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Fearing and Fetishizing Innovation in Behavioral Healthcare

October 16, 2019

The news reports have become more routine and specific on how industries will be transformed by automation and workers replaced in the process. The automotive industry is already heavily automated, but auto companies can predict with precision the decline in workers over the next few years. We tend to think this trend is specific to manufacturing because this has historically been the case.

Behavioral healthcare clinicians presumably would be secure amid such changes because their work hinges on the uniqueness of interpersonal relationships and communication. Not so fast. What if therapy took less time? What if we could forestall problems to the point where therapy was not needed? What if we could separate the parts of treatment that need a professional from those that don’t? What if smart technology that could perform essential parts of the therapy experience for consumers?

We are told that some workers displaced by automation will transition to a new job doing some remaining vital role, while others will need to switch to new jobs entirely. People who earned advanced degrees and professional licensure never expected to encounter such a fate. However, profits are partly driven by greater efficiency, and there will be no hiding from the laws of capitalism. The therapy hour is not sacrosanct.  

Early signs of change

What are the tools of automation in behavioral healthcare? The early phase is marked by tools of facilitation. Face-to-face services can be held by phone instead, or better yet, by video. The therapist is still critical, but the therapy office is not. The wellness industry introduced the health coach, and the nurses who initially helped people focus on chronic illnesses or lifestyle changes have been supplemented by non-professionals. These coaches are sentient beings, available by phone or text.

The content of what professionals impart to people can be presented in compelling ways via web and mobile devices. Digital tools can take complicated therapeutic interventions such as cognitive behavioral therapy and present them in bite-sized, interactive form. Therapist lectures and personal stories of recovery can be filmed and presented online. Adult learning principles can be used to inform highly effective, evidence-based digital modules. Sentient beings and offices are now both passé.

Consumers appreciate the broad availability of telehealth and digital tools, while businesspeople value their quality and cost. Innovation now relies on departments rather than disrupters, and financial officers are projecting savings. None of this started with animosity directed at therapists. Try telling that to a therapist being displaced. The irony here is that the power of therapy motivated these changes.

The challenge of harmonizing

“We live in a time of change,” qualifies as an ageless platitude. The real question is which forces for change we prefer. Some metaphor for conflict might seem most appropriate since there are big winners and losers as industries evolve. I think the real mission is to weave together several distinct melodies into a pleasing harmony.

Business executives love each of these melodies, and this is what makes the task challenging. A love for the behavioral healthcare industry (aka operations) is an easy starting place. Let’s find ways to increase access and improve quality for the millions depending on our critical field. A love of finance can be found within any successful businessperson. We must continually fuel sustainable growth with efficient operations and reasonable profits. Finally, a love of innovation (with technology as a component) consumes those developing new products or charting strategies to drive long-term financial and operational success.

The challenge is to harmonize these melodic strains, not choose one over the other. Not every melody can be harmonized. Some strategies for growth and innovation can damage the industry, while popular industry tunes of the past may imperil it today. The behavioral healthcare executive must nurture a convincing and satisfying harmony from all three of these powerful melodies. However, innovation is the least familiar of the three and the most likely to inspire extremes of emotion.

The timing for innovation

Innovation works for good or bad, depending on one’s perspective. It might cannibalize some existing jobs for clinicians, and yet innovation may ensure that clinicians work largely “at the top” of their licensure. Professionals largely should be paid to use their clinical judgment rather than carry out lesser administrative tasks, and innovation may facilitate this.

Innovation can amplify clinical quality. For example, innovative design can ensure that the measurement of clinical results is core to the delivery of all interventions, and in so doing quality is enhanced. Consumer empowerment can also be supported by insisting that consumer feedback is assessed before, during and after any innovative plan.

Despite many potential advancements, innovation needs to be approached with caution. It is vitally important to avoid innovation for the sake of innovation. This can result in important industry or financial goals being sacrificed. Love for the latest technology too often seems to be the real driver for change. Falling in love with technology can be dangerous.

Such love can mean that we fall prey to solutions in search of a need, solutions that eliminate necessary clinical judgment, or innovations that are really passing fads. It is not always easy to tell a game changer from a dud. Several years ago, a wearable device was developed that could chart a person’s movement over the course of the day. Entrepreneurs postulated this as a solution to charting depression since inactivity is a feature of depression.

Thanks to technology like this, we may one day be wearing devices that read our changing moods over the course of the day. Or not. When should a treatment program invest in such a technology? Most leaders will not reduce clinical staffing or invest operating revenue for the admiration of being an early adopter. If the clinical goal is earlier identification of depression, most leaders will push instead for existing solutions like getting depression screening tools used more widely in primary care practices.

The theoretical model on adoption labels the second wave of leaders investing in an innovation the “early majority adopters.” They take more time to deliberate over new ideas, but they are faster at implementation than the late majority or the laggards on the adoption train. We need studies on the comparative experiences of executives implementing solutions like digital CBT at different stages.

Digital CBT is ripe for study since it has been undergoing dissemination and refinement for about 10 years, and it is now a clinically validated innovation in early majority adoption. Every CEO must decide when an innovation is ready for their system and when investing in it harmonizes with operational and financial plans. A good CEO knows how to create an energizing harmony for her company from three lines of melody.

Ed JonesEd Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.

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