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If clinical and leadership best practices intersect, why don't we have the upper hand?

July 13, 2011
by Ann Borders
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The ‘aha!’ moment is almost inevitable. A group of behavioral health administrators are discussing leadership best practices when a face lights up and somebody says, “That’s just like what happens with good clinical care!” The same connection is made frequently during our organization’s Leadership Academy sessions. (See Unleash Passion and Potential, January, 2010 edition.)

We have in our possession the unique ability to add clinical insight and expertise to the management of the businesses that we operate. Elizabeth Fisher’s Motivation and Leadership in Social Work Management: A Review of Theories and Related Studies and David Godot’s Transformational Leadership in Mental Health Administration are two works that have made insightful connections between management theory and behavioral health clinical practice.

So, if we have this spectacular leadership advantage, why aren’t we… better? I don’t want to offend anyone, but in my view I don’t think we’ve distinguished ourselves yet as Masters of the Managerial Universe. Certainly, many esteemed colleagues have indisputably earned the superhero tee-shirt, but too many of us would have to settle for a Mr. Limpet XXS, and I’m not talking about size. Who amongst us hasn’t seen behavioral health organizations suffer or even collapse because the most basic management principles were not applied? How many inspired ideas have you heard about that never got off the drawing board or weren’t sustained over time?

We should have the golden touch in the area of employee relations, but why are we such stark outliers in terms of staff turnover? “Research from the past two decades indicates that turnover rates in mental health agencies are high, approximately 25-50% per year.” (Wolfman, et.al., Psychiatric Services, 2008) The 2011 rate in Indiana is 27% for community mental health centers. (Barry Associates, LLC, 2011) In contrast, Workforce Management (March, 2011) shows a 15.6% turnover rate for general healthcare, 14.9% for not-for-profits, and 15.9% for all industries. Tom Gimbel, CEO of the LaSalle Network, a Chicago recruiting firm, notes, "In all of the studies we've done, 80 percent of the people who leave jobs don't leave because of the job but because of their manager.” (Entrepreneur.com, July 8, 2011)

We are nice people and we are smart people. So why do we have problems with organizational effectiveness? One obvious thought is that so many of us were schooled in psychology, social work, or medical programs. Our career preparations didn’t address organizational leadership, business strategy, finance, or human resources management.

Another factor might be a “thought silo” brought about the strict (and entirely appropriate) ethical boundaries that demand that we never, ever take a clinical approach to staff supervision; that we never attempt to diagnose, treat, or otherwise assume a therapeutic relationship with employees. Because of those boundaries, we may be inclined to wear only one hat at a time. The clinical hat goes on the shelf when addressing organizational issues and vice versa.

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Hi Ann,

Thanks for reading and sharing my paper on mental health administration leadership practices. The site you linked to has gone down, so I put this paper up on my own web site, at: http://davidgodot.com/transformational-leadership-in-mental-health-administration/

Best wishes,
David

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Ann Borders

President and CEO, Cummins Behavioral Health Systems, Inc

http://cumminsbhs.org/

Ann Borders is president and CEO of Cummins Behavioral Health Systems, Inc., serving eight...