Every day, articles and reports emerge that discuss the erosion of our health and social service systems’ safety net. SAE Behavioral Health Consulting (SAEBHC), formerly known as SAE & Associates, has witnessed the negative impact of this accelerated change on our service providing clients since March of 2020.

In our efforts to provide comprehensive behavioral health planning and systems change for providers, we see behavioral health organizations across the country struggling mightily to meet the increased deleterious impact of higher than normal staff vacancies, massive staff illness, and a marked inability to find and hire qualified staff, all of which have forced them to reduce operations and placed them in financial peril. At the same time, they are experiencing an increased community need for timely access to behavioral health services and integrated care, at levels higher than experienced pre-pandemic. Complicating the need for timely access, the staff shortages are occurring not only among direct service staff, but at the executive and middle management levels. These factors have severely inhibited the operational efficiency of their administrative, programmatic, and fiscal components, and further impede patient access to timely and appropriate care.  Even telehealth, a promising service technology, has been negatively impacted by these factors. As a result, two and half years into the pandemic and with a still-unknown number of years ahead to recover operational equilibrium and stabilize networks of care, behavioral health organizations are often without the necessary infrastructure to support current operational needs, much less employ innovative and promising treatment alternatives, even when they can assist in meeting increased demand.

It is within this fast-changing and unpredictable behavioral health environment that one is tempted to take refuge in the concept of “thinking outside the box”.  However, it is also our experience that one can only resort to this cognitive methodology when one has the hands-on, in-depth operational understanding of how an agency or network of agencies engage, enroll, motivate, and maintain patients in the systems of care that are made available. Considerations of how effectively the administrative, fiscal and programmatic systems are integrated, and how the agency’s cultural values, norms and beliefs overtly and covertly impact the provision of care to its populations of focus are frequently given little attention. With these observations in mind, now more than ever, SAEBHC believes community-based behavioral health organizations need both strategic and tactical support to achieve their mission.

Tactical Operational Planning and Implementation Support

Tactical operational planning and implementation support may include everything from developing actionable operation’s plans, revising and redesigning workflow processes that improve client outcomes and client experience, to outsourcing administrative and supervisory functions based upon data driven decisions that point to their positive impact on patient care.  To help providers confront these critical issues, SAEBHC suggests   leveraging experts with direct hands-on, operational experience and success in resolving the operational problems or “pain points” that providers are now facing. This consultant(s) will roll up their sleeves and quickly commit to first listening and learning about your  organization to understand what are your populations of focus, what are the gaps and barriers to clients’ service needs, what potential provider partners are available to collaboratively fill gaps in services,  how to identify and engage with other non-behavioral health providers/systems to address your patients’ resiliency needs, and where pitfalls in your community partnerships and agency are.  This will allow agencies to come up with implementable solutions that solve critical operational and systemic problems in real time. This consultant will have to have a commitment to this perspective and a history of successful operational hands-on experience to best assist agencies in the development and implementation of actionable roadmaps to serve and support the sustainability and growth of each organization in these challenging times.

Strategic Operational Planning and Implementational Assistance

In most cases, one would need to start this process with a focus on the agency executive leadership team, the starting point for strategic operational planning and implementation assistance. It has been our experience over the past 20 years, consulting with a variety of community-based behavioral health providers in strategic and tactical operational planning, that successful implementation of evidence-based practices and programs almost always requires organizational change. One critical pillar to support and implement successful change is a firm commitment from agency leadership to the implementation/change process.

We understand that agency leadership must initiate and guide the organization through complex change processes, that explicit goals are to be set and communicated clearly throughout the organization, and that commitment is made to resolve conflicts with other operational goals or practices that may negatively inform the change process. We also recognize that agency leadership must be committed to the involvement of agency and community stakeholders as well as client participation in the planning, selection, and oversight of the programs/change processes chosen for implementation.

Expanding a Responsive Approach

Our consulting efforts with regard to strategic operational planning and implementation assistance are guided by the following principles: a commitment to alignment of organizational structure to prioritize the integration of staff selection, training, performance evaluation, and identification of training activities to positively impact staff performance and patient improvement. This may include providing training to staff to maximize their effectiveness in this new remote and hybrid work environment with a strong focus on assisting the organization in recruitment of new types of staff (such as peers or physicians’ assistants) to support new program initiatives like integrated behavioral health and primary care services that require innovative job descriptions, modified workflow analysis, and focused data collection efforts to measure the effectiveness of such innovative, yet necessary, program ventures. We also see a greater need for inculcating within agencies a commitment to quality assurance/performance improvement measures; a substantial commitment to data analyses; fact-based decision-making; and operational workflow analysis across the administrative, fiscal and programmatic components of the agency.  Doing so allows providers to better assess their efficiency of enrolling clients into services to minimize no-shows and increase client engagement, enrollment and retention in services.

If the agency feels the need to increase staff retention and program engagement, we propose making sure service delivery staff have received appropriate and effective training and supervision in best practices for behavioral health services, establishing or reinforcing an organizational culture that promotes staff wellness and morale and increases staff engagement.

This process effort would include training supervisors in specific practices that facilitate staff engagement. We have also found that organizations may want help to review revenue management processes, funder requirements and maximization of EHR capabilities to ensure that reimbursements are being maximized, and that patient health information is not only accurate but also securely maintained.  In summary, the fundamental goal of an effective consulting service, be it operational planning or internal process support, should be to ensure the alignment of organizational structures to achieve horizontal and vertical integration of the agency’s executive, program management, and direct care staff.

Finally, given the volatile health environment, we suggest behavioral health organizations review their current strategic plans now. If an agency hasn’t done so, we believe they are working with outdated and likely non-responsive strategic and operational plans.

Most current models do not contain operational roadmaps that can respond efficiently to the long periods of uncertainty and change faced today. Operationalizing current strategic plans require an organization to identify via their executive leadership what their organizational problems/“pain points” are in order to more thoroughly integrate the needs and capacity across all levels of the organization, to ultimately improve agency efficiency, and from there, better support and improve patient care. Our experience shows it is most effective to utilize an independent consultant or a team of consultants to attack these issues by collaboratively developing a roadmap that specifically and measurably implements change through data-driven identification and measures of the progress and outcomes in identified critical areas. Clearly, the goal of this collaborative process is to measure what matters.

We will continue exploring deeper dives into several of the areas and issues of concerns noted above to provide suggestions and insight from the perspective of the knowledgeable consultant experts at SAEBHC. Our hope is that this effort will assist community-based behavioral health organizations to embrace successful sustainability efforts through more accessible, efficient, and effective patient care strategies on behalf of the vulnerable populations of focus they, and we, all serve.

Also published into Issue Briefs March 11, 2022