Archive for February, 2012

February 26, 2012

An Ounce of Prevention…

by Richard Edwards

I’ve been reading Strategy for Sustainability, by Adam Werbach, about how to create sustainable efforts around environmental sustainability–reducing carbon footprint, reducing waste, reducing negative environmental impact in general–and doing so in a way that adds value to a business as well as the world. I recommend it, but not because I’m an environmentalist–I’m not, really. I recycle; I drive a fuel-efficient-but-plain-old-gas vehicle; and I try to watch my energy use, but that’s about it.  I recommend it because it clearly explains a construct for driving organizational change with the least amount of top-down energy possible.

I work mainly in quality improvement in the non-profit sector, specifically human services. It is a field that is heavily regulated by payor sources, licensing agents and state and local governments. Not for nothing, but there are a lot of rules. And in a process-oriented environment, it’s easy to mistake rule compliance–which is the foundation–for the mission–which is actually the target.  The floor becomes the ceiling.

For instance, let’s say you live under threat of audit every day, and understandably, you focus your efforts on 100% record compliance to withstand those audits. But, if 100% is your goal, what is acceptable? 99%? 95%? By most scales, 95% is an ‘A’–very good. And if you got 95% of the way towards a target goal, most people would say that’s pretty good, too. But remember, 100% isn’t the goal, it’s the starting point. If people believe 100% is the target, and targets are–by their very definition–aspirational, it’s not hard to understand how people come to accept slightly less than perfect as perfectly acceptable.

In small organizations, where a few people can drive and reinforce behavior and culture–and even do the quality assurance themselves–this can be corrected. But in larger organizations, this becomes increasingly difficult, and the tendency is to create systems whereby fraud and abuse and waste are eliminated through making the process fool-proof (but why would you want to hire fools in the first place?), or by making your quality assurance team the equivalent of the internal affairs cops (aka, the most hated officers in the building).

Werbach points to a different way, which is essentially to get all your employees involved, but what good is that if they are duped into 95% being acceptable? (Plus, eventually, 95% becomes the goal, and then what’s acceptable?) The trick is to come up with a transformational goal–something truly aspirational–that everyone can work towards in their own way. In this way, creating an ethical (or environmentally conscious) culture becomes sustainable, because everyone puts in at a level of energy they can maintain and reaches beyond simple compliance.

Similarly, when a martial artist breaks a board–or boards, or bricks, or cinder blocks–with their bare hand(s), they will tell you they are not aiming for the board. They will tell you to aim beyond the board. Otherwise, you will naturally pull up short of the contact point, making it less likely you will break the board, and more likely that you will break your hand.

So, what’s the aspirational goal when we’re talking about compliance? My angle is that the real target–the real outcome we’re seeking–is trust. Trust is not something you’re reimbursed for in healthcare, but without it, you can’t expect to survive. The great thing about it as a goal is that it’s something that all employees at all levels of the organization want, and that kind of common driver is essential to bringing an effort like this to scale.

But that’s just my angle. What are your thoughts?

February 26, 2012

A Pound of Cure…

by Richard Edwards

This morning, at my church, we did a small, share-the-plate fundraiser for a local non-profit service provider to persons with mental illness, specifically, a psychosocial rehabilitation setting.

Psychosocial Rehabilitation settings–PSRs (warning: pdf)–or clubhouses, as they are commonly called, provide a daytime setting in which individuals with significant mental health issues can find support. Typically, and in the case of this provider, they are provided in concert with other services, such as supported employment, or even supported residential apartment settings.

Sounds positive, right? In this case, it is–the people who work there are compassionate and committed, and they have undoubtedly had a positive impact in the lives of many, many people. But here’s where it goes wrong–in the words of one of its own board members (paraphrased, but not by much), “People with mental illness need clubhouses like this one because they do not feel comfortable in the community.”

That’s where the wheels come off the wagon, as far as I’m concerned, for PSR models. They are, essentially, congregate service settings. They are a place to go. And they are a workaround to the central problem, which is–that people with mental illness do not feel comfortable interacting with the community, because they are not welcome in the community. And because PSRs are congregate settings–they will never in a million years solve that problem.

Instead of talking about creating places in the community where people with mental health issues–and indeed, this could apply to all people with disabilities–feel welcome, my angle is that we should be creating communities where people are included. It is only when people have access and are expected to participate in the life of the community that they can truly be members of that community.  Location is not the same as membership.

But that’s just my angle…what are your thoughts?