Child & Adolescent Treatment Services: HR Strategy Proposal

Presented by Jane Blatz

David CharronAshley Illuzzi

Manish KulkarniMeghan Lafferty

What Success Look Like?

ANSWERChild & Adolescent Treatment Services' vision is to be the best outpatient children's mental health agency in our community.  Being the best means providing the highest quality treatment, highly-skilled staff, ongoing workforce development, child-friendly facilities, so each child thrives and feels hopeful.

CATS in a Brief

Who: 75 years promoting emotional well being for families & children

What: Treated 2,746 clients in 2012Where: Across Erie CountyHow: 6 Programs, 135 Full-Time StaffWhy: Roughly 1 in 4 children will

experience a diagnosable mental health problem, 79% who need services will not receive them (AJP, 2002)

Purpose & Stated Goals

CATS REQUEST

Evaluation Tool Last assessed over 5

year ago Over correction of

subjective measures Challenge to pay for

performance bonus

OUR GOALS

Overall HR Strategy Performance

Management System Update Evaluation Tool Update Evaluation

Process Review Recognition and

Reward System

Evaluation Tool Proposed Changes

CURRENT

Behavioral

Manager Driven

Vague

Subjective

Ratings Developed by Primary Manager

PROPOSED

Blended

Employee & Manager Input

Clear

Measurable

Ratings Calibrated with All Managers

Clinician Evaluation Lifecycle

Management Set Goals

Employee Set Stretch

Targets

Midyear Review

Employee Self

Evaluation

Managers Evaluation

Managers Calibrate Ratings

Employee Ratings

Delivered

Rating Calibration

Employee evaluations completed Together Managers use guidelines to apply

ratings Managers propose how to distribute any raise

or bonus

Identifying the game changing performers across programs and locations

Identify areas of internal strengths and weakness across the organization Provide areas for training & development Areas of consideration for HR strategy

Motivation Findings

ASSUMPTIONS

Everyone wants a bonus

Vacation time is valued

Additional Training as a bonus

FINDINGS

Majority prefer a raise

Majority afraid to take time off as it impacts performance numbers

Training mostly happens during personal time, not additionally motivating without raise

Motivation Findings * PLEASE ADD IN HERE WHAT ELSE YOU THINK THEY SHOULD KNOW

ASSUMPTIONS

Kudos Program Motivates

FINDINGS

Kudos Program Demotivates & disrupts workflow

Managing Staff Performance is Crucial to Success

Personnel Cost,

5,911,056,73%

Operating Expense,

2,186,401 , 27%

Our Approach

Analyze Performance

Evaluations Employee

Satisfaction Surveys Customer

Satisfaction Surveys Meetings

Senior Leadership Six-Sigma Team

Focus Groups Clinicians Managers

Explore Workforce

Management Models Non-profit

Management Systems

Strategy Maps Company Goals

Initial Findings

Problematic Staff Evaluation Tool & Process

Chasing the All Important STAT Differentiating Quality vs Quantity Motivation and Performance Misalignment between Strategy and

Goals

Evaluation Tool & Process Findings

Results are Positively Skewed Unclear Evaluation Scale

Measures “Do-Able” not “Deliverables” Hospital Example: ▪ # of patients treated vs. % of lives saved, improved

Overemphasis on a single indicator “Stat” is 10% of the evaluation, 90% of the

focus Only Measures Past Performance

Data is subjective and difficult to use for future decision making and change

Measures “Do-Able” not “Deliverables”What Does 8 Stats Say About Quality of Care?

Compare this to Multiple Measures?Client keeps all appointments, but school reports increase in truancy Cancels often due to

lack of outreach reminders

After 2 years, has received $2,000 in unbillable services because she doesn’t have state ID

Cancels often due to lack of transportation

Customer Survey: Parent 90% satisfied with service, gives specific praise to clinician

Maximize Margins and Mission

DOLLARS$ 0 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33

Cost per Session

Reimbursement Per Session

Issue: “Different Programs Have Different Reimbursement and Impact”

Understand trade-offs in program portfolio in terms of impact and financial results

Strategy 1: “We should cut costs”

Cost cutting has limited benefit in a lean organization, will it decrease service quality?

Strategy 2: “60% productivity is the target”

What about cancel/fail, unforeseen events, different program reimbursements, and costs?

Strategy 3: “We must expand in order to remain financially stable.”

Expansion is costly and what about serving those on the waitlist first?

Motivation and Performance

End GoalProviding Quality

Customer Service

Training

Knowing

what to do

Motivation

Wanting to Do it

“Money will make me happier, but not work harder, I already work hard.”

“There is no money for training”

“When we taught other school workers what we know, we understood it better ourselves”

“I love feeling appreciated”

Is CATS Retaining “Highly-Skilled” Staff?

2012201120100%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

CATS Turnover is Higher Than Expected and Grow-ing, but Who is Leaving?

CATS Turnover Rate

National Turnover Rate for Social Service

Use Findings to Develop Strategy

Problematic Staff Evaluation Tool & Process

Chasing the All Important STAT Differentiating Quality vs Quantity Motivation and Performance Misalignment between Strategy and

Goals

Developing Strategy

CATS has three goals:1. Quality2. Sustainability3. Expansion

We looked at these 3 goals as a guideline for the strategy map

Strategic Goal #1

• Provide the best possible service to customers

• People-focused organization• Focus more on giving the best

treatment rather than quantity• Not give as much emphasis

on stats

Quality

Strategic Goal #2

• Reduced overhead • Greater amount of funds for raises and employee recognition

• Less worry about day to day financial sustainability

Financial Stability

Strategic Goal #3

• Eventually grow in terms of both services offered and number of people served

• Have a well known brand that people choose to go to because of its reputation

Expansion

StrategySetting the Corporate Objectives

CATS OVERALL MISSION

1. To be the best evidence-based mental health prevention and treatment organization in western New York.

2. To be financially sustainable

3. Expand services beyond Erie County

Strategy Map

Resource Perspective

Process Perspective

Financial Perspective

Client Perspective

Information Capital: 1 organization, many different teams.

Organizational Capital: Importance of Databases, Scheduling & Billing

Human Capital: 73% of entire budget – 100% of the work

Customer Management:High Customer Satisfaction Crucial, 30% Avg cancel/fail (10-50% range)

Innovation: Sufficient

Operations Management: Needs improvement

Cycle Time (See More Clients)

Quality (Critical)

Price Selection ServiceFunctionality

Partnership: Schools & Private Practice

Brand: Accreditation

Reduce Cost Structure: Not Enough Info

Increase Asset Utilization: Must achieve >60% work productivity

Increase Customer Value: Set by insurance

Expand Revenue Opportunities: Grants & Programs at 50% of income

Operational Efficiency Revenue Growth

Service AttributesImageValue

Network

OVERALL MISSION

To be the best evidence-based mental health prevention and treatment organization in western New York.

To be financially sustainable in the long-term

To expand our services and expertise to those who need them

Financial Sustainability & Social Impact Map

(150,000) (125,000) (100,000) (75,000) (50,000) (25,000) 0 25,000 50,000 75,000 100,000 125,000 150,000

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

UnivDBT

FFT

East

PCIT

West

South

Lancaster

CAC Prg

ICM Prg

SCM Prg

Other DMH

Oth Non-DMH

Foundation

Child and Adolescent Treatment Services Financial Sustainability & Social Impact Map

* Bubbles Sized According to Annual Program Expense

Social Impact 4=Excellent

3=Above Avg2 = Below Avg

1 = Low/Not Relevant

(Loss) /Profit

Detailed Logic Model

Logic Model Components

Building a leadership brandOptimizing human capitalDeveloping talentShaping organization & communication practices

Driving performance

Building a Leadership Brand (Doables)

Walking tour, skip-level meetings & focus groups

Ongoing HR and strategy meetings Ongoing middle management

meetings Reward dinners and luncheons Supervisory meetings

Building a Leadership Brand (Deliverables)

Addressing employee satisfaction Corporate strategic plan Strategic plans by middle managers Addressing top performer turnover Supervisory meetings ensure

compliance

Leadership Outcomes

Shorter -Term

• Consistent face-to-face interaction

• Sense of unity and teamwork

• Employee satisfaction

Intermediate

• Cross program collaboration

• Up-to-date performance management process

Longer-Term

• Staff collaboration

• Meeting performance goals

Optimize Human Capital

Hire an HR coordinator to work with staff and clinicians

satisfaction & performance understanding of bottlenecks Ability to focus on:

Reports New training & development Recruitment plans

Optimize Human Capital

Restructure data management system

time spent on data analysis by 50%

ease of use

Optimize Human Capital

Hire staff that add both impact and economic value

profit impact

Optimize Human Capital

CURRENT

Behavioral

Manager Driven

Vague

Subjective

PROPOSED

Blended

Employee & Manager Input

Clear

Measurable

Developing Talent

Senior leaders participate coaching

and providing leadership training both for themselves

and for middle managers

Employees receive stat credit for

participating in training

Employee engagement/satisfacti

on increases, productivity and other

performance improves

Management and employee

performance scores improve

Shaping Organization & Communication Practices

Mentorship Program for New Hires Inter-Program Collaboration

School Education Seminars External Pilot Programs

DBT and UB School of Social Work Mastery, Autonomy, and Purpose (Drive, by Daniel

Pink)

Mastery – In House Training Autonomy – Staff Set Their Own Reach

Targets Purpose – Celebrate Impact Frequent & Often

Driving Performance

New Evaluation Tool

Evaluation Process Proposed timeline

Goal Setting

Evaluation Process

Senior Leadership Annual CATS Presentation Review▪ Evaluate CATS goals

Adjust goals Quarterly reviews▪ Meetings with middle managers

Quarterly staff appreciation events

Evaluation Process

Middle Managers Performance evaluation meetings Compensation meetings Coordinate strategic initiatives Quarterly Meetings▪ Receive and give coaching with senior leaders▪ Set team goals▪ Coach front line staff

Evaluation Process

Front Line Personal goal setting Quarterly team meetings▪ Best practices▪ Coaching & development with middle

managers

Goal Setting

Align new evaluation process

results with company goals

Company Goals Campaign

-Serve 3,000 children-10 controllable

actions-Measurable deliverables

Program Goal Development

-Support company goals

Identification of Botteneck

Implementation (next steps)

Recommendations

Summary of Logic Model

Building a Leadership Brand

Employee satisfaction

through improved

communication

Development of corporate

strategic plans

Developing Talent

Clinician coaching &

training

Performance scores

improvement

Shaping Communication &

Organization Practices

New hire mentorship programs

Cross-program collaboration

Summary of Logic Model (Contd.)

Use of measurable metrics

Manager as well as employee driven

Optimizing

Human Capital Evaluation

process

Goal setting

Driving Performanc

e

QUESTIONS