the university of georgia variations in the adoption of management practices across types of...

The University of Georgia

Variations in the Adoption of Management Practices Across Types

of Substance Abuse Treatment Systems

Paul M. RomanHannah K. Knudsen


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 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


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


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


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


Human Resource Management

• SA organizational HRM practices are:

SignificantImportantMake a difference in

“workforce” behavior


Research Questions

• Are there differences in HRM practices & policies across the four types of centers?

• Which HRM practices are associated with counselor turnover?


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


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


Results:HRM Practices and Policies


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


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


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


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


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


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


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


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


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


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


Results:HRM Practices/Policies & Counselor Turnover


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


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)


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


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)


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


The authors gratefully acknowledge the support of research funding

from the National Institute on Drug Abuse (R01-DA-14482 and R01-DA-

13110).

This presentation and other reports from the National Treatment Center

Study are available at http://www.uga.edu/ntcs

the university of georgia variations in the adoption of management practices across types of...

Documents

typology of treatment

public government

knudsen slide

types of centers

workforce behavior slide

hrm practices policies

funded centers n

nonprofit organizations