IHI Expedition Expedition: Making Mental Health Care Safer in the - - PDF document

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IHI Expedition

Expedition: Making Mental Health Care Safer in the Hospital Setting Session 1: Partnering with Patients and Families December 2, 2014

These presenters have nothing to disclose

Teresa Pasquini Charles Saldanha, MD Kelly McCutcheon Adams, LICSW

Today’s Host

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Dorian Burks, Project Coordinator, Institute for Healthcare Improvement, is a current coordinator for web-based Expeditions. He also contributes to the IHI work in the Triple Aim and Improvement Capability focus areas, as well as the Leading Quality Improvement series. Dorian is a member of the Diversity and Inclusion Council at IHI, where he and fellow staff members develop strategies to enhance IHI’s inclusive culture, both internally and externally. Dorian graduated from Massachusetts Institute of Technology in Cambridge, MA where he received his Bachelor of Science degree in Biology and humanities concentration in Anthropology.

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Audio Broadcast

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You will see a box in the top left hand corner labeled “Audio broadcast.” If you are able to listen to the program using the speakers on your computer, you have connected successfully.

Phone Connection (Preferred)

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To join by phone: 1) Click on the “Participants” and “Chat” icon in the top, right hand side of your screen to open the necessary panels 2) Click the button on the right hand side of the screen. 3) A pop-up box will appear with the option “I will call in.” Click that option. 4) Please dial the phone number, the event number and your attendee ID to connect correctly .

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Audio Broadcast vs. Phone Connection

If you using the audio broadcast (through your computer) you will not be able to speak during the WebEx to ask question. All questions will need to come through the chat. If you are using the phone connection (through your telephone) you will be able to raise your hand, be unmuted, and ask questions during the session. Phone connection is preferred if you have access to a phone.

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WebEx Quick Reference

• Please use chat to

“All Participants” for questions

• For technology

issues only, please chat to “Host”

• WebEx Technical

Support: 866-569-3239

• Dial-in Info:

Communicate / Audio Conference (in menu)

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Enter Text Select Chat recipient Raise your hand

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When Chatting…

Please send your message to All Participants

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Chat Time!

What is your goal for participating in this Expedition?

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Join Passport to:

• Get unlimited access to Expeditions, two- to four-month,

interactive, web-based programs designed to help front- line teams make rapid improvements.

• Train your middle managers to effectively lead quality

improvement initiatives. . . . and much, much more for $5,000 per year! Visit www.IHI.org/passport for details. To enroll, call 617-301-4800 or email improvementmap@ihi.org.

IHI Open School Courses

More than 20 online courses developed by world- renowned experts in the following topics

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Improvement Capability

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Patient Safety

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Person- and Family-Centered Care

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Triple Aim for Populations

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Quality, Cost, and Value

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Leadership

More than 26 continuing education contact hours for nurses, physicians, and pharmacists. NAHQ has also approved the courses for CPHQ CE credit. Basic Certificate of Completion available upon completion of 16 foundational course. Mobile App for iPhone and iPad 20% Discount on organizational subscription for Passport Members

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What is an Expedition?

ex•pe•di•tion (noun)

• 1. an excursion, journey, or voyage made for some specific

purpose

• 2. the group of persons engaged in such an activity
• 3. promptness or speed in accomplishing something

Expedition Support

All sessions are recorded Materials are sent one day in advance Listserv address for session communications: MentalHealthSafety@ls.ihi.org

– To add colleagues, email us at info@ihi.org

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Where are you joining from?

Expedition Director

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Kelly McCutcheon Adams, LICSW has been a Director at the Institute for Healthcare Improvement since 2004. Her primary areas of work with IHI have been in Critical Care and End of Life Care. She is an experienced medical social worker with experience in emergency department, ICU, nursing home, sub- acute rehabilitation, and hospice settings. Ms. McCutcheon Adams served on the faculty of the U.S. Department of Health and Human Services Organ Donation and Transplantation Collaboratives and serves on the faculty of the Gift of Life Institute in

• Philadelphia. She has a B.A. in Political Science from

Wellesley College and an MSW from Boston College.

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Today’s Agenda

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Ground Rules & Introductions Pre-Survey Debrief Partnering with Patients and Families IHI’s Model for Improvement Action Period Assignment

Ground Rules

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We learn from one another – “All teach, all learn” Why reinvent the wheel? - Steal shamelessly This is a transparent learning environment All ideas/feedback are welcome and encouraged!

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Expedition Objectives

At the conclusion of this Expedition, participants will be able to: Explain the importance of partnering with patients and their families to improve safety for patients with mental health conditions Identify different areas to improve mental health care safety Describe examples of improvement efforts at other

• rganizations

Plan tests of change to begin or continue patient safety improvement

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Schedule of Calls

Session 1 – Partnering with Patients and Families Date: Tuesday, December 2, 1:00 - 2:30 PM Eastern Time Session 2 – Making the Physical Environment Safer Date: Tuesday, December 16, 1:00 - 2:00 PM Eastern Time Session 3 – Why Flow Matters Date: Tuesday, January 13, 1:00 - 2:00 PM Eastern Time Session 4 – Medication Safety Date: Tuesday, January 27, 1:00 - 2:00 PM Eastern Time Session 5 – Ensuring Staff Preparedness Date: Tuesday, February 10, 1:00 - 2:00 PM Eastern Time Session 6 – Being Proactive and Avoiding Crises Date: Tuesday, February 24, 1:00 - 2:00 PM Eastern Time

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Pre-Work Assignments

Complete the IHI Open School Course QI 102: The Model For Improvement: Your Engine for Change Complete the Expedition: Making Mental Health Care Safer in the Hospital Setting Pre-Survey

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Pre-Survey Results

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Thank you to all who responded!

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Faculty

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Teresa Pasquini, Mom/Advocate, Chair Behavioral Healthcare Partnership of Contra Costa Regional Medical Center is a community volunteer and advocate for improving the mental health system of our county, state, nation and world. As a family member of a son and brother with serious mental illnesses, her lived experience drives her passion to improve care for those consumers and families who suffer without treatment and recovery. An outspoken champion for all of the disenfranchised and under-served, she is the Chair and a founding member of the Behavioral Healthcare Partnership of Contra Costa Regional Medical Center (CCRMC.) This local effort brings community members to decision-making tables to transform the way healthcare is delivered. She also serves as a patient and family advocate on the Executive Operations team

• f CCRMC. She is a founding member of Treatment Before

Tragedy, a new national organization. She is a strong voice for change and creating a vision of hope to make health care welcoming and accessible for all.

Faculty

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Charles Saldanha, MD is an Assistant Clinical Professor of Psychiatry at the University of California San Francisco and a psychiatrist at Contra Costa Regional Medical

• Center. He completed medical school at the

Duke University School of Medicine, postgraduate training at the Brigham and Women's Hospital, UCSF, and Yale University School of Medicine. His interests include the interface of law and psychiatry and public psychiatry with an emphasis on acute care settings.

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Improving Quality of Hospital Based Psychiatric Services Through Partnerships with Community Stakeholders

Teresa Pasquini

• Dr. Charles Saldanha

December 2014

Objectives

• Identify benefits of involving community

stakeholders in the design of patient and family centered psychiatric services

• Describe methods for engaging patients,

families and community-based organizations in quality improvement

• Identify potential barriers to developing

relationships with community partners and strategies for overcoming them

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Contra Costa Regional Medical Center & Health Centers

…Doing common things uncommonly well

• Contra Costa Regional Medical Center (CCRMC) is a

166 bed acute-care public hospital in the San Francisco Bay area

• Psychiatric Emergency Services
• 23 bed Acute Inpatient Psychiatric Unit

Where did we start?

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Right care, right time, right place?

• Patients with a behavioral health crisis were

brought to the medical emergency room via walk-in, ambulance, or police

• Patients first waited for a medical clearance

and then were sent to the Psychiatric Emergency Service

• Patients too often left without being seen

What happens when you involve patients, families and community members as partners?

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Sharing experience

• Patients, family and other

community members wanted meaningful roles

• Passionately wanted change
• Wanted right care, at the

right time, in the right place

• Series of rapid improvement

events for Psychiatric Emergency Services

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Go and See

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Setting an aim

• Quicker access to care
• No unnecessary medical emergency room waits
• Make access friendly and inviting

Open the door! Test

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Before After

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May 2010 Process changes 658 130

510 x approx. 1/2 hour for unnecessary medical clearance = 255 staff and pt hours freed since the May '10 process changes.

4/27/2015 21 # of BH related LWBS in the ED (9/09 - 1/11)

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The avg. number of psychiatric patient's who AWOL'd from the ED prior to PES care dropped by half after the May 2010 process changes.

May 2010 process changes 35% 28.2%

• Avg. % of PES patient's who presented voluntarily for service (11/09 - 4/10) = 28%
• Avg. % of PES patient's who presented voluntarily for service (5/10 - 1/11) = 34.8%

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May 2010

More effective and patient centered care in the PES is demonstrated by a decrease in what is known at CCRMC as "Code Grey" and "Assist Team" calls. These are rapid response type teams which respond to acute behavioral emergencies modeled after Code Blue teams in other facilities. Since the May 2010 process changes, the unit has seen a significant decrease from 7% of patients to 4.9% of patient's whose behavior escalated to the point of requiring a multi-staff response to contain (a nearly 30% drop).

Transforming healthcare into a welcoming, accessible experience for all

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What we have learned

• Engage the heart and mind
• Focus on meaningful change
• Change starts with you
• Honor the truth-don’t recover too much
• Better together
• Set a shared aim – be bold

“we will have a patient/family member on every improvement team by…”

• Begin - soon is not a time

To improve healthcare… We must acknowledge harm...(transparency) We must hear....(listen and learn with respect) We must hope....(create a shared vision) We must humanize...(tell our stories) We will heal.

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Thank you

Teresa Pasquini- tcpasquini@gmail.com

• Dr. Charles Saldanha-

Charles.Sadanha@hsd.cccounty.us

Questions/Discussion

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Raise your hand Use the chat

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What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement?

Model for Improvement

Act Plan Study Do

Aim of Improvement Measurement

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Improvement Developing a Change Testing a Change

Adapted from Langley, G. J., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. The Improvement Guide: A Practical Approach to Enhancing Organizational

• Performance. San Francisco, CA: Jossey-Bass, 1996.

Plan

• Compose aim
• Pose questions/predictions
• Create action plan to carry
• ut cycle (who, what, when,

where)

• Plan for data collection

Do Study Act

• Carry out the test and

collect data

• Document what occurred
• Begin analysis of data
• Complete data analysis
• Compare to predictions
• Summarize learning
• Decide changes to make
• Arrange next cycle

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Why Test?

Increase the belief that the change will result in improvement Predict how much improvement can be expected from the change Learn how to adapt the change to conditions in the local environment Evaluate costs and side-effects of the change Minimize resistance upon implementation

Repeated Use of the PDSA Cycle

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Hunches Theories Ideas Changes That Result in Improvement

A P S D A P S D

Very Small Scale Test Follow-up Tests Wide-Scale Tests

• f Change

Implementation of Change

Sequential building of knowledge under a wide range of conditions

Spread

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Multiple PDSA Cycle Ramps

Transfusion Administration Safety Communication and Awareness Strategies Engaging with Leadership

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Implementing Transfusion Guidelines

Questions/Discussion

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Raise your hand Use the chat

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Action Period Assignment

Please think about times when you have effectively engaged patients and families in any improvement work related to safety for patients with mental health issues

– Share via the listserv before next session:

MentalHealthSafety@ls.ihi.org

Expedition Communications

Listserv for session communications: MentalHealthSafety@ls.ihi.org To add colleagues, email us at info@ihi.org Pose questions, share resources, discuss barriers or successes

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Next Session

Session 2 – Making the Physical Environment Safer Tuesday, December 16, 1:00 – 2:00 ET

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