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We developed the MMSE to solve a clinical problem on a geriatric psychiatric inpatient service. The diagnoses of patients on our unit included depression, dementia, delirium, and occasional late-life schizophrenia. We needed a practical quantitative cognitive exam in order to aide clinicians in determining the severity of cognitive impairment ranging from mild to severe and to document improvement or decline. At the time, Susan was a psychiatry resident rotating on the geriatric psychiatric unit where I (Marshal) was a junior attending. Always a perfectionist, she was not happy when I repeatedly asked for cognitive information that she had not asked about. So she asked me to write down all the items that I wanted her to include.
Over the years, students and other users made many suggestions about how to improve the MMSE. There was a need to clarify the instructions so that certain tasks were administered; there was a need for phrases that were more easily translated into other languages; and users requested multiple forms in order to minimize practice effects with serial administration. In addition, we had long wanted to develop a shorter version that could be given very quickly in busy clinical settings, and also a longer version that would eliminate ceiling effects. We wanted this longer version to be more sensitive than the original MMSE to disorders of executive function and to the kinds of memory impairment found in mild cognitive impairment.
The MMSE-2 Standard Version scores are equivalent to the original MMSE scores. We took care that subjects tested during development scored the same, regardless of whether they were given the original MMSE or the MMSE-2 Standard Version. Longitudinal studies currently underway can switch to the new version without any adjustment to scores. The original, unrevised MMSE is still available if users do not want to change to the revised versions.
Marshal takes flute lessons and is trying to improve his photography. Susan enjoys gardening and reading spy novels, biographies, Jane Austen, and Patrick O’Brian. She has a new job at the University of Miami School of Medicine with a joint appointment in psychiatry and in the Hussman Institute for Human Genomics. We both like to write and watch old movies.
Bob Smith: Absolutely. There has always been an issue of test security. People who steal tests are not only costing us money, but they’re also harming the industry and depriving the test authors of royalties. Having a stolen test floating around is potentially quite harmful.
Cathy Smith: We have two employees who regularly surf the web, looking for people who are reproducing our content without permission. They’ve gotten very good at catching these folks and getting them to delete any of our content off their Web sites. Bob Smith: On every order we send out, there’s a statement on our Order Form that says the Customer agrees to abide by the rules and not reproduce our products without written permission.
Bob Smith: Usually, a letter or phone call asking them to stop will do. Most people ultimately want to do the right thing.
Bob Smith: We have hired attorneys in numerous situations to protect our copyrights, and we will continue to do so.
Bob Smith: I agree with the verdict. The student was stealing.
Bob Smith: Don’t do it. Our products are very useful and they are valuable products that are used to help people make better decisions. By infringing on the copyright, you could help to invalidate the measure, causing harm not only to the instrument, but to the test publishing industry, the authors, and most importantly, to the client/patient. PAR’s position is that Customers may not release copyrighted and confidential material to individuals not professionally qualified to obtain, review, or interpret them. PAR’s instruments are trade secrets protected by intellectual property laws, including copyright and trade secret laws. Their usefulness and validity would be greatly compromised if they were available to the general public. Cathy Smith: All materials in our catalog and on our Web site are protected by copyright. This applies to all Web site information, testing products, and everything associated with them. Submitting a completed PAR Qualification Form and/or placing an order to purchase materials from PAR implies your acceptance of these terms and conditions.
Bob Smith: No, our products are not for rent. We do encourage the use of our proprietary tests in research projects. However, we require that a formal written permission agreement be obtained from PAR prior to beginning the work if a modified version or only a portion of test is needed.
Bob Smith: It has always been this way in this industry. Test products must be kept secure. Our products are highly restricted and will stay that way.
Bob Smith: When PAR first got started, the majority of the products we sold were developed externally by authors and sent to us for publication consideration. If we accepted a product, we would provide editorial and production assistance and then market the product. As the company grew, so did our ability to provide a collaborative, internal system of developing products. Today, we internally develop most of our test products in collaboration with outside authors.
Bob Smith: It’s much more expensive now to develop tests than it was in 1977. Unfortunately, the potential revenue doesn’t support the development of some good products today. And because it is so expensive to develop most new tests and because our staff has great test development expertise, we most often develop tests in collaboration with external authors.
Bob Smith: Typically, it takes 3-5 years to develop a test from its conceptual stage to a finished product.
Cathy Smith: We presently have over 40 tests and new software products in development.
Bob Smith: I strongly disagree with the current philosophy that all information on the Internet was intended to be free to share. It costs a significant amount of money to develop a product.
Bob Smith: Thankfully, no. We’re in an industry where the sale of our products is restricted to those who have certain qualifications as well as the training to use our tests. In addition, the tests are supposed to be kept secure. People in our industry understand that a stolen test could completely invalidate its use. So stealing is not nearly as prevalent as it is in other industries, at least not yet. Cathy Smith: We are very careful about whom we sell our tests to and how our tests are distributed.
Bob Smith: In addition to having the copyright notice on all our tests, we also print a warning on our tests that states that if this test is not printed in a specific color of ink on white paper, then it’s an illegal copy.
Bob Smith: Yes. And we follow up on every one that is reported to us. Sometimes we even have to notify the head of an organization that one of their employees is illegally reproducing our tests.
Cathy Smith: No, it’s a way of life here at PAR. The difference between PAR and other companies is our service. PAR employees live and breathe Customer Service. Bob Smith: I was determined that regular communication with our Customers and outstanding Customer Service would be two qualities that would distinguish PAR from competitors. Excellent Customer Service has long been a core value of the company, from answering the phones with a live person to fulfilling orders on the day of receipt, responding to Customer e-mail inquiries within 24 hours, and providing error-free shipments. Years ago, a Customer named David Nichols wrote me a letter when a product he’d purchased was delayed in shipping. He said that “... it was not right to promote your products, take Customers’ money, and then not deliver the product... delaying product delivery is not right.” I’ve never forgotten that. And, since David wrote that letter, he and I became good friends and we remain so today.
Cathy Smith: Every year we ship tens of thousands of packages with an amazingly small number of shipping errors. Our distribution staff prides itself on making sure that our Customers receive exactly what they ordered as quickly as possible. We get thank you notes from our Customers all the time, telling us how much they appreciate our Customer Service and outstanding delivery and shipping.
Bob Smith: Yes! We measure Customer satisfaction in many ways. We send comment cards in every order, which all management staff read when they are filled out and returned by the Customer. We also do Customer surveys and talk to our Customers. We also offer an excellent return policy. If a Customer is not satisfied with a purchase, we will accept the return of any item—no questions asked.
Bob Smith: The merger has helped us differentiate ourselves from our competition, and enabled us to be responsive to Customer needs by continuing to deliver outstanding Customer Service and innovative new products to our Customers.
Bob Smith: We will continue to innovate, grow, and evolve, and we will continue to take care of our Customers. Our company is not for sale, and PAR will remain family owned.
Cathy Smith: Twenty years ago, Bob and I decided that it was our corporate responsibility to give back to the community in which we lived. Over the years, that commitment has grown, and last year we donated to more than 80 organizations in the Tampa Bay area, including the Humane Society, Meals on Wheels, United Way, and a scholarship program at the University of South Florida, to name just a few. We also encourage our staff to participate in community activities and to support local charities.
Bob Smith: We shortened our name from Psychological Assessment Resources to PAR, because that’s what our Customers called us. We changed our slogan to “Creating Connections. Changing Lives.” It sums up not only what we do every day, but it captures what we aspire to do as well.
Bob Smith: I served as a staff psychologist at the James A. Haley Veteran’s Administration Hospital in Tampa, Florida, and was in private practice as a clinical psychologist from 1975 until 1986. Cathy Smith: I worked at the VA Hospital for 10 years as a psychiatric nurse.
Bob Smith: I didn’t want to be in clinical practice forever, and yearned to do something on my own. Cathy and I thought of opening a cookware store like Williams-Sonoma, or some other type of business. PAR was more of an experiment.
Bob Smith: We released our first product in 1978. It was the scoring keys for supplemental scales of the MMPI. Today we sell approximately 400 products on our Web site and through our catalog. Cathy Smith: We started out with $2,251 in capital. Initially, we ran the business on our kitchen table. Bob’s Uncle “Rip” used to come over to the house and help out.
Cathy Smith: Of course! We are very sentimental. The table is now in the break room of our distribution center. We also still have the Selectric typewriter we used to start the business.
Bob Smith: My father ran his own CPA firm for many years. I’m sure that had an influence on my decision to go out on my own. I always wanted to create something of my own. I was also inspired by Tom Peter’s book, A Passion for Excellence. I still have the dog-eared copy of that book on my office bookshelf.
Bob Smith: Cathy and I are able to work together because we share a mutual respect for one another. We share similar values and are passionate about many of the same things. Cathy Smith: Bob runs the business and the final decisions are his. Only one person is responsible in the end, and that’s Bob. That is the difference between leaders and bosses.
Bob Smith: For the first 8 years, Cathy and I took no compensation, and we reinvested everything we made into PAR. At one point in the early 1980s, we thought the business might not survive. We managed things very conservatively, which helped us survive during leaner times.
Bob Smith: We presently have 58 full-time employees.
Bob Smith: We try to take very good care of our staff. For the most part, when people start working here, they want to stay, and we want them to stay. We have 24 employees who have been here over 10 years. We know that in order to expect our employees to take good care of our Customers, it is important for us to take good care of them.
Bob Smith: We hire smart people who are very conscientious. We surround ourselves with people we want to be around. PAR employees are our extended family. You must invest up front, and find the right people to succeed.