Transforming Mental Health Care
Applying Performance Improvement Methods to Mental Health Care

Book Description

Each of us working in the mental health system has grappled with the inadequacies and shortcomings of our current system. We have been reminded time and time again that our system is fraught with quality and safety problems that leave patients and their families at the receiving end of sub-standard care and dissatisfied. There are a wide range of problems from access-to-care issues to errors to complications stemming from poor care. Even modern advancements such as EMRs or newer medications such as atypical antipsychotics have created their own unique challenges as they are integrated into our system. The system as a whole requires a closer examination with regards to whether or not it flows seamlessly, and whether or not it provides the right quality at the right time and at the right cost, because our patients and their families deserve nothing less. Our country is on an unsustainable path as our health care expenditure keeps growing, and it is projected to reach 20% of our GDP by 2020. Mental health professionals have gotten used to doing whatever it takes to provide each of our patients with everything they need in order to keep them healthy. In doing so, we have not been able to view the big picture of how our system operates. We do not have a clear idea about which of the steps in our processes add value and which are just wasteful, in that they do not add any value to the patient or their experience of care. Workarounds, excessive documentation, and over-reliance on auditing in order to ensure quality have become an accepted reality in our highly-regulated industry. Nevertheless, it is a widely accepted fact that a conservative 30-50% of everything we do does not add value to the life of our patients.

If we are like spokes in a fast-spinning wheel, how can we observe the path along which we are travelling, to either make sense of it or to do something to change its path? Many of us are so busy seeing patients, documenting about the care we provide them, doing research, attending meetings or performing our administrative duties that we have very little time available to think of how we can improve our system. Even if we wanted to improve it (as required by AGGME’s and ABMS’s core competencies), most of us have not been taught the necessary performance improvement skill set which is so prevalent and widely used in other industries. It also might be hard to imagine for many how a methodology that emerged and evolved in the world of manufacturing can be an effective methodology when applied to mental health care. In conjunction with our collaborative work at Sheppard Pratt Health System, our mental health professionals have been working with a systems engineer to apply this extremely rich knowledge base of performance improvement methods in order to solve some of our most troubling and chronic problems as a mental health system. In doing so, we are seeing some very promising results in the first few years of our work.

This book is a primer to the performance improvement skill set as it is applied to unique problems in our field of mental health care, which takes into account the real challenges that are relevant to our field, is a highly needed gap in the literature. The Institute of Medicine laid out six aims for improvement in response to the scathing 2001 report entitled, Crossing the Quality Chasm. It proposed a vision - an imperative call to make our system more effective, safe, patient-centered, timely, efficient and equitable. In 2008, the Institute for Healthcare Improvement articulated its bold "Triple Aim" initiative. It urged all of us to try to redesign each of our microsystems with their three aims - to improve the patient’s experience of care to include both quality and satisfaction, to improve the health of populations, and finally to reduce the per capita cost of health care. This book provides the steps toward achieving these aims.