HEARING RECOVERYS VOICES

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HEARING RECOVERYS VOICES

• CREATING SERVICE CULTURES

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• INTRODUCTIONS

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Who is She?

• Director of Operations for 10 years
• ODADAS Cert / COA Accreditation
• Manager of Customer Service Dept. at QS9000
  Manufacturing Plant
• 9 yrs. experience Legal Aid
• Waitress and insurance experience
• Negotiated 3 UAW Union Contracts
• Lead team member in due diligence process

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WHO IS THIS GUY?!?

• LISW, PCC-S, LICDC
• ¼ Century of clinical experience - CMHC,
  hospital, Clinical Director _at_ STEPS for 7 years
• Publication Holding Accountability Systems
  Accountable
• Carry a briefcase
• Wearing tie
• Traveled well over 30 miles

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Who is We?

• Change Team Leaders
• Trainers throughout Ohio Michigan
• National Conference call speakers
• STAR-SI Mentor
• NIATX 200 Coach
• Conference call facilitator for organizations in
  Washington, Michigan New York
• Indiana Gambling Initiative Coach
• Witnesses to STEPS others very dramatic,
  significant outcomes via NIATx

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Where in the World is Wooster?
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Where in the World is Wooster?

• STEPS at Liberty Center
• Full continuum of services
• 50 Staff 3.5 mil. Budget
• 1000 citizens Tx
• 30K prevention
• Special population Amish
• Largely rural

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Unique Challenges for Rural Areas
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Unique Challenges for Rural Areas DWI Offenders
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Goals of Presentation

• Look to outside influences in exploring new
  strategies to
• Define quality
• Hear customer voices (including non-verbal and
  digital)
• Establish standards, exceed expectations,
  sustain a service culture

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Albert Einstein

• While everyone is looking for the right answers

Im looking for the right questions.
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Participation

• Be a Part of the Action!

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NPR
Narrative Stories

• Vs
• OPRAH

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Fun

• Excellence is Fun
• Ok to laugh

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• DEFINING QUALITY

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Debatable Need for Improvement

• Very Good satisfaction surveys
• Reputation for quality services
• Recognition for innovation

• Relative to a system that encourages mediocrity
• Challenge is good to great!

DEFINING QUALITY
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Good Good Outcomes
DEFINING QUALITY
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Bobbi DouglasSTEPS Executive Director
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Bobbi DouglasSTEPS Executive Director
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WHY does this matter if we already have too many
customers?

• Client Engagement
• Comfortable place, likelihood of continuation
  successful outcomes
• Funding Competition
• UW Outcomes
• Stakeholders community member feedback
• Noble Story
• Mergers Acquisitions for the future
• Surviving Entity
• Makes it a better place to work (internal CS)

DEFINING QUALITY
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Why Worry?

• Dean Rusk (Former secretary of State)
• The best way to persuade people is with your
  ears - - -

by listening to them!
DEFINING QUALITY
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Client Voice or Accountability?
Just havent hit bottom yet
Doesnt want it bad enough
How can we make recovery easier?
Needs to qualify some more
Wasnt doing it for him/her self
Character defect
Not hurting bad enough
DEFINING QUALITY
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Recoverys Voices a Foreign Language?
DEFINING QUALITY
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Along the Journey

• Thats the only way to get there!

DEFINING QUALITY
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Stuck on Old Paths
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Stuck on Old Paths
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What is Quality

• Customer Based
• Fitness for use, meeting customer expectations
• Manufacturing Based
• Conforming to design, specs, requirements. No
  defects.
• Product Based
• The product has something that other similar
  products do not that adds value (hybrid)
• Value Based
• The product is the best combo of price features
  (Cruise packages)
• Transcendent
• It is not clear what it is, but is is something
  good.

DEFINING QUALITY
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Customer Based

• Meets customer standards
• Meets and fulfills customer needs
• Meets customer expectations
• Will meet unanticipated future needs and
  aspirations

DEFINING QUALITY
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• CREATING SERVICE THEMES

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Charles Handy

• The first step is to measure whatever can be
  measured easily.
• This is OK as far as it goes.

e.g. Documentation Compliance
CREATING SERVICE THEMES
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Charles Handy

• The second step is to disregard that which cant
  easily be measured or to give it an arbitrary
  quantitative value.
• This is artificial misleading.

e.g. Initial Milestone Values
CREATING SERVICE THEMES
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Charles Handy

• The third step is to presume that what cant be
  measured easily really isnt important.
• This is blindness.

e.g. Treatment Outcomes
CREATING SERVICE THEMES
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Charles Handy

• The fourth step is to say that what cant easily
  be measured really doesnt exist.
• This is suicide.

CREATING SERVICE THEMES
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Ultimate Outcome w/o Change
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Get Ideas From Outside the Organization
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Decision-makingKey Players-the STEPS Community
Staff
Coach
Peace Corps
DJ
Interior Design
Marketing
Hospital
Teacher
Registered Nurse
Construction
Sales
Waitress
Manufacturing
College
Law Enforcement
MHRB Board
Legal Aid
Retail
Magazine Editor
Road Crew
Telemarketer
United Way
Missionary
Janitor
Farming
Insurance
911 Operator
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Pilot Test Ideas External Experts

• Potted plants
• Classical music
• Decorative rugs
• Books (nobody reads)

• But folded Toilet paper?!?

CREATING SERVICE THEMES
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The Bent Fork to Folded Toilet Paper Experiment
CREATING SERVICE THEMES
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Pilot Test Ideas

• Hostess approach
• No wait
• Client needs addressed first STEPS needs
  (paperwork) last
• Opinion important
• 42 minute extreme make-over

CREATING SERVICE THEMES
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Content Vs Process Small Items Can Make A Big
Difference
CREATING SERVICE THEMES
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CREATING SERVICE THEMES
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No Simple Solutions
CREATING SERVICE THEMES
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No Simple Solutions
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External Experts - Advisory Committee

• Restaurant Owner
• Politician
• Family Member
• Banker
• Car Dealer
• Small Business
• Entrepreneur

You dont try to sell a Ford Focus the same way
you sell a Ferrari
CREATING SERVICE THEMES
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Key Questions

• Who answers your phone?
• Who makes the reminder call?

CREATING SERVICE THEMES
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Royal Oak Clinic

• St. John Hospital
• Royal Oak, Michigan
• Change Leader, Warren Levin
• 50 increase in show rate
• 700/month increase per therapist

CREATING SERVICE THEMES
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Hidden Resources
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Hidden Resources
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Involving the Customer
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Trivia Quiz

• What is most unique about a ducks quack?
• What is most unique about a clients voice?

CREATING SERVICE THEMES
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Innovative Ideas

• Group Coverage
• Service Stories
• Story Telling Group
• Serendipitous discovery

CREATING SERVICE THEMES
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Clients Listening to Clients
Dear Friend Welcome to Beacon House.
CREATING SERVICE THEMES
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Participation

• LISTENING TO RECOVERYS VOICES
• WHAT INNOVATIVE WAYS HAVE YOU HEARD CLIENT
  VOICES?
• WHAT HAS SURPRISED YOU WHEN YOU HAVE TRULY
  LISTENED?

CREATING SERVICE THEMES
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• ESTABLISHING STANDARDS

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How Do You Measure Quality In Our Field?
ESTABLISHING STANDARDS
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Customer Based

• Meets customer standards
• What are they?
• Are they different for each customer?
• Whos your customer?

ESTABLISHING STANDARDS
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Customer Based

• Meets and fulfills customer needs
• What are the needs?
• Are they their needs or our needs? (paperwork)
• Are the needs folklore?
• Do the needs change?
• Airport charging centers
• Pay at the pump

ESTABLISHING STANDARDS
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Customer Based

• Meets customer expectations
• What do they expect?
• Be upfront on expectations
• Dating??
• Integrity
• Organizational Integrity

ESTABLISHING STANDARDS
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Customer Based

• Will meet unanticipated future needs and
  aspirations
• Always looking forward
• Ex. Drivers license
• Staying abreast of current events in our field
  (med assist tx or technology)

ESTABLISHING STANDARDS
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Expectations

• How long should someone wait for clinician in
  waiting room?
• How long should someone wait on hold on the
  phone?
• Is it ok for me to talk with a client if I am in
  administration?

ESTABLISHING STANDARDS
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Ritz Carlton Model

• Customer Market Focus
• Move heaven and earth to satisfy a customer
• Lateral Service
• Spending Authority

ESTABLISHING STANDARDS
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Customize

• Ritz Carlton Pepsi Cola CEO
• Question?
• Are we paying attention to our clients and
  customizing our services for them?
• Or are we simply herding them through our
  processes?

ESTABLISHING STANDARDS
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Walk-Thrus - - Boldly going where our clients go
daily!

• Be a customer!
• What does it feel like?

ESTABLISHING STANDARDS
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ADDRESSING CLIENT NEEDS EMOTIONS

• Malcolm Gladwell The Tipping Point
• Small things make a big difference
• All sales are about relationships.
• Relationships occur when emotions expressed
  needs met
• Marketing data clearly demonstrates this is
  especially true for women
• STEPS data
• Womens NS rates higher for intake
• Womens retention rates higher after 1 session
• How many intake ?s would you ask meeting
  someone new at a party?

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We May Not Be As Welcoming As We Think!
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ESTABLISHING STANDARDS
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Is this welcoming?
ESTABLISHING STANDARDS
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Welcome Letters
Welcome to East Clinic! We trust you will find
our services meet or exceed your expectations.
You are encouraged to ask questions and or
comment about your care to your therapist at any
time. If you have any suggests as to how we can
be more helpful or have any particular concerns
you are invited to call the Business Staff, or
you may wish to speak directly with me. We look
forward to serving you and your family Thank
you. Warren C. Director Program Manager,
Innercity Office
ESTABLISHING STANDARDS
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True Confessions

• Go on in complete your paperwork.

ESTABLISHING STANDARDS
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True Confessions

• Group Room Directions

ESTABLISHING STANDARDS
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Get Ideas From Outside the Organization
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OUTSIDE INFLUENCES

• Restaurants
• Verizon Wireless Wooster
• BMV
• ER Visits
• Sprint

ESTABLISHING STANDARDS
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Signage - - Other Businesses Know
Visible from highway
Where do you go from here?!?
ESTABLISHING STANDARDS
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Discoveries

• Let Your Fingers Do the Walking
• Septic service lt30 seconds
• Vs
• Treatment services gt30 minutes
• Theyre really yellow!
• Quest Recovery Services
• Canton, Ohio
• Change Leader, Lynn Ormiston

ESTABLISHING STANDARDS
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Its What You Say.

• Customer left waiting in waiting room 10 minutes
  past appointment.
• They didnt tell me you were here. Come on back.
• How About.
• I am sorry to keep you waiting. Would you like a
  cup of coffee before we get started?

ESTABLISHING STANDARDS
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Or how you say it

• Is that all?
• I am sorry there is nothing I can do.
• We close at
• Do you need an intake?

• Is there anything else I can do for you?
• I am sorry I cant do that but this is what I can
  do for you.
• We are open til to serve you.
• Let me connect you with Sandy and she will assist
  you.

ESTABLISHING STANDARDS
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Or how you say it

• Your counselor is in session. May I put you into
  his voice mail?
• You can wait in our waiting room while your son
  is in session.

• Your counselor is in session. Would you like to
  leave a message on his voice mail or is there
  something I can help you with?
• You are more than welcome to wait in our WR, and
  help yourself to coffee. Or you can check out
  OASIS Recovery Club on the first floor. They
  have..

ESTABLISHING STANDARDS
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Internal Customer Service
CONCIERGE
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OUR CS MOTTO.
Under Promise Over Deliver
CREATING SERVICE THEMES
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Stories of Despair
ESTABLISHING STANDARDS
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Stories of Despair
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Eastwood Clinic

• Detroit, Michigan
• Change Leader, Steve Candela
• Developed quarterly client sensitivity training
  for support staff
• Outcomes indicated a significant improvement in
  customer service and client response

ESTABLISHING STANDARDS
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Involving the Customer
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NPR This I Believe
ESTABLISHING STANDARDS
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NPR This I Believe
ESTABLISHING STANDARDS
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Current Event

• Cleveland Clinic Listening to Client Voices

ESTABLISHING STANDARDS
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Are We Listening?

• Do we give our clients more then 18 seconds at
  intake?
• Page 5

ESTABLISHING STANDARDS
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List Psychological Services

• Caro Michigan
• Change Leader Kim Kern
• Focus on the client first visit vs the paperwork
• Diane List Private Practice Model
• Risk not being able to bill for 1st session
• 100 return rate for next several months!!

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Involving the Customer Clients Often Best
Drivers
ESTABLISHING STANDARDS
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Clients Listening to Clients
ESTABLISHING STANDARDS
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Clients Listening to Clients
ESTABLISHING STANDARDS
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Other Outside Influences
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Spotlight Universal Motivators
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Incentives Work!
Contingency Management
30 Increase in Continuation
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Traffic Flow

• Restaurants on each corner
• Colleges High School Advanced Placement Classes
• Schools recreation centers
• Museums Yoga classes

ESTABLISHING STANDARDS
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Traffic Flow Treatment

• Treatment business
• TOSS

ESTABLISHING STANDARDS
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Traffic Flow Treatment

• Treatment Fun
• Oasis

ESTABLISHING STANDARDS
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Hearing Non-verbal Voices

• Functional Magnetic Resonance Imaging (fMRI) w
  gt2000 subjects
• Customers do not identify keys or may not be aware

Martin Lindstrom
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Inside Indicators of Outside Influences

• What messages do we see?
• - shape of diet salad dressing bottle
• - shape of residential treatment program

• Visual images impacts on buying

ESTABLISHING STANDARDS
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What Vision Would Tempt You to Buy?
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What Message Would Tempt You to Buy?
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Inside Indicators of Outside Influences

• Many companies use smells - - Cinnabons/Smoking
  Cessation
• Sounds effect buying - - wine based
  on nationality of music playing or hallway voices
• Feel effects buying - - weight of
  remotes or sticky floors
• Cost
• - Family Brand or Delmonte
• - private practice or public agency

• Marketing isnt restricted to visual

ESTABLISHING STANDARDS
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Participation
Do the smells, sounds, feels, and sights we
offer sell our product?

• Marketing isnt restricted to visual

ESTABLISHING STANDARDS
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Inside Indicators of Outside Influences

• E.T. Reeses Pieces
• Perfume from Paris or Detroit
• Victorias Secret

• Product placement works if integrated

ESTABLISHING STANDARDS
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Inside Indicators of Outside Influences

• Alcohol ??

• Product placement works if integrated

ESTABLISHING STANDARDS
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Inside Indicators of Outside Influences
WHAT PRODUCT WAS BEING SOLD?!?
- sex!

• Sex sells

ESTABLISHING STANDARDS
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ESTABLISHING STANDARDS
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Any Question Here?
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Inside Indicators of Outside Influences

• Brands attract zealous followers
• Most Valuable Brand Names
• Marlboro
• Coca-cola
• Budweiser

• Successful branding functions like religion

ESTABLISHING STANDARDS
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Inside Indicators of Outside Influences

• Brands attract zealous followers
• Tags
• Im a Mac Im a PC
• You can do it we can help
• Midwives help people out
• Great taste Less filling
• Treatment???

• Successful branding functions like religion

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Inside Indicators of Outside Influences

• Brands attract zealous followers
• Simple rituals gives added cachet.
• How do you eat an Oreo?

• Successful branding functions like religion

ESTABLISHING STANDARDS
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Brands attract zealous followers
What do you serve with a Corona?
What do you drink at the Kentucky Derby?
How do you pour a Guinness?
ESTABLISHING STANDARDS
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Good News

• STEPS has been recognized nationally as a
  premier provider of services

CREATING SERVICE THEMES
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Bad News

• We are far from perfect wont always have the
  results you want

CREATING SERVICE THEMES
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STEPS Promise

• We promise to strive to exceed your expectations
  in achieving your goals.

CREATING SERVICE THEMES
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Participation

• WHAT IS RECOVERYS BRAND?

AA
28 day Tx
Relapse
Celebrities
Anti-medicine
Fakers
Betty Ford
ESTABLISHING STANDARDS
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Disneys First Foremost Brand

• Walt Disney was afraid of mice
• Is the treatment field too afraid to change
  brands?

CREATING SERVICE THEMES
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• EXCEEDING EXPECTATIONS

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Benjamin Franklin

• When you are finished changing

Youre finished.
EXCEEDING EXPECTATIONS
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Sustaining a Service Culture

• Walt Disneys dream was that Disneyland would
  never be finished!!

EXCEEDING EXPECTATIONS
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Get Ideas From Outside the Organization
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Getting Ideas from Outside the Organization -
Customer Priorities
Cardinal Health Columbus, Ohio
Speed i.e. wait time
Flexibility i.e. individualized care
EXCEEDING EXPECTATIONS
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Involving the Customer
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Individualized Treatment Unnecessary Repetition
Unnecessary Resistance

• Oh boy! . . . Its Chalk Talk again!

EXCEEDING EXPECTATIONS
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Traditional Treatment Programming
EXCEEDING EXPECTATIONS
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Traditional Treatment Programming
EXCEEDING EXPECTATIONS
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Traditional Treatment Programming
EXCEEDING EXPECTATIONS
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Traditional Treatment Programming
EXCEEDING EXPECTATIONS
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Traditional Treatment Programming
EXCEEDING EXPECTATIONS
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Traditional Treatment Programming
Outpt.
IOP
Res.
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Traditional Treatment Programming

• Welcome to Treatment!
• Wk 1 Use, abuse or addiction
• Wk 2 Disease concept
• Wk 3 Health consequences
• Wk 4 12-Step groups
• Wk 5 Anger management
• Wk 6 Gambling addiction
• Wk 7 Spirituality
• Wk 8 Family dynamics
• Wk 9 Stress management
• Wk 10 Wrap-up

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Getting Ideas from Outside the Organization

• Henry Ford
• You can choose any color you would like
• as long as it is black!

EXCEEDING EXPECTATIONS
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Ramping Up External Influence

• Ability to test out of courses
• Progressive knowledge construction
• Developmental
• Different majors

EXCEEDING EXPECTATIONS
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New Process
Residential
Outpatient
IOP
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New Process
Eating Disorders
Smoking Cessation
Family
Anxiety
Anger
Stress
Trauma
Residential
Outpatient
IOP
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New Process
Eating Disorders
Smoking Cessation
Family
Anxiety
Anger
Stress
Trauma
Residential
Outpatient
IOP
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If Burger King can offer choices, why not STEPS?
Have it your way!
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Individualized Treatment Client Choice

• Thats the first time in this whole process
  that anyone has given me a choice in anything.
• Mark R.
• (one of Dans clients during his 1st session)

Dan Stavnezer, Outpatient Therapist
EXCEEDING EXPECTATIONS
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Outcomes29 Reduction in No-Shows
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of Admissions (By Fiscal Quarters)
200
FY 2005
FY 2006
FY 2007
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100
50
0
Jul 04 - Sep 04
Jul 05 - Sep 05
Jul 06 - Sep 06
Oct 04 - Dec 04
Jan 05 - Mar 05
Apr 05 - Jun 05
Oct 05 - Dec 05
Jan 06 - Mar 06
Apr 06 - Jun 06
Oct 06 - Dec 06
Jan 07 - Mar 07
Apr 07 - Jun 07
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Get Ideas From Outside the Organization
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Multiple Small Milieu Changes

• WOW!!

EXCEEDING EXPECTATIONS
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Current Event

• Disney monorail
• They are perfect
• Courtesy
• Efficiency
• Safety
• Show

EXCEEDING EXPECTATIONS
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Rapid Change Cycles

• Anything worth doing is worth doing poorly

When you loose, do not loose the lesson. Dalai
Lama
. . . the first time.
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Content Vs ProcessThe Bell Curve by Atul
Gawande
Expected Distribution of Positive Outcomes

• Actual Distribution of Positive Outcomes

EXCEEDING EXPECTATIONS
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The Bell Curve by Atul Gawande

• We are used to thinking that ability depends
  mainly on science skill these may be the
  easiest parts of care
• great knowledge technical skill can have
  mediocre results
• more nebulous factors like aggressiveness
  consistency ingenuity can matter enormously.

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The Bell Curve by Atul Gawande

• What the best may have, above all, is a capacity
  to learn adapt to do so faster than everyone
  else.
• (Steven Hackers Creative spirits?)

EXCEEDING EXPECTATIONS
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Stretch Our Imaginations
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Stretch Our Imaginations
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Master, now that I have reached nirvana, what do
I do?

• Chop the wood carry the water.

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M. C. Richards

• Let no one be deluded that knowledge of the path
  can substitute for putting one foot in front of
  the other.

EXCEEDING EXPECTATIONS
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So Whats New?!?
EXCEEDING EXPECTATIONS
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Skepticism DistrustUse of Data

• Statistical Fact
• 84.27 of all statistics are made up on the spot
• 88 of organizations have exaggerated positive
  outcomes
• Error factor of /-12

EXCEEDING EXPECTATIONS
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• SUSTAINING A SERVICE CULTURE

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Benefits of change
Infrastructure
Credible Benefits
10 key factors that increase the likelihood of
sustainability and continuous improvement
Adaptable Process
Fit with Goals Culture
Monitor Progress
Involved Trained
Senior Leadership
Empowered Believe
Clinical Leadership
SUSTAINING CHANGES
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Sustaining this culture

• Define quality in your organization
• What it should look like
• What is staffs responsibility
• Interview / Orientation / Job description /
  evaluations
• Add to policies and procedures (embed)

SUSTAINING CHANGES
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Sustaining this culture

• Create internal service theme
• What environment would you like to see?
• What would help the clients and families feel
  welcomed?
• What would enhance continuation and successful
  recovery?
• Get staff buy-in
• Use outside influence

SUSTAINING CHANGES
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Sustaining this culture

• Establish Your Standards

SUSTAINING CHANGES
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Sustaining this culture

• Exceed Expectations
• Acknowledge staff who excel
• Post your results
• Celebrate your successes (Magical Moments)

SUSTAINING CHANGES
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• Who Thinks Like This?

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Who Thinks Like This?
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• Who is crazy enough to be next?

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• Who is crazy enough to be next?

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Thank You

• Lara Ginsburg, Director of Operations
• J. Charles Ross, Clinical Director
• STEPS at Liberty Center
• 104 Spink Street
• Wooster OH 44691
• 330-264-8498
• Email ginsburgl_at_steps-ewh.org
• rossc_at_steps-ewh.org
• www.stepsatlibertycenter.org
• www.NIATx.net

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