mindful leadership: leader know thy self - … · mindful leadership: leader know thy self...

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.


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


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


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


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

6

Change/Rest Cycles


7

Transformational Change Formula

• Transformational Change =

(Values + Beliefs + Actions) X (CQI)2

______________________________

Resistance

Source: Kathryn Powers, Director of CMHS


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


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


Recognize leadership qualities and behaviors needed to lead transformational change


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


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


Source: David Lloyd (2015) Leadership Essentials

Recognize the objectives of a communication planning around

change


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


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


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


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


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


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



President & CEO


[email protected]


Author “The Unapologetic Woman: Leading With Power and Confidence”

mailto:[email protected]

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


President and Chief Executive Officer


[email protected]



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


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


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


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


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


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


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


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


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.


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


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


Maree Wacker, MPP



[email protected]



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


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


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


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


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!!!


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


• 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


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


Questions and Feedback

• Questions?

• Feedback?

• Next Steps?

ActionNext Steps


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

[email protected]

Web Site: mtmservices.org


Executive Director


[email protected]

Maree Wacker, MPP



[email protected]


President & CEO


[email protected]






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


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