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Clinical Program Management - Six Principles For Coping With Rapid Change Environments

An Article By Terence T. Gorski
GORSKI-CENAPS Web Publications
Published On:
August 10, 1992          Updated On: August 07, 2001
© Terence T. Gorski, 2001

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Clinical Program Management
Six Principles For Coping With 
Rapid Change Environments

By Terence T. Gorski

In 1989 the field of chemical dependency treatment began a constant and radical change that has resulted in the closing of nearly 50% of the nation's private sector treatment programs and has left the remainder struggling to survive.  The delivery of treatment services changes radically.  More patients were treated in outpatient programs and the length of residential treatment radically reduced.  Program administrators and managers, while struggling to understand and adapt to this change, discovered three powerful trends which were driving these changes.

The first and most powerful trend was cost containment.  Decisions were made at the highest level of government and private industry that the cost of health care must go down regardless of the impact upon public health.  These radical cost containment strategies forced administrators to attempt to treat more patients with fewer resources.  This gave birth to the second trend -- greater efficiency.  Administrators were forced to treat more patients with fewer resources.  This demand for greater efficiency forced counselors and therapists to modify traditional treatment approaches and the third trend slowly came to life -- improved treatment technology.

Megatrends Driving Chemical Dependence Treatment

                 1.  Fiscal:  Cost Containment

                 2.  Administrative:  Greater Efficiency

                 3.  Clinical:  Improved Treatment Technology

These trends have forced the chemical dependency field out of a stable environment and into a rapid change environment.  In stable state environments, there is gradual change that corresponds with known and predictable principles.  In a rapid change environment, there are fast and explosive changes that emerge from a wide variety of unpredictable sources.  The chemical dependence programs that survive will be managed by a new breed of clinical administrators who are able to adapt and thrive in this new rapid change environment. 

Fortunately, a set of six guiding principles is emerging as a basis of new management philosophy.  Originally proposed by Tom Peters in his book, Thriving On Chaos, these principles form a philosophy for managing programs in unstable and unpredictable environments governed by rapid change.

These principles build upon each other and, in order to work effectively, all six principles must be used simultaneously. 

Principles For Coping With Rapid Change Environments

                                     1.    Outcome Focus

                                     2.    Total Client Responsiveness

                                     3.    Fast Paced Innovation

                                     4.    Empowered Staff

                                     5.    Proactive Leadership

                                     6.    Effective Support Systems

1.    Outcome Focus:  The treatment industry must become outcome focused.  Cost containment can only work if treatment works.  Treatment can only work if the primary goal is to produce long-term recovery through early identification, treatment in the least restrictive environment, and relapse prevention to keep patients in recovery.  This preoccupation with producing better outcomes leads us to the second principle.

2.    Total Client Responsiveness:  Good outcomes are produced one client at a time.  We need to bond with our clients and learn to meet their needs and wants.  In the new managed care environment, every counselor has two clients, the recovering addict who they are treating and the insurance company or managed care provider that is paying for the treatment.  The needs of both must be met.  This is best done with what John Naisbit in his book Megatrends calls a high-tech and high-touch response.  High-Tech refers to effective clinical and fiscal procedures that keep patients in recovery while satisfying the requirements of third party payers.  High-Touch refers to building quality interpersonal relationships with both our patients and the third party payers.  We must assure that everyone involved with our treatment programs feels listened to, understood, taken seriously, and affirmed.  This personal relationship coupled with effective treatment systems is the key to success.  To make it happen, we must move into our third principle.

3.    Fast Paced Innovation:  To survive in the new rapid change environment of the 1990's, treatment centers must individualize and adapt standard approaches to meet the rapidly emerging needs of patients and third party payers.  Standardized programs and cookie cutter treatment plans don't work in rapid change environments.  Therapists and counselors must be able to get the information they need and respond quickly.  When continued stay must be approved every three or four days, therapists cannot be forced to wait until the weekly staffing to get permission to alter treatment plans.  In order to have fast paced innovation, we must utilize the third principle.

4.    Empowered Staff:  The ability to effectively innovate requires a well trained and motivated staff whose members are empowered to respond immediately to the client's needs.  This means we must train, train, train.  We must help staff become expert problem solvers.  This means giving them the best available technical information about treatment and the fiscal constraints that impact the treatment process.  In order to survive, treatment programs must invest in their clinical staff. 

       Once the staff is trained, the next step is to measure, measure, measure.  We must develop ways of measuring outcome, client satisfaction, and treatment quality.  The staff must learn to do simple measurements which can tell them if current procedures are working.  They must be empowered to make improvements based upon what they learn from the measurements.  This will lead to higher levels of pride in performance.  To develop and manage this high powered clinical staff leads us to the fourth principle.

5.    Proactive Leadership:  If chemical dependency programs are to survive, they must be managed by clinical administrators who are pragmatic, vision-oriented and principle- oriented.  The job of a pragmatic leader is to remove the obstacles that prevent employees from doing high quality work.  The job of a visionary leader is to always begin with the end in mind.  In other words, give people an end vision of what they need to accomplish.  Help them envision the specific steps needed to accomplish it, and remove the obstacles that stand in the way.  Principle-centered leadership puts a strong emphasis upon the underlying values and character traits that make long-term success possible.  Responding to clients and referral sources requires fast-paced innovation that can only be provided by an empowered staff operating under proactive leadership. 

6.    Effective Support Systems:  In order for managers and clinicians to have time for fast-paced innovation, they must have effective and efficient support systems.  Support systems involve the routines, rituals, and equipment that maintain organizational integrity and efficiency.  Support systems include clinical programs, policies, procedures, accounting systems, and computer support.  Unfortunately, many treatment centers just don't invest in the support systems needed to keep their clinical staff responsive to patient and referral source needs.  For example, most grocery store clerks have more computer support in doing their jobs than most counselors and therapists.  In an environment where 30% of a counselor's time is spent in repetitive documentation and one claim denial can cost $15,000, this just doesn't make sense.  Treatment programs must invest in support systems that make it easy for their staff to respond to the needs of patients and referral sources.

These six principles can form the basis of management philosophy that can allow treatment programs to survive and thrive in the rapidly changing health care environment of the 1990's. 

Terry Gorski and other member of the GORSKI-CENAPS Team are Available To Train & Consult On Areas Related To Recovery & Relapse Prevention
Gorski - CENAPS, 17900 Dixie Hwy, Homewood, IL 60430, 708-799-5000,,

About the Author

Terence T. Gorski is internationally recognized for his contributions to Relapse Prevention Therapy. The scope of his work, however, extends far beyond this. A skilled cognitive behavioral therapist with extensive training in experiential therapies, Gorski has broad-based experience and expertise in the chemical dependency, behavioral health, and criminal justice fields.

To make his ideas and methods more available, Gorski opened The CENAPS Corporation, a private training and consultation firm of founded in 1982.  CENAPS is committed to providing the most advanced training and consultation in the chemical dependency and behavioral health fields.

Gorski has also developed skills training workshops and a series of low-cost book, workbooks, pamphlets, audio and videotapes. He also works with a team of trainers and consultants who can assist individuals and programs to utilize his ideas and methods.
Terry Gorski is available for personal and program consultation, lecturing, and clinical skills training workshops. He also routinely schedules workshops, executive briefings, and personal growth experiences for clinicians, program managers, and policymakers.

Mr. Gorski holds a B.A. degree in psychology and sociology from Northeastern Illinois University and an M.A. degree from Webster's College in St. Louis, Missouri.  He is a Senior Certified Addiction Counselor In Illinois.  He is a prolific author who has published numerous books, pamphlets and articles.  Mr. Gorski routinely makes himself available for interviews, public presentations, and consultant.  He has presented lectures and conducted workshops in the U.S., Canada, and Europe.  

For books, audio, and video tapes written and recommended by Terry Gorski contact: Herald House - Independence Press, P.O. Box 390 Independence, MO 64055.  Telephone: 816-521-3015 0r 1-800-767-8181.  His publication website is

This article is copyrighted by Terence To Gorski.  Permission is given to reproduce this article if the following conditions are met:  (1) The authorship of the article is properly referenced and the internet address is given;  (2) All references to the following three websites are retained when the article is reproduced -,,,; (3) If the article is published on a website a reciprocal link to the four websites listed under point two is provided on the website publishing the article.

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