The Mental Health and Mental Retardation Authority of Harris County

Last month, I wrote about the tragic events that occurred in our country on September 11th and the country’s response to those heinous attacks. I had started an article that was internally focused on the changes occurring within MHMRA but decided to hold those thoughts due to the impact of the national and worldwide actions on our local consciousness. Now, as I dust off the topic (being another month down the road from September 11), the spread of effect on our daily lives, the economy, the national legislative agenda (including a myriad of hopes for healthcare and funding for persons with mental disabilities) is becoming a little clearer. So much has, in fact, been impacted — so much has changed.

The national adjustments to internal terrorist threats/attacks continue to unfold. The war on terrorism continues to intensify. Both have required significant readjustments of Federal budgetary priorities. Add to that the effect on the Texas and local economies in terms of reduced consumer spending and adjustments within major corporations (resulting in substantial job reductions) as a major blow to the tax support for Texas government impacting its many functions and activities. Some speak in hushed tones about the 78th Legislature facing billions of dollars (that’s with a “B”) in deficit when they come back into session and undertake the appropriations process for Fiscal Years 2004 and 2005. While much will occur over the next 14 months (the session starts January 2003), the Legislative Budget Board (LBB) review process of the state agencies’ biennial budget submissions (developed in response to firm guidance from the LBB — called the Legislative Appropriations Request — LAR) will occur during the late summer and fall of 2003. The LAR development process by the various state agencies such as TDMHMR will start this spring, with formal action anticipated by the State Board of TDMHMR on a document for submission to the LBB probably early in the summer of 2003. If one listens to those who know, including those most concerned and sympathetic to the service and support needs of Texas residents with mental disabilities, the 78th appropriations process is not going to be “pretty.” In fact, it is probably going to be one of the most difficult sessions in recent memory. The finances of the state, coupled with the potential changes in composition as well as legislative leadership due to the redistricting and forthcoming elections, may combine to make this coming session an “experience to remember.” For sure, finances will be tight and the budget process difficult.

This sets the backdrop for the primary point of this article — the changes in progress within MHMRA. For some time now we have been concerned about the support and operations components of the Agency and whether or not there were opportunities for improvement such that we might better address the primary mission: ensuring the provision of vitally needed services and supports to and for the people within Harris County who have a significant, often complex, mental disability qualifying for such care under the available payor plans financing our public “safety net” system. Increasing requirements by the Texas Legislature to earn up more and more of our financing, coupled with minimal tax-based inflationary adjustments, necessitated another look at what we do and how we do it. It became increasingly obvious that we, as an organization, needed to undertake an objective, thorough evaluation of the operations under the departments of Accounting and Finance, Contracts and Purchasing, Information Technology (including the problems/issues with our primary software vendor — Anasazi), and Human Resources such that our extremely limited resources could, in fact, produce the greatest impact in assisting our consumers to lead participatory, constructive lives as members of our community. Additionally, due to the explosion in expenditures under our pharmacy budget (the cost of pharmaceuticals becoming an ever-increasing portion of the budget — particularly draining the Adult Mental Health available resources), we needed to better understand this important aspect of our available treatments, both in terms of how to efficiently deliver consumer services as well as contain the costs of these expenses to the degree possible.

Thus, a series of outside consultants were identified and hired starting last spring to undertake evaluations in each of the areas mentioned above: Accounting and Finance, Contracts and Purchasing, Information Technology, Human Resources, and Pharmacy Services. Those evaluations — a serious self-examination — were in progress over the summer — some of which continue to-date. We now have final reports from the initial evaluations of IT, HR, and Pharmacy with preliminary reports from the folks reviewing Accounting/Finance and Contracts/Purchasing — all of which have been reviewed internally as well as with the MHMRA Board. In each area, important findings have indicated that opportunities indeed exist for being able to better utilize the resources we have to enable our clinical components to be more effective.

This process, which we initiated ourselves, is a painful one. As you are aware, changes have occurred in several key positions within the organization. Policies and procedures are being rethought, rewritten, or, in their absence, written for the first time. Positions and functions are being evaluated to determine what we, as an organization, need to “go forward” into this next decade of behavioral healthcare changes — what we need to be truly competitive, effective, and efficient.

This is not an easy process — the level of retooling to ensure that we are maximizing productivity and delivering quality services will take many months. We are, in essence, creating a new level of expectation within MHMRA. We are recreating ourselves. Holding our values up to the light and expecting that we behave in a consistent fashion. It raises the level of anxiety throughout our organization for obvious reasons. It is a process that I hope will cause every one of us to look at how we function: are there ways of boosting productivity and reducing inefficiencies (reducing non-essential tasks or activities)? Are there ways of working smarter, not just harder? Are there ways of better meeting or exceeding the expectations of our consumers and their families?

Accountability — now and into the future. Accountability at the individual staff level — each one of us — and at the organizational level — the system as a whole. These are challenging times that require that we shed the mantle of governmental lethargy. It is essential that we truly obtain “best value” for the resources available. As we continue to subject ourselves to the microscope of self-examination and compare ourselves to the best practices within the industry, I am confident that we will find ourselves stronger, more vibrant, responsive and, ultimately, more closely attuned to our consumers and their families.