Best Practices: Managing Performance Indicators for Physicians in Community Mental Health Centers

In a recent column for this series, Glazer (1) discussed the need for psychiatrists and other mental health workers to reestablish control of the patient-provider relationship in this era of managed care. He suggested that methodologies to identify and implement best practices might go a long way toward achieving that goal.

He also argued that the collective cottage-industry mentality of psychiatry and other mental health disciplines is an obstacle to regaining professional autonomy. The effects of this mentality are critically important in the changing world of medicine. Medicine is indeed in the midst of a transition from an old-fashioned cottage industry into a truly industrialized business. This change is not unexpected, for such transitions occur in the natural history of all business sectors.

Many examples of this process can be found in history. The experience of one well-known cottage industry is instructive. Before Henry Ford's development of the automobile assembly line, local artisans working at the behest of individual customers built automobiles and other carriages. But Ford's model for the industrialization of automobile manufacture led to a significant transition for that business sector and its practitioners. Surely the carriage makers fought this transition, and surely they grieved the change, for it brought along a loss of autonomy and the personal relationships that these artisans had developed with their customers. Unable to compete financially, the artisans gave way to unionized workers on assembly lines. The old-fashioned carriage makers (including my grandfather) had to find another way to make a living.

Psychiatrists and other mental health professionals currently walk a similar plank toward the same fate. As we do, we bemoan the sight of "managers with clipboards" walking in the opposite direction—those faceless bureaucrats perceived as more concerned with money than with quality who nonetheless seem to be taking control of our industry (2). If we are to avoid that fate, we must learn to manage ourselves with those same clipboards. If we do not, then the business and congressional leaders who foot the bill for health care will continue to turn to others—not to psychiatrists and other mental health professionals—for advice on how to manage mental health care. If we do not learn how to manage our work financially as well as clinically, then we will be turned into technicians and relegated to the same fate as previous generations of cottage industry practitioners.

This column presents a method used by the physician leadership in our community mental health center to think like managers with clipboards. Specifically, it describes the management process for financial and clinical performance indicators for our center's psychiatric staff. It is critical that we focus on both financial and clinical performance, because payers in our burgeoning industry will not hear our message about clinical best practices unless we, as practitioners, demonstrate our ability to keep our financial house in order.