Documenting a Recovery Approach: Recovery Innovations Adapts Documentation to Fit Operations and Culture
Ashcraft, Lori, Anthony, William A., Behavioral Healthcare
How many times have you made a declaration to become a "recovery" organization and trained your staff in new principles, only to sec little change in actual practice and outcomes? There's no shortage of possible reasons: The staff didn't "get it," the trainer was boring, the consumers arc sicker than everyone else's, and so on. However, there's often a more likely culprit: documentation that requires staff to focus on a consumer's weaknesses and challenges rather than his or her strengths.
Such documentation compromises the efforts of recovery-trained staff because it prevents them and the consumer from utilizing this approach. Instead, staff can become frustrated and give up trying to fit new "recovery" learning into old structures. The documentation process "undoes" the learning.
This is a big problem! Documentation contents and processes must be built around our organizations' values if we want them to reflect and reinforce the principles and practices we instill in our workforce. When they don't, we lose traction and waste effort, time, and money.
So, all we have to do is create a new recovery-based documentation system! A simple task, right? No, say organizational leaders. Many have already invested in electronic health record (EHR) systems, and, for the most part, these systems were not designed and built to reflect and reinforce recovery practices. Adapting an existing EHR system to support recovery can be a daunting task, even if it can advance recovery values and fast-forward culture change.
We've been watching a company go through this process and want to share their story so you can learn from their experience. Recovery Innovations (RI), a multi-state non-profit, is dedicated to producing recovery outcomes. They face many of the same organizational challenges noted above in terms of developing and completing documentation that reinforces the values that guide their service delivery.
RI developed an in-house electronic medical record in the mid 1990s. By 2000, this EMR was in full use at the time when its CEO, Gene Johnson, committed RI to a recovery-oriented transformation of its services and culture. As the organization learned the implications of a recovery approach, it soon found that its home-grown EMR did not support recovery practices. RI staff agreed, noting that it was very frustrating to translate recovery-focused content onto forms that didn't recognize or accommodate recovery principles. All agreed that an overhaul of RI's EMR system was necessary.
Almost immediately, the company discontinued using much of its existing EMR in favor of a hard-copy system that reflected and reinforced recovery values and practices (Figure 1). To automate access to the hardcopy documents created by this system, RI adopted scanning and imaging technology that enabled electronic document filing and retrieval.
Figure 1: Principles of a recovery-focused documentation system
A recovery-focused documentation system must not only be structured around key principles associated with recovery, but must also be presented, developed, referenced, and used in a way that creates a strong counselor-consumer relationship and empowers the consumer striving toward recovery. The recovery principles to be embodied in a documentation system include:
Participation: The document design and interface must enable the consumer to participate in the development of the content, for example, by writing their own recovery plans and creating their own progress notes.
Progress: Through their structure and questions, the forms must reflect an expectation of progress and invite exchange about the consumer's effort and actions toward recovery.
Strengths: The sequence used to develop the documentation must begin with detailed consideration of the consumer's strengths, the role of these strengths in the recovery process, and details of how the challenges of recovery create learning and growth opportunities for the consumer. …