Enduring principles as healthcare changes; Customer & team values; Marchers’ messages
- How do we slowdown rising healthcare inflation?
- How do we ensure timely access to care?
- How do we assure Value = health outcomes per dollar spent? In other words, how do you focus on achieving effective services while being good stewards of resources and being cost-conscious? Value is the embodiment of being “cost-effective.”
For more on this, read “What is Value in Health Care?” Value in Health Care?
- How easy or hard it is for people to access services? Is there a complicated phone answering system with a confusing menu of branching responses where a distressed client or family might not be able to navigate? Is there a long waiting list?
- How focused are you on identifying and prioritizing what the client wants versus what you think they need? How attached to you get to prescribing treatment with which they must comply? Is your first question and concern: “What is the most important thing you want which made you decide to call or come today?” Or is it “What insurance do you have?” Is the treatment plan a written expression of the therapeutic alliance (agreement on goals and methods and strategies within the context of a collaborative relationship)? Does the client even know their treatment plan? Does it makes sense to them? (After all, they are the ones who should have helped write it.)
- Is there really shared decision-making about how treatment is progressing or not, when and how to move through the continuum of care? Is the focus on patient compliance and completing the program? Are you focusing on progress and outcomes as assessed by the client in collaboration with the clinician? Is the client focused on “doing time” and saying the right things, or on an individualized plan guided by the clinician within a mutually trusting and safe, empathic therapeutic relationship?
- The identified patient or client may want symptom relief from depression or anxiety; “to get people off my back or get my children back”; to escape the impacts of addiction like a loss of job or relationship, or medical complications, or legal issues; or ideally to embrace recovery and well being.
- The family and significant others may want their loved one to be safe, or behave, or get a job or better grades, or leave, or stay, or be happy.
- The judge, law enforcement and criminal justice teams may want public safety, decreased legal recidivism and crime and safety for children and families.
- The employer may want increased productivity, decreased workers comp. cases, absenteeism or presenteeism (Presenteeism)
- The school may want better attendance, grades or behavior, less arguing with the teacher, and no vandalism.
- The legislator may want better use of public funds, health care initiatives to get them re-elected, services to improve their district and constituency.
- The managed care company, payer or funder may want services at the lowest cost which will be accepted by their membership or insurance customers.
- The labor union may want services costing the lowest co-pay; or even no insurance co-pay; or easy to access services, or comprehensive services like there has been in past years.
- Some long-time addiction counselors view residential treatment as the gold standard. They believe all patients should start with at least a month, then go to aftercare. That perspective is diametrically opposed to a flexible continuum of care in a chronic disease management model.
- Some mental health clinicians believe most addiction clients use substances because of underlying mental health conflicts, and that these need to be resolved first for the person to stop using.
- Some counselors focus on consequences like suspension or discharge for substance use while in treatment. They would never do that for a patient with an acute flare-up of suicidal or cutting behavior.
- It allows the team to create their principles and discuss the implications of those values before hard decisions are made about – for example: What levels of care should we add? What staff qualifications do we need and who should be hired? Perhaps our program needs more mental health professionals in the addiction program or vice versa in a mental health setting?
- It engages all team members in fruitful examination of personal attitudes and team attitudes about: What is addiction treatment? How should services be designed? What do we think about medication in addiction treatment? How do we handle the patient who uses substances while in treatment?
- For example, suppose one Value was the following:
Relapse in addiction and mental health are both addressed as crises in a person’s treatment requiring evaluation of the crisis and revision of the service plan. Suspension or discharge from treatment and zero tolerance of relapse will not apply to either a person’s substance use or mental health crisis. This value, if embraced by all team members, would impact policies, procedures and how the continuum of care is used.
A mind is like a parachute.
It doesn’t work if it isn’t open
witnessed two of those marches in Oakland and
|Civilized exchange of ideas|
San Francisco, California, which drew 60,000 and 100,000 people respectively. He photographed signs, handcrafted and painted, expressing people’s feelings, thoughts, admonitions and inspirational messages.
|To be Great you must Do Good|
They thought they could bury us.
They didn’t know we were SEEDS
Mr. Rogers: When I was a boy and I would see scary things in the news, my mother would say to me, “Look for the Helpers. You will always find people who are Helping.”