a suitable fit. This process creates a treatment environment in which the clients/patients will function well within the services/treatments offered by the agency, and the clients/patients will thrive and grow and become more well. Once a client/patient is engaged in the services/treatments offered by the agency it becomes beneficial for the agency to retain that client/patient in the program in order to maximize client/patient outcomes. So, the practice of soliciting feedback from the client/patient throughout their treatment engagement will provide the balanced organization the information they need to individually address concerns of each client/patient. Also, this data can provide illumination on the various aspects of treatment that are working well for the client/patient.

Another aspect of business is operations. This includes functions such as accounting, utilization review, food services, purchasing, facilities, human relations, motor pool, housekeeping, etc. while these functions may not have as significant an impact on the client/patient relationship as the services/treatment, they are nevertheless critical to the survival and performance of the agency. Therefore, in a balanced organization, the operational aspects of the business are monitored, measured, and communicated throughout the agency with the objective of each employee/contractor possessing a general knowledge that all functions within the agency must work in concert with one another in order to create an agency that functions well.

The employees/contractors of the agency are also a critical part, if not the most critical part, of a balanced organization. Just as the needs of a client/patient will change over time, so too do the needs of the employee/contractor. So it is important to continually monitor and measure employee/contractor performance in order to gauge where the agency needs to commit more resources to provide better outcomes for the client/patient. For example, a clinical supervisor may recognize that a counselor is having difficulty developing strong therapeutic relationships with the clients/patients on their caseload. Because the clinical supervisor is incorporating a process that specifically identifies the therapeutic relationship as a critical component for the effectiveness of the counselor, they are able to send the counselor for additional training in this area.

The balanced organization will also use the employee/contractor performance monitoring tools to identify individuals which no longer fit within the culture of the agency, or who have been unable to consistently perform critical functions within the agency. Once these employees/contractors are freed from the agency the balanced organization will communicate the reasoning and fair action taken, and the remaining employees/contractors will have an excellent understanding of why the action needed to take place. Additionally, the same performance metrics can be used to identify the outstanding employee/contractor and provide advancement opportunities or motivational rewards. Again, the balanced organization will communicate the reasoning and fair action taken.

There are also shareholders/stakeholders that must be accounted for within the balanced organization. In the case of a shareholder, there is a financial interest in the organization’s success, so shareholders must be included in the balanced organizational model. Stakeholders do not have a financial interest in the organization, but may likely have some other important role pertaining to the agency. For example, a stakeholder may include the community surrounding the agency. A balanced organization must take into account the community if that community has, or may have, a bearing on the agency’s future. So, a communications process must be established to keep the community informed about agency activities and performance.

In a balanced organization all of these business operations interact with one another. One operation is not separate from another, one aspect of business does not operate exclusive from another.

Anna: How do these aspects of business interact with one another in a balanced organization?

Andrew: I would like to answer this question in the form of a case study of a large residential treatment facility.

If applying a balanced organization approach within a treatment agency it would quickly become obvious that there is a problem with client/patient retention because it is being measured and reported on a regular basis. This would, in turn, allow for swift activity within the agency to identify the reasons for the reduction in client/patient retention. Because the organization is operating in balance, the accounting department is alerted and communicates that the accounts receivable for a specific managed health care provider has significantly declined over the same period as client/patient retention has declined. The utilization review department notices the correlation and identifies the reason that client/patient retention is down is due to a recent change in the allowed services by that specific managed health care provider. It now becomes possible for the program director to modify the services/treatments for those clients/patients insured by that specific managed health care provider such that they can remain at the agency without fear that their insurance will not cover their expenses.

Anna: How does an agency become more balanced in its operation?

Andrew: Any agency wishing to incorporate a balanced approach must first consider the organizational culture. If the culture is not suited to sharing the sort of information I am suggesting, then the organizational culture must first be modified. Perhaps the organizational culture is appropriate to incorporate a balanced organization approach: then the task falls to management to implement the approach. Management must live and breathe a holistic view of the business. Every manager, from executive to middle management, must clearly identify with a business model that is integrated and inclusive of all aspects of business. There is no room for operational silos within the organization. Once management has completely synthesized this approach, it is then their job to lead all of the agency employees in the same thinking.

Anna: Is there a best practice regarding how to lead employees in a balanced organization?

Andrew: in my experience, the best practice to lead employees into a balanced organization structure, is to be candid and transparent with information about how the agency is operated and performs. It is often necessary to conduct some trainings for various departments within the agency because many employees will not have had any exposure to aspects of the business other than their own. During these trainings I have found that some of the most unlikely sources will have some of the best ideas with regard to improving agency functions.

It is not easy to create transparency within an organization that has not experienced it before. Being transparent with performance metrics can be frightening, particularly if one area of business operations is underperforming. Management must lead the way in disclosure and be sensitive to identifying employees that are having great difficulty in the shift to a balanced organization.

Anna: Thank you for allowing Serene Scene Magazine to share in your experience and expertise today.

Andrew: The pleasure is mine.

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