Posts Tagged Management
Robert A. Mines, Ph.D., Chairman and Chief Psychology Officer
Thank you John Oliver and your staff for a significant public service on your show this week! Your commentary and excellent coverage of a major problem in substance use disorder and alcohol treatment will have an impact far beyond what the insurance and professional communities have been able to do.
MINES has patients who have gone out of network, received poor care, the payors have received outrageous bills, the patients are stuck with bills that can only result in medical bankruptcy and as you noted, people die in these disreputable facilities. A major component that you pointed out is patient brokering. When people Google substance abuse/use treatment, the top 20-30 are facilities, mostly in Florida and California, or are patient brokers. Reputable facilities in the person’s community do not even make the list. Then the facilities sometimes even pay the airfare to fly the patient to their facility and if the patient does not meet medical necessity for that level of care, the facility turns them out on the street to find their own way back to the state/community they live in.
You mentioned addictionologists as a resource for finding reputable care. In addition, Employee Assistance Programs as well as managed behavioral health services (insurance) are knowledgeable and informed about substance use and alcohol treatment. They know which facilities and programs are in network with the insurance and which ones do a good job.
Evidence-based treatment supports the use of a continuum of care from outpatient, intensive outpatient, partial hospitalization, residential and detox (medical and social detox). There are medications that also contribute to sobriety and health.
These are chronic illnesses/conditions that require the patients to cope with all their lives. Learning relapse prevention and adherence skills are essential.
If you decide to delve into this national problem further in a future episode, I would be happy to consult with you and your team.
The following clip may be not suitable for some work environments:
This is a link to a pdf of an article published by the Self Insurance Institute of America on predatory treatment facilities and managed behavioral healthcare strategies for helping the patients and the payors. http://www.minesandassociates.com/documents/Predatory_Facility_Article.pdf
Psychology of Performance #62: Veteran’s Mental Health, Memorial Day and President Trump’s Stigmatization During Mental Health Month*
*This blog has nothing to do with party affiliation, it is about leadership, modeling, and stigma and its consequences.
President Trump has made stigmatizing comments related to mental health during Mental Health Awareness month (May 2017). This is unacceptable leadership behavior on many levels. As the Commander-In-Chief of our armed forces, he has now sent a message to our active duty personnel and veterans that it is ok to call people “nut jobs” and other derogatory names related to mental illness, psychological stress, and behavioral problems. The irresponsible nature of this during Mental Health Awareness Month, and right before Memorial Day when we honor those who have served our country, now sends a message to our active duty personnel and veterans that they should not seek help or they will suffer social or job-related consequences.
Why is this a problem?
You may be wondering why am I making an issue of this? The US Department of Veterans Affairs has the following quick facts (not fake news, just the facts).
- In 2011, more than 1.3 million Veterans received specialized mental health treatment from VA for mental health related issues.
- The Rand Center for Military Health Policy Research, Invisible Wounds of War, 2008 noted that of the 1.7 million veterans who served in Iraq and Afghanistan, 300,000 (20%) suffer from post-traumatic stress disorder or major depression.
- The American Psychological Association has identified the critical need for mental health professionals trained to treat post-traumatic stress disorder and traumatic brain injury. Please review this commentary. http://www.apa.org/about/gr/issues/military/critical-need.aspx
The commentary goes on to note:
- suicide rates are increasing for returning service members;
- unemployment rates for veterans outpaces the civilian rate;
- brain injuries are linked to PTSD;
- female veterans are particularly likely to suffer from mental health issues related to “military sexual trauma” (20%);
- many in need (about 60-70%) do not seek help;
- stigma associated with mental illness in military communities; and
- long term consequences of unaddressed mental health needs.
Leadership and Stigma
It is well established in the psychological literature that social learning through the modeling by others has an impact on subsequent learning and behavior. When President Trump engages in direct insults to people while using derogatory mental health terms, his subordinates, employees, constituency, and his military receive the message that he is modelling that implies that having a mental illness (caused by serving our country) or stress (caused by serving our country) means you are less of a person, not competent to work, is something to be ashamed of, and should be kept a secret. Furthermore, it gives others permission to act in a similar manner further pushing those who are concerned about seeking help away and reinforces the stigma in the military and in society. Finally, his comments about grabbing women’s genitalia that came to public awareness while he was a presidential candidate further erode female military personnel’s safety in their own units when twenty percent (20%) have already experienced “military sexual trauma”.
Psychology of Performance
Employees’ performance can be negatively impacted by “bullying behavior”, or demeaning comments about their illnesses. It is exacerbated when leadership models this behavior because then it becomes acceptable with no organizational accountability. The consequences are lowered productivity, increased absenteeism, presenteeism, and increased medical costs. The cost of untreated mental illness to employers, families, and society is significant. President Trump’s behavior as a leader in this area is concerning and needs to stop.
This Memorial Day, I ask you to remember those who served and honor those who are still alive by letting them know the pain and suffering they experienced can be healed if they have such symptoms. They deserve our support, compassion, and gratitude. There are many resources available to them, encourage them to use them. Finally, stand up to those such as our President and Commander-In-Chief who model unskilful and unwholesome behavior.
Have a day filled with loving kindness and compassion!
Robert A. Mines, Ph.D., Chairman and Psychologist
I have blogged before about managerial hierarchy and accountability. It is worth another look at Elliot Jaques classic book, Requisite Organization, as new generations are coming into the workforce, technology has created the opportunity for virtual teams, and performance is still relevant for any organization to sustain itself. The following information comes directly from Dr. Jaques’ work. I encourage you to read his work in its entirety. This blog was generated out of the organizational psychology and human resources consulting MINES does with its clients. Time after time, accountability and authority are unclear in an organization’s structure. This often happens when marketing titles are given that imply authority when, in fact, there is none. Accountability for results may be unclear and personnel layoff decisions are made only to be repeated with the next employee group as the underlying system issue has not been clarified. This blog provides Jaques’ perspective and the results of over 50 years of his body of work.
Assumptions (Based on Organizational Theory of Managerial Hierarchy):
The basic business unit consists of a manager, one or more supervisors, and front-line producers. In the discussion to follow, “manager” is used to describe the role, accountability, and authority of both the manager and supervisor (a subordinate’s boss). In function, the manager is working on systems issues while the supervisor is working on quality assurance and work assignment(s). In the following discussion Manager and Supervisor are used interchangeable as the discussion is about hierarchy not role/level. Think about this discussion as related to an employee’s “direct boss.” In reality, a manager has a longer decision time span than a supervisor and has different functions.
Manager-Subordinate Accountability System
Accountability and authority establishes where people stand with each other. They determine who is able to say what to whom, and who under given circumstances must say what to whom. They establish who can tell who to do what, especially, in the managerial hierarchy, if one person is being held accountable for what another person does or for the results of what the other person does.
Accountability and authority define the behaviors that are appropriate and necessary in the vertical relationships between managers and their subordinates, and in the horizontal cross-functional relationships between people. The vertical relationships are those by means of which the work that needs to get done is assigned, resourced, and evaluated; and the cross-functional relationships are those by means of which the flow of work across functions gets processed and improved through time.
- What are the accountabilities of managers, or of individual contributors?
- What authority does a manager have in relation to subordinates?
- What authorities do employees who work together have in relation to each other?
Managerial Accountability and Behavior
It is absolutely imperative that organizational leaders be clear not only about their own decision-making accountability, but they must also make it equally clear for each and every manager below them in the organization. All of these managers must also meet regularly in two-way discussions about major issues with their immediate subordinates, in order to get their help in making decisions for which the manager alone must be accountable. In discussions between managers and subordinates, it is always the manager that is ultimately accountable for decisions. Even when the subordinate has more knowledge than his or her manager on a given matter and tells the manager what he or she thinks should be done; if the manager accepts the subordinate’s view then it becomes the manager’s decision. There will be times in an organization’s growth or life span when a manager may have multiple roles/levels that they are accountable for. The manager may be a level three, two, and one on a given day if the department or work group is small enough or does not have the resources to accommodate separate levels and roles. This is a situation referred to as “down in the weeds,” ”wearing many hats,” or “collapsed strata” (also known as time span within which one operates). This is not ideal; however, at times it may be the best we can do.
Who should be accountable for results?
Two basic principles:
First, all employees, including managers, must be held accountable for the continuous exercise of full commitment of capability (doing their very best) in carrying out the tasks assigned.
Second, managers must be held accountable for the results of the work and working behavior of immediate subordinates.
Definition of a Manager
A manager is the incumbent of a role in which s/he:
- Is assigned accountability for doing his/her best to use assigned financial, physical, and human resources (the human resources comprise subordinates under contract to do their best).
- Is accountable for deciding how best to get optimum short-, mid-, and long-term results from an assigned functional area (e.g., a production department, geographical area, or a customer category).
- Is accountable for maintaining a team of subordinates capable of doing the necessary work.
- Effectively applies all managerial leadership practices in relation to subordinates.
- Adds value to the subordinates’ work.
- Is accountable for providing necessary trainings, materials, and support to both supervisors and all subordinates.
- Says what they are going to do. They do what they say they would do and when they can’t (as infrequently as possible) they explain promptly. They expect others to behave the same way.
- Creates clearly defined goals because without clarity it is difficult to be held accountable
- Keeps consistent priorities.
- Documents agreements.
- Creates performance measures and evaluates progress or lack thereof.
In addition to managerial hierarchy, cross-functional relationships also need to be clearly defined.
My hope is that this information will allow you to evaluate your role and function in your organization and if there is room for improvement, to have a blueprint to help you and your colleagues proceed.
Have a day filled with compassion!
Robert A. Mines, Ph.D., CEO & Psychologist