Transcript PPT - Mady Chalk, Ph.D. - UCLA Integrated Substance Abuse

A Vision for the Future: Workforce Investment
Mady Chalk, Ph.D.
Treatment Research Institute
CADPAAC
March 28, 2012
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Addictions Treatment Workforce Issues
• Increased demand for higher skills, greater flexibility,
and expanded roles for clinical staff
• New types of patients in new settings
• Decreasing supply and maldistribution; fewer people
choosing health professions
• Non-standardized professional credentialing criteria
• Lack of technology applications
• Employer requirements and criteria, curricula, and
specialized or targeted skill areas are not aligned
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Factors Affecting Workforce Demand
• Aging staff
• Longevity is short; turnover is high
• Expanded scope of practice related to viewing
recovery from addiction as a long-term process
• Treating addiction as a chronic illness, adapting
treatment so that it is patient-centered
• Scientific advances requiring new skills and flexibility
• Insurance coverage and reimbursement in public and
private sectors---what’s covered, what isn’t
• Advances in technology
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Factors Affecting Workforce Supply
• Declining enrollments in professional schools
• Poor minority representation in health
professions schools
• Mal-distribution of providers and clinicians
• Salary, benefits, working conditions
• Lack of unified state plans for investment in
workforce development
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What Have Other Industries Done?
• A number of other industries have had similar
workforce problems
• Are there things we can learn from what they
have done to cope with similar issues?
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Examples from Other Industries
• Honda – Flexifactories
• Semiconductors Industry Evolution and
Workforce Investment
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Some Basic Concepts
• We are an industry and we are evolving
• We are living in a time of rapid scientific
advances that are not being adequately
applied, e.g., use of medications in treatment,
care coordination
• Consolidation is occurring (e.g. CRC and
Deutschebank) as it is in other industries.
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Honda Flexifactories
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Honda Flexifactories
What is a “flexifactory?”
• A flexifactory is capable of changing the
product it makes with relative ease, at low
cost, and great rapidity: whether changing
volumes, models, or the nature of the
products made. ..
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Honda Flexifactories
• A flexifactory forms the vital bridge between
the relationships of individual employees with
each other and with technology and the
corporate strategies of highly successful
companies for coping with rapidly shifting
markets.
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The Fixed vs. the Flexi Factory
• Fixed-factories
– Factory is built for production of a single model
– Changing models is infrequent
– Tasks of employees are controlled and limited by
prior agreement
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The Fixed vs. The Flexi Factory
• Flexi-factories
– Capable of making more than one model
simultaneously
– Employees are expected to be flexible to
accommodate shifts in mix of models
– Operated as networks to balance their capacities
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Can We Create FlexiTxPrograms?
• “Flexitxprograms” are NIMBLE.
• They are capable of changing administrative
and organizational approaches with relative
ease, changing treatment models, or
changing the components of treatment to
meet the individual needs of patients.
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Can We Create Flexitxprograms?
• Flexitxprograms form the vital bridge between the
relationships of individual clinicians with each other
AND
• with technologies (e.g., clinical assessment,
continuous recovery monitoring, and telephone
follow-up)
AND
• the organizational strategies of programs for coping
with shifting referrals and treatments.
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And FlexiClinicians?
• Flexiclinicians are capable of adapting
treatment approaches and services with
relative ease depending on the patient/client
sitting in front of them
• Flexiclinicians can provide the same quality of
care to different types of patients but know
the limits of their knowledge
• Flexiclinicians can function on teams whose
members each have different skill sets
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A Hierarchy of Flexibility
A network of flexible organizations
Flexitxprogram1
Flexitxprogram2
Flexible clinicians
Flexible clinicians
+
+
Flexible treatments
Flexible treatments
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What Can We Learn?
• Studies of existing “Flexitxprograms” can
reveal:
– how treatment modalities change over time,
– how the modality mix is altered on an individual
basis, and
– how whole programs (organizations) make new
types of treatment available.
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What Can We Learn?
• Flexifactories that operate as networks have
an advantage over fixed and standalone
factories; networks can balance the
capacities of each program. Is the same true
of Flexitxprograms?
• Can flexitxprograms and flexiclinicians make
it easier for patients (customers) to stay in
treatment?
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The Semi- Conductor Industry
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The Semiconductor (Computer) Industry
• A knowledge-based industry that has used
scientific advances to double computing
power about every 18 months.
• An industry in which technological challenges
(labeled “show stoppers”) have occurred and
threatened to derail the industry unless
employees devised clever solutions.
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What is a Knowledge-based Industry?
• An industry that puts an emphasis on creating
value from new ideas and concepts as
distinct from material inputs and physical
labor.
• An industry characterized by the skill and
education of its workers, in which workers
create, interpret, analyze and transform
information to create value from knowledge.
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Responding in a High-Velocity Environment
• A high velocity environment is one in which
uncertainty is created by technological change,
fluctuations in demand, and regulatory decisions.
• Studies find that successful firms in these
environments use more high quality information in a
shorter time period for more innovative decisions by
workers and managers than firms operating in other
environments.
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Implications for Addiction Treatment
• We can expect:
– an increased rate of the development of new
technologies in the coming years (e.g.,
medications for cocaine and meth)
– an increased complexity of the process of care
– a greater emphasis and focus on management
issues relative to technical issues
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Implications for Addiction Treatment
• If new technologies and processes are
introduced as quickly as they are developed,
we need organizational and infrastructure
supports such as:
– equipment (computers),
– medications
– human resources that can use information to
adapt treatment, and
– multi-organizational coordination (e.g., with
primary care).
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Management Implications
• Managerial capabilities must expand to:
– manage the volume of clients incl. new types of
clients that will be generated by healthcare reform
and need to be treated in a more flexible treatment
organization
– manage the pace of movement of clients across
primary and specialty care and through the
continuum
– implement multi-organizational collaboration, and
– bring in new types of human resources (in-source)
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What Are The Challenges?
• Learning from other industries, we know that
product (treatment and recovery) complexity
will increase and, as science advances,
issues will emerge at an increasing pace and
have to be solved.
• “Disciplined creativity” is needed to balance
long-range plans with short-term decisions so
they are consistent.
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More Challenges
• Performance improvement of the processes
of care, the individual clinician’s practice, and
the infrastructure for service delivery will be
required.
• A program’s direction will need to be
reevaluated more frequently as the rate of
change of technology accelerates.
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What Should We Be Thinking About?
• As technical demands increase, treatment programs
might focus on developing their areas of strength and
“outsourcing” other aspects while maintaining their
flexibility.
• The changing landscape now supports the growth of
other complementary services, e.g., SBI (front-end),
telephone follow-up, sober housing (back-end), and
recovery centers with which outpatient treatment
programs need to collaborate.
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More to think about
• There may be an increasing trend toward
specialized treatment programs that then
could link in a highly collaborative way to
create the combined capabilities needed to
offer a complete continuum of care (patientfocused, adapted, and flexible) at a
reasonable cost.
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What Does Management Need to Do?
• Management, as clinical staff, needs to be
able to continuously adapt.
• What is “adaptive management?”
– Relies on an accumulation of credible evidence
(data and information) to support a decision that
demands action
– Designed for situations where there is uncertainty
but a need for action
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From Data to Wisdom
What does this paradigm look like:
Oceans of Data
Rivers of Information
Streams of Knowledge
Droplets of Wisdom
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How Can We Fail?
• Getting stuck in the past
• Losing track of useful information about scientific
advances
• Not wanting to try new processes and revisit old
decisions
• Staying stuck in process and not making new
decisions
• Not adapting to the new reality that identifies
substance use disorders as a chronic health
condition
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In Summary
• Critical workforce issues need to be faced at
organizational (management) and clinical levels
(clinicians and supervisors).
• In the current environment we can learn from other
industries
• Collaborative problem solving and adaptive
management are central to moving ahead
• Expectations and measuring performance matter
• Clinicians need to expand their vision of themselves
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