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Mindful Leadership:Leader Know Thy Self
Presented by:
Michael Flora, M.B.A., M.A.Ed., L.P.C.C.
Senior Operations and Management Consultant
M.T.M. Services Consultant
Web Site: mtmservices.org
Patrick Schmitz, MA, LMHC
President and CEO
Plains Area Mental Health Center
Maree Wacker, MPP
Chief Executive Officer
De Paul Treatment Centers
Danita Johnson Hughes, Ph.D.
President & CEO
Edgewater Behavioral Health Services
Presented By: MTM Services
The current healthcare landscape is changing
rapidly. Transformational change can be risky,
multi-dimensional,
Today we will learn from CEOs who have
changed their organizations, the challenges and
solutions that witness how one agency was able
to meet the need transformational change.
Presented By: MTM Services
Learning Objectives
• Recognize leadership qualities and behaviors
needed to lead transformational change
• Recognize the objectives of a communication
planning around change
• Recognize stages of transformational change
and real examples of how they can work with
their community, team members and
stakeholders to improve their organizations
performance and deliver outcomes
Presented By: MTM Services
Overview
In my work with employers through
consulting with businesses around the
country many behavioral health
executives find it difficult to motivate their
teams to peak performance during
transformational change and find the
balance they need to stay focused and
present
Presented By: MTM Services
What is Transformational Leadership?
• Creates cultural change with staff and the organization
• Creates positive change that drives value
• Enhances motivation, morale and performance of team members
• Creates a purpose and alignment with the mission, vision and
guiding principles of the organization
• Moves the organization to a future state that increases efficiency,
operational performance
Source: Adapted from Transformational Leadership http://www.langston.edu/sites/default/files/basic-content-files
Presented By: MTM Services
Change Management Models
• “Sequential Change” – Complete one goal
and then address next goal, etc.
• “Transformational Change” – Continuous
change management model using Rapid
Cycle Change Model (PDSA)
5Presented By: MTM Services
7
Transformational Change Formula
• Transformational Change =
(Values + Beliefs + Actions) X (CQI)2
______________________________
Resistance
Source: Kathryn Powers, Director of CMHS
Presented By: MTM Services
Finding Balance
• Mindfulness is often viewed as being in the present and having a sense
of awareness of how our leadership style and actions effect the
performance of others.
• Its finding the balance of self and the environment that is
interdependent and relational to the goals of the organization.
• Its being present and having the focus to lead transformational change.
• Leading with mindfulness in transformational change requires that we
come to the challenge of assisting our teams manage the future state of
change while at the same time understanding the fundamental
requirements of change
Presented By: MTM Services
Mindful Leadership
• In todays environment …
– We must be able to lead with clarity.
– We must be able to lead with compassion.
– We must be able to lead with focus for our
own goals and the organizations goals.
– We must be present.
Source: Adapted from- Janice Marturano Finding the Space to Lead: A Practical Guide to Mindful Leadership, Institute for Mindful Leadership
Presented By: MTM Services
Recognize leadership qualities and behaviors needed to lead transformational change
Presented By: MTM Services
11
Leadership Qualities
1. A quality of work life that is attractive to others
2. Aware of what is going on with organization and with staff –
Has a Sixth Sense of Awareness….360 degree scan of day-to-
day happenings
3. Has an ability to face tough and good times with
professional decorum….a panic-filled leader is not one to
follow
4. Has knowledge of subject matters
5. Energized by life and work accomplishments
6. Has ability to look at the lighter side of the issues
Presented By: MTM Services
Source: David Lloyd (2015) Leadership Essentials
12
Leadership Qualities7. Constant awareness of Horizontal Accountability needs
of organization
8. Going somewhere vs. hanging around model
9. Provides guidance through establishing values and work ethics for self and for staff
10. Facilitates empowerment of staff … Pushing decision-making down
11. Establishing mutual accountability levels for manager/staff
12. Grooming future leadership – providing an arena to practice decision-making and leadership skills
Presented By: MTM Services
Source: David Lloyd (2015) Leadership Essentials
14
• Cultural transformation can be
successful only to the extent that a
planned, intentional effort is made to
deploy change management
behaviors
Source: Levett, Hannah and Roberts 2010
Presented By: MTM Services
Recognize stages of transformational change and real examples of how they can work with their community, team members and stakeholders to improve their organizations performance and
deliver outcomes
Presented By: MTM Services
Action Steps Key for Mindful Focus
• Develop Action Plans to facilitate moving staff
from current performance levels to new standard
levels
• Team work sessions to identify and problem
solve barriers to meeting new standards
• Document the process and decisions and
provide regular updates of progress to staff
Presented By: MTM Services
17
Stages of the Need to Change and Leadership “Blinking”
1. Denial
2. Negotiation
3. Anger – Blaming – Outside then Inside
4. Drop Out – “It’s Awful!”
5. Acceptance of the Need to Change
Presented By: MTM Services
9 Steps to Successful Organizational Change
1. Create a sense of Urgency
2. Pull together your guiding team
3. Develop the change vision and strategy
4. Communicate for understanding
5. Engage Stakeholders
6. Empower others to act
7. Produce Quick wins
8. Don’t Blink
9. Create the NEW culture
Source: J.P. Kotter 1995
Presented By: MTM Services
C
h
a
n
g
e
Time
Phase I - Activity
Phase II- Processes
Phase III- Culture
Eliminate work build confidence
Build sense of contribution through
Urgency, Speed and simplicity and prove
results
Begin re-inventing the
Organization
Getting started
“Quick Hits”
Gaining momentum
Cross functional issues
Becoming part
of the
culture
Self sustaining
spontaneity
Part of the Process
Finding a better way…..every day
Presented By: MTM Services
Danita Johnson Hughes, Ph.D.
President & CEO
Edgewater Behavioral Health Services
Presented By: MTM Services
Author “The Unapologetic Woman: Leading With Power and Confidence”
Gary, Indiana
• Population: 77,909
• Income per capita 44% lower than national
average.
• Median household income 49% lower than
national average.
• Unemployment rate 67% higher national
average.
• Poverty level 148% higher than national
average
US Census Bureau
Gary Employment Information
Index Gary Indiana National
Income per capita $15,983 $24,953 $28,555
Median household income $27,458 $48,737 $53,482
Unemploymentrate 9.7% 5.7% 5.8%
Poverty level 38.7% 15.5% 15.65US Census Bureau
Edgewater Systems
• Two Divisions
– Edgewater Behavioral Health-1974
– Edgewater Primary Care-Fall 2016
• Annual Operating Budget- $15M
• 150 Employees
• Number of Clients/Patients Served
Behavioral Health 3,500
Primary Care 6,000
Total 9,500
Edgewater Services Provided
• 6 outpatient treatment sites (medical and behavioral) – Addictions
– Rapid Access Center (crisis services)
– Headquarters Location-Houses (BEAT, Family & Youth Services, Administrative Offices)
– Primary Care-Gary
– Primary Care-Griffith
• 3 Group Homes– Transitional Residential Services (TRS)-15 beds
– Supervised Group Living (SGL)-2 sites/30
• Semi-independent Living (SILP) Apartments- 15 2-bedroom Units
• Permanent Supportive Housing (PSH) 60-1 and 2 bedroom apartments
• RAC-subacute & detox
• Inpatient treatment beds at the local hospital, Methodist Hospitals
Where we started-July 2010
• Sweeping changes to Indiana Medicaid Rehabilitation Option (MRO)
program including changes in service delivery and reimbursement
• Major source of funding for Edgewater Systems (68% of revenue)
• Transformation initiatives redefined consumer eligibility, service
models, provider credentials, authorization procedures and
reimbursement rates and rules
• Specific changes to rules:
– Required special authorization for services
– Focus on community based services and elimination of others
– Limited number of clients eligible for services
– Limited amount of services can provide to each client
– Significantly lower payment rates for MRO
– Increased staff qualifications required to bill MRO
– Immediate impact- 35% reduction in net MRO revenues
Operations Impact
• Changes required a significant change in our
business model
• Slow to adapt
• Reduction in staff positions from 215 to a low
of 104 (currently150)
• Elimination of some programs
• Staff resistance to change
• Managers reluctant to use data to manage
• Recognition that there would likely be some
casualties
Impact to Financial Stability
• $400,000 loss in MRO revenue per month
(potential of $4.8M/yr.)
• At end of FY ‘2011 -$2,027,338 in red
• Overall net MRO revenue decrease by 27%
over previous fiscal year
Our Response• Recognized we needed some professional assistance
• Secured Board Resolution supporting CEO in whatever steps needed to stabilize organization
• Instituted a Rapid Cycle Change Plan to:
– Enhance service capacity for outpatient and community-based services
– Institute open access
– Developed and implement key performance indicators tied directly to job descriptions
– Revise productivity standards from 67% to 75%
– Develop centralized scheduling utilizing “back fill” management
– Design and implement no show/cancellation management
– Design and implement re-engagement/transition procedures for current cases not actively in treatment
– Implement collaborative/concurrent documentation
– Assess service capacity and resource deployment
– Assess administrative vs. clinical tasks to increase operational efficiency
– Develop supervisor and management competencies to support the new community based service delivery performance culture
– Tackle staff & management resistance to improvement efforts
Where Are We Now
• Average days to intake 0
• Reduced time to service for physicians from 70 days to 8
days
• Reduced time to therapist from 12 days to 3.8
• Improved billing & collections starting at front end
• Improved productivity performance (82% meet 75%
productivity)
• Expanded service offerings
– Constructed 60 unit HUD Shelter Plus Care
independent living complex
– Started first in Indiana crisis stabilization center
designed to address acute psychiatric episodes
– Embarked on an Integrated Care initiative by
acquiring a successful primary care practice with two
locations
Mindful Leadership Practices
• Approach change proactively
• Think strategically
– Know the industry
• Create the game plan, including how to
implement your strategy
• Communicate your goals and vision
effectively
– In messaging be clear, consistent, and
continuous in communicating
– Set the standard and don’t cave to pressure or
indifference
– Expect your leadership team to be on
Mindful Leadership Practices
• Be courageous & willing to make the hard
choices
• Recognize that you can’t go it alone
• Get staff buy-in
– Recognize star performers and let them shine
• Manage your stress DARE TO BE SELFISH
• Stop apologizing and own your power
• Be resilient & always ready for the next big
crisis
Patrick Schmitz, MA, LMHC
President and Chief Executive Officer
Plains Area Mental Health Center
Presented By: MTM Services
Plains Area Mental Health, Inc.
• CMHC located in NW Iowa serving 11
counties directly and 23 counties in total
when including surrounding areas
• Rural area w/ 2.75 hr. drive between NW
location to our SE location – all country roads
• Total population of the 11 counties is 175,452
• 110 staff serving 6500+ individuals/year with
a budget of approximately $8M
Presented By: MTM Services
Services @ PAMH, Inc.
• Therapy, Psychiatry, Outreach, Drop-In,
Psychology, Integrated Health Services,
Consultation and Education, School-Based
Services; PCP Clinic Behaviorist; MH Services
at Job Corps and State of Iowa Sex Offender
Unit, 24-hour Emergency on-call and Crisis
Stabilization House
• Future – Mobile Crisis, Jail Diversion, SUD
Presented By: MTM Services
PAMH, Inc. changes since 2004
• In 2004, we were a 4 County CMHC with 25
staff providing Therapy, Psychiatry, Outreach
and a Senior Peer Program
• In 2008, added Buena Vista County
• 2012 added Carroll & Greene Counties
through the assumption of services left by a
departing CMHC
Presented By: MTM Services
Changes continued
• 2014 - Crawford, Sac and Monona Counties
through acquisition of a CMHC and addition
of Integrated Health Services; doubling size
of agency in under 3 months; plus the MHDS
System in Iowa changed to Regions; and as a
result, added Calhoun County;
• 2016 Opened a Crisis Stabilization
Residential Services program in one of our
MHDS Regions
• April 2016 - Medicaid Reform/MCO initiated
Presented By: MTM Services
Service Delivery Redesign 2015-Present
• Embarked on significant service
redesign:
– Open Access/Same Day Services
for Therapy via Telehealth and
Just in Time for Psychiatry
– Trained in Collaborative
Documentation; DSM-5/ICD-10;
E&M Coding; Customer Service;
Leadership; and costing of
services
– Implemented Primary Care
Integration; School Based
Presented By: MTM Services
Service Delivery continued
• Started a Regional On-call
System
• ASIST Training for all staff and
stakeholders
• Added CMA’s to Psychiatric
Services
• Trained and implemented the
DLA-20 across our 2 Regions
• Meaningful Use Attestation and
started PQRS Reporting
• Working on developing Levels of
Presented By: MTM Services
Leadership Qualities
• Humbleness – know that you don’t know it all
• Learner – constant striving to learn more about
leadership; about the industry; about funding
• Persistence – sticking to the plan yet adjust
(PDCA cycle)
• Forward thinking – know the trends in your
industry; read and get around others w/ similar
mindset yet different ideas and perspectives
• Being Comfortable with Discomfort
Presented By: MTM Services
Leadership Qualities continued
• Intentional in your leadership approach/style
• Share leadership training; growth;
development; drive it down in organization
• Self-care – exercise, diet, more balance,
reading, listening to music, friends/colleagues
• Model for staff what you teach – customer
service, teamwork, self-care; learning;
openness; vulnerability; communication;
humility; growth; optimism and determination
Presented By: MTM Services
Changes we went through
We have gone through and continue to cycle through all of the classic stages of change at various times in the different aspects of what we are attempting. As soon as you think you’ve achieved Maintenance, you discover you’re not all there and the work continues. At other times, achieving Maintenance is simply one step in the longer term process of evolving and once there, its time to change some more and re-cycle through the stages. Reaching “Transcendence” in this marketplace is unlikely due to constant demands to evolve.
Presented By: MTM Services
Lessons Learned
• Be intentional in your leadership style and
approach – learn new ideas and strategies
• Grow your Leadership Team – invest in them!
• If at all possible, do this before big changes
• Support and train leadership ability as far down in
your organization as you can
• Gather ideas and input from front line team
members
• Develop clear communication methods and
decision making paths
Presented By: MTM Services
Lessons Learned continued
• Communicate often and in various methods
throughout your organization
• Hold weekly touch-base meetings with direct
reports and have them do the same with theirs
• Hold weekly All-Team Huddles to
communicate Wins, Information and answer
Questions
• Model and practice self-care
Presented By: MTM Services
Maree Wacker, MPP
Chief Executive Officer
De Paul Treatment Centers
Presented By: MTM Services
De Paul Treatment Centers, Inc.Portland, OR
• 42 year history providing substance use and mental health treatment
• $13 M operating budget, 3 locations
• Full continuum of care
• 12 medical detox beds
• 80 adult residential beds
• 40 youth residential beds + accredited high school
• Day Treatment, Intensive Outpatient & Outpatient
• Family and Mental Health Therapy
• Medical care
• 75% of clients are Medicaid enrollees
• Mission to make treatment available to everyone
Presented By: MTM Services
De Paul 2014• Board involved in operations
• First year of ACA managed care
• New medical detox program (2 mos)
• Youth program losing $600k annually
• Outpatient program losing over $400k annually
• 17 year departing clinician executive
• CFO/Finance function underperforming
• $500k negative operating budget
• Punitive environment, low morale, siloing
Presented By: MTM Services
De Paul 2017• Board at strategic level and fundraising
• New CFO and finance and billing practices
• Medical detox finally stabilized
• Outpatient program is break even but not done
• Youth program improvement by $350k
• High morale, team environment
Presented By: MTM Services
My Style Takeover• Collaborative style
• Transparency and candidness
• Had to draw the line for the Board on occasion
• Executive team needed to get comfortable with group decision making
• Not a micromanager but reserve the right to drill down
• Bring others to the table when you are not the expert
• Address and deal with issues head on
• Be intentional and have situational awareness
• Empowered everyone to lead and
own our results
Presented By: MTM Services
What I learned…• I don’t like not being the expert
• Open door can be a challenge to productivity
• Had to get comfortable with letting go of details
• Clinical employees are processors and need time to engage
My Mindfulness…• Leave the office at the door• Amateur artist – creativity time keeps brain occupied• Trusted advisor who understands my dark side &
shortcomings• Lots of Home Improvement!!!
Presented By: MTM Services
Stages of Change• Cash crisis
• High staff & manager turnover; reorganization – more than once
• Relationships with payors, referents, other providers –centrally organized, managed
• Initial doubt until follow through moved us to trust
• Improve performance – built performance metrics and review achievement monthly
Presented By: MTM Services
• Agency goals tied to individual goals in performance management system
• Everyone in agency understands they are accountable to financial & clinical organizational goals
• Silos are now interdepartmental teams
• HR became more than application and hire processing
Stages of Change
Presented By: MTM Services
In the End…
• Stay true to who I am but round out the leadership and get the right the people on the bus
• Patience pays but it is HARD!
• Employees get their weekends too!
• As the leader, you don’t always get the whole picture
• Work furiously but a break is coming…
• Plan, analyze with Executive Team
Presented By: MTM Services
Questions and Feedback
• Questions?
• Feedback?
• Next Steps?
ActionNext Steps
Presented By: MTM Services
53
Contact Information
Michael Flora, M.B.A., M.A.Ed., L.P.C.C.
Senior Operations and Management Consultant
M.T.M. Services Consultant
Web Site: mtmservices.org
Patrick Schmitz, MA, LMHC
Executive Director
Plains Area Mental Health Center
Maree Wacker, MPP
Chief Executive Officer
De Paul Treatment Centers
Danita Johnson Hughes, Ph.D.
President & CEO
Edgewater Behavioral Health Services
Presented By: MTM Services
References
• Gonzolez, M.( 2012)Mindful Leadership the 9 ways to self awareness, transforming
your self and inspiring others. Wiley
• Kets de Vries M. (2014) Mindful Leadership Coaching: Journeys into the Interior.
Palgrace Macmillan, UK.
• Kotter, J.P. (1995) Leading Change: Why Transformation Efforts Fail. Harvard
Business Review
• Levett, Hannah and Roberts (2010) Building the Foundation: A framework and
Process for initiating cultural transformation of an Accountable Care Organization.
Accountable Care News. Health Policy Publishing LLC.
• Marturano J. (2015) Finding the Space to Lead: A Practical Guide to Mindful
Leadership, Bloomsbury USA
• Misner, J. W. (2014). Mindful leadership and navigating the seas of change in the
information age. Journal of Leadership Studies, 8(2), 46–50. doi:10.1002/jls.21330
• Sethi, D. (2009). Mindful leadership. Leader to Leader, 2009(51), 7–11.
doi:10.1002/ltl.311
Presented By: MTM Services