Help! I just assumed the director’s role at a 40 bed residential program with an outpatient arm. Things do NOT look good. The previous director retired unexpectedly and is suddenly nowhere to be found. So much for transition. Apparently he didn’t believe in computer records or filing cabinets so there are piles of paper all over my office. There’s no staff evaluation system and it looks like most of our 50-plus employees haven’t had an evaluation in three years. The Board’s not much help and the supervisors spend most of their time arguing over minutia. I know I have to put in a real HR component, but if you were in my place, where would you start on turning this into a real treatment program?”

Wow. We feel your pain. Glad it isn’t ours, heh-heh.

Seriously, I see two ways to look at this. One, it’s a frickin’ mess. Two, any improvements will be noticed. Like cleaning out a really cluttered closet — at least you can see how much junk you’ve removed.

As far as where to start: I’d do a little informal interviewing with the staff that work most with the patients — including support staff — to get some idea of who your strongest clinicians are. Listen particularly for the phrase, “his/her patients just seem to do better than most.” Those will be your ‘anchor’ staff, the ones that can perhaps actually produce an outcome. Then sit them down individually under the heading of general fact-finding and see how happy or unhappy they are. You may want to make sure you hold on to them.

By the way, in a dysfunctional organization, it’s often the weaker employees who get promoted, because they don’t represent a threat to the weak leader. So your management team may require some revising.

Good luck. Write back and tell us how things go.