Reframing the Most Significant Outcomesby Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP on 05/02/18
An occupational hazard exists for health and human service professionals (e.g. social workers, nurses, physicians, allied health professionals); caring more than our clients about their treatment outcomes. Of course, we care for good reason. It is the ethical responsibility of every health and behavioral health professional to attend to those we are tasked to care for; professional standards of practice and codes of ethics are clear to that end. However, a grand challenge exists amid a health care industry so focused on demonstrating successful outcomes. Assessing a client and caregiver's intricate circumstances and demonstrating empathy through actions often pale in comparison to other more pressing goals, such as the need for hasty inpatient discharge planning or providing behavioral health treatment in as few sessions as possible. The workforce is stressed to perform and more readily talks 'at' clients instead of 'to' them.
The importance of the client relationship has shifted, being reframed as client or patient engagement. A variety of new treatment interventions have appeared across the industry to enhance this engagement process. Motivational interviewing and Short term brief intervention and referral to treatment (SBIRT) are among the most popular. Evidence-based treatment manuals now guide behavioral health interventions, with the expectation to accomplish complex clinical recovery in ten sessions or less. An assortment of patient engagement tools have been developed to further the interaction effort, including:
· Patient portals
· Secure email
· Mobile scheduling (including reminders)
· Patient-generated data (via EHRs)
· Social networks
The goal to engage clients at lightspeed, then move forward with treatment, is well intended. Yet it still takes careful effort plus clear expertise to intervene with clients, many presenting at their most vulnerable moments of life, whether prompted by physical or behavioral health issues.
While the industry searches for the holy grail of client engagement actions, its culture mandates successful outcomes that are measurable:
· Treatment adherence
· Length of stay
· Clinical progress
· Return on investment
Organizations and the industry itself tout the value of evidence-based goals that are SMART: specific, measurable, achievable, relevant, and time-bound (Doran, 1981). These goals are usually aligned with financial imperatives that are most paramount to our employers. Yet, it can’t be ignored that the essence of client engagement still lies in establishing rapport. How this effort is accomplished takes careful attention that starts with developing strong client relationships. The human element of building client rapport is an intentional effort that easily presents as a lost art. In these technology-driven times I have wondered if health and behavioral health professionals are seeking to function more as efficient machines than empathic practitioners.
My colleagues share how the most rewarding part of their day often involves the ‘little things’; those interventions and actions of professionals that aren’t traditionally measured. With grand organizational emphasis on evidence-based outcomes alone, it becomes easy to question the value of our professional purpose. I would argue that the subjective elements of interactions between practitioners, their clients, and caregivers create the true foundation for building the professional relationship. In the end these actions not only mean the most to clients, but also fuel workforce satisfaction and support the attainment of more successful outcomes.
· Providing empathic listening to a client in need
· Engaging in advocacy on a client’s behalf
· Validating family member concerns about the client’s prognosis
· Attending to client anxiety about an upcoming treatment
· Partnering with clients to call for follow up appointments, particularly when clients feel unable or overwhelmed to do so on their own
· Sitting with a client in silence as they engage in anticipatory grief and mourning when a new terminal or chronic illness is shared
The art of client engagement should not be dependent on rote processes alone. This effort begins with how each professional approaches the unique client and family unit, then builds rapport. More intentional front end engagement allows professionals the opportunity to enter a window that is open for a finite period of time, yet allows a portal into the client’s reality. There is no magic pill to empower this effort; it begins with authentic presentation.The effort takes limited extra time, and saves emotional energy in the long run. Striving to respond to the human condition involves starting where a client is, as opposed to where we want them to be. This is one of the simplest acts that can be completed, albeit one of the hardest.
At the end of the day our most successful industry outcomes may not be those blatantly measured in administrative reports, scores, or analytics. Yet, these outcomes become the most meaningful to measure true client satisfaction, build meaningful client engagement, and foster workforce sustainability.
Until next time...Stay Resilient,
Doran, G. T. (1981). "There's a S.M.A.R.T. way to write management's goals and objectives". Management Review. AMA FORUM. 70 (11): 35–36.