Commentary and Weblog

Mike Schiks, MA, ACATA, Principal Partner of Minnesota Model Consulting shares thoughts, experiences and observations in his new weblog.  Mike's 25 years in the addiction field include hands-on clinical practice and extensive leadership and management roles.  Want to hear Mike's thoughts on a particular topic? Use our contact form to offer suggestions and ask questions. We appreciate hearing from you.

On “Caring Community”

As a young counselor in training I was introduced to the concept of “potency.”  It speaks to the effectiveness of counselors to engage their clients in the recovery process.  It is an intangible characteristic that encompasses the entire demeanor of a counselor/helper. 

Over the years I have come to believe there is an organizational parallel or counterpart for this concept.  I and others refer to it as caring community. It transforms a physical location and group of skilled and competent staff into a “true healing place.”

Building a caring community involves creating an environment that feels safe enough for people to let their guard down and take the risk of sharing themselves, not just what they want others to see, but who they really are.

During my years working in treatment centers I hosted a number of visits and tours of our programs and facilities. One of the comments I was always glad to hear was, “This place has a good feel to it.”  I too have experienced this feeling when touring other programs. I think it has much to do with the status or “state of” the caring community.

A caring community brings value to the entire organization

      For patients/clients

A caring community is a powerful therapeutic tool that entices and engages patients/clients into the treatment process. It fosters an atmosphere of mutual support in their journey toward recovery.   Conversely, the absence of a strong caring community may be reflected in patients feeling disconnected, aloof  and/or approaching treatment as if they were passive participants waiting for recovery to happen.

For staff

The presence of a strong caring community has the capability of continuously energizing staff as they try to make a difference in people’s lives. A strong and healthy caring community can create an infectious spirit of people working together in helping their patients/clients as well as advancing the agency.  A caring community environment engenders pride and ownership among staff.  On the flip side, a weakened caring community can be marked by distrust and infighting. Staff may see themselves as contributors but despite an agency's turmoil.

For agencies/organizations

From an agency perspective a strong caring community provides leaders with a sense of confidence that staff will do what is best for patients/clients and also watch out for the interests of the organization. Staff members act as eager ambassadors of the organization. Conversely without the presence of a strong caring community, leadership may find themselves viewed as adversaries or in the role of referee between different staff factions.  Grapevine communication may have more credibility than formal communications. An agency may deteriorate into a place of stress and pressure detracting from the clinical results and overall effectiveness of the agency.

Organizations have the capacity to foster a caring community

What elements make up a caring community?

Organizations are dynamic; they are constantly changing.  Whether this change moves them forward or continually recycles the same issues depends on establishing and nurturing the building blocks of a caring community. In my experience the following are the key focus areas that together form an effective caring community:

·         Shared vision

·         Physical environment 

·         Organizational/staff culture

·         Leadership

·         Patient Peer Culture 

Shared Vision

Most organizations have grappled with the exercise of writing mission and value statements. Hours are spent debating semantics and struggling with the right words and phrases to capture “the essence” of the agency. Some focus on why the agency exists while others focus on the aspirations of the organization. Still others try to communicate identity. It is all too easy for an organization to get caught up in writing a flowery statement that is more promotional than practical.  A good rule of thumb however is be careful what you write because you will be judged by how you to live up to it.

Effective mission and values statements provide guidance and vision that reflect what stakeholders see at work in day-to-day transactions. That means staff, alumni, donors, community and referents/customers are getting the same message.  There must be congruity between mission/values and practice. The absence of congruity leads to ongoing debate about the spirit, integrity and motives of the organization. Left unchecked this can affect both an agency’s internal operating effectiveness and its’ relationship with external stakeholders. The potential results can include fewer donors, dissatisfied referents and poor results for patients, clients and families.

Physical Environment

Another ingredient in building and sustaining a caring community is the physical environment. Creating the right physical environment involves balancing practical use of space with the softer side of décor and feel.  When designing or expanding treatment facilities architects/designers will try to capture how the space will be used from a practical perspective. They consider the number of people using the space, traffic flow, and how the space will be used in daily operations. 

Good designers go further. They take into consideration the softer dimensions of design that support the mission and intent of an agency/organization.  This design requires a remedial understanding of the process of recovery and what clients the agency serves. A goal is to create an environment that communicates a sense of belonging, well being, safety, support and caring.

Organizational/Staff Culture

Reams of informational have been written about the definition and/or components of organizational culture.  For the purpose of this “musing” suffice to say that organizational culture and staff culture are so interdependent they are essentially interchangeable. Culture encompasses all staff at all levels and includes leaders.

Organizational/staff culture affects how information is communicated and interpreted throughout the organization. It defines norms in the work environment including work habits. Ultimately culture impacts everything including an organization’s effectiveness in the delivery of its services. It can move an organization towards excellence or bog it down to the futility of “wheel spinning” mediocrity.

Some organizations/agencies tilt towards operating primarily at a transaction level.  Everything is a transaction.  Simply stated, staff is hired to do a job. The organization provides space and resources needed to do the job. Staff is fairly compensated. Productivity goals are achieved. Clearly all organization’s need to achieve this basic function or they could not operate.  However if this dimension dominates in a value-driven, people-based organization, it may be viewed as “hard edged,” too “business oriented” or directly contrary to the spirit, mission and values of the organization. It may work to the detriment of the caring community.   

On the other end of the spectrum there are value-driven organizations that seem to be consumed in the drama of over-active staff cultures.  Continuous navigation through a myriad of staff relations issues distracts from getting the real work of the agency done. In this case the work processes may gradually evolve to meet the staff’s preference at the expense of the patients/clients.  There may be an absence of accountability and a “fly by the seat of the pants” culture that can leave the organization vulnerable. 

Most organizations fall in between. The challenge is finding a balance that supports the work of the organization and contributes to a caring community.  One impediment to finding that balance is when people are entrenched and cannot see or communicate in the gray areas between the extremes. This can set the stage for an ongoing “mission versus margin” conflict.

One of the basic principles of today’s view of continuous quality improvement is the absence of fear in the work culture. You can only work on improving quality to the extent you know an issue that needs improvement exists. Trust has a lot to do with whether or not staff will come forward with problems or ideas. Today, getting the fear out of an organization is considered critical to quality improvement. Contrary to the belief of some, this does not contradict the need for accountability or measurement, both of which are integral components of continuous quality improvement. What’s more important is how those measures are used, either to blame or in healthy organizations, in the spirit of making improvement.

Leadership

Addiction treatment services have a complexity of their own.  Helping addicts is a passionate enterprise. Professionals who have been trained in their respective disciplines - whether psychology, psychiatry, medicine, or counseling - often have little training in working as a team.  Staff in recovery themselves (most often counselors) must balance the use of their personal addiction experience with professional boundaries and interactions. This combination isn’t necessarily a recipe for automatic teamwork and therefore must be systematically structured and encouraged.  To make it effective takes genuinely committed and capable leaders who have the capacity to “read” an organization at multiple levels and who have the communication skills to address a number of different audiences.

It has been said that leaders are only leaders so long as they have followers. Whether an agency’s mission/value statements are effective guidelines for an organization often hinges on the actions of organizational leaders. When there is alignment, an agency/organization can effectively work as a productive, caring community. Conversely if there is even a perceived gap it can be difficult to continuously nurture a caring community.

Above all leaders need to be viewed as genuine.  Staff members in a treatment programs are astute. They are trained observers in deciphering incongruity between what people say and what people do. This training often serves as a filter for how they view leaders and ultimately the organization. Respect, empathy, commitment, fairness and competence are baseline elements expected of a leader.

Finding effective leaders for an addiction treatment agency is not easy.  It requires someone who can navigate the staff culture of a caring community and negotiate the realities of operating in a complex health care arena (which for addiction creates another set of challenges). Leaders that rise from the clinical ranks may struggle with balancing their personal commitment to recovery with the necessary business/transactional aspects of the organization. External leaders or generalists without experience with the mission and values of an organizational culture, are subject to missteps when they misread the importance of value-laden cultures. These circumstances require very different leadership development plans that unfortunately are all too often neglected. The stakes are high because it’s within leadership that a caring community is fostered or neglected.

Patient Peer Culture

The final ingredient in building and sustaining a caring community is the understanding and skill of building and nurturing a constructive patient/client peer culture. There is an old “tongue and cheek” saying in residential treatment centers, especially those with a healthy caring community: The patients get well when the staff go home.  Self-help and peer support are basic tenets of the Minnesota Model of addiction treatment.

Some years ago, as our residential treatment centers were seeing more complex patients, I toured a number of psychiatric units on a fact-finding mission.  One observation from these visits was the relative absence of patients helping each other on these units. Care was almost entirely staff driven. Besides sharing the same space and their own humanity the diversity of their issues simply didn’t lend itself to a strong mutual help process. 

In substance abuse treatment the “experience of addiction” provides a commonality that is transferred into strong peer relationships.  The Alcoholics Anonymous text refers to these relationships as “the common peril that binds us.”  Strong peer connections are a vital part of the recovery process. 

Skillful clinicians carefully orchestrate the building and maintenance of a positive peer-group process. This starts with continuous orientation and fostering the common message of mutual support and community. The first order of business is communicating ground rules and expectations that pertain to being part of a peer group.  Patients/clients are instructed (scheduled) to tell each other their personal stories, i.e. what their addiction years were like, how they got to treatment and what their hopes are going forward. Alumni and outside self-help group members are often brought in to tell their stories, again fostering the idea of helping each other.  Staff is continuously looking for ways to support the “training ground” dimension of treatment in which patients/clients practice sharing and helping each other.

Building a peer strong peer culture supports clients participating in follow-up caring communities, i.e. self-help groups.  This self-help community contact is crucial and is something that research suggests impacts and improves outcomes.

In closing

The obvious and the subtle dynamics required to maintain and nurture a caring community are present, to some extent, in most effective addiction treatment programs.  Building and nurturing a healthy caring community throughout an organization reaps benefits in multiple ways.  It promotes patient care and healing, and supports healthy, sustainable organizations that can continue to serve well into the future.  However it is applied, in the end it is the “still suffering addict” that benefits. And that, we must remember, is why we are doing this work in the first place.

Michael A. Schiks, principal partner of Minnesota Model Consulting, is the CEO of Project Turnabout Vanguard treatment center in Granite Falls, Minnesota and former Executive Vice President of National Recovery Services for Hazelden based in Center City, Minnesota . Mike formed Minnesota Model Consulting to work with all types of treatment providers who wish to establish or improve their clinical and/or business operations, and to integrate the "heart and soul" of the Minnesota Model and 12-step recovery into their therapeutic program.