The Behavioral Health Leadership Wave: Prepare with Open Access and Open Minds

A Tidal Wave Approaches

The behavioral health field, especially community based substance use disorder (SUD) treatment organizations, is facing an unusual wave of personnel changes at the highest levels as many CEOs and senior leaders of community based behavioral health organizations near retirement age.

This generation of leaders began their careers when nonprofit health and welfare positions were abundant and encouraged in the spirit of President Kennedy’s “Ask not what your country can do for you” speech. Many of them are founders of their organizations or have led the organization for a decade or more.

Through this period these leaders led both mental health and SUD treatment fields through significant transitions, including deinstitutionalization, the increased use of medications, the availability of health insurance for reimbursement, and operating in a health care-oriented research and science context. Change has come to these organizations, in the substance of what they do, and in their leadership.

More change will shape the tenure of the next generation of leadership. Preparing the organization to adapt to those changes, without their founder or another long-term leader at the helm, is fundamental to a successful transition.

Open Access

SSTAR, Inc. (Fall River, Mass.), a community family, primary, specialty and behavioral health center, reflects all these forces and provides an exquisite example of how planning and predicting the transition can help an organization avoid the potential ill effects of this leadership transition wave.

Nancy Paull has worked at SSTAR since the 1970s, when it was the Center for Alcohol problems; she’s been CEO since 1985. Paull’s commitment to the patient and her passion for innovation and science led to the addition of women’s services, mental health services, an integrated family health center (FQCHC), full range of medication-based care, mental health, and a continuum of SUD prevention, treatment and recovery support services.

Among other features, SSTAR is known for its open access programs. An early adopter of NIATx model quality improvement, SSTAR removed traditional appointment barriers by instituting a same-day, open access clinic that provided assessment, short-term treatment and placement. Under Paull’s leadership, the organization kept pace with changing circumstances. But with more change coming, it was important to have a new CEO in place who could continue the innovative approach to SSTAR’s work.

Open access, a practice that has been key for patient success, was also key to SSTAR’s leadership transition. Total transparency and on-time response and information flow were key: for the board and search committee engagement; for staff stability and confidence; and for candidate recruiting, review, vetting and selection. The transition to new leadership was successful because the board of directors’ readiness and leadership, staff engagement and trust, and the dedication and grace of the outgoing CEO.

Preparing for a new generation of leadership

This board had great trust in Paull, and granted her considerable leeway. Anticipating her retirement, and with her active support, the board resolved to make itself stronger and more knowledgeable about the organization, to hire and supervise a new CEO more effectively. The board recruited new members and Search Committee members with experience and sophistication in finance, human resources, governance, policy making, equity and diversity, community relations and health care administration. These individuals respected each other; they represented a diversity of views and experiences; they welcomed give-and-take and rigorous analysis, and they agreed on the need for a deeper understanding of the organization. The sum of these parts was clearly a greater whole.

While still technically a founder’s board, this was a board with the experience and the skills needed to oversee the next generation of leadership. The exercise of searching for a new leader greatly strengthened these qualities.

Staff engagement and trust building

The Open Access approach used by the search consultant fostered strong Search Committee engagement. Committee members developed a deeper understanding of the agency status and needs, and effectively employed that understanding to screen, engage with and make decisions about candidates.

The search committee included two staff members, one from the senior leadership and one at the service delivery level, both of whom were respected by their colleagues. They were welcomed as fully equal committee members; they were honest and enormously helpful in explaining the inner workings and politics of the organization. Encouraging candor, respecting differing views and promising to hold the committee dialogue in absolute confidence created a powerful and effective forum in which to address any number of complex and challenging issues that typically arise in a transition of this nature. In addition, the search process began with an invitation to each operating and administrative department to meet with a representative of the search process to discuss their needs and to inform staff about the process. “Blinded” information from these meetings was provided to the search committee to use in discussing agency needs with potential candidates. The staff input was complemented by four all-staff search committee updates meant to keep staff informed of progress through the process.

A graceful founder

The departing founder respected the board’s readiness to control this transition. She shared her views with the committee and welcomed a fresh look at her tenure and the organization that the board needed to develop as a part of its evolution. At key moments in the search, she offered her insights and perspective, and trusted the committee to use that information without further influence from her.

Board leadership

The Search Committee Chair showed up, big time. A CEO transition, and notably a founder CEO transition, involves far more than personnel matters. Policy, strategy, culture, organizational development and performance, and politics are all fluid and changing in the face of new leadership and a new direction. Problem solving, gathering information, forging key connections, and building trust within the committee and with the larger board and community was a constant requirement. The activism, the integrity and the time commitment from that individual made an enormous difference, to the good.

Open Access/Open Minds

The genius of Open Access lies in its recognition that requiring patients to navigate conventional health care bureaucracy closes off care to those most in need. Understanding that objective reality first, and then applying that understanding to the institutional framework, opened up the creative and adaptive approach that made SSTAR a leader in this field.

This CEO transition was based on the same principle: To understand the objective circumstances awaiting the new leader, and to center the process and the dialogue – with staff, with the board and search committee and with serious candidates — on that reality. The learning that resulted from each other and from candidates, brought us to a consensus and established a foundation of trust and understanding among the board, staff and the new CEO that will pay dividends as we move forward.

Guest Author

Victor Capoccia, Ph.D. and Ted Ford Webb
Ford Webb Associates