Wednesday, October 14, 2009

Do you work in a barn?

As they say, first impressions are lasting. Most will attest to the fact that customer services can be the most pleasant and helpful or abrasive and frustrating experiences known to man. There is usually little gray area. From the employee perspective, either you enjoy what you do, what you provide and respect customers or you don't and won't attend to their needs because you can't keep your eyes off the clock.

Most of us know how to behave when we get poor customer service - we ask for a manager, file a grievance, get loud or give back what we received. Those who are vulnerable and have difficulty managing themselves,their families or their immediate situations do not have the knowledge, energy or ability to advocate for themselves and end up being steamrolled by the very systems established to help -iatrogenic care.

As an intake worker for four non-profits, three for-profits and one governmental agency and, of these, three community mental health agencies, three hospitals, one addiction treatment center and a county probation department - front-end service delivery winds up dead last in importance. Without exception, it is most poorly run, underutilized, understaffed, exploited and inadequately funded department found in organizations. The reasons are many and simple - intake functions do not fit neatly into clinical, administrative or financial domains and do not consistently produce billable activity that can be pored over or bean counted. Not recognizing its value is akin to leaving your front door open because it doesn't wash your clothes, chill or heat your food, entertain your guests or feed your family. But a good, solid front door helps with heating and cooling expenses and provides some measure of privacy and security, not to mention a host of other supports.

I have spent my entire career advocating for greater support for front line workers in mental health settings and have been largely ignored. A few years ago, a group of university professors at the University of Wisconsin-Madison got a clue and established the Network for the Improvement of Addiction Treatment (NIATx) to reduce waiting times and no-shows while increasing admissions and treatment retention. Organizations and providers would do well to check out the great work they have been doing with applying process improvement to the helping profession and utilizing proven solutions to identified challenges.

Now, go show your front door some love. Unless you've decided you didn't need it after all.