JAMES W. WEST, MD, QUALITY IMPROVEMENT AWARD WINNER
Lakeside-Milam Recovery Centers (LMRC) is a family-owned addiction treatment company that offers adult and adolescent residential treatment in 2 facilities and outpatient treatment in 11 offices along the Puget Sound corridor. Celebrating our 25th anniversary this year, we are proud that we provide “effective, affordable treatment” to almost 4,000 patients and their families annually.
At the end of 2006, my management team and I performed our usual review of key performance benchmarks. Everything looked positive: Revenues were up; the patient population grew; and managed care relations were stable. One benchmark, however, was disturbing: We suffered a 30% turnover in our clinical staff.
It is not news to anyone managing addiction treatment programs that finding capable clinicians is daunting. More than one expert has called the dearth of professionals in the field a crisis. We found ample proof of the counselor shortage in our own region. A survey of 263 programs by the Northwest Frontier Addiction Technology Transfer Center (NFATTC) revealed that 40% of agency directors reported significant clinical understaffing; 83% regarded the lack of qualified applicants as the biggest obstacle in recruitment. According to the Washington Department of Health, the certifying agency for chemical dependency counselors in the state, only 130 new chemical dependency professional certificates were awarded in 2006, and 125 counselors chose not to renew their certification. NFATTC also found that the average clinician turnover rate in Washington State was 26%—ours was higher (30%). Clearly we are in a flourishing industry with a profession that is waning.
To address our turnover rate, we began by looking at who left our company (examining their level of experience, years with LMRC, etc.) and why. We also surveyed our current counselors to learn what they liked and disliked about working at LMRC. Our work yielded these key conclusions:
Among resigning staff, more clinicians left outpatient programs (67%) versus inpatient centers (37%).
Three outpatient programs registered a noticeably higher turnover rate than others.
One-third of counselors who resigned were trainees in their positions less than a year while another 23% had less than two years of experience at LMRC. One-third of those who left had been at LMRC for three years or more.
Too many exiting employees (38%) cited “communication problems with supervisors” as their reason for leaving.
More communication with management and among programs was cited as the number-one suggestion by 21% of the respondents to our survey.
We clearly were facing a multidimensional problem that required multidimensional solutions. Our goal was to reduce clinician turnover by 33% (from 30 to 20%). The entire management team was involved.
One priority was to focus on the experienced, capable clinicians who are the “anchors” of their programs but often are unrecognized. We created a mentorship program that would tap this group's experience and recognize their value to the company. Seventeen clinicians were named mentors. Their job was to take new trainees under their wing for a week or more and let the new staff shadow them daily. For each trainee they shepherded mentors received a $250 bonus. We held a lunch at a hotel to recognize their value and presented them with framed certificates acknowledging their new status.
We also gathered six of the most inexperienced outpatient administrators and held a biweekly management roundtable discussion, an open exchange of ideas on supervising and motivating staff. Our vice-president of quality assurance facilitated these sessions with help from other management team members.
In mid-size corporations becoming productive can come at the expense of effective communication between headquarters and the programs we serve. Thus, I asked the seven members of the management team to spend at least 40% of their workday at our programs. The charge was simple: Listen to the staff and hear what their concerns are; solve problems and answer all questions about the company and its direction.
To increase communication among staff of different programs, who are often too busy to call each other, we held a monthly series of brown-bag lunches for clinicians. The lunches were training opportunities but also social gatherings, highlighted by interactive games that prompted staff to get to know each other. The senior vice-president of marketing, an energetic, creative woman, kept the sessions lively and fun.
At the end of 2007 we tallied the results. Only 1 of the 17 mentors left LMRC (the person left for a position in another state). Of the mentored trainees only 1 left, and all the surveyed trainees listed the mentorship experience as the most valuable aspect of their training regimen. All of the managers attending the roundtable discussions remained in their posts at the end of the year, and turnover dipped at the programs experiencing high turnover in 2006. The management team made 228 separate visits to programs, a more than 150% increase from 2006. An average of 33 clinicians attended the brown-bag lunches. Most critically, clinician turnover dropped from 30% in 2006 to 19% in 2007. An additional bonus was that we saved $170,000 in recruiting, hiring, and training costs.
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