Congruence in Behavioral Health | Valley Cares
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August 15, 2016 By Gary Larcenaire

Enduring brands are those we trust, that fulfill a need and resonate with us emotionally. In “behavioral health”–the umbrella term I use to include psychiatry, developmental disabilities, addiction, rehabilitation, counseling, and social services–brand loyalty increases over time when “stakeholder” expectations and the brand experience are tightly aligned.

I use the word “stakeholders” here as opposed to “customers” because, in not-for-profit behavioral health, there are so many individuals depending upon the service system, that the term “customer” is simply too narrow to do justice to the demands and expectations placed upon our (typically under-funded) service systems.

[Behavioral health practitioners, support staff, and administrators have to dance every bit as gracefully as everyone else, we just have to do it] “Backwards, and in [borrowed] heels”, Ginger Rogers

In behavioral health we certainly have “service recipients” or what other industries would call “customers”, but the broader range of “interested parties” in behavioral health may, at any time, include all three branches of government, a slew of payers and regulators, a host of family, friends, social and legal advocacy groups, and last but certainly not least: a highly-skilled, passionate, fiercely independent, (and scarce) workforce. It’s one thing to mess up a fast-food order. It is quite another to fall short when arranging thoughtful, collaboratively developed, patient-centered discharge planning.

I am not complaining about our broad stakeholder base; just stating a fact I have observed over nearly 30 years of service. Maybe I am minimizing the complexity of other fields, but I don’t think so.

I believe that behavioral health practitioners, support staff, and administrators have to dance every bit as gracefully as everyone else, we just have to do it in the famous words of Ginger Rogers: “Backwards, and in [borrowed] heels”. I, of course, added the bracketed content, but the quote fits the behavioral health field perfectly.

Congruence is very much possible to reach in the behavioral health field, but it is more challenging, and harder to measure than in other fields. Marketing and branding serve to provide visual and emotional reinforcement of what a brand stands for, and how we will all benefit from using those goods or services when we need them.

Study the picture above that I found online while researching this topic. We have all experienced the opposite of congruence. It is no fun. Few things are as disappointing as when a brand or product’s advertising campaign resonates with us, but the experience falls so short from the ideal, we are left feeling unfulfilled and slightly defrauded. Have you ever had this happen to you? If so, please describe your experience in the comment section below. I do not intend to demean the fast-food industry. Without it, I would have been penniless in high school, and likely would have starved in college, but admittedly, it is one thing to mess up a food experience; it’s another to fall short when discharge/transfer planning for a patient or client. I believe that the emotional (not to mention financial) consequences are far more substantial when behavioral health systems fall short.

Few things are as disappointing as when a brand or product advertisement resonates with us, but the experience leaves us feeling unfulfilled and even defrauded.

Broadly, there are two essential steps to establishing standards and measuring congruence:

Step One:

In step one, it is critical, especially in behavioral health, to budget time–and money–to develop a list of core, non-negotiable values, a concise mission statement, logo, a marketing plan, and clear branding guidelines. Step one is not easy. Done properly it is arduous, emotionally draining work. The essential task of developing deeply empathic descriptions of the emotional states of every stakeholder, and how our service systems can, and should respond, is draining and takes hours (days) to complete.

Step one is challenging, but relatively easy compared to step two:

Step Two:

Developing a process of ensuring that the stakeholder experience, is tightly aligned with the developed and approved brand model.

“Congruence” Is the compliance between the ideal self and actual self” -Carl Rogers

Author John Spence’s description of congruence, relative to the high-end automobile market isn’t something I can improve upon so I won’t try, but I did add the bracketed content to align with behavioral health processes:

“At the heart of this concept [congruence] is the strong belief that every single aspect of the brand experience must be uncompromisingly consistent throughout all touchpoints with the consumer [stakeholder].

From first exposure,[crisis call, web site inquiry, ad exposure] to pre-purchase, [intake assessment, prescreening] to the buying event, [co-pay collection and billing, service provision and follow-up, solid performance in contract and regulatory compliance, and of course, measurable clinical improvement] to product decline and eventual obsolescence [discharge planning, referral, post-acute care monitoring] and finally to re-purchase [referral or relapse]— every interaction must fully support the brand promise.” -

What Mr. Spence describes is an ideal to strive for at all times. This should be made clear to every employee in behavioral health. We must make it clear to all new hires and veterans that falling short of our carefully-crafted brand expectations, represents a “gap” and obligation to learn and improve. We have made a promise, and intend to keep it!

I see no more pressing challenge for leaders in behavioral health than to establish a marketed “ideal”, and then to work tirelessly to close the gap between that ideal and the experienced “actual” for our stakeholders.

Let me underscore, that by definition here, “brand congruence” and “gap management” applies as much to the employee experience as external stakeholders.

If employees feel that they were “sold” one company at interview and on-boarding and are then disappointed, the problems of turnover and low employee morale will certainly render more difficult if not impossible “gap closure” in other areas. Accordingly, do not fail to establish and measure employee congruence with the same vigor and accountability! Metrics should be centered around measuring congruence and made a routine topic in staff communication, training, on-boarding, compensation and performance review.

Do not fail to understand and measure employee congruence with the same vigor and accountability The essential ingredients necessary for brand congruence include Non-negotiable core values, brand congruent, well-sourced and-supported (superior training and paid for performance) employees, brand-congruent, well-maintained infrastructure, constant measurement, and broadly-shared feedback. Here is a good checklist to get started:

Step One Steps:

Budgeting for congruence.

Core Value Development: A multi-level, externally facilitated “gut check” about what a brand stands for: aka non-negotiable “core values”. Stakeholder Identification and description of their likely emotional state. Broad release of branding guidelines and strict adherence at all levels. Development of 12-month marketing calendar

Step Two Steps:

Incorporation of core values into applicant screening, employee evaluation, and compensation design.

Routine stakeholder survey process. (Daily, weekly, monthly quarterly, semi-annually, annually; judgment is required here to avoid stakeholder saturation and fatigue, but also to maintain value)

Broadly shared, prompt, constructive feedback and training processes at all levels regarding survey findings. Prompt feedback and training mean prompt. At ALL levels of the service system.

Compensation alignment which is substantially based upon the closing of the “Congruence Gap” (Stakeholders and Infrastructure) I hope this has been helpful. Valley Behavioral Health has solidly completed step one tasks. I would like opinions on where you think we are on the second step tasks!

Disclosure: The number of exceptional authors and consultants who have shaped my thinking on this subject over the years are simply too numerous to mention. If you are one: I am eternally grateful to pass on my experience, influenced by your original works.

NOTE: Valley Behavioral Health Directors: I hope this has been a helpful starting point. I look forward to furthering discussion here, and at our leadership sessions in Fall 2016.

Gary Larcenaire,
CEO Valley Behavioral Health

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