There was a need in the community to develop a program specifically for men and do so in a way that supported men’s specific needs. The program faced men’s resistance to seeking out the help they needed but were afraid to make known to anyone.

Developed a group process that dovetailed on the surface with what was known at the time as the “Men’s Movement.” This seemed to give them permission to participate with an attitude of ‘Everyone’s doing it, so I can too.’

Started with one weekly group process that was immediately filled to capacity. Added two other groups with other counselors that filled, as well. Met with other counselors to establish ground rules for how the groups were to be facilitated and created to plan to follow. After three months, 40% of the men had made appointments to do individual therapy for themselves or their families.

Using the "Men's Movement" as a way to give men permission illustrated that men were eager to find help for issues if they could find an avenue that made it acceptable to do so. These groups continued for six years and then began to disband. They were seen as absolute successes in the business. Over the six years these groups ran, they contributed over 25% of the total counseling revenue to the business.

The community needed CME workshops that were local so local counselors would not have to pay the high expense of going to the major metropolitan areas of the state to get the hours they needed. No one had yet figured out a way to run the workshops in a way that truly met the need.

Used consulting business to develop and conduct workshops in the Midland-Odessa area that met local needs. Developed two tiers of workshops: one basic and one advanced. Utilized the local agencies to determine what subjects they needed and scheduled the workshops.

Conducted monthly workshops for the professional counselors and social workers in the local area, offering subjects they requested. Charges were not significant compared to the cost of leaving town.

The workshops’ profit met budget goals and stayed at 100% for the duration of the time the consulting business was open. The consulting firm met the needs of the community and grew in stature in the community as a result. On many occasions, the consulting firm was asked to conduct private workshops at specific agencies, increasing the firm’s credibility even more. The workshops reached a point where the volume of counselors attending remained at capacity after the first year.

Extremely poor time management was rampant in Alaskan operation and resulted in loss of productivity, further impacted by lack of education. Strong cultural resistance existed to a “work all day” and “get it done” work ethic.

Developed and implemented management skills training for all supervisors and then required this training of all new supervisors. Worked to earn buy-in at every level of the division from native staff (95% native). Instituted, for the first time in this corporation, an appraisal system that had measurable expectations with 90-day cycles of improvement, and expected the same of them for the staff they supervised. Once this system was in place and buy-in ensued, productivity began to increase.

Productivity of all staff increased overall 50% in conjunction with other changes that were being made. This level of productivity was difficult to maintain and required close supervision by area managers.

Evaluation showed the increase in productivity was maintained but not at the level it initially obtained. Ongoing productivity was closer to 35%, and although it could be much higher, there is still a belief that culturally it will be a slow process even though the corporation desires to have both an efficient operation and at the same time foster native determination.

The changing field of therapy required a new way of thinking to switch to managed care’s philosophy of brief and solution-focused therapy and allowing fewer than half the sessions that most clients averaged to meet their needs.

A number of problems arose in the practice staff: attitudes about brief and solution-focused therapy; attitudes about being told by a managed-care staff member with no therapeutic experience what to do and for how long to do it; resistance to preparing treatment plans that did not complete treatment in the counselor’s opinion.

Brought the team together and had long, hard meeting about the way things were whether the team liked it or not. Brainstormed alternatives and everyone brought their ideas to the table. In the end, the team came together with a plan to make it work and worked together to follow the plan. The plan had ten strategy points; it was decided if all ten were followed, the change could not only be survived, but strengthen the team and organization. In addition, developed a training program for all staff to move quickly into the brief and solution-focused therapy mode that involved teaching each other and implementing those skills with clients.

Everyone quickly learned the relatively simple processes of brief and solution-focused therapy from each other and was able to implement them fully within three months. Worked with alternatives to the managed care system with those clients who needed more and those who were willing to pay a little more and not use their insurance. Met income projections and budgets every year the practice was in business.

The team did an outstanding job of adapting to the managed care model and kept insurance payments to the max for the clients who needed it. The practice explored every alternative that could be created for those who were cut off or ran out of insurance, and never turned a client away due to nonpayment. Although everyone worked harder and longer, personal incomes were kept at comfortable levels and the business maintained, even in a horrible environment. Incredible adaptivity was displayed by the team, even when doing something we did not believe in, but needed to meet the needs of the community treated. The overall counseling operation was termed an absolute success.

Basic organizational infrastructure of Alaska operation was seriously lacking in terms of standardized, established clinical operating procedures. Lack of systematic logistical procedures to ensure timely delivery and return of supplies, materials and pharmaceuticals hindered productivity.

Encountered resistance from area supervisors and clinic staff to another “hot shot” from the lower 48 states who had all the answers and was going to change the way things are done. The organization also lacked interface, communication and cooperation between departments. Resistance to change fostered attitudes of “This is the way we do it,” “Don’t rock the boat,” and “You don’t know enough and haven’t been here long enough to know how it really is.”

Worked closely and intensely showing area supervisors the benefits of each process change and the personal improvement it would make for them individually. Developed and designed datasets and spreadsheets for all systems changes in order to create a structure to give supervisors the information necessary to make informed decisions and take appropriate action. As the supervisors were empowered, they also implemented concepts that illustrated a ‘business’ perspective rather than a personal one. Interfaced and networked with all necessary department heads to get cooperation and buy-in, and proved to them, through individual presentations on root cause and improvement modeling, how it would improve their situation if new and standardized procedures were developed and implemented.

Received total buy-in from area supervisors and most department heads. Improved the organizational infrastructure, empowered area supervisors, changed haphazard logistical processes to standardized processes and supply chain logistics improved drastically.

Evaluation showed increased productivity at every level. Area supervisors became managers and made decisions based on data not previously available, and were empowered to take functional control of their assigned clinics and staff. Departments not previously engaged in prioritizing clinic needs began to move this division up their priority list and respond an average 50% faster to needs. Supply chain issues were improved over 50%. Exceptions and problems that continued were related to outside vendors and circumstances beyond company control such as charter flight operators who could not keep schedules and inclement weather.

Charged with effectively integrating Behavioral Health services into community clinics. Behavioral Health providers were previously housed independently in separate offices in each community and were resistant to be held accountable for their activity.

Spoke with BH directors about slowly moving the providers into the clinics and creating space for them. Decided they would continue to only report to their previous supervisors and would not be managed by clinics until they were fully deployed in all the clinics, and then realignment would begin. Once the BH providers were in and had lost connection with their previous locations, began to monitor and report their activity and compare that with reports they were making to their supervisors.

Upon request of the BH directors and supervisors, took the lead in monitoring their staff and making them accountable. Made reports as well as made measurable clinic expectations available to the supervisors so they could begin to hold their staff accountable.

BH provider activity increased after the transition by more than 300%.

Area supervisors were afraid to make decisions based on history of micromanagement. As a new Director, they feared more of the same. No labor pool available to replace existing supervisors.

Networked vigorously with area supervisors on a team and individual basis. Developed and implemented measurable expectations and appraisal system; created and implemented supervision training program at local college for area supervisors and enrolled all of them. Established 90 cycles of improvement appraisals and refused to make decisions for them. Coached supervisors and empowered them to believe in their own decision-making.

100% successful in empowering area supervisors to begin taking responsibility for their assigned clinics and working with appraisal measures following training in management skills. Increased productivity of area supervisors 80% and productivity in the clinics by over 50%. As productivity increased, costs decreased, and as revenue was enhanced, this division became more visible and credibility within the organization was enhanced as well.

Even though there was a history of neglect and lack of confidence that this situation could be changed, following these efforts it was clear to the senior management team that this division could in fact function as a revenue center of this corporation rather than an expense center.

Clinic staff burnout and lack of direct attention and training was leading to increased attrition. The company had a culture of accepting limitations, belief that budget was a limit, and no one had tried to change it before.

As Director of Clinic Operations, restructured supervision department in order to hire mid-level training staff, showed how the budget could be adjusted to accommodate the changes, and hired 2.5 FTE for field training. Took two FTEs in support department and focused their energies on providing additional and more frequent clinic travel.

Increased employee satisfaction among clinic staff and contributed toward more than 15% decrease in attrition. Increased staff available for training slots by 40%, further increasing employee satisfaction and motivation due to completion of training and improved skill of level of clinic providers. Moved clinic providers through training an average of one year sooner than previous.

Restructuring supervision department was total success from a training perspective. It increased retention of highly trained clinical providers (average cost to train a provider is $150-200K). Success was also measured in terms of employee satisfaction, which translated into greater patient satisfaction, better employee attendance and productivity. Direct labor cost reduction was over 40%, retention increased more than 15%, and revenue enhancement increased more than 50%.

Established an independent business and sought a way to offer a higher level of excellence in counseling than was offered in the community. This required a new startup, and capital was very limited.

Opened private-practice counseling and therapy service in a small building on personal residential property. Marketed carefully, and after six months it was evident the business has tapped into a need in terms of excellence and service: the business growing beyond a one-practitioner capacity. Moved the business and hired another counselor who had a similar philosophy, and within another six months it was at capacity again.

The business continued to grow at a rate of 100% per year for eight years. Added staff to accommodate the need and even as managed care began to diminish payments, continued to grow the business and find new and creative ways to keep it funded.

Success at staying aggressive and competitive kept client base and income at levels higher than thought possible. Met budget goals every year at 100% in a very difficult and changing market. Company thrived and remained independent when many agencies were consolidating to pool capital or folding and leaving the industry.

It became apparent very quickly after opening private practice that the community needed a consulting firm to support the other agencies: conduct analysis, team building, and offer to do the things they were either unwilling or incapable of doing. Needed a creative approach to help industry in the community and improve personal standing in the community.

Began marketing the consulting side of the business and selling business expertise, team building, expertise in managed care issues, and solving staff and management problems.

The consulting firm grew in the first year to become 30% of the overall business. Services were added as needed, as were teaching at the local college and conducting CME workshops for professionals. The consulting firm often partnered with nonprofits to conduct more lengthy workshops and offered them 50% of the income received from the workshop. The consulting firm worked with corporations in the local area to conduct team building workshops, offered emergency trauma response teams when industrial accidents occurred and worked with several companies to train their staff in conflict resolution. Mediation services were offered for companies, couples and individuals. In addition, the consulting business developed curriculums for the local college and taught classes.

The consulting side of the business continued to meet all budget expectations at over 100% of goal every year. The business grew over 80% per year and when managed care began taking revenue from the counseling business, the consulting business kept the business alive and vibrant.

Corporation was isolated at a state level from the other state programs and the resulting disconnect made it difficult to make changes at statewide level and institute needed changes which required statewide approval. There was very little sense of this program being part of the state “team” of programs.

This corporation is the largest and wealthiest native healthcare corporation in the state of Alaska. It and its CEO wield enormous power and have political leverage of which the others only dream. The resulting envy isolates it from the other programs.

Named to the state board and began to network with the other programs and participate not only in statewide meetings, but with them individually to foster and strengthen relationships. Utilized own influence to enhance their positions, support their growth, and highlight similar goals of providing the highest quality service possible. Aligned with them in improving their programs and asked them to do the same.

Elected Vice-chair at the first opportunity and Chair-elect the following year of this statewide board. In addition, recruited to two other boards, both of which determine the standards of practice and approve the training programs of those corporations that have training centers.

Evaluation showed this governing board was in need of new blood and leadership that could infuse it with energy to get it back on track and fulfilling its purpose of enhancing the clinic programs statewide: someone who could short circuit the issues that were getting in the way of it doing exactly that. In addition to fulfilling that role, reconnected the corporation to the rest of the state.

Yukon Kuskokwim Health Corporation (YKHC) made a commitment to the Malcolm Baldrige process in early 2002 in order to take the corporation to another level of service excellence, productivity and profitability. Needed to surmount a very traditional approach to health delivery and attitudes that were very possessive and parochial.

Participated fully in this change process and was assigned membership on one of the pillar teams. Invested in the learning and change experience as the corporation fought attitude battles necessary to make required changes and evolve the organization to optimized levels of service and accountability.

Integrated the Balridge experience and principles into the division at every level, and found productivity and attitudes changing beyond expectations. Though the division was the envy of all programs statewide, it became even more so because of the innovative changes made, especially in the Training Department. This format became the benchmark for training providers statewide and other programs are beginning to adapt theirs to the model.

Evaluation showed the Baldrige process was taking hold, changing attitudes and increasing productivity through increased employee and patient satisfaction. Increases in productivity are estimated at over 40%, and accountability and self-initiative are showing estimated increases of over 60%.