I’ve been browsing some of the websites where employees can post anonymous reviews of their workplaces. Couldn’t helping noticing the really awful reviews that many addiction treatment companies, especially the larger for-profit corporations, are getting from the folks who work for them.

Of course these sites naturally skew towards the dissatisfied, much like radio talk show callers, so we should take that into account. Still, some well-known companies are being lambasted for a host of bad employment practices. It’s the sort of thing you might expect to hear from staff at bottom-quality nursing homes, or telemarketing firms. Not from companies that own pricey rehab facilities.

No Human Resources director, even Dilbert’s evil Catbert, would wish that sort of feedback. It makes for real challenges when you go to recruit quality staff.

What’s going on? Your guess is as good as mine. But I find myself wondering if it doesn’t have to do with the corporatization of the rehab field.

Big for-profit corporations, after all, are run with a principal goal of maximizing profits for investors. Nothing nefarious about that; it’s the point, isn’t it? But people who work in addiction programs often do so for other motives, perhaps having to do with their own recovery, or that of a loved one. It sets up a natural culture clash when management of the first type assumes control of a workforce drawn from the second type.

Over the decades I’ve had the opportunity to observe the rise and fall of several large for-profit ventures– some ‘up close and personal’– and it seemed to me the ones that didn’t make the cut had several key features in common.

One was too rapid expansion. One CFO described his acquisition-minded firm as “a shark that needs to swim and feed to survive.” In this case, the food was acquisitions and expansion. At some point that began to include some risky and even unwise investments. Oddly enough, the middle managers in this case recognized the flaws early on and offered warnings that were ignored by higher-ups.

Another was fierce expense-cutting. Maybe two-thirds of addiction treatment costs are wrapped up in staff, so whenever a company looks to reduce expenses, that’s where cuts are likely to come. For instance, a business that isn’t meeting investor expectations might decide to launch an aggressive marketing campaign without a corresponding increase in staff. That can really help a profit margin but also cause problems in daily operation. When census rises, so can errors and incidents if there aren’t enough people on duty to prevent them.

A third factor: short-range planning. A favorable quarterly report brings so much praise from the business press that it’s easy for management to forget the longer-term impact of expansion and expense cuts. I’m always wary of CEOs who complain that their employees can’t see the ‘bigger picture’. That’s sometimes because they’re aware of the more fundamental problems at the lower level.

A discontented workforce with legitimate complaints that aren’t being heard, accompanied by higher rates of turnover, vacancies, and absenteeism, along with a rising number of critical incidents– that’s a reliable recipe for future trouble. It’s often prelude to lawsuits and regulatory problems.

It can mean the foundation is crumbling even though the exterior still looks grand.