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Process versus product

December 1, 2007
by Richard R. Karges, LISW, ACSW
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Is the field focusing too much on how we deliver services rather than on what we deliver?

As a behavioral healthcare executive long on experience, I sometimes wonder whether the process of what we do is becoming more important than the product we ultimately deliver. As leaders in our field, are we doing all that we can to prove what we do has efficacy and is worthy of further investment? Could we, in our earnest efforts, be so caught up with the process of getting ahead in the marketplace that we are losing sight of our need to demonstrate and improve our outcomes?

Many behavioral healthcare organizations across the country have steadily grown their budget, staff, and number of facilities, despite formidable funding and system challenges. We are serving more clients, are implementing best practices, are respected in our communities, and have received prestigious awards for our work.

Despite these self-assurances, lingering in the back of my mind remains a nagging doubt and speculation well-articulated by author/philosopher Will Durant: “The first lesson of philosophy [and life] is that we may all be mistaken.”

Are the process and appearance of what we deliver in fact being mistakenly identified as our end product? Some of my well-intentioned colleagues would point out how far we have come. They would point out that despite formidable funding challenges and system/policy changes, their organizations have become more sophisticated and businesslike. Guided by well-intentioned vision- and mission–driven ideologies (as vague as some of these may be), many organizations have transformed from mom-and-pop operations to well-honed corporate entities concerned with product lines, value-added services, merger and acquisition strategies, and innovative managed care models. They would note our increasing national presence to advocate for our concerns and causes. They would note that our education and research contributions are being increasingly valued by general healthcare; our professional trade associations are evolving; we have more sophisticated national policy initiatives; and consumers and families now play critical roles in driving behavioral healthcare advocacy.

Yet I wonder whether the process of what we do and say has become, at times, more important (and safer) for us to address than the product (outcomes) we deliver to our clients and communities—the real measure of making a difference. Are we so captivated by flavor-of-the-month models of care, innovative process improvement methods, and winning negotiation strategies that we, in fact, have lost some of our core purpose: meeting clients’ needs where they are and helping them get to where they want to be?

In short, it may all sound good, but does it work? Furthermore, from a financial perspective, are we truly delivering the best product, for the best price, that renders the greatest return on investment? Given an increasing regulatory and pay-for-performance environment, such questions will be increasingly essential for us to address to further demonstrate the value and efficacy of what we do.

Futurist David Zach refers to our society's popular innovations (fads) as frequently market-driven processes tending to be actively pushed. As soon as something stops pushing them, fads fall away.1 Is the behavioral healthcare field getting too caught up in market-driven (versus outcome-driven) cycles? Are we leading the way or merely following the market and the money, rationalizing that our actions are in the best interest of the field?

In her April 2006 Behavioral Healthcare article “You have to run faster than the other guy,” OPEN MINDS CEO Monica E. Oss says, “In turbulent market times (such as those ahead), it is survival—and not excellence—that determines winners.”2 Is this where we have arrived? Are outcomes (results) only by-products of a get-ahead philosophy? Is outmaneuvering our partners, gaining market share, and beating the competition our ultimate endgame? Is this how we define “making a difference” and delivering a meaningful product?

Dennis P. Morrison, PhD, president and CEO of the Center for Behavioral Health in Bloomington, Indiana, speaks correctly and morally of evidence-based treatment as the “right thing to do,” noting that clients “deserve measurable effective treatment” and that the future would be driven by clinical outcomes.3 He adds, however, that while the push is for more evidence-based treatment, few are talking about how to pay for its implementation and application over time, concluding, “If we can't demonstrate value and neither public nor private payers want to pay for EBT or research-based treatments, how can we go on?”

Process is the way; product is the result of our efforts. Zach advises that we “play with innovation, work with trends and live by principles.”1 I believe these are great words to live and lead by. I hope that behavioral healthcare organizations ultimately do not get caught up in trying to ensure their own survival at the expense of compromising proven, quality, sustained clinical care.

I trust that at the end of the day, our commitment to our core values and principles will remain intact, and we will continue to make a positive difference in the lives of our clients and communities by doing what is right, measurable, and evidence-based; our ultimate product will be a healthier and improved quality of life for all those we serve. But we should not lose sight of the pressures that are pushing us to act otherwise.