Review of Behavioral Health Services Overview Organizational update - - PowerPoint PPT Presentation

Review of Behavioral Health Services

Overview

• Organizational update
• Nursing Operations
• Medical Staff oversight
• Regulatory update
• Behavioral Health Contract
• Future state – Long term Plan

Organizational Update

• Transition of leadership roles
• Chief Administrative Officer (CAO)
• Director of Nursing (DON)
• Interim leader identified and starts 11/11/19
• Interim leadership at the unit level
• Chief Operating Officer providing all administrative oversight

for the facility

• Chief Nurse Executive in collaboration with Interim Chair of

Psychiatry to support and provide oversight of all clinical practices

• Additional support provided by the Chief Quality Officer and

Associate Chief Medical Officer

Organizational Update

Nursing Operations

• Town Hall meetings with all staff
• Six (6) total meetings capturing all shifts – well attended
• Gain full understanding of the regulatory issues identified
• Provide feedback and share concerns
• Workgroups developed to lead and drive the work from the ground

level up

• Suicide screening tool
• Modified swallow evaluation
• MD escalation
• Treatment sheets
• Seclusion rooms
• Conservatorship
• Daily rounding on all units by CNE, CQO and the quality team to

ensure the processes are understood and followed

• Allows for direct interaction with staff
• Staff have expressed how grateful they are to see a leadership presence

Nursing Operations

• Weekly Quality Assurance and Performance Improvement (QAPI)

meeting was created to track the changes, quality improvement and education

• Trained nursing staff to perform initial swallow evaluation
• Dramatically reduced the number of patients who need to be on a 1:1

pending a formal swallow evaluation

• Herculean support from the SAPPHIRE team providing at the elbow

support

• Some key items remain on paper while we hardwire processes for the re-

survey

• Installation of card access for seclusion rooms
• Provide audit trail for review of proper utilization
• Staffing model has been reevaluate – adjustments made
• Short and long-term plan to staff MHS and RNs to revised core

Nursing is much better positioned to care for this vulnerable population

Medical Staff Oversight

• Job descriptions of hospitalist in PES and inpatient have been

defined

• Planned adoption of co-management structure with clearly-

delineated agreement

• Planned expansion of hospitalist hours in PES while

maintaining same inpatient John George hospitalist coverage

• Future incorporation of hospitalist in daily PES morning huddles
• Physician leadership daily chart reviews based upon higher-

risk patients identified on unit-based Treatment Sheets aligned with improvement elements in the Plan of Correction

• Weekly physician huddles led by Chair of Psychiatry to

promote communication and education

• Development of new policies and clinical protocols that help

guide the medical care of patients at John George

Regulatory Update

• Timeline
• Complaint Validation: March 26 to 28
• Revalidation Survey: July 8 to 11
• Conditions of Participation NOT met during validation:
• Governing Body
• Patient Rights
• Nursing Services
• Quality Assessment & Performance Improvement
• Sept 3: Plan of correction submitted
• Sept 17: Plan of Correction accepted
• Oct 1-6: SAPPHIRE SWAT
• State Agency re-visit expected anytime
• Termination Deadline if Conditions of Participation not met:

November 18, 2019

Regulatory Update

• Plan of Correction Activities
• Governing Body Activities:
• Leadership changes, Daily oversight by COO/CNE/Chair/CQO
• Review of staffing, New clinical educator
• Patient Rights & Nursing Services:
• Significant workflow changes in seclusion room, patient

monitoring, aspiration risk care, conservatorship & consent, suicide prevention, medical co-management.

• QAPI Activities:
• Town Halls, Rapid Improvement Workgroups, Implementation

& Training Roadmap, Weekly multidisciplinary QAPI meetings, Daily rounding by Quality team, Mock surveys with staff, Random & concurrent chart auditing

Behavioral Health Contract

• County based Toyon assessment concluded
• Material differences in estimated shortfall not reconciled
• BHCS/AHS retrospective Mental Health contract augmentation
• Adjustment to rates based on higher costs for PES/IP Psych Services to

achieve maximum contract dollars

• Multiple Fiscal years (FY13-14 – FY17-18)
• Total - $23M (included in FY20 Budget)
• Awaiting BOS approval (now contingent on results of MGO audit)
• BHCS/AHS reviewing rates for FY18-19 and FY19-20
• Goal is to ensure sustainability by aligning costs to reimbursement

Future State

• Future state – Long term Plan
• Review of overall Behavioral SBU structure
• Further collaboration with HCSA – BHCS
• Goals include scaling services to current/projected demand
• Long-range is to be broad in context to include full continuum of

care and social determinants

• Possible investment opportunities include
• Adjustments to current PES/CSU model to possibly improve throughput and

reimbursement in both services in the mid-term

• Possible investments to increase size and/or relocate PES in the long-term
• Expand PES and acute psych discharge placement options