A Vision for the Future: Workforce Investment

1. A Vision for the Future:Workforce Investment Mady Chalk, Ph.D. Treatment Research Institute October, 2007

2. Major Issues Affecting the Workforce • Shortages • Mal-distribution of professionals • Aging of the workforce • Inequitable minority representation (diversity) • Lack of technology applications and innovative methods for education and treatment services • Non-standardized professional licensing criteria and data about the workforce

3. Factors Affecting Workforce Demand • Aging population/longevity • Expanded scope of practice • Scientific advances • Insurance coverage and reimbursement • Advances in technology • Impact of chronic illnesses on workforce shortages

4. Factors Affecting Workforce Supply • Declining enrollments in professional schools • Lack of interest in health professions • Poor minority representation in health professions schools compared to numbers in population • Mal-distribution of providers • Salary, benefits, working conditions • Lack of unified state plans for workforce development

5. Addictions Treatment Workforce Issues • Increased demand for higher skills, greater flexibility, and expanded roles for clinical staff • Decreasing supply; fewer people are choosing health professions • Mal-distribution, including minority representation, is causing problems in many locations • Employer requirements and criteria, insurance benefits, curricula, and specialized or targeted skill areas are not aligned

6. Examples from Other Industries • Honda – Creation of Flexifactories • Semiconductors Industry Evolution

7. Cars and Semiconductors? • We are trying to produce treatment services and recovered individuals, not “widgets” so how can we learn from these industries? • But, we are an industry and we are evolving • And we are living in a time of more rapid scientific advances that are not being applied • Consolidation is occurring as in these other industries

8. Honda Flexifactories What is a “flexifactory?” A flexifactory is a factory capable of changing the product it makes with relative ease, at low cost, and great rapidity: whether changing ..volumes, models, or the nature of the products made. ..It forms the vital bridge between “micro” flexibility (relationships of individual employees with each other and with technology) and the corporate strategies of some highly successful companies for coping with rapidly shifting markets.

9. The Fixed vs. the Flexi Factory • Fixed-factories • Factory is built and machinery installed for production of a single model • Changing models is infrequent • Tasks of employees are controlled and limited by prior agreement • Flexi-factories • Capable of making more than one model simultaneously • Employees are expected to be flexible to accommodate shifts in mix of models • Operated as networks to balance their capacities

10. What about a FlexiTxProgram? • “Flexitxprograms” are capable of changing administrative and organizational approaches with relative ease, changing treatment models, or changing the components of treatment. • They form the vital bridge between the relationships of individual clinicians with each other and with technologies such as clinical assessment, continuous recovery monitoring, and telephone follow-up and the organizational strategies of some highly successful programs for coping with shifting markets.

11. A Hierarchy of Flexibility • Flexible organization • A network of flexible organizations Flexitxprogram1 Flexitxprogram2 Flexible clinicians Flexible clinicians + + Flexible treatments Flexible treatment

12. What Can We Learn? • Examination of existing Flexitxprograms will reveal how treatment modalities change over time, how the modality mix is altered, and how whole programs switch to making new types of treatment available. • Flexitxprograms that operate as networks have an advantage; the network can balance the capacities of each program.

13. The Semiconductor Industry • The semiconductor industry has doubled computing power about every 18 months: Moore’s Law. • At various points technological challenges, labeled “show stoppers” have occurred. • Each time it threatened to derail the industry unless employees devised clever solutions.

14. The Semiconductor Industry • A knowledge-based industry: one that puts an emphasis on creating value from new ideas and concepts as distinct from material inputs and demanding physical labor. • A knowledge based industry is characterized by the skill and education of its workers. • At the production level workers create, interpret, analyze and transform information to create value from knowledge.

15. Environments • The semiconductor industry functions in a “high-velocity” environment: one in which uncertainty is created by technological change, fluctuations in demand, and regulatory decisions. • Studies have found that successful firms (in these environments) use more high quality information in a short time period for more innovative decisions.

16. Environments • But, technology is changing in speed and direction. • The acceleration of change increased challenges that merit managerial attention and present new opportunities to potential new entrants into the industry.

17. So, how does this apply to us? • Because of the increased rate of new technologies (medications, best clinical and organizational/administrative practices) accompanied by increasing complexity of the process of care, management issues are more important relative to technical issues.

18. And the implications are? • If new technologies and processes are to be introduced quickly as they are developed, we need additional organizational and infrastructure supports such as new equipment (computers), medication supply, human resources and multi-organizational coordination (e.g., with primary care).

19. More implications • Managerial capabilities: managing volume of clients, the pace of movement through the continuum of care, multi-organizational coordination, and bringing in of different human resources (in-sourcing) will distinguish the leading treatment organizations. • “Disciplined creativity” is needed to balance long-range plans with short-term decisions so they are consistent.

20. What are the challenges? • Learning from other industries, we know that product (treatment and recovery) complexity will increase and, as science advances, issues will emerge at an increasing pace and have to be solved. • Costs will have to be managed both of assuring that treatments are valid for particular types of clients and are retooled (adapted) as necessary.

21. More challenges • Performance improvement of the processes of care, the individual clinician’s practice, and the infrastructure for service delivery will be required. • A program’s direction will need to be reevaluated more frequently as the rate of change of technology accelerates.

22. What should we be thinking about? • Treatment programs, just as in the semiconductor and car manufacturing industries, need to focus on developing their areas of strength and “outsourcing” other aspects in light of new technical demands. • The structure of our industry is evolving because of new technical demands and scientific advances.

23. What should we be thinking about? • The changing landscape now supports the growth of other complementary services, e.g., SBI (front-end), telephone follow-up, sober housing under the aegis of outpatient treatment programs (back-end), recovery centers.

24. More to think about • There will be an increasing trend toward specialized treatment programs interacting in a highly collaborative way because we need to combine capabilities required to offer a complete continuum of care at a cost we can all live with.

25. Changing Management Concepts • Adaptive Management – a concept from ecology, forestry, and conservation • Relies on an accumulation of credible evidence to support a decision that demands action • Designed for situations where there is uncertainty but a need for action

26. Adaptive Management Uses Data • From Data to Wisdom Oceans of Data Rivers of Information Streams of Knowledge Droplets of Wisdom

27. Does this sound familiar? • Six steps in adaptive management: • Problem assessment • Designing a management, monitoring, and feedback plan • Implementation • Monitoring indicators of effectiveness (does it work?) • Evaluation – comparing actual outcomes to forecasts • Adjustment of plan

28. Adaptive Management: Identified Pitfalls • Not wanting to revisit a decision • Not clearly explaining a process e.g. how decisions are made • Being trapped in process and not making decisions • Getting stuck in the past • Losing track of useful research

29. In Summary • There are critical workforce issues that need to be faced at the organizational (management) and clinical levels (clinicians and supervisors). • In the current environment we can learn from other industries. • Collaborative problem solving and adaptive management are central to moving ahead. • Expectations matter.