“Looking at these five ways we have been unknowingly and unintentionally wasting the agency’s money has been extremely helpful, though shocking. I hope we are ready to find out what else we may have been doing so we can best address it.” Jeff, the CEO at the HOPE Care Center opened today’s meeting with these words. Last week, Rodis, the consultant had met with them to speak of ways they might have been wasting the agency’s money. They uncovered five surprising ways (see previous article entitled, 5 Ways You Have Been Wasting Your Agency’s Money for further reading), and today, they are discussing possible additional ways they may have been wasting money.
1. You are missing the forest for the trees:
You are making decisions and advising the rest of the leadership team to make decisions based on how much the agency can save right now, in the short term. However, failure to think about mid-term or long-term ramifications will result in missing the forest for the trees, without even realizing it.
As an example, consider the practice of double or triple booking, as a way to address a high no-show rate, instead of really addressing it through a root-cause design analysis. It takes some effort to think long-term and is often easier to focus on the short-term—the now. However, you will either pay now or pay later. And missing the forest for the trees is one significant way to waste your agency’s money. It is true that “all these other clinics are doing that.” But it is also true that “all these other clinics are ruining their reputation without even realizing it.”
2. You are failing to address the social determinants of health:
In a series of articles on Social Determinants of Health, I explained that according to the World Health Organization (WHO), social determinants of health are the conditions in which people are born, grow, live, work, and continue to age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. In certain community clinics and programs, the rate of homelessness for those affected by mental illness and substance use disorder are over 30%. This subpopulation is often the hardest to reach; they often go missing and have high rates of emergency room visits, inpatient hospitalizations, and recidivism.
As I explained in that article, we may need to start paying more attention to housing while simultaneously attempting to stabilize someone with mental health, dual diagnosis needs; we may need to make housing and food security a priority, while trying to resolve the acute mental and physical health needs of our patients and clients. We are now at the point where it is clear that the solutions to mental health and physical health needs are elusive, if our only tool is medication or even therapy. It is now clear that addressing those social determinants, like homelessness, food insecurity, unsafe neighborhoods, and financial insecurity, are all as equally as important, if not more important than expecting our patients and clients to simply come to see us in the clinic or office every week or every month. This is another daunting task and the easiest thing to do may be to ignore it and continue to conduct business as usual. However, addressing the social determinants of health can have tremendous benefits for our agency. These benefits include better clinical outcomes, better reputation for our agency, and less burnout for our clinicians, resulting in a decrease in waste for our agency as a whole. Failure to address the social determinants is one additional way you may be wasting your agency’s money. This is an area you can take action on right now.
3. You are failing to manage up:
“The agency is part of the system, and I feel it is only part of the solution. For the agency to be successful at addressing burnout and promoting self-care, the whole system needs to be examined,” assured Jeff, the CEO of the HOPE Care Center, during an executive meeting with Rodis. This was one of the initial steps in laying the groundwork to stop the cycle of burnout for their staff and to promote self-care throughout the agency. “I agree with Jeff,” said Deline, the CFO. “We have been losing money on the clinic and some of the other programs. For us to make the needed change, the whole system needs to start doing things differently,” added Deline. The C-Suite at the HOPE Care Center finally decided to pay attention to clinician feedback regarding their level of burnout (see Preventing Burnout: From a System Perspective: 4 Reasons Why, to read more on this).
They decided to do something and realized they needed the help of the whole system; they needed to manage up. Managing up, in this context, means going to your funders to let them know that in order for your agency to meet targets, you will need to take care of your clinicians working with the target population; you will need to account for protected time for training and supervision for your clinicians; and you will need to receive a reasonable rate that allows your clinicians to allocate enough time to engage your patients and clients, which will ultimately enhance show rate, productivity, and clinical outcomes. Failure to manage up will cause you to lose and waste money for your agency. There may be a fear that they will simply take their grants to a different agency. My response to this is “stick to your values and ultimately they will respect you and seek you at the end.”
4. You are failing to institute systems
In an article entitled, Turn Your Organization Around, I explained that once your expectations are clear and you provide the tools and support for staff success, the next best step is to develop systems and processes for your staff. I also described that having a system helps with efficiency, effectiveness, and better delegation, regardless of how simple or complex the task may be.
In that reference article, I illustrated the case of Carol, a manager, who would often ask her staff to do certain tasks, but the instructions were so variable and non-systemized that employees were frustrated and accomplished little. The proper employee learning curve suffered as a result. Carol did end up putting some systems in place, resulting in a dramatic difference in smooth workflows without interruptions. Remember, if you are failing to institute systems, you are wasting your agency’s money.
5. You are failing to recruit strategically
In a series of articles on Recruiting Successfully, I described the following first five strategies to successful recruitment:
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establish a supportive community at your agency
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address clinician burnout
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make training available for your staff
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provide opportunities for growth
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promote self-care
As you can see, recruiting strategically has much to do with other essential tasks, which may be costly to your agency, if you are not performing them (not addressing burnout, for example). Some additional strategies that I described in this series are: (1) help inspire; and (2) promote excellence. If you are failing to use these strategies, it means you are also failing to recruit strategically, and also you have been wasting your agency’s money (See Recruiting Successfully: 5 Key Strategies; and Recruiting Successfully: 5 Additional Key Strategies, respectively, for further reading on this topic).
“I just came from the budget meeting and it was so discouraging. We have been losing so much money and we can hardly understand why.” Dan the COO of the HOPE Care Center articulated these words to Rodis, the consultant, who then responded, “It all starts with looking at what we are doing or not doing. Let us take a closer look.”
Rodis took a closer look and found the first five main ways the leadership team at the HOPE Care Center has been wasting the agency’s money:
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The clinicians at the HOPE Care Center are burnt out
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The clinicians have limited time for training and supervision
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The clinician turnover rate is high
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The leadership team has been adopting a reactive instead of a proactive stance
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The leadership team is unknowingly damaging the agency’s reputation
In a subsequent meeting with the leadership team, Rodis addressed five additional ways they have been wasting the agency’s money:
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They have been missing the forest for the trees
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They have been failing to address the social determinants of health
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They have been failing to manage up
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They have been failing to institute systems
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They have been failing to recruit strategically
After they have found out and analyzed these ten ways they have been wasting money, the leadership team at the HOPE Care Center decided to do something. They began working with Rodis to make the needed changes for a more sustainable agency.
When would you like to start addressing at least one of these ten ways you have been wasting your agency’s money?
Contact us and let us know how we can help.
References:
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Acker G. The challenges in providing services to clients with mental illness: Managed care, burnout and somatic symptoms among social workers. Community Mental Health Journal. 2010;46(6):591–600.
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Ducharme LJ, Knudsen HK, Roman PM. Emotional exhaustion and turnover intention in human service occupations: the protective role of coworker support. Sociological Spectrum. 2008;28(1):81–104.
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Slack MK, Cummings DM, Borrego ME, Fuller K, Cook S. Strategies used by interdisciplinary rural health training programs to assure community responsiveness and recruit practitioners. J Interprof Care. 2002;16:129-139.
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Curran V, Rourke J. The role of medical education in the recruitment and retention of rural physicians. Med Teach. 2004;26:265-272.
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Fairbanks J, Montoya C, Viens D Factors influencing the recruitment and retention of nurse practitioners into rural, underserved and culturally diverse areas. Am J Nurse Pract. 2001;5(4):21-31.
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Falk-Rafael, A. (2005). Speaking truth to power: Nursing’s legacy and moral imperative. Advances in Nursing Science, 28(2), 212-223.
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Linking Clinical Care with Community Supports (Linkages); Michigan Primary Care Association; accessed Oct. 27, 2015.
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Jason A. Helgerson; Redesign Medicaid in New York State;Medicaid Redesign and Its Focus on Super Utilizers, Innovative Strategies to Address Social Determinants of Health; NYS Department of Health; Aug. 2013.