Bringing more diversity of thought to behavioral healthcare

When we explore best practices in behavioral healthcare, we constantly look inside our field and rarely seek best practices of psychology and experience from other services and industries. This is limiting our ability to be more effective and truly great practitioners of care.

This week I’m participating as a panelist to discuss the use of “data to drive growth” in behavioral health. My fellow panelists have deep experience in billing and revenue cycle management, operations, and technology. Each of us come from uniquely different backgrounds, which for me, is the great opportunity of this event … a strong diversification of thought. Oftentimes, when I’m in rooms of leaders in the addiction, recovery, and behavioral health field, the spectrum of ideas, beliefs, experiences, and solutions is not very wide.

Will Guidara is a restaurateur. He grew up under Danny Meyer (Union Square Cafe and Shake Shack), eventually taking over Eleven Madison Park. If you’re in the restaurant world or a foodie, you know these guys and these restaurants. They are the best, the pinnacle of quality and hospitality.

During a book promotion interview, Guidara said this about developing a great restaurant:

“If you only learn from people that do what you do, it’s very hard to develop your own unique point of view.

“I found that the more we reached out to other companies and other industries and borrowed things from their approach and brought them home, the more that we were actually able to really start to revolutionize our specific corner of the restaurant business.”

The behavioral health field is in a precarious moment. Despite advancements in technology, influx of capital and talent, and increased awareness, overall quality of care is not great, access and availability of care remains limited, and the rates of addiction and overdoses continue to increase.

Everyone is working harder, but are we working smarter? Are we limiting ourselves to a set of “best practices” that themselves suffer limitations? Every industry falls prey to being insular and staying in its echo chamber. But as Guidara points out, that doesn’t have to be the case.

The addiction treatment, recovery, and behavioral health field needs to get out and learn from other industries (hospitality, car manufacturing, supply chain/logistics) to improve. This, I believe, can have a real impact on the brutal state of addiction in the U.S.

What could a behavioral health clinic learn from how the best restaurants operate and serve their guests?

When I’m in Denver, I will have dinner at Sunday Vinyl, a Bobby Stuckey restaurant. Sunday Vinyl is next door to Stuckey’s other culinary and experiential gem, Tavernetta. Stuckey is a James Beard Award winner and master sommelier. As much as I will be present and enjoy my time with friends, I will be taking notes on how Sunday Vinyl orchestrates my dining experience.

In 2018, I led the expansion of Face It TOGETHER to Denver. We built a 12,000 square foot, state of the art peer coaching facility. I was introduced to Bobby Stuckey as a master of hospitality. Stuckey actually refers to himself as a “hospitalian,” a portmanteau of hospitality and Italian (his restaurants are all Italian oriented). We visited Tavernetta to see how world class service is delivered. Here’s what I witnessed:

When you enter the restaurant, there is an almost uncomfortable amount of space between the door and the host podium. The podium is barely noticeable and seemingly in the middle of the restaurant. The podium is just wide enough to stage an iPad and menus. You start to walk toward the podium, but never make it. The hosts meet you in the middle. They almost always know who you are and greet you by your party name. It’s magic. Your coats are removed and sent to the coat room just off the entrance. You are immediately cared for.

Your eyes go in two different directions. To the right is the bar and a more casual dining room. It’s open, inviting, and very Scandinavian. Straight ahead is a path that takes you in front of the open kitchen. On your immediate left is the pasta making station. Someone is always there expertly and effortlessly crafting the gnocchi (or other pasta on the menu) you are about to order. My go to is the gnocchi.

Every member of the service team and chef staff are on a stage. They seem to swim through the dining room and food prep stations. Each table is engaged in precise intervals by the service team. The service team is all dressed sharply is dark grey pants, brown shoes, and white oxford shirts. But if you look closely, you’ll notice differences in aprons and how the aprons are worn. This tells you who is who on the team and what they do.

It’s not unusual to see Stuckey himself running service. He’s dressed in a typical checkered sportscoat and colorful tie. But he slides in and out of service like a conductor that knows every note and every measure for every instrument in an orchestra.

We haven’t even sat down yet.

One of the last times I was at Tavernetta, it was a celebratory dinner with my wife. I made the reservation and indicated it was our anniversary. I indicated that she loves champagne. They asked for my preference, I said that I didn’t drink. When we sat down, the service team made us comfortable, greeted us, and just as they were congratulating us on our anniversary, a sparkling champagne cart arrived to offer my wife her choice of bubbly. For me, they had prepared a sparkling alternative for an appropriate toast.

The detail. The attention to us was everything.

What can we learn from all of this and take into the practice of behavioral healthcare?

We could absolutely reinvent the admission process, which is driven not necessarily by compassion and experience, but by the name on a person’s insurance card. The series of events around insurance identification, verification, and utilization review is so cold and uncaring. It sets a bad tone for the rest of the care experience. It creates this canyon between the person seeking care and the provider.

Imagine if you walked into a restaurant and before you could even get a reservation … you had to guess at what you wanted to eat, couldn’t see the menu and prices, AND had to prove that you were good for it first?

You wouldn’t eat at that restaurant.

But because people are desperate and dying, they’ll accept additional suffering. This is par for the healthcare course.

Sadly, when leaders in our field get in a room to talk about best practices around this issue, no one is bringing the hospitality perspective (or other industries). No, it’s a vortex of regurgitated “solutions” that moved insurance verification into a digital offering on the provider website. “Did you see our chatbot verification tool?”

That’s the best practice … but it’s still utterly terrible. There’s nothing best about it.

This is one moment in a journey of 1,000 critical moments that have dramatic influence on patient outcomes. My colleagues in the field don’t like when I state the next part … these process moments likely have a more outsized effect on “treatment success” than the actual clinical interventions. This is admittedly hyperbole and supposition, but we know from other industries that customer joy typically doesn’t come from the mechanics of the thing – but the experiences around the thing.

Read Rory Sutherland’s book, Alchemy. Sutherland recounts work he did in the UK to improve ridership on trains. Sure, some of the trains were updated and were better, but the mechanics of the train itself and how it gets from A to B isn’t what brings joy to the journey. What Sutherland and his team found was that improving journey times could be greatly impacted through small queues in the ticketing experience. The overall journey time, when reduced, affected how the traveler perceived the experience.

The same psychology was at work in the colonoscopy findings that won Daniel Kahneman a Nobel Prize in economics.

I am sure the train operator feels slighted by a marketing executive who knows nothing about how the train gets from A to B. But at the end of the day, rider psychology overrules reality. Same for addiction treatment. 

So, this week, I’m going to watch the orchestration of my dinner service at Sunday Vinyl and take notes. What I learn will be incorporated into how we help our customers improve the patient experience that influences the recovery intelligence we bring through data and engagement design and analytics.

Do not be afraid to seek influence and thought from outside the behavioral health and addiction space. Whether you like or not, patients are consumers with a psychological orientation derived from other service and product experiences. They bring all that outside experience with them. Use that to your advantage to increase admission, retention, and discharge rates; which can deliver positive and lasting outcomes.