Pros and Cons of working at MHS - Therapist Meridian Health Services Employee Review

A lot of turnover at all levels - executive, HR, middle-leadership, and direct service providers. This is not generally uncommon, but when compared to comparable organizations in the community, turn over at this agency is noticeably more frequent. In my time with the organization (around 2 years), we have lost approximately half of our HR team and multiple executive level and middle-level managers. Understandably, this can present issues with staff support and training which, in turn, can harshly impact patient success. Lack of racial and ability diversity in executive and middle-level management - Within these groups, approximately 1% of management represents diversity in race and ability. Additionally, white males are over-represented at the highest levels of management. Personal reports of diverse staff reflects lack of awareness and consideration of how diversity affects experience in the leadership role. Management who are diverse in race and ability have communicated feeling ostracized and stifled. Furthermore, these managers have reported needing to code switch in these environments in order to "get along". Unreliable EMR - MHS uses a very unstable EMR for daily documentation. The organization has used this EMR for 10+ years and is aware of the issues this platform creates for their staff, but does not take steps to make changes. This creates frustration and more work for staff due to lost forms, EMR outages, and other barriers to timely documentation on patient interactions. As a result, staff are required to re-enter information or follow-up with the IT department to avoid potential write-ups for late documentation. The organization has the ability to explore other EMR options, but has not. Trauma-informed care in word, not in practice - This organization reports that it is a TIC organization, but policies, practices, trainings, and other considerations do not reflect TIC practices. A trauma-informed system is one where the impact of violence and trauma on patients and staff have been taken into consideration when developing and maintaining all levels of practice and services. There exists verbal acknowledgement of TIC practices, but there is a lack of follow-through at the working levels of the organization. Currently, there are no established methods for feedback on TIC practices and how they impact patients and staff. Additionally, patients and staff outside of the highest levels of leadership and coordination are not involved in discussions regarding development and implementation of TIC practices. Company growth is not accompanied by transparency - direct service providers and middle-leadership roles are often not updated on processed at all or, if they are updated, it is not in a timely manner. Growth has created conflict with licensed providers being able to align with licensing guidelines which presents risk of license revocation for providers. Management communicates an interest in addressing conflictual practices, but does not take action on addressing these practices. From the provider view, it seems that focus is on growth first and then making sure ethical practices are addressed later. Direct service staff are often told that C-level leadership are evaluating concerning practices that affect direct service and patient care, but updates are concerningly slow or never come. Role ambiguity - Community service providers are essentially providing a taxi service and not actively addressing patient care needs (goals and objectives). Focus on revenue diminishes the effective work that community service providers could provide. Middle-level managers often email staff stating that a patient needs a ride and will continue to email until a community service provider volunteers to provide rides to patients. Management has communicated to staff that providing rides to patients is not a billable service, but encourage staff to provide and bill for staff to provide rides to patients. This does not align with the care plans that are developed for individual patients and can cause confusion on the services that this agency is providing to patients. Micromanagement limits autonomy of independently licensed providers - Licensed providers have very limited autonomy and support from clinical leadership outside of the watching eye of management. Licensed providers are not given full schedule flexibility and are required to gain pre-approval schedule changes. Licensed providers are unable to make quick, in-the-moment decisions to meet patient needs without gaining approval from managers who often do not respond to calls or emails in a timely manner. "I cannot afford for my patients to be mentally unwell" - Licensed clinical providers and community service providers are pushed to make money, not collaborate with patients to work toward wellness goals. Management routinely evaluates dollars made and licensed providers can be written-up for not making "enough" money. This leads to providers employing restrictive practices that are focused on increasing revenue, not patient wellness. Consideration for mental and physical wellness are not taken into consideration when management evaluates provider revenue on a weekly basis. Middle-level management who are not clinically trained or licensed are tasked with providing guidance to licensed and unlicensed staff on how to increase revenue. This practice is concerning because middle-level managers are looking at patient care through a lens of productivity, not wellness. Middle-level managers encourage staff to employ questionable practices that affect patient care (i.e. double booking, cold calling, "check-in sessions" that are not aligned with treatment plan, and providing patients with rides instead of working on treatment plan goals and objectives.). Direct service staff, licensed and unlicensed, are encouraged to learn the billing rate structure to maximize dollars made without a focus on time spent working on treatment plan objectives. Sub-par clinical supervision - Clinical supervision is arranged to occur, at minimum, for 2 hours, monthly. Unlicensed staff are generally able to practice as independent providers. Staff do not always have prior training in the area of behavioral health, so staff often "figure out" what it means to be an ethical, competent provider on their own through trial and error. Clinical supervision is structured to allow clinical supervisors to make money for talking about patient cases. Clinical supervisors are encouraged to talk about 4 patients per clinical supervision session to maximize profits for each supervision session. A major issue with this structure is that unlicensed community service providers carry 20+ patients on their caseloads and therapists have 50-100 patients on their caseload. In a month, on average, direct service staff are only able to staff the cases of around 8 patients. Clinical supervisors are supposed to be available for immediate consultation, but are often unavailable due to barriers presented by role requirements. Clinical supervisors, like direct services providers (i.e. community service providers and licensed/unlicensed therapists) are tasked with meeting a weekly productivity standard. Due to this, clinical supervisors are required to schedule a certain number of staff and patient appointments which often leaves them unavailable for consultation. As a result, "clinical consultation" is often provided by non-clinical staff without clinical licensure or clinical education. Concerning team team interactions - Unhealthiness within teams (e.g. arguments, interpersonal conflict between staff and management, lack of responses to inquiries, and lack of focus on resolving active conflicts) is not effectively addressed. Minimal, non-effective strategies are employed to address team health (i.e. Predictive Index, online trainings regarding customer service and team communication practices without follow-up/debrief/focus on real-world application). There is an unspoken hesitance to directly address behaviors and communications which has led to team conflicts not being addressed. Stress within the management team can be felt and seen by direct service providers. Stuck-ness - employees are actively discouraged from learning more about practices, providing feedback to middle- and upper-management. Inquiries and feedback are met with generic responses and lack of follow-up. When concerns are communicated, middle-level management verbalizes their own lack of autonomy and frustration with processes, leaving employees feeling powerless and stuck. Autonomy provided to unlicensed management - Unlicensed management with high school and associate degrees are provided autonomy to train and guide unlicensed and licensed staff holding high school, associates, bachelor's, and master's degrees. Concerns arise when unlicensed management that have not had training or education on wellness or effective, ethical treatment are providing documented training to staff. This has led to encouragement of concerning or unethical practices that focus on revenue and not achievement of wellness objectives.