What we can learn from Starbucks and McDonald's: both train middle managers to be more effective leaders.

What do you think is more difficult to do: manage a coffee shop, oversee a burger joint, or supervise mental healthcare professionals? If your answer was based on the length of training programs each industry requires of its managers, coffee shop and hamburger chain managers would rank before supervisors of therapeutic services.

Starbucks requires its store managers to complete nine months of on-the-job training, an apprenticeship, and classroom instruction plus be personally examined by senior staff. McDonald's requires a similar experience over eight months. Yet the typical behavioral healthcare manager is lucky if she has any opportunity to develop managerial knowledge and skills prior to taking on more complicated responsibilities.

Even after many years in a behavioral healthcare management position, stalwarts commonly have received nothing more than informal on-the-job training. If they are lucky, they may receive supervision and guidance from an experienced manager, but more often they are supervised by someone with similarly inadequate experience.

We can no longer accept this.

In Behavioral Healthcare's October 2006 issue, articles pointed out the inadequacies of management training in our field and the impending crisis that faces us if we do not aggressively address the problem. In one article, winners of the National Council for Community Behavioral Healthcare's Lifetime Achievement Award in 2006 note that many of our accomplished and experienced leaders are nearing retirement. (1) They also note a decrease in the number of talented people of diverse backgrounds moving into behavioral healthcare management.

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In the same issue, David J. Powell describes the addiction treatment field's perception of the leadership crisis. (2) He cites a University of Georgia longitudinal study that found that 30% of addiction treatment program directors/CEOs were age 50 or older in 1995-1996, which increased to 54.8% by 2003-2004. This portends a frightening leadership gap. Powell notes that "we are at least ten years late in leadership program development."

One Agency's Response

The North SuffolkMental Health Association has decided to not sit still. In the spring of 2007, we implemented an in-house training program for middle-level managers. North Suffolk is a mid-size community mental health organization in Chelsea, Massachusetts, that has served the greater Boston area for more than 47 years. Approximately 750 staff members in more than 70 programs provide developmental disability, mental health, and substance abuse services at more than 40 sites.

We decided to launch this program because we:

* recognized that middle-level managers are the keystone of the organization, providing vital connections between line-staff and senior managers;

* had consistent difficulties attracting, hiring, and retaining competent managers; and

* saw the consistently negative effects of the gaps in management, which included staff turnover, low morale, and less-than-ad-equate financial performance.

Two Key Principles

Our management training program is based on two key principles: feminist learning philosophy and work-based learning.

Feminist learning philosophy. The majority of our staff members and managers are women (as is the case in the field). Thus, we decided to optimize the learning experience for women. We considered the words of the authors of Women's Ways of Knowing: The Development of Self, Voice, and Mind: "[F]or many women, the 'real' and valued lessons learned did not necessarily grow out of their academic work but in relationships with friends and teachers, life crises, and community involvements." (3)

We designed the program to include opportunities to build relationships, practice managing crises, discuss real crises, and be involved in a community of supportive peers. We looked for ways to enhance the authority of managers (male and female) and improve communication to gain attention and respect.

Work-based learning. There is general recognition that professional schools are not adequately preparing staff to work in 21st-century behavioral healthcare. The Annapolis Coalition on the Behavioral Health Workforce promotes more focused and relevant education for behavioral healthcare workers. (4)

One answer to this challenge is work-based learning: instruction that integrates workplace requirements and experience with technical education. Work-based learning includes curriculum-based on-the-job requirements, viewing a worker as a learner, integrating the job with instruction, and including continuous learning in work expectations. (5)

How Our Program Works

All senior managers receive an e-mail announcing the training, which includes an annotated table of contents on what the training covers. Senior managers are reminded of the training program in their monthly meeting and a posting on the agency's intranet. Senior managers are encouraged to discuss program participation with likely candidates they supervise. As the class list builds, senior managers are kept informed of the number of open slots. The optimal class size is 16 or 18, allowing for multiple small groups of equal sizes.

As the program is highly interactive and involves sequential sessions, participants must commit to attending all nine four-hour sessions on consecutive Friday mornings. Participants, their managers, and their staff also must ensure that enrollees are completely "offline" during the training sessions so they may participate without interruptions.

The curriculum is based on a program I previously developed and field-tested, and it has been adjusted to fit the specific needs of our managers. The curriculum involves 21 interrelated modules (table). Each session is a mix of didactic presentation, practice exercises, and discussion. I teach the modules (I am an experienced manager and educator). Short, often humorous videos maintain the energy level. Practice exercises include small team projects, role-plays, and case examples. Simple homework occasionally is assigned to ensure learning is carried over from week to week. Most exercises provide participants with tools they can use as soon as they return to work. Participants receive a 100-page training manual in a three-ring binder with pockets for handouts. This format allows participants to remove specific sections and use them repeatedly while working.

For the final session the class is divided into two teams and completes a final project that addresses real-life scenarios incorporating all of the knowledge presented during the program. At the end of the program the agency's CEO presents participants professionally designed certificates of completion.

Progress

Two classes have completed the training program. Participants' averaged 1.5 years of management experience with a range of 2 months to 5 years. The first training class had participants from six different countries (five in the second class).

Participants report feeling less isolated, more supported, and empowered by the organization, and they regularly report that they are using the program's tools with successful results. Participants from the first class attended a follow-up meeting three months after their training ended. They continue to meet monthly to engage in mentoring and support. This class also requested (or more like demanded) that three modules be added to the program: Time Management, The Shift (from staff to manager), and "How to Talk Good" (table).

We continue to recruit managers for the program, with the goal of providing it to all our managers. The third class probably will be open to managers from other agencies, as our colleagues are interested in the program.

In addition, our Quality Improvement Department is helping to develop metrics to assess the program's effectiveness. We are considering measuring the manager turnover rate, staff turnover rate, tenure of managers, staff satisfaction, and various measures of program performance.

Conclusion

We believe we are taking a proactive approach to addressing the leadership crisis. We have stimulated our managers to become continuous learners as they enthusiastically engage in further learning opportunities. In addition to the classroom experiences, we strive to instill a passion for helping people and changing their lives for the better.

David R. Selden, ACSW, LICSW, is Director of Community Rehabilitation Programs at the North Suffolk Mental Health Association in Chelsea, Massachusetts. He is also Adjunct Faculty in the Department of Psychology at Salem State College.

Selden has more than 35 years experience as a clinician, supervisor, consultant, and executive-level manager in provider, managed care, and business settings. He may be reached at (617) 851-6223 or DSelden@northsuffolk.org.

References

1. Browning-McNee LA. Advice for new leaders. Behav Healthc 2006;26(10):17-18.

2. Powell DJ. No time to reinvent the wheel. Behav Healthc 2006;26(10):10,12.

3. Belenky MF, Clinchy BM, Goldberger NR, Tarule JM. Women's Ways of Knowing: The Development of Self, Voice, and Mind. 10th ed. New York: BasicBooks; 1997.

4. An Action Plan for Behavioral Health Work force Development. Cincinnati: The Annapolis Coalition on the Behavioral Health Workforce; 2007. www.annapoliscoalition.org/files/Strategic_Planning/WorkforceActionPlan.pdf.

5. LaMaster S, Nemec P. Work-Based Learning: An Approach to Workforce Development. Presented at the MassPRA 7th Annual Conference; October 18, 2007; Worcester, Massachusetts.