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
These Books & Manuals On Relapse
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Clinical Program Management
Six Principles For
Rapid Change Environments
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
Driving Chemical Dependence Treatment
Improved Treatment Technology
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
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
3. Fast Paced
4. Empowered Staff
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
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.
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
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.
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
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.
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 www.tgorski.com, www.cenaps.com,
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
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 www.relapse.org.
|This article is
copyrighted by Terence To Gorski. Permission is given to reproduce
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given; (2) All references to the following three websites are
retained when the article is reproduced - www.tgorski.com,
www.relapse.net; (3) If the article
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