Pulling Teams Through Transformational Change to Build a Culture of Compliance

In 2012, Central Nassau Guidance & Counseling Services (CN Guidance) faced a challenge familiar to almost every behavioral health organization today: survival.  In a world of dramatically shifting payer requirements, CN Guidance needed to not only change … they needed to transform themselves to survive and be sustainable.  They knew the key was to increase their service volume while meeting new industry integrated care benchmarks and diversifying funding sources. But how to do that was less clear.

Enter the opportunity to become a Certified Community Behavioral Health Clinic (CCBHC).  CCBHCs provide comprehensive, integrated services, including 24-hour crisis care, utilization of evidence-based practices, and care coordination, in exchange for enhanced Medicaid reimbursement rates. CN Guidance knew this was an important opportunity, but it required transformational change – for the organization, their employees and the people they serve.

To help make the shift, CN Guidance engaged MTM Services to put the necessary systems – open access, centralized scheduling, incentive compensation models, and collaborative documentation – in place. But CN Guidance did not have time to implement them one at a time. To be eligible for Vital Access Provider funding from the state of New York, they had to implement all the changes at once. To make this work, they needed the full buy-in and support of the entire team.

Building a culture of compliance with transformational systems is central to what MTM does

Working with MTM founder David Lloyd, the CN Guidance executive management team used data to shift thinking. Right away, they looked at each clinician’s costs to understand how much time they were spending face-to-face with clients. The answer was sobering.  As CN Guidance’s Chief Program Officer Nancy Manigat said when first reviewing the data, “I was shocked at how much unbillable time there was, even though I knew everyone was busy.”  At that point, it was clear that moving forward, everyone needed to change their thinking and start utilizing new systems.  

To get everyone ready, David took the entire team through the change process:

  • Step 1: Denial – “Nothing is wrong; I don’t have to change”

  • Step 2: Negotiation - Supervisors “push” staff to change, but there is resistance because the supervisors individually do not support the proposed change

  • Step 3: Anxiety/Anger/Blame – First the problem is beyond, then it is inside the organization

  • Step 4: Drop Out – “This is too much.  This is awful. I am not doing it!”

  • Step 5: Acceptance – Finally, a genuine recognition of the need to change and a desire to be part of it!

  • Step 6: Excitement – Everyone is ready to take advantage of the opportunities; managers no longer push the team but rather “pull” them forward through the process of acceptance

While members of the team were excited to implement many changes, Manigat noticed that, over time, some of the new systems started unravelling as people went back to old habits.  She knew that managers needed support to get back on track to maintain the transformational change required.

Navigating through transformational change

David stayed engaged throughout this process and worked with the team to tackle the real-life challenges.  As Manigat recounted, after a session where David focused on how people can be obstacles to change, one manager confessed to being “so embarrassed” – she was guilty of trying to make the system work around her, rather than embrace a system that works for the organization and its clients.  

Manigat's response:

“Don’t be embarrassed. I’m glad you could recognize the problem and ask yourself, how can I make this better. I am giving you the responsibility and authority to make it work. And in turn, you should expect the same from your team.”

Bottom line for Manigat: “Get the monkey off your back. You cannot get your job done if you are too busy solving everyone’s problems. Empower your team to fix the problems they encounter, to bring a solution to the table. And everyone will be measured by how they perform.  It’s no longer good enough to say things are ‘getting better’ - we will look at the data to tell us.”

“David and the folks at MTM have been with us throughout this process, helping us to continually maintain and improve our operation,” said Jeffrey Friedman, CEO. “It is an incredible partnership and he’s a passionate advocate and teacher, helping us navigate through transformational change and, in turn, making life better for the people we serve.”  As one of the managers said during the training – “I wish I had been through this process with MTM 20 years ago.”

What one participant had to say about MTM’s training:

“My role changed over the years. When I first started as a supervisor, I was involved in decision making for every client. We had only a few staff members, some with little experience, to manage a very difficult population. The staff relied on me to make every decision for them. I rationalized this as ‘teaching,’ hoping they will learn and grow from it. But thanks to this training, I can see it does not empower staff to grow and make decisions for themselves. Additionally, it keeps me stuck ‘in the noise’ and unable to grow myself. And, of course, it leads to lots of anxiety. It’s time for me to make some changes. I love my job, and thanks to this training, I am going to start doing it better.”

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