In 2011, Thresholds in Illinois swapped out its EHR system for a new one. Why? Because staff members said that the old system didn’t have everything they needed to document appropriately under the fee-for-service model.
“We purchased a new electronic health record solely based on the needs of the end-user,” says Debbie Pavick, LCSW, chief clinical officer for Thresholds. “It took two years from selecting the company we were going to go with to developing the system, which included all levels of user participating in the development of the product.”
Pavick says the organization is now moving into the mobile world and has plans to implement a system for staff to document remotely from outside of the office. As much as 70 percent of Thresholds’ interaction happens in the clients’ natural environment, so remote access is a worthwhile goal.
“Thresholds is fortunate to have resources to do that,” she says. “We also realize if you can make things easier for the staff, if you can commit some resources up front, then it will help establish the revenue that the staff needs to bring in through the work that they do.”
In today’s landscape of increased demand for services coupled with a work force shortage, behavioral health organizations are all the more motivated to keep their staff engaged. Recruitment and retention is an ongoing challenge, Pavick says.
Another staff engagement strategy is training and development. Pavick, who’s been with the organization for 30 years, says national experts have come to Thresholds to train its development teams on everything from safety to evidence-based practices. Recently, a local professional offered eight-hour training sessions on leadership for 250 employees.
“The staff feel that we’re investing in them—not just in what they’re currently doing but also to help them develop,” she says.
With a budget that’s grown over the last two years from $50 million to $70 million, Thresholds has experienced increased demand related to the expansion of Medicaid in Illinois and other state-specific policies. And that increased demand is calling for a larger work force.
Mark Ishaug, MA, CEO of Thresholds, says the organization’s staff has increased by nearly 300 people over the past two years. They cover 75 locations from drop-in centers to offices, but most of the interaction is delivered in client homes and community spaces.
“The state is operating under several consent decrees, in which people with mental illnesses are given the opportunity to move out of nursing homes and institutes of mental disease to fully integrated settings in the community,” Ishaug says. “Thresholds is the largest community-based provider of mental health and housing services for the consent decree population.”
After receiving feedback from key managers, Thresholds also created a new onboarding process to help incoming employees become familiar with their roles, Pavick says. A four-day orientation covers everything from culture to how to use the EHR system, so employees can roll up their sleeves and get to work.
Ishaug says with such a large organization and so many levels between the executives and the case managers, communication has to be clear and frequent. Rather than feeling as if management is imposing rules, staff should understand the reasons behind policies and procedures. Likewise, executives should be in touch with what happens every day in the field.
“You have to generate sponsorship all the way down the line,” Pavick says. “If your top management isn’t engaged, then staff don’t buy it all the way down either. Make sure the CEO is aware of what’s happening and is part of it.”