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
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