Rogers Behavioral Health contributes to industry standards for inpatient care11/26/18 01:30:pm
Rogers leaders participated on a team of field experts who produced a set of resources, in collaboration with the American Hospital Association (AHA), to be shared with behavioral health providers nationwide. The team made a site visit to Rogers to observe Rogers’ use of clinical outcomes to improve care at the individual, program, and system level. Team members also learned about how Rogers uses lean methodology to improve processes, make decisions, and engage frontline employees. In addition, Rogers leaders educated the team on the use of compassion resiliency training to facilitate the highest level of quality and compassionate care and prevent caregiver burnout.
“It has been gratifying to share our work with others and know that the best practices we’ve collectively developed will help to save lives and raise the overall quality of behavioral healthcare,” comments Brian Kay, vice president of continuous improvement. Kay and Jessica Cook, manager of clinical effectiveness, were part of the team that produced the best practice standards.
The body of work is available online in a new resource called “Delivering High Quality Behavioral Health Care: Practices and Innovations from Leading Organizations.” Designed for freestanding psychiatric hospitals and hospitals with psychiatric units, the resource provides new ideas and implementable practices that can improve care delivery and safety for patients and workers. These practices have been collected from freestanding psychiatric hospitals across the United States with diverse payer mixes, patient populations, and geographies, making the practices, tools, and ideas implementable by a broad spectrum of facility types. The practices presented were chosen because of their potential to have a significant impact on clinical and cultural outcomes. The project was completed by the AHA as part of the Centers for Medicare & Medicaid Services funded Hospital Improvement Innovation Network (HIIN) program, which aims to improve patient safety nationwide.
“I’m proud to be part of a team that’s contributing to the knowledge base of leading practices for behavioral healthcare that thousands of patients will benefit from,” comments Paul Mueller, Rogers Hospital Division CEO.
Inpatient treatment at Rogers goes beyond the norm to save lives
An impatient mental health unit is the equivalent of a hospital ICU or emergency room with lives on the line. With the goal of improving the quality of care for those patients in crisis, a team of leading clinical experts at Rogers set out to standardize inpatient treatment to ensure consistent use of the very best treatment possible.
And that’s no small task. The team started by examining system best practices as well as peer-reviewed literature from the medical field. Then using a disciplined approach with lean methodology, they spent nearly a year developing, implementing, and refining the best possible protocols for treatment at Rogers’ three inpatient hospitals for adults, adolescents, and children. The work is now applied to some partial hospitalization programs too.
Skill development for patients
In addition to helping patients prevent self-harm during a crisis, the protocols are aimed at engaging patients in understanding the value of participating in therapy and starting work to build skills that can help them in the long run. Patients participate in five groups a day with a skill focus for each. There are mental health and addiction tracks with some groups targeting depression and other mood disorders, anxiety, or addiction.
Using cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT), the groups focus on both patient engagement and safety. For example, patients learn about how to address anxiety with respiratory control and deep muscle relaxation. They practice mindfulness and the use of distraction to manage distress. And, they participate in motivational interviewing to understand the costs and benefits of treatment, understanding stages of change, and goal setting. Patients receive a workbook developed by the Rogers team with educational resources and homework to be completed during treatment. A family resource guide is also being developed to help family members understand the mental health disorder, treatment, and how they can play a positive role in recovery.
Kim List, support specialist in the adult inpatient unit in Oconomowoc, explains, “The biggest and best change is consistent and structured patient groups. Patients are being challenged more to be the leading force in their own recovery. We have them strongly engaged in therapeutic work for most of the day, and we all use the same language and same thought directing/changing therapeutic language with the patients in and outside of groups.”
Demonstrating clinical effectiveness and patient satisfaction
“One of the most exciting parts of this initiative is the ability to measure its impact. We now collect outcomes on all inpatient units and we’re seeing positive results from the protocols,” shares Dr. Brad Riemann, PhD, chief clinical officer.
- Using the Clinical Global Impressions (CGI) scale, a clinician-rated assessment of patient severity upon admission and assessment of improvement at time of discharge, 81% were much improved or very much improved, up significantly from 71% before use of the new protocol. For patients being treated for addiction, it went from 56% to 75% with a five-day stay or less and 20% to 92% with a six-day stay or longer.
- 93% of patients (263/283) reported lower scores on the QIDS assessment, which measures depression symptoms at discharge compared to admission.
- Patients show a higher level of satisfaction on Press Ganey surveys with more patients saying they would recommend Rogers.
- Patient engagement in groups has improved as measured by attendance.
- There are significant reductions in self-reported suicide risk from admission to discharge.
- By a thorough outcomes analysis, Rogers also determined that those who experience a dose of treatment including two full rotations of care with the five group sessions building skills have the greatest improvement upon leaving inpatient care. Results were better with treatment lasting six days or more compared to five days or less.
Standard but individualized
While the protocol demands standardization to ensure consistency in quality at the system level, treatment is customized based on individual needs. Rogers’ approach uses data to drive the development of treatment plans and to make sure that treatment consistently effective over the course of care. “If the treatment is not producing the desired results, we are able to make adjustments. And then we analyze data at the program and system levels to continuously improve our approach,” explains Brian Kay, vice president, continuous improvement.
“This standard of care helps Rogers to meet the Quadruple Aim for healthcare: improving quality with better outcomes, increasing patient satisfaction, affecting cost by providing higher value, and ensuring a more engaged and satisfied workforce,” says Jerry Halverson, MD, chief medical officer. “This work is critical because we know patients have a lower risk of suicide; lives are being saved.”