Ben, Thanks for your thoughtful discussion of the ways that "business" can be structurally out of sync with the relationship base that should be present in healthcare. I wish that many of the primary care practices I consult to held their relationship base in as high esteem as you and I do. So many administrators feel that they need to run their health center as efficiently as a business like Walmart. That means that every new program (I am usually helping them add behavioral health) has to be profitable from the beginning. To do this, they set unreasonably high "productivity" targets, leading to a culture of impatience with their BH clinicians, leading to high turn over, leading to the loss of access that the program was supposed to provide for patients. Primary care behavioral health is a different arrangement of the skills used to succeed as a mental health clinician, like taking your finely honed dance moves and having to do them on roller skates. It's about understanding the process of learning of the clinicians who will be in the relationships, first they have to learn to do it, then they have to learn to do it well, and then they learn to do it efficiently. In the exemplar sites, where clinicians build healing relationships with patients efficiently and more than pay for the cost of the BH service, the start up (3-7 years) was usually a revenue loss that was supported by the health center. These are also the centers now with very low turn over who spend less time on searching and on-boarding new staff. Alexander Blount, EdD Professor Emeritus of Family Medicine and Community Health, UMass Medical School.
Sandy, thank you for this thoughtful and quite grounding comment. I admit to being a bit optimistic about the relationship in health care, and yet I also recognize that we have squeezed some of the life out of it through our payment models and culture.
I love your take on learning how to do it, do it well, and then do it efficiently. I once heard someone say that you can't really split up effectiveness from efficiency in health care - one needs the other to really work.
We all know the relationships matter most; yet, it is undoubtedly the one thing that is hardest for the "industry" to commoditize into unit that they can "value."
If a business is in the health care field, and it also creates products that significantly damage physical and mental health, is that not a conflict of interest?
Ben, Thanks for your thoughtful discussion of the ways that "business" can be structurally out of sync with the relationship base that should be present in healthcare. I wish that many of the primary care practices I consult to held their relationship base in as high esteem as you and I do. So many administrators feel that they need to run their health center as efficiently as a business like Walmart. That means that every new program (I am usually helping them add behavioral health) has to be profitable from the beginning. To do this, they set unreasonably high "productivity" targets, leading to a culture of impatience with their BH clinicians, leading to high turn over, leading to the loss of access that the program was supposed to provide for patients. Primary care behavioral health is a different arrangement of the skills used to succeed as a mental health clinician, like taking your finely honed dance moves and having to do them on roller skates. It's about understanding the process of learning of the clinicians who will be in the relationships, first they have to learn to do it, then they have to learn to do it well, and then they learn to do it efficiently. In the exemplar sites, where clinicians build healing relationships with patients efficiently and more than pay for the cost of the BH service, the start up (3-7 years) was usually a revenue loss that was supported by the health center. These are also the centers now with very low turn over who spend less time on searching and on-boarding new staff. Alexander Blount, EdD Professor Emeritus of Family Medicine and Community Health, UMass Medical School.
Sandy, thank you for this thoughtful and quite grounding comment. I admit to being a bit optimistic about the relationship in health care, and yet I also recognize that we have squeezed some of the life out of it through our payment models and culture.
I love your take on learning how to do it, do it well, and then do it efficiently. I once heard someone say that you can't really split up effectiveness from efficiency in health care - one needs the other to really work.
We all know the relationships matter most; yet, it is undoubtedly the one thing that is hardest for the "industry" to commoditize into unit that they can "value."
Excellent piece, Ben, and especially great use of Jimmy Eat World lyrics!
If a business is in the health care field, and it also creates products that significantly damage physical and mental health, is that not a conflict of interest?