Transcript Ohio’s Quality Improvement Strategies

Transformation: ACMHA,
The President’s Commission,
And the Change that we Seek
Beginning (and concluding) thoughts…
(How DO we) Be the change that we want to
see in the world.
Mohandas Gandi
(Can we become) A small group of thoughtful
people (to) change the world. Indeed, it's the
only thing that ever has.
Margaret Mead
Our Ideas: Comments on Selected Group
Recommendations
• De-stigmatize mental illness through direct contact, education,
legislation
– So much talk about stigma, so little action
• Gauge audiences, tailor effective messages to influence power
– YES to using communications technology
• Next year: “Success Off” (Transformation successes)
– Time to use a strengths-based approach!
• ACMHA’s agenda should include innovation/ transformation
skill development
– YES: much known, little applied about science of change
• Align business and financing models
– Crucial: it’s not just policy and program
• Support adoption of the 10 IOM rules to guide care delivery
– Yes: IOM frame is right, IOM report on mental health will be “next new
thing” providing momentum to field
But: Group Recommendations Perhaps Reflect
a Too-Low Priority on Some Key Issues
• Recovery: 5x…Are We Clear About the
Vision? (and resilience, equity)
• Medicaid: 1x…One recommendation re:
the Biggest Funding Stream? (NB lots of
conversation)
Illustrative Medicaid Dynamics; Ohio Department of Mental Health
Community GRF (502+508+408) and Medicaid
FY 1990 – FY 2007 (est) Deflated 3% per year
millions
$200
$150
millions
$200
Medicaid FFP
Medicaid Match
Remaining GRF
$150
$100
$100
$50
$50
$0
$0
-$50
-$50
-$100
-$100
-$150
The Squeeze
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
-$150
Group Recommendations Perhaps Reflect a
Too-Low Priority on Some Key Issues
• Recovery: 5x…Are We Clear About the Vision?
(and: resilience, equity)
• Medicaid: 1x…One recommendation re: the
Biggest Funding Stream? (NB lots of
conversation)
• IT/Internet/Software…One Mention: with Internet,
Network of Care, Emergence of EMR, shouldn’t
we be more focused?
Provocative Questions About Group’s Dialogue
(Observations of “Roving Reporter” Arthur Evans)
• Inclusiveness: More usual suspects, or others?
• Transformation: Is it a process or outcome? (yes)
If we are “doing transformation” is it enough?
• What is the end point?
– Treatment system change?
– Changed societal approach to mental health and illness
• Do we assume transformation and success
requires more resources? Is this right? Is it
likely?
• Are transformations often stimulated by crisis?
Can we do this without a crisis?
• Can we learn from our history?
– Deinstitutionalization
– What happened following the Carter Commission
Some Reflections
• Revisiting the Commission’s logic
• Thinking about change
President’s Commission: The Context
and the Commission’s Approach
– Presidential Commissions Are:
• Rare Opportunities in Mental Health
– Don’t blow it… with White House,
shareholders
• “Recommenders” not “Implementers”
– Do the job we were assigned, AND
– Leave a menu of opportunities
Transformation was not Achieved by the
Commission: It Depends on Action
that We and Others Will Advance
What Problems Does Transformation Address?
The NFC’s Diagnosis of Mental Health Care
• The public mental health system is not oriented to
recovery:
– Late detection/intervention
– Not consumer-centered, or deeply oriented to
recovery…unintended ”maintenance” focus
– Uneven quality/poor use of evidence based interventions,
massive workforce problems
• While care is not accessible in sectors/settings where it
is needed:
– Schools, early education, child welfare, JJ
– Health care settings, law enforcement/criminal justice,
workplaces, disability programs
Transformation is needed because OF REFORM:
Our old mental model of community mental health
Federal level
SAMHSA-CMHS
State level
DMH
Funding?
Local level
Coordinated
Care
County
M.H. Care
Case Mgt.
Child
Court
Clinic
Meds
Social
Services
School
Income Support
Complexity of Services and of Change after “Reform”
HRSA
Health
Justice
DYS
CMHS
Medicaid
State Medicaid
Agency
DMH
ACF
DSS
Education
Ed/SpEd..
County
M.H. Care
Case Mgt.
Family
Child
Court
Clinic
Meds
?
Social Svce
LEA/School
Income Support
SSA
BDD
Because “Reform is Not Enough”…
The Commission Proposed:
• Transforming Mental Health Care, not Reforming It
• Vision for Mental Health in America
• National (and State and Local) Goals
Vision For A Transformed
Mental Health System
We envision a future where recovery and
resilience are the expected outcomes and
when mental illnesses can be prevented or
cured.
We envision a nation where everyone
will have access to early detection and the
effective treatment and supports essential to
live, work, learn and participate fully in their
communities.
This is Why “Reform is Not Enough”…
The Commission Proposed:
• Transforming Mental Health Care, not
Reforming It
• But, what is “transformation”?
– Not: reform…to be “implemented” or “rolled out”
– Linked Actions, at Many Levels
– Large and Small Actions adding up to Dramatic
Change
– Change in Processes, Not Just Programs (e.g.
“Using the Skills of Consumers and Families to
Advance Recovery and Resilience”)
Examples of Business Transformation (Dick Dougherty)
New Business Models and
Products Transforming their
Markets
When it absolutely positively
has to be there overnight –
Order tracking and services
24 -7 Copying Services
across the country
On-Line Auctions with volume
Businesses with Internal
Transformations
Discount Flights with
transparent pricing for
peanuts
Search the world with google-bots
Discounts
with leather
and screens
The home of the
Macintosh finds
new music and a
shuffle
Mainframes to Services;
in and out of PCs.
From Tweed to teen fashion with lust
From private banking to the #1 worldwide
servicer of mutual funds and pensions and
investment management of pensions.
Political Transformation:
Which Approach Has Been
Effective?
• Democratic Strategy
• Republican Strategy
(since early ’80s)
President
Political
Machinery
Concept
Communicators
Concept Generators
Big Focused Money
This is Why “Reform is Not Enough”…
The Commission Proposed:
• Transforming Mental Health Care, not Reforming It
• But, what is “transformation”?
–
–
–
–
Not: reform…to be “implemented” or “rolled out”
Linked Actions, at Many Levels
Large and Small Actions adding up to Dramatic Change
Change in Processes, Not Just Programs (e.g. “Using the
Skills of Consumers and Families to Advance Recovery
and Resilience”)
• Transformation is adaptive change…nonlinear change
occurring via a “punctuated equilibrium” model
• Transformation is like Recovery:
– A process as well as an outcome
– To paraphrase Ed Knight: No one can “transform”
someone else…each must do their own work….
hope and supports are essential
Seven Ways of Leading (HBR April ’05)
Managers Can Grow. WE can Grow. We can Grow Others.
Action Logic
Characteristics/Strengths
% Mgrs
Alchemist
Generates social transformation
Strategist
Achiever
Generates org. transformations
4%
Inquiry. Vigilance. Vulnerability
Weaves personal/org. goals:
10%
good consultant, venture mgr.
Meets strategic goals: “Manager” 30%
Expert
Logic/expertise…Good at tasks
38%
Diplomat
“Glue” personality…Supportive
12%
Opportunist
WIN…Good in Sales, Crises
5%
Individualist
1%
What Are Our Responsibilities?
What Can Leaders Do?
• First, do as little harm, and provide as little energysapping “leadership” as possible
• Balance stabilizing and de-stabilizing forces.
• Be clearer about which changes are transformational
• Create capacity, don’t “roll out”:
– Hope, motivation, energy for change
– Tools
• Toolkits plus
• Information and platforms for learning
– Infrastructure for change:
• Support, participate in Leaning Communities
• I. D. and support: Salesmen, Mavens, and Connectors
• Facilitate “flow”
Beginning (and concluding) thoughts…
(How WILL we) Be the change that we want to
see in the world.
Mohandas Gandi
(Let ACMHA Become) A small group of
thoughtful people (to) change the world.
Margaret Mead
Thank You