Let’s face it, the behavioral healthcare field is confronted with an assortment of changes it hasn’t had to contend with on this scale ever before. Nobody is really certain what the near future holds. Parity and reforms represent a sea-change of massive proportions for the mental health and substance use disorder treatment fields. Moreover, it’s all of the unknowns and unintended consequences that are likely to upend even the most experienced managers among us.

Top 10 Prerequisites for Change

Clearly, the most important thing providers can be doing now – be they governmental agencies, non-profit organizations, private-practice practitioners or for-profit, free-standing facilities – is to prepare for operational changes. These include significant changes to operational policies, operational processes and workflow and your core information systems. Change management relies on the following key determinants (in no particular order):

1. That you and your leaders and your key staff know change is required in the first place
2. That you understand and agree what the change requires of you
3. That you have adequate leadership
4. That you have a plan to manage your change process
5. That you have an adequate change management methodology
6. That you have change management tools
7. That you have access to expertise (internally and externally) and that you have adequate capacity among your staff to affect change (this requires excess capacity prior to engaging in change)
8. That you understand realistically where you stand today – your “current state” – in relation to the “future state” of your organization
9. That you have an appropriate timeline
10. That you have a realistic budget and commitment to resource requirements

Top Ten Failings

Having been witness to large-scale change initiatives that worked and a few that haven’t (otherwise known as abject failures), I can tell you that change projects involving funding streams, accreditation, policies, processes and technology (among other) fail for some of the following reasons. These are the “Repeat Offenders” if you will (in no particular order):

1. Poorly understood/misunderstood vision, goals and objective
2. Poor/non-existent communication between stakeholders, departments and co-workers
3. Unrealistic expectations resulting from a near or total lack of leadership and project planning
4. No project ownership or dedicated project management
5. No project monitoring or status reporting
6. Failure to monitor the correct performance measures
7. Near or complete lack of self-awareness related to one’s “current state”  – the “as-is” in relation to the objective
8. Inexperienced Process Owners, managers and insufficient internal subject matter expertise
9. Ignorance of “Total Cost of Ownership”, failing to account for all of the costs and budgetary requirements of a project
10. Attention deficit resulting in one “shiny object” after another derailing leaders

Lessons Learned: Top 10 Things You Can Do

1. Share the Vision. Communicate it well, consistently, repeatedly until it is understood by all. Build true consensus agreement before pressing forward. Provide people with updates and progress reports. Brand your Big Change!
2. Express Dissatisfaction. Tap into frustrations with the status quo.  This is often complicated by the fact that some people want to maintain the status quo whilst others want change, so the dissatisfaction is not unanimous but you have to tap into it nonetheless
3. Take Baby Steps and Score Small Victories. Engage in small, practical first steps to initiate change. These must be well-received and perceived. You must score some small “wins” to win hearts and minds. Write your project plan with small victories at predictable junctures and celebrate them.
4. Exhibit Leadership & the Commitment of Management. Walk the talk and beware: this is a long-term responsibility and any wavering and equivocating will be picked up immediately by your sensitive and observant staff.
5. Expect and Inspect Employee Commitment. Demonstrated by a willingness to accommodate work on the change project or alternately by blocking schedules and prioritizing other meetings. You must hold people accountable for their participation and contributions. This is their job. This is non-negotiable stuff. If they fail, you fail. If you fail, the change process fails and the future of your organization hangs in the balance.
6. Motivate Members of the Change Team(s). Ensure that people hear, see and feel recognition for contributing extra effort to change projects. Train them in what kinds of messages they can and should relay to colleagues.
7. Establish a Critical Path. Develop a professional project management arsenal and project manager on your staff and develop a timeline with milestones, tasks and resource requirements. Understand that tasks and people have dependencies and that each task or activity will require a start and stop date. Don’t forget to develop a plan that accommodates work-in-progress.
8. Engage Your Experts. Your subject matter experts are your most critical asset. They may or may not be leaders and managers. Who are your internal experts? Who do you run to with a question? Who can answer your toughest questions? Dedicate these folks to your project. Negotiate time with their boss. Properly re-assign their regular responsibilities to someone else (who is adequately skilled to cover for them).
9. Engage Outside Experts. Know when to admit you don’t have time, expertise or internal resources for your change. Consultants may be costly on an hourly basis but if a short-term engagement gets you though your change, it will have been a wise investment. A good consultant can and should reliably save you time and do for you what you couldn’t done for yourself at a lower cost. We hire lawyers and accountants for the same reason. It is also a demonstration of how seriously you are taking the challenge.
10. Properly Assess Your Current State. Launching down a change path without first orienting yourself in the present to how things are done is an avoidable, preventable error. Before fixing your gaze on the “to be” future and the outcome or the “finished picture”, establish the “as is” today and map the gap between the two. There are many benefits and advantages to doing things in this fashion. You’ll discover brilliant “work around” tactics your smart people have devised to overcome arcane obstacles in an outdated infrastructure. You’ll quickly learn where your bottle-necks and stove-pipes are. You’ll see the inefficiencies you’ll want to correct prior to paving over them with new stuff and you’ll detect quality concerns you’ll want to correct before making additional changes.