Tempers in Washington are hotter than the record-breaking midsummer weather outside. The President and Congressional leaders are engaged in an epic struggle between Democrat and Republican views about the desired future direction of American society. On one hand, Democrats seek to maintain Social Security, Medicare, and Medicaid, while increasing taxes on the wealthy. On the other, Republicans seek to cut these entitlement programs to reduce the tax burden on businesses and “free” the economy.
Let me be blunt: Neither “solution” will work. Why? Because neither does anything to address why we have such large deficits in the first place. Large, structural deficits are caused by the increasing inability of our national economic system to be innovative and competitive in the world. We attempt to compete with a poorly trained workforce using 19th century organizational processes.
Much of our workforce has skills that were required in the 1950s and 1960s, when production and service processes were done with virtually no automation. With the advent of computerized automation of these processes, many fewer of these workers are now required. Hence, we have a large, unemployed population that is unemployable in the absence of new skills training.
Similarly, our hierarchical, centralized, organizational structures were designed during the early period of industrialization. Today, they are costly and slow, and they do little to increase competitive ability. Those few organizations that have made the transition to a flat, virtual structure, with flexible matrix organization, principally in the social networking industry, are designed to compete much more effectively in today’s fast-paced environment.
Thus, rather than just being reactive and simply arguing that entitlement programs should not be cut, we from behavioral health must go forth with a much bolder agenda. We must seek today’s training with today’s training methods for our consumers and ourselves, and we must change our own antiquated organizational structures that are far too top-heavy and far too inefficient. Both of these steps will make us much more competitive, cost-efficient, and mission effective. Our greater productivity will not only contribute to the improvement of the U.S. economy, it will also make entitlement dollars go much, much farther.
Clearly, today’s training methods involve distance learning and virtual, simulated participation in related processes, whether they be service delivery or production. They also emphasize the interpersonal skills necessary to work in small flexible groups that are matrix organized around task execution. Innovation and change are valued attributes communicated at each step of the training.
To envision what will be involved in this training, just think about tomorrow’s behavioral healthcare: Most care will be done at a distance by peers or providers, using modern social networking tools, or virtually using smart systems. These smart systems will employ avatars that are automated or person-directed. Obviously, we do need to provide appropriate training so that our peers, providers, and managers are capable of working in this new environment. These training concepts also extend to other sectors of the economy, such as education, services, and production of intellectual and material products.
Let me cite one specific example: As our elderly population doubles over the next two decades, it seems clear that we will need a dramatic expansion in our workforce trained in complex service roles who will have the capacity to work with our seniors. Clearly, peer and provider-led behavioral health services will be needed by this population.
We must also look inward and change our own organizational structures to make them much more adaptable and flexible in today’s environment. Areas that will require close examination include the size and nature of any leadership, management, or headquarters unit, the size and structure of mission-oriented units, the physical location of these units, and the role of information technology.
To envision what will be required here, imagine your future organization with no headquarters unit, small flexible mission-oriented workgroups of no more than seven to ten persons, no fixed physical location, and a modern IT system used to support the organization, coordinate care, and actually deliver care. Care will be both virtual and interpersonal, and will occur where the consumer is in the community, not in a traditional office.
Our organizations of tomorrow will hold their team and workgroup meetings virtually, and there will be no physical workspace to “manage”. Because the workgroups will be small, and semi-autonomous, like franchises, multi-level management structures will not be appropriate.
These comments just barely scratch the surface of the topics that I have raised here. The approaches are intended to be provocative examples that will require further systematic analysis and demonstration.
As we continue to engage in the deficit-debt debate, we need to contribute to the solution, not just remain part of the problem. As is almost always the case, simply arguing in the negative that something should not be done or should not be changed will not produce a viable solution. Creating a new framework, based in social and technical innovation, will clearly be necessary. In fact, probably only by innovating in our training and our practice will we be able to move the issue forward in a productive way in the behavioral health field.
Are you ready to begin? I am.
|Ron Manderscheid, PhD, is Director of the National Association of County Behavioral Health and Developmental Disability (NACBHDD). He served in the federal government for over 30 years, most recently as Chief of the Survey and Analysis Branch at SAMHSA's Center for Mental Health Services. He is also a member of Behavioral Healthcare's Editorial Board.|