LEADERSHIP DEVELOPMENTSAVED $65 MILLION IN TURNOVER COSTS

Christopher S. Amenson, Ph.D. 2013 National Council for Behavioral Health Conference

VISION OF THE LEAD PROJECT

The vision of the LEAD project is to train, coach and support supervisors and managers in administrative departments and treatment programs, so that:

1. Managers increase their skill, motivation and commitment to the agency.2. Staff receiving excellent supervision are inspired in their work, continually improve their

skills, perform their work to high standards, and stay and grow with the agency.3. Consumers, receiving services from inspired and skilled staff, reach more of their life

goals.

LEAD PROJECT ELEMENTS

Extended initial training for new managers to instill skills that prevent management problems a three month, six-session course in supervising staff or managing programs immediately followed by a time limited coaching group

Refresher courses for all managers to reinforce common concepts and processes.

Consultations to divisions and departments to improve management teams and systems

Individual and group coaching and support to continue the development of managers and promote early resolution of management problems

LEADERSHIP EDUCATION AND DEVELOPMENT (LEAD)PROJECT ELEMENTS

INITIAL TRAINING FOR NEW HIRES AND PROMISING CANDIDATES

TIME-LIMITED TRAINING AND COACHING TO LEARN AND DEVELOP SKILLS

Time-limitedindividual coaching

Advanced management courses

Supervised practice (months 4-7)Group coaching with peers from course

ONGOING COACHING TO APPLY AND DEVELOP SKILLS

Program consultationwith management team

Group coachingwith peers from course

Group coachingwith other peers

Initial 3-month training courses Supervising Treatment Staff or

Managing Behavioral Healthcare Programs

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INITIAL ASSESSMENT OF SUPERVISOR BEHAVIOR AND SATISFACTION WITH SUPERVISION

412 staff in 34 programs of a large behavioral healthcare agency completed surveys rating their satisfaction with the supervision and training they were receiving and the frequency of 36 supervisor behaviors. Supervisor behaviors correlated with staff satisfaction were identified.

There were no correlations between satisfaction with supervision and focus on billable hours or focus on documentation. This means that increasing focus on billable hours or documentation does not lead to less satisfaction with supervision.

Focus on quality of services to clients and focus on your growth as a professional were strongly correlated (r = .51 and .53) with satisfaction with supervision.

Focus on working with team members and focus on promoting agency values were correlated (r = .36 and .40) with satisfaction with supervision.

SELF-MONITORING OF TIME SPENT SUPERVISING AND MANAGING

Supervisors recorded the amount of time they spent doing each type of supervision and the amount of time focused on each task.

A strength is that the largest focus of supervision and training is on consumer care (39%).

Although only 7% of supervision time is spent on productivity, staff complain that billable hours is the agency’s only concern. Staff may believe this because billable hours is the only area of staff performance that was consistently measured and clearly and objectively related to performance appraisal ratings at the time of the survey.

35% of supervision was unscheduled. This is a strength in that support and problem solving is available for the frequent crises that programs must manage. The strength can be overdone and become a weakness if supervision is less efficient (e.g., answering the same question many times) or less effective (e.g., creating dependency by solving problems for staff, rather than growing staff by teaching them to solve routine problems; and/or using a crisis management focus that leaves little time for teaching skills that lead to better consumer outcomes and to staff growth).

Group supervision, the method with the strongest evidence base for psychosocial rehabilitation, intensive and field-based services, was used infrequently (7%) and focused on treatment, growth and teamwork only 60% of the time. Few supervisors have received training in leading group supervision and may be reluctant to use this method.

Supervisors spent only 3% of their time conducting formal training. Because most “teaching” is done one staff at a time, supervisors feel over-burdened at the same time that staff feel under-trained.

Training supervisors to effectively provide group supervision and formal training would address many of the issues raised in this time study.

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CORRELATES OF POSITIVE RATINGS OF SUPERVISIONas identified by agency staff in 2007/2008 Staff Surveys

and organized into a coherent model of quality supervision

Teach skills and problem solving Provides direct suggestions Demonstrates specific skills Encourages me to learn/use new skills Helps me think & learn how to think Helps me select interventions that fit

Nourish learning relationship Listens to, understands & values me Is flexible in meeting my needs Provides praise and encouragement Involves me in decision making Helps me develop self confidence

Supervision focuses on quality Focuses of quality of clinet services Focuses on my professional growth Focuses on my professional growth

Learning goals drive supervision Helps me define learning goals Develops my strengths & capabilities Focuses on my learning goals

Both support and teaching are required Makes learning a constructive process Treats mistakes as learning opportunities

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AGENCY-WIDE OUTCOMES

Reducing turnover from 29% to 22% saved $65 million over 12 years

In the 5 years before the LEAD project, agency-wide staff turnover was slightly below the national average of staff turnover in similar community mental health agencies. During the LEAD project turnover was reduced to ¾ of the national average. An average of 84 fewer staff leaving each year saved the agency 1.5 times their annual salaries (the standard for mid-level, professional staff) or $5,460,000 per year.

The LEAD project is only partially responsible for this change. A staff retention committee was established at the same time as the LEAD project and the Dr. Amenson founded an internal training institute two years prior. The directors of these three projects coordinated efforts to train and develop staff, supervisors and managers. The synergy of these efforts produced the reduction in staff turnover.

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Management learning goals were met

To maximize learning in multi-session management courses, participants confer with their immediate supervisor to develop 3-5 management growth goals that the course will help them attain. Course participants discuss the progress they are making with their immediate supervisor and work together to apply the principles and skills taught in the course with their team and program.

After the course, participants and their immediate supervisor independently rate the degree of progress the participant made toward each goal. They are encouraged to share and discuss ratings to inform future management development plans. The table below shows these ratings.

A coherent management culture was established throughout the agency

Building consistency and cohesiveness in the management team was an explicit goal of LEAD. Cohesiveness was built by modeling, training and coaching teams of managers through a change process. The successful results promoted a perception of succeeding through team effort. Examples of increased consistency and cohesiveness include: By all levels of the management team taking similar courses, managers developed a

common language and approach to management that is consistent with the agency’s vision and values and integrated with Human Resources policies and procedures.

Managers implementing skills learned in LEAD courses are supported by immediate supervisors, who took the same or similar courses.

Many managers report feeling more trusting and connected with their management team and an increased frequency of talking with, and helping each other.

Staff and managers became masters of change with the attitudes and skills required to implement any change.

Ideas and tools are disseminated across divisions with each division learning best practices from the others.

Management manuals and courses have been developed on topics such as communicating with staff, implementing evidence based practices, mastering change, group supervision, managing client outcomes, resolving performance problems, clinical supervision, leading meetings and time management.

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DIVISION OR PROGRAM-SPECIFIC OUTCOMES

Some divisions and programs of the agency set unique goals and measured specific outcomes of improved management and supervision methods, which are reported below. Anecdotal evidence suggests that similar changes occurred to varying degrees in all divisions.

Increased use of evidence-based supervision and management methods

Before the LEAD project, managers in one division spent 40% of their time providing drop in assistance, answering each question individually as it arose. Managers said they were too busy to plan training or do group supervision. The LEAD project provided extensive training and supervised practice in the evidence-based management methods of group supervision and staff training. After learning how to provide effective training and group supervision, managers reported that staff had learned skills and solved problems as a group so that managers spent much less time providing drop in assistance to individuals. Many managers reported that adding group supervision and training actually reduced the total time they spent supervising staff.

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Agendas for supervision and management became more vision and value based

By shifting agendas to begin each meeting and supervision session with client outcomes and staff skill growth managers inspired staff to celebrate their growth and the progress of their clients. Staff felt recognized for their strengths and that they and their supervisors had similar visions and values. With this stronger, vision-based supervision alliance staff became more collaborative and solution-oriented when discussing billable hours and documentation.

Staff and supervisors report feeling more effective and less burdened

Staff and supervisors report more satisfaction with supervision guided by written plans to improve treatment quality and teach staff skills.

Staff rated their manager more favorably in 360-degree evaluations citing an increased focus on quality and professional growth as major factors.

Many managers reported program improvements in referrals, client outcomes, revenue, and documentation quality and timeliness.

Managers stated that increases in staff job performance led to improved morale. Staff felt like winners, whose dedication and efforts achieved their personal vision and the vision of the agency. This championship culture attracted and retained staff, who wanted to be peak performers. Powerful informal team norms were established in which peers expected and supported each other to achieve the vision by meeting performance standards. If team efforts to help a peer improve did not work, team norms encouraged the poor performer to leave.

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LESSONS LEARNED

In conducting the project some expected and unexpected findings helped shape the focus of interventions, including: There was no correlation between satisfaction with managers and the amount of time

managers focused on billable hours and documentation. Staff appear to understand that these efforts are needed.

Manager focus on quality and professional growth were strong predictors of satisfaction. These foci most closely aligned the personal vision of our staff with the agency vision. Focus on teamwork and agency values were moderate predictors of satisfaction, possibly due to a moderate associate with personal vision.

The move from therapist to manager is not a promotion; it is a career change. The personality, approach and skills are very different. The most common new manager mistakes arose from assuming a “therapist” focus on empathizing and supporting the person in front of them rather than taking a “manager” focus on helping a team of employees meet performance expectations in service of clients and the agency. Making this transition required extensive training and support. A few new managers appropriately returned to therapist positions that fit their preference and style of working.

The skill level of first level managers was less than expected, often due to inexperience. Trainers and facilitators had to begin work on goals at a foundational level and to provide more supervised practice over time than initially planned. For example, some supervisors needed training in understanding their role and how to talk to staff in order to effectively implement management skills. Reframing new managers as having about 100 of the 10,000 hours that they need to master their jobs led to more emphasis on, and patience with learning foundational skills.

Increased focus on management skills lead to increased expectations of managers. This usually led to a virtuous cycle of improved supervision relationships up and down the agency. On a few occasions managers using improved skills became less satisfied by the management that they were receiving.

Participating in LEAD management improvement processes made the level of management skill and willingness to learn of each manager more apparent to all, leading to:

o identifying strong managers, providing growth opportunities and promoting them,o providing extra support for inexperienced, but promising managers, ando moving managers, who remained ineffective, out of the agency

For further information contact:Christopher S. Amenson, Ph.D. amensonconsulting@gmail.comAmenson Consulting 626-203-9621419 E. Las Flores AveArcadia, CA 91006-4862

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