Academic journal article Education & Treatment of Children

How to Involve Staff in Developing an Outcomes-Oriented Organization

Academic journal article Education & Treatment of Children

How to Involve Staff in Developing an Outcomes-Oriented Organization

Article excerpt


Outcomes management requires the active participation of clinical staff and/or network providers to succeed. They form the bedrock of the system, since they are the ones who most typically administer the outcomes assessment questionnaires to consumers, encourage them to complete them, and respond to questions and complaints about them. Resistance from clinicians can cause even the most well-designed outcomes management system to fail. Yet with the application of several basic principles, organizations can maximize active participation from its clinicians to operate a dynamic outcomes management system. This article describes the principles involved and the action steps necessary to implement them. These principles include: articulate the value of the outcomes management system, involve clinical staff in its design, make it relevant to treatment goals, assure clinicians the system will not be used punitively, show them how it will be used to improve treatment, obtain staff feedback routinely on how the system is working, and demonstrate how the organizational culture from top management down uses the outcomes information to make decisions.

Movements to improve the quality of services and increase accountability of behavioral healthcare providers are encouraging many organizations to develop outcomes measurement systems (OMS) to support the management of care. The April 1997 issue of Behavioral Healthcare Tomorrow provided an overview of current report card initiatives (such as PERMS, MHSIP, and HEDIS) being developed by private and public behavioral healthcare organizations. Each report card incorporates slightly different indicators of outcomes, but they are all innovations with potential to affect participating organizations in profound ways.

In the past the organizational culture of behavioral healthcare and social services providers has been oriented toward reimbursement, and the amount was only indirectly related to outcomes. Implementation of an OMS will require fundamental organizational transformation to produce its intended benefit. Should it fail to do so, organizational analysts may attribute the cause to a failure in implementation, not to a failure in the original idea (Hackman & Wageman, 1995; Klein & Rail, 1995; Klein & Sorra, 1996; Reger, 1994).

For any innovation to be implemented effectively, it must have a "good fit" with the users' values (Klein & Sorra, 1996). All stakeholders in the organization should be involved in the initial planning to ensure that the OMS measures and indicators are significant to the users of the information. Assessment of outcomes must be perceived as consistent with the values of the organization and its members. Effective implementation of an OMS relies on staff members who have direct contact with consumers; that is, service providers who collect data, recruit consumer participants, and use the information to improve services. Unfortunately, it is often the same group who values assessment of outcomes the least. Service providers frequently report that they do not need an assessment to know if a consumer has improved.

Special steps must be taken to facilitate their active support for the OMS or the outcomes data produced will be of questionable quality. The following suggestions for obtaining the committed involvement of service providers in the process of developing an outcomes-oriented organization are based on the authors' experiences implementing performance and outcomes measurement systems in both the private and public sectors.

Advantages of Involving Staff in the Design Phase

Service providers who have direct input in the design of the outcomes management system to be used in their organization will provide feedback that can produce a better system, use the output to improve their practice, and eventually, value the assessment of outcomes. They benefit by gaining greater understanding of the purposes, goals, and operation of an OMS. …

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