Robin Mindell about Quality Management in Psychotherapy.

QM in Practice

Quality in individual work settings, therapy sessions and charity-related work requires a sound organizational setting. QM must therefore be a comprehensive principle that guides the dealings of all members in the shared practice, as well as the collaborators in Spielzeit and its sponsor. Consequently, the work environment must be such that all team members are motivated and self-reliant in realizing their potential. Quality is not only assessed at the conclusion of therapy but is incorporated from the beginning of treatment. This approach requires an organizational setting that values open communication and motivation, supporting employees’ feedback (i.e. how to improve work processes). Thereby, each team member becomes responsible for the quality of services.

Our operational goals are not meant to compete with other therapeutic organizations. Instead, we strive to improve the administrative, financial and therapeutic performances overall.

Spielzeit’s QM approach is not merely a “nice idea”. It constitutes a long-term effective strategy. Each person’s participation in the thinking process and solution-oriented approach is integral to Spielzeit’s everyday operations. The continuing assessment of improvement opportunities and new challenges organically provides important “construction sites” to launch QM efforts. The goal of this assessment is to identify “critical occurrences” by systematically probing individual work processes for potential misunderstandings, chinks and flaws. These may include reliability, professional competence, performance as well as friendliness.

Quality Goals

While the concept of “quality” is challenging to define, its very definition has important implications. It has become apparent that quality in the context of social organizations should no longer be defined by the team alone but instead must lay emphasis on the expectations of clients and donors. Insofar, a mutually agreeable consensus is to be sought. Performance agreements governing donations as well as therapy processes must incorporate quality as a central tenet; the client thereby assumes the role of an independent and self-reliant contract partner. He must rate the means and benefits of therapy and subsequently decide whether these services are worthwhile. We therefore no longer view only the patient as the exclusive client but also his support system. This extended patient group includes children, adolescents and their families, other therapists, doctors, employees of government agencies as well as donors with their specific ethical philosophy of how their contribution ought to be used.

In accordance with the tradition of transparence, we will now elaborate on our views of quality, as they greatly influence our collaboration with “clients”.

Quality is the result of constructive consensus building between service provider and client. Spielzeit philosophy holds that children and youths must be supported in their development to become self-reliant individuals within their personal means. At the same time, they must be empowered to become autonomous participants of society. We thereby follow an integrative approach to therapy based on social tolerance and respect for each child’s individuality. We create a psychotherapeutic environment that is free of value judgments and accepts each child’s physical and mental uniqueness. Essential to societal integration, this focus on the child’s intrinsic values bolsters his self-respect in relation to self and others.

Relationship between Donor, Provider and Client

A quality-focused agreement between donor, client and Spielzeit therefore requires combined efforts to determine a child’s potential and to bring together the different views of what development for each child means. The assessment of these pre-established therapy goals provides a continuing challenge for all parties of the agreement.

The goal stipulation formulated together with the donor builds the cornerstone for a mutually effective “relationship”. Our information brochure provides detailed information about donation and sponsorship opportunities and their practical applications. At the basis of all contribution activities is that a donor earmarks funds to Spielzeit’s sponsor MLI for a specific project or the therapy costs of an individual child. Spielzeit regularly informs the MLI about the need for sponsorships. In particular, Spielzeit communicates to the MLI whether there are any inquiries for therapy from gravely ill or otherwise impacted children of financially challenged families.

Requests to the MLI detailing the financial needs of clients are kept anonymous. Any such correspondence with the MLI is governed by the provider-patient privilege and executed according to clearly stated mandates. Applicable requests are then assessed. If approved, and the needed funds are available, the MLI will compensate Spielzeit for the therapy costs on behalf of the requesting family. The child and his family are given fictitious names to provide the donor with a regular progress report. These updates inform the donor of the exact allocation of his donations and the subsequent therapeutic results. He can then assess the usefulness of his financial contributions and decide on the continued support of the child’s therapy, if warranted.

Quality: An Opportunity

Unmatched anywhere in Switzerland, these efforts allow for a unique system that treats all sponsorships, donations or grants as separate entities. General and specific contributions alike are clearly described in the MLI’s annual report. Each sponsorship is listed as a separate cost unit (consisting of separate accounts) in the annual budget and income statement. In this manner, each expenditure is clearly accounted for and the sum of all services become transparent. If the cost unit of a sponsorship carries a surplus at the end of the therapy year, the sponsor is refunded the surplus amount.

These are the agreements made between donors and the MLI to allow Spielzeit to offer free or cost-reduced therapy: Donors and providers have a binding agreement setting forth treatment provisions and quality control.

Thus, the detailed financial and therapeutic documentation contains the following:

• Goal definition (the therapy patient with specific needs and therapy goals)
  
• Timing and procedure of goal assessment (therapeutic quality assurance)
  
• Provisions for personnel and organizational resources (expenses)
  
• Financial stipulations (pledges for individual sponsorships)
  
• Timing and procedure of financial account files (financial quality assurance) and
  
• Documentation of the psychotherapeutic treatment courses.
  
  The ability of the MLI to execute QM to this extent depends on several factors, including generous volunteer and community service work. QM applications, however, can mostly be attributed to strict economy measures and work efficiency, with administrative expenditures limited to maximally 12.5% of the entire budget.
  
  QM applications help avoid flaws and uncertainties common to daily practice; rendered services are improved and a positive work atmosphere is created. Last but not least, each co-worker’s creativity and enthusiasm for the joint goals made transparent through QM are integral to Spielzeit’s philosophy: they are the substance that allows for our young as well as our grown-up clients to be interested in a constructive collaboration. Every good relationship within the team and, above all, the good relationhips with our clients, sponsors and agencies create a fruitful working community. Such a community is the fertile soil upon which the severely challenged children are able to develop their fullest potential.

  Zurich, December 2006
  

  Robin Mindell, M.Sc.
  

   

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