I was reading the magazine of the Australian Institute of Company Directors (AICD), Company Director (August 2018 edition) whilst the radio droned in the background a steady diet of politicians talking about the leadership crisis in Australia and the problems of self interest in politics and the loss of faith and trust of the community in democratic processes and their representatives. I turned to the Company Director and started flicking through it and couldn’t help noticing that every page seemed to be headlining the issue of TRUST:
- The trust deficit caused by poor corporate culture,
- Financial services and banks losing people’s trust due to inappropriate or illegal charging of fees,
- The findings of the Royal Commission into Institutional responses to Child Sexual Abuse that there were numerous governance failures that contributed to child sexual abuse and that institutions require a systematic overhaul of the culture, structure and governance practices that allowed abuse to flourish over many decades,
- The Roy Morgan list of trusted and distrusted companies,
- The reformation attempts of companies such as Uber, Facebook, AMP, CommInsure and others who through data breaches, privacy breaches, cultures of bullying and sexual harassment and unethical financial practices have tarnished their brand and severely punished their own bottom line.
What was there in all of this to learn for a small business owner of a psychology practice from these major failures of processes, dismissal of ethics, disregard of risk mitigation, lack of transparency, gouging, poor customer service and blatant corruption?
Michael Levine, CEO of Roy Morgan Australia lists the top drivers of trust in 2018 as:
- Good customer service
- Ethical behaviour/integrity
- Previous good experience with the company/business
- Social Conscience and good corporate citizen
- Good quality products
- Long history
- Customer focus
The top three drivers of distrust are:
- Greed, self-interest, profits before customers
- Dishonest and deceitful, false and misleading advertising and false product claims
- Being unethical, lacking integrity
The learning for us is as follows:
- If we are in private practice, we are running a business
- A health business is subject to many of the same expectations as a commercial enterprise
- Government and the community trust psychologists. We have earned that trust generally through our training and due to the greater importance now placed on mental health
- That trust however can be lost if we take it for granted. It is given to us by our clients and that clients are forgiving if we don’t get their problem or chose the right intervention in the first instance. However, they will also expect that we are prepared to understand their difficulties and find a way forward for them.
Creating Trust in a Psychology Private Practice
So, what are the top drivers of trust for a psychology private practice (following the Roy Morgan list):
1. Good customer service
Clinical excellence that is based on evidence-based practices, utilisation of client feedback, a focus on continuous improvement with each client and processes that support routine outcome measurement, so we can identify lack of progress or deterioration whilst receiving psychological services and ‘drop out’. A capacity to build a therapeutic alliance with clients with a broad range of goals for therapy and a deep understanding of these and our role as therapists.
We identify when we are not currently helping a client achieve their goals or that we need to change our approach with their feedback at the centre of those changes. Honestly acknowledging that clinicians are not in the best position to identify lack of progress or deterioration and often tell themselves things like “the client wasn’t ready to change, that’s why they stopped attending” to hide the reality that they didn’t see the client drop out coming. Referring a client to someone who could help them better is not an admission of failure.
3. Ethical Behaviour/Integrity
We need to have business practices and procedures that clearly outline to the client rights and responsibilities in regards billing practices, risk management, treatment planning, consent and confidentiality, record keeping, communication with clients and other work practices that are part of their engagement with our practice.
4. Previous Good Experience with the Company/Business
We value personal referral by (ex) clients and our referring GPs and others. That we seek to communicate with GPs and other health professionals in a way that is consistent with our obligations to the client to act in their best interests but to also be transparent in our approach to issues such as consent, confidentiality and self harm.
When we make an appointment with our clients that this is a special time set aside for them and only them. We don’t move client appointments around to suit ourselves and we work to create a commitment and a sense of urgency with and for clients that communicates that attending appointments is a priority and a path to achieving their goals.
We are not mind readers and we do try to convey to the client our perspective on their difficulties, the why where and how we might pursue a particular approach to therapy given those difficulties and share our understandings of the client and our reflections on their beliefs and barriers to change.
7. Social Conscience and Good Corporate Citizen
Being a registered health professional requires a standard of ethical behaviour but also identifies us as requiring a higher level of integrity in our interactions with the community and our clients because we can (usually inadvertently) do harm due to our position in the community. Being asked to undertake health education and promotion activities in our communities is a privilege.
8. Good Quality Products
We do not promise things we can’t deliver nor advertise that we can cure everything that may be wrong with a person. No testimonials from former clients, no selling products that trade on the trust that a client or the community may have in our opinion just because of our qualifications as a psychologist. Attention to dual relationships so that where we are known to the client in another environment we take steps to manage this and support the client
9. Long History
Psychology has a short history in the private health market compared to GP clinics which have been around for a long time. Our inclusion in Medicare via the Better Outcomes scheme since 2006 says that Government believes in our value to the Australian community particularly in the area of mental health. This is not to be taken for granted or squandered.
10. Customer Focus
Client focused and outcome driven care is the methodology and focus of contemporary psychology. We are scientist-practitioners. Our tool in our work is ourselves and our relationships with our clients. Relationships are not easy to manage without having someone who can help you to gain a perspective on your overall practice, your work with individual clients and your business management. You cannot do all these things without a coach, supervisor, mentor, expert help (e.g. accountant, legal, administrative support) and an orientation to your practice that privileges the feedback from others.
Let’s hope psychology can learn from the review of the commercial and finance sectors and assuage greed and self-interest and follow our long held core values associated with the provision of safe, professional and collaborative services to our communities.