Post on 26-Dec-2015
The University of Georgia
Variations in the Adoption of Management Practices Across Types
of Substance Abuse Treatment Systems
Paul M. RomanHannah K. Knudsen
The University of Georgia
General Theme
• The importance of the organizational framing of health services issues
• Tap into a massive research literature• Reduce isolation and learn from other
“industry” experience• Generate novel applications of
theoretical frameworks
The University of Georgia
The American Substance Abuse Treatment System
• The national “system” that has evolved since the 1970s draws from diverse roots, such as:– Public substance abuse treatment facilities– State psychiatric hospitals– Community-based non-profit organizations that
draw heavily on government block grants/contracts for funding
– Private general hospitals and psychiatric hospitals– Entrepreneurial for-profit treatment programs
The University of Georgia
A Typology of Addiction Treatment Centers
• Much of the literature views the system as a simple dichotomy: public (government-owned) vs. private (all others)
• By integrating information on:– Ownership (public vs. private)– Profit status (non-profit vs. for-profit)– Funding/revenue sources (government block
grants/contracts vs. insurance/self-pay)• A typology of treatment centers emerges:
– Government-owned– Publicly funded non-profits– Privately funded non-profits– For-profit
The University of Georgia
Applications of the Typology
• This four-category typology has substantive meaning in terms of service delivery– Differences in medication adoption by center type– Differences in availability of integrated care for co-
occurring substance abuse & mental health conditions
• It is less clear if this typology is meaningful in characterizing the management of these different types of organizations– This presentation focuses on human resource
management (HRM) practices and policies– We also consider whether HRM is associated with
counselor turnover rates, a measure of organizational performance
The University of Georgia
Human Resource Management
• Has generally been overlooked in SA health services research
• This neglect is found together with near-panic level concerns with “workforce” issues
• Within the SA policy field, “workforce” seems exclusively defined as labor market issues:– training – salaries – mobility – turnover
The University of Georgia
Human Resource Management
• SA organizational HRM practices are:
SignificantImportantMake a difference in
“workforce” behavior
The University of Georgia
Research Questions
• Are there differences in HRM practices & policies across the four types of centers?
• Which HRM practices are associated with counselor turnover?
The University of Georgia
Sample
• Data from the National Treatment Center Study– Community-based addiction treatment centers– Must offer a minimum of outpatient care (as defined by
ASAM)
• Two nationally representative samples– Publicly funded centers (n = 363): > 50% of revenues
from government block grants/contracts Response rate = 80%
– Privately funded centers (n = 401): <50% of revenues from government block grants/contracts
Response rate = 88%
• Data collected via face-to-face interviews with administrators and/or clinical directors
The University of Georgia
Key Measures
• Human resource management practices/policies in three broad categories:– Financial benefits– Employee well-being– Family-friendly practices/policies
• Counselor turnover as number of counselors that left in the past year
The University of Georgia
Average Counselor Salary
$34,090
$35,380
$29,270
$32,840
0 10000 20000 30000 40000
For-Profit
Private Non-Profit
Public Non-Profit
Gov-Owned
• The average counselor salary was $32,690• Gov-owned > public non-profit• Private non-profit > public non-profit &
gov-owned
The University of Georgia
Universal Eligibility for Employee Benefits
73%64% 60%
47%
0%
20%
40%
60%
80%
100%
Gov-Ow
ned
Public
Non-
Profi
tPr
ivate N
on-P
rofit
For-P
rofit
• Administrators were asked if all counselors were eligible for employee benefits
• About 60.9% of centers reported that all counselors were eligible for benefits– For-profits less likely to
have universal eligibility than government-owned & public non-profits
The University of Georgia
Retirement Program
91%
70%
86%
51%
0%
20%
40%
60%
80%
100%
Gov-Ow
ned
Public
Non-
Profi
tPr
ivate N
on-P
rofit
For-P
rofit
• Administrators were asked if the center makes financial contributions to a retirement program for its employees
• Although a clear majority of centers have a retirement program (75.7%), there are considerable differences by center type– For-profits less than all
others– Public non-profits less
likely to offer than government-owned & private non-profits
The University of Georgia
Family Leave Policy
95%86% 92%
86%
0%
20%
40%
60%
80%
100%
Gov-Ow
ned
Public
Non-
Profi
tPr
ivate N
on-P
rofit
For-P
rofit
• Administrators were asked if the center had a family leave policy
• Family leave policies are nearly universal (89.4%)
• No differences by center type
The University of Georgia
Child Care for Employees with Children
13% 13%
36%
7%
0%
20%
40%
60%
80%
100%
Gov-Ow
ned
Public
Non-
Profi
tPr
ivate N
on-P
rofit
For-P
rofit
• Administrators were asked if the center offered childcare services to its employees with children
• About 20.4% of centers offer childcare, but this is largely driven by the significantly higher rate of childcare in private non-profits
The University of Georgia
Elder Care for Employees with Aging Parents
2% 4%12%
1%0%
20%
40%
60%
80%
100%
Gov-Ow
ned
Public
Non-
Profi
tPr
ivate N
on-P
rofit
For-P
rofit
• Administrators were asked if the center had an eldercare program
• This benefit is very rare (6.3%), but again, private non-profits are more likely to offer it than other types of centers
The University of Georgia
Flextime Scheduling
73%66% 65%
62%
0%
20%
40%
60%
80%
100%
Gov-Ow
ned
Public
Non-
Profi
tPr
ivate N
on-P
rofit
For-P
rofit
• Administrators were asked employees had the option of a “flextime” work schedule
• The majority of centers (65.7%) offer flextime options
• No differences by center type
The University of Georgia
Wellness Program for Employees
64%
48%
73%
42%
0%
20%
40%
60%
80%
100%
Gov-Ow
ned
Public
Non-
Profi
tPr
ivate N
on-P
rofit
For-P
rofit
• Administrators were asked if the center offered a wellness program
• This is also a benefit that has been adopted by a majority of centers (58.1%)– Government-owned
more likely to offer wellness than public non-profit & for-profit
– Private non-profit more likely to offer than public non-profit & for-profit
The University of Georgia
Employee Assistance Program (EAP)
80%
51%
76%
38%
0%
20%
40%
60%
80%
100%
Gov-Ow
ned
Public
Non-
Profi
tPr
ivate N
on-P
rofit
For-P
rofit
• Administrators were asked if the center had an employee assistance program (EAP)
• The majority of centers have an EAP (62.1%), but availability varies widely across the four types of centers– For-profits less likely than
government-owned & private non-profits
– Public non-profits less likely than government-owned & private non-profits
The University of Georgia
Summary
• The four-category typology revealed significant differences in HRM policies and practices
• Within the public sector, government-owned centers tended to be more advanced in HRM than publicly funded non-profits
• Privately funded non-profits tended to be ahead of other centers in family-friendly practices (e.g. childcare, eldercare)
• For-profit centers tended to lag behind the other types of centers in HRM
The University of Georgia
Counselor Turnover in Addiction Treatment Centers
• There is growing concern about the high rates of counselor turnover – Some estimates range from 18% to 50% per
year
• Health services researchers have been trying to identify organizational factors that reduce turnover
• No research on whether HRM practices/policies can reduce turnover
The University of Georgia
Counselor Turnover Rates
• Across all centers, the average rate of turnover was 18.1%– Government-owned: 16.1%– Public non-profit: 23.9%– Private non-profit: 14.6%– For-profit: 14.4%
• Turnover in public non-profits significantly greater than both types of private centers– Trend for higher than government-owned
(p=.08)
The University of Georgia
Modeling Counselor Turnover
• There is substantial skew in the measure of turnover rate– 35.0% of centers reported no counselor turnover
in the past year– In small centers, turnover rates can look inflated
• We model the number of counselors who left in the past year, while controlling for the number employed– We use negative binomial regression because it
is less sensitive to skewed data than OLS regression
The University of Georgia
NBR Model of Counselor Turnover:
Center Type• Net of HRM, levels of care, and center
accreditation, there was one significant difference in counselor turnover by center type– Compared to public non-profits, turnover
was lower in private non-profits Expected count of turnover 28.1% lower in private
non-profits
– Turnover in for-profits, relative to public non-profits, trended lower (p=.06)
The University of Georgia
NBR Model of Counselor Turnover:HRM Practices & Policies
• Net of center type, levels of care, and center accreditation, three HRM measures were significant– Average counselor salary negatively associated with
turnover A standard deviation increase in salary (about $7,700) was
associated with 11.8% decrease in expected count of turnover– Universal eligibility for employee benefits negatively
associated with turnover If all employees were eligible for benefits, the expected count
of turnover was 22.3% lower– Presence of a childcare program reduced turnover
Expected count of turnover was 30.4% lower in centers with childcare
– Trend of presence of a wellness program reducing turnover (p=.06)
Expected count of turnover 17.2% lower in centers with wellness program