Will new organizational structures, leadership competencies be de rigueur in the future?

I suspect that I was asked by the same author as Terry Stawar (What’s on the Horizon, posted on 12/7/2010) to comment on the future of behavioral health leadership. Here is my response to the same question:

At almost any point during the history of community mental health, “change and challenge” would aptly describe the times. From the initial infrastructure building, to the evolution of the care continuum, to the near escapes from public policy and funding disasters, to the throes of managed care, and now to healthcare reform and beyond—the behavioral health leader has always required an expansive array of skills cemented by an abundant dose of fortitude. This has never been an endeavor for the faint of heart.

Over recent years, however, unprecedented circumstances have given birth to a “change-and-challenge-on-steroids” scenario. In our state, public policy and funding changes have required a full-blown reengineering of almost all clinical and administrative systems within the provider organizations. Healthcare reform will do the same nationwide—provided, of course, that community mental health can find a place at the healthcare table. Administrators are also challenged to optimize the benefits of technological advances while mitigating the risks and liabilities imposed by them. Electronic records, teletherapies, meaningful use, social media, and the explosion of new software applications all present opportunities for enhanced performance and service access, but at the same time are rife with legal and regulatory hazards.

We are also experiencing a “change of personality” within our industry. Those CEO’s who joined community mental health as young clinicians in the 1960’s and 70’s are retiring almost en masse. These leaders set the vision, articulated the values, shaped the cultures, and in many ways defined the organizations that they led. Entering the scene are new CEO’s who weren’t even born at the time of the 1963 enabling legislation. So, where will these new leaders take us? What leadership constructs, structures, and competencies will define future success?

I believe that executives must begin by reimagining the entire concept of organizational leadership. When we think of behavioral health leaders today, we generally think of the CEO and the executive team. Successful organizations of the future will tap the leadership potential of each employee. Every brain cell of every staff member must be engaged in managing the organization of the future. We can no longer afford to allow talent and expertise to lie dormant.

We must also reexamine our organizational structures. Community mental health centers have traditionally operated in a fairly centralized manner, often propelled forward by the vision of a longstanding leader. Organizational charts are eerily similar across the country. With few exceptions, there is generally a CEO who leads a team of clinical experts, along with individuals who manage quality/compliance, technology, finance, and other administrative functions. Several layers of management separate the front line from the chief executive.

This needs to change, I believe. Successful organizations will redesign their structures and move toward flatter and more fluid systems that fully engage staff and mine the talents of all employees. A few mental health centers have moved in this direction, employing high performance team or similar principles within their organizations. Front line staff are trained in high level managerial techniques. Teams analyze performance data and formulate strategies for improvement. Members recruit new staff, assign roles, and evaluate one another’s performance. They actively work to eliminate any vestiges of organizational “silos” that create bureaucratic bottlenecks and hamper care delivery. There is a strong investment in professional development for all staff—and this includes leadership training. It’s a no-excuses environment marked by personal accountability and broader individual authority than can be found in traditional systems.

Future leadership competencies include employee and team engagement skills, the ability to increase efficiency (probably to a greater degree than any of us think possible today), the capacity to develop internal and external alliances, a talent for promoting innovation and organizational learning, and the ability to apply new technologies to every aspect of operations. The successful leaders of the future will create passion for the mission and sustain a culture marked by personal accountability and achievement.

There are any number of ways that community mental health stands to lose its heretofore protected status within the new healthcare environment: if we fail to be recognized as the healthcare home for persons with chronic behavioral health conditions; if we are slow in adapting to the new health information and technology requirements; if lawmakers decide that it’s time to fully integrate healthcare—and to achieve that through public health entities; or if we are too slow to redesign systems, structures, and processes to meet the fiscal and public policy challenges of the future.

Top-down, layered organizational structures and traditional notions about leadership aren’t enough to succeed—or possibly to survive—in this new world. Our staff need to know what we know, and to be given the authority (and expectation) to lead. They need to manage their own teams while the executives negotiate ways to make their organizations indispensible to the public healthcare systems of the future. It can be done, but it will require us to rearrange our thinking about best practices for managing the ever-present challenges of change.