Managing the Residential Treatment Center in Troubled Times

Gordon Northrup

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9781560246763
• eBook ISBN: 9781317764687
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Here is an informative guide to help directors and staff of residential treatment centers (RTCs) cope with the financial and administrative problems resulting from today's financially turbulent times. Financial problems have closed some centers and managed care or other health care changes will soon reach others. Managing the Residential Treatment Center in Troubled Times deals directly with current difficult financial and management problems in RTCs and presents practical advice, discussions of current problems, and possible solutions. Authors explore a wide range of topics from dealing with community hostility to planning for the future. Specifically, chapters discuss:

• the application of total quality management to RTCs
• reasons and rationale for the decline of residential establishments in England
• how changes in an RTC affect the youngsters who live there
• privatization and purchase of service contracting
• profit vs. nonprofit organizations
• one agency's experience in establishing an RTC in a resistant neighborhoodManaging the Residential Treatment Center in Troubled Times offers fresh perspectives and alternatives for professionals involved with RTCs, including directors, government regulators, social and child care workers, and psychiatrists and psychologists.

Permanent “White Water” Time: Can Children’s Residential Treatment Survive in the Nanosecond Nineties?

W. R. Cozens, MBA, PhD

SUMMARY. This paper reviews the proposal that radical alteration in management practice and organizational culture is necessary for survival in today’s times of ever increasing environmental stress and uncertainty. This proposal and its possible implications for residential treatment are discussed. One approach to carrying out such change, called Total Quality Management, or TQM, is reviewed at length. The nature and extent of the organizational changes that adopting a TQM program structure would involve are also discussed along with a description of the problems inherent in making such an alteration.

Creating an organization in which members feel responsible for and involved in the success of the organization is an attractive and effective approach to management. Managers can achieve this approach by correctly structuring work, providing good leadership, and putting appropriate management practices in place. In reality, however, most organizations are not managed in a way that involves most individuals, that uses even part of the potential of most human beings, or that leads individuals to be committed to the success of the organization. Why does this enormous gap exist between what seems so right and so logical and the reality of how most organizations are managed?^{(22, p. 3)}

Introduction

Whenever the production of goods or services requires the skilled participation of more than one person, the problem exists as how best to manage and organize such an endeavor to insure maximum quality of output and efficiency of effort. Throughout history, various approaches have been found, each of which, for a time, seemed to offer a satisfactory solution to this problem. As time passed, however, and the economic, sociocultural and technical realities changed, a growing mismatch would occur between current management practices and the exigencies of the new era. The solutions of the past often became a source of problems in the present. To remain viable would then require the development of a new organizational structure and management style.

In the past, the rate of such change was slow and adjustment could proceed at a gradual pace. Often years, or even centuries, could go by with little or no need for alteration in an organization’s structure or its management processes. Long periods of stability, interspersed with short periods of upheaval and change, were the rule. That this is no longer the case has become today’s conventional wisdom. The intervals of stability have diminished to a matter of months if not weeks. In the view of some, we have entered an age of permanent “white water” wherein the rate of change has become so rapid that it borders on chaos.^(25,29,31)

Adapting for Survival

Operating within an atmosphere of increasing complexity and uncertainty, today’s organizations must acquire the capability of remaining intact while, at the same time, producing more and better products and services with increasingly reduced resources. This will necessitate, in the view of many, radical change in the organization’s structure, culture and managerial processes.

The traditional control-based, hierarchical operating practices of most organizations, including many in residential treatment, have become increasingly ineffective and unable to compete in today’s milieu. Optimally designed for relatively stable and predictable situations, such organizations tend to “. . . break down under conditions of uncertainty and instability because of the inability to reconfigure and the lack of emphasis upon the discretion by individuals.”^{(24, p. 113)}

The introduction of the changes that are being proposed as necessary to meet today’s new challenges is, however, not an easy task. It cannot be accomplished quickly nor without some risk of major organizational disruption. Why, then, should it even be attempted? The consensus answer given to this question by the major writers in this field is both direct and simple. There are no other viable options for long-term survival. “The future will belong to those who embrace the potential of wider opportunities but recognize the realities of more constrained resources-and find new solutions that permit doing more with less.”^{(17, p. 18)}

Among the “new solutions” that are currently being proposed, those that involve some form of high-involvement management system such as Total Quality Management (TQM) would seem to be the most favored. Evidence in support of such systems, in manufacturing as well as service industries, is overwhelming with respect to improved: quality, productivity, service, operating costs, responsiveness to change and ability to attract and retain qualified workers.^{(4,11,12,15,17,18,21,23,24,25,32,33,35,36)}

Although somewhat late in “getting the message” of the need to adapt, hospitals, as well as other health care settings, are now also attempting similar reorganizations as they too find themselves faced with the same demands for increased quality under conditions of reduced resources.^{(10,13,17,20,25,34})

The third-party payment system along with the competition-free contractual agreements which have served for many years to insulate health care (including residential treatment) from the economic realities of today’s quality-based, customer-satisfaction focused marketplace, are breaking down. Encountering these realities, those in health care are being forced to find better ways to provide better services. Hampered by their tradition bound organizational rigidities, as well as the inherent resistance of any organization to alteration of its basic structures, such change has not been easy.^{(10, pp. 3-19, 13, pp. 182-216, 14,20,25, pp. 229-232, 34)}

Implications for RTCs

Are these changes, although proven to be beneficial in industrial settings, and now also in hospitals, really applicable to RTCs? The answer would seem to be “Yes.” Although there are important differences, the fact remains that most, if not all, RTCs must increasingly face the same difficult challenges to their continued existence as those which exist in industry and hospitals.

Let us now take a more detailed look at what changing to an organizational structure such as TQM would entail. In the following pages, the basic elements underlying TQM will be reviewed under ten headings. There will then follow a discussion of their application to residential treatment.

The elements basic to TQM are:

1. AN ACTIVE, INVOLVED MANAGEMENT. A commitment by management, in deeds as well as in words, to the creation of an organization that is focused on the twin goals of exceeding customer expectations and continuous improvement.

2. A “WORKING” STATEMENT OF PURPOSE. An up-to-date, concise statement of purpose or mission that is understood and accepted by those in the organization and used as a guide for determining the appropriateness of the organization’s present and future operations.

3. A VISION TO LEAD BY. A shared vision of the agency’s future, developed through the joint efforts of all concerned, that provides a clear, compelling sense of direction for everyone in the organization.

4. A COMMITMENT TO LEADERSHIP, NOT SUPERVISION. A dedication to “Management by Vision” which relies upon eliciting employee involvement and facilitation of goal attainment and not a control-based conformity to agency policies, procedures and rules. This is a system of management that is grounded upon the basic assumptions that employees really:

a. Want to be responsible,

b. Are capable of directing themselves,

c. Are able to work collaboratively and in concert with com mon goals, and

d. Are ultimately the best source for operational improve ment and innovation.

5. A REDUCED BUREAUCRACY. A “flat,” administrative structure wherein decision making authority is pushed down as far as possible to those actually doing the work.

6. AN EMPOWERED STAFF. A well-educated, cross-trained work force organized into self-guided work groups which are empowered with the operational responsibility for sizeable portions of the organization.

7. A “COMPLETE” SHARING OF INFORMATION. A system of communication that insures the flow of information (up, down and sideways) such that it is available to those who need it, when they need it, and in the form they can best use it.

8. A COMMITMENT TO THE CUSTOMER. A clear understanding of whom the agency is serving (both within and without the agency), what their needs are, and the importance of continuously striving to not only meet, but to exceed these expectations.

9. A COMMITMENT TO LEARNING. An acceptance of the necessity of learning how to learn from the continuous review of both successes and failures wherein the ongoing educational upgrading of employees is clearly recognized as an essential cost of doing business and not a discardable “add on.”

10. A VALUE-BASED SALARY SYSTEM. A method of employee reimbursement that allocates rewards in accordance with the “value” an employee adds to the product/service produced and not just his/her job title or place in the organizational chart.

Even if the above are accepted as guidelines for survival in today’s time of turbulence and uncertainty, are they applicable to a residential treatment setting? Also, would the time and effort needed to incorporate these guidelines into an RTC be worth the benefits that might accrue?

I would argue that the same top-down management structures, excessively rigid procedures, overly prescribed tasks and narrow job descriptions cited in the literature as being no longer applicable in business as well as hospital settings, are also to be found in the typical residential treatment center. As difficult as change might be for these RTCs, to try to continue to do business as usual under today’s chaotic conditions and wait until “things return to normal,” is to follow a path to oblivion.

That the threat is real is evidenced by the fact that the last ten years have seen a closing of a significant number of previously well established, well regarded residential treatment settings. In a few instances, the total situation had become so problematic that a shutdown of operations could not have been avoided no matter what actions were taken. In most cases, though, it would seem that a major factor leading to closure was the RTCs hierarchical, traditional organizational structure. Inward directed, often ignorant of and/or openly indifferent to the changing expectations of their customers and funding sources, it was difficult for these RTCs to even recognize the need for modification, let alone mount a successful change effort.

It would thus seem prudent for all RTCs currently experiencing difficulty in meeting the challenges of today’s turbulent environment, to seriously examine the possibility that their existing organizational structure is a significant contributor to their problems. In such cases, the adoption of some form of high-involvement management system, such as TQM, may be indicated. As a means of helping to determine if this be so, let us now further explore both the indications for, and the implications of, making such a change. The reader will be asked to consider a series of ten questions as they apply to the residential treatment for children. Each of these queries, and accompanying discussion, relate to one of the basic elements of TQM cited previously.

Who’s in Charge Here, Anyway?

The process of changing a TQM organization must begin at the top with senior executives who vigorously espouse a commitment to continuous improvement of service delivery, exceeding “customer” expectations, and actively seeking creative input from everyone in the organization. The vast majority of the problems that an organization encounters are not due to the actions of the workforce; but, instead are a product of the system and process instituted by management to govern its operations. ^{(33, p. 94)} Changing the system to one that facilitates, rather than hinders, employees is thus a management responsibility. Management, however, cannot do the job by itself. Successfully bringing about such change is a people process that must involve everyone in an organization.

Although no longer the source of all knowledge, expertise, and decision rights, top management still has a vital role as the primary driving force in bringing about such change. As such, they must act as facilitators who encourage the flow of knowledge regarding: why change is needed, what this change will entail, who will be involved, and how and when it is to be accomplished.

Changing an RTC to an organization whose empowered workforce no longer sees the pursuit of quality as a process of minimizing problems but rather as one of exploiting opportunities to ever increasingly delight its customers, will require an involved, active top-level leadership that is committed to the long haul. “New skills have to be learned; major investment decisions have to be made; old habits have to be broken; new behaviors have to be learned.”^{(15, p. 88)}

Among other things, this means that “... the speeches...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Permanent “White Water” Time: Can Children’s Residential Treatment Survive in the Nanosecond Nineties?
• Putting on the Business Suit in Residential Treatment: What Have We Taken Off?
• Bankrupt
• Reply to Dr. Northrup’s “Bankrupt” Letter
• The Changing Provision for the Child in Need of Care: A Nottinghamshire, England, Case Study
• Leaping in the Dark: The Fear of Transition
• Purchase of Service Contracting
• Growth: An Interview with Bruce Bona
• Not in My Backyard: Preserving Children’s Rights in the Face of Discrimination
• Preliminary Notes on a Profit and Non-Profit Life