5 ways to build behavioral centers of excellence

When damage from a hurricane led to the closure of Vermont’s only state-run psychiatric facility, the situation ultimately presented an unforeseen opportunity. In time, the facility transformed from “the scapegoat of the state mental health system” into a leader in the community, according to Jeff Rothenberg, CEO of Vermont Psychiatric Care Hospital.

When the new facility opened last year, management and staff had a plan to become a center of excellence under the guidelines issued by the National Council for Behavioral Health.

“We are learning new things each day and continuing to focus on how to improve the treatment and the experience patients have when they are at our hospital,” says Rothenberg.

Given that the psych hospital’s patients are typically admitted involuntarily, the center of excellence goal seems that much more ambitious.

Building the framework

National Council’s behavioral healthcare centers of excellence framework focuses on five key elements:

• Easy access;
• Customer service built on a culture of engagement and wellness;
• Comprehensive care;
• Excellent outcomes; and
• Excellent value.

How behavioral healthcare organizations define and pursue these elements is up to them, however. Following the framework doesn’t result in an accreditation or seal of approval but rather it’s a process that organizations can create for themselves to benchmark against the industry’s top standards.

Each facility will have a unique path to follow in response to community and population needs. A good starting point is for programs to determine how the five elements can help them achieve their overarching missions.

“The centers of excellence are a conceptual framework for behavioral health organizations,” says Chuck Ingoglia, senior vice president, public policy and practice improvement at the National Council. “How do organizations want to position themselves within the healthcare ecosystem?”

He also sees synergies between the centers of excellence framework and the demonstration projects for Certified Community Behavioral Health Clinics included in the Protecting Access to Medicare Act passed last year.

Implementing and sustaining change over time is at the core of any effort to become a behavioral healthcare center of excellence. The initiative shouldn’t be a one-time walk-through.

“Most people and organizations are resistant to change,” says Rothenberg. “Organizations often just can fall back into old habits.”

Safety improvement

In Vermont, with funds from the Federal Emergency Management Agency (FEMA), state officials were not only able to finance a new psychiatric facility but also rethink the way it approached treatment of severely ill patients. The fact that the Vermont facility was built from the ground up and brought on many new staff members provided an opportunity to change the culture of care delivery to be in line with industry top standards.

After benchmarking with experts and leaders of peer organizations, Rothenberg identified specific goals for the new hospital as it opened its doors, including: improved safety for patients and staff; reduced seclusion and restraint; and improved discharge planning. Ongoing, each of the hospital’s departments works on a quality improvement project and is required to report quarterly on results. There is also a steering committee made up of staff from all levels of the organization and a leadership group that focuses on overseeing overall quality improvement.

These activities are already showing results, according to Rothenberg. For example, the hospital experienced the fewest emergency involuntary procedures (EIPs) in the state even though its population is more acute.

Such results show that “it is possible for large systems to change because it is occurring all around us,” says Rothenberg. “It takes leadership to set the direction and move at a pace that is quick enough to accomplish your goals but not so fast that your staff can’t keep up.”

Reaching out

In addition to internal practices, behavioral healthcare organizations can apply the five principles across relationships with other healthcare providers, Ingoglia says. Expanding the application of quality will be increasingly important as accountable care organizations (ACOs), medical homes and other entities that focus on outcomes begin to integrate.

Centers of excellence will be more attractive to potential partners because they are focused not only on managing conditions for their clients, but also on providing concrete metrics around outcomes that many new partners will require. For example, by using standardized tools to measure long-term treatment response, behavioral healthcare organizations can demonstrate that they have quantified real world results, such as sobriety at six months or a year after intensive substance-abuse treatment. Even tracking the intake process can be of value.

“If someone asks about the average time to treatment in your organization, you can answer that,” says Ingoglia.

He explains that centers of excellence framework can also assist in the development of the language necessary to answer other questions about the value the organization brings. “That puts you in a better position to have conversations with other players in your system,” he says.

Integrating healthcare

Three years ago, the Center for Health Care Services in San Antonio began its effort to become a center of excellence as part of a larger initiative to provide integrated healthcare services in its community.

“We wanted to integrate physical and behavioral healthcare because our patient population has a lot of chronic medical problems, in addition to mental health issues, and is often turned away from the county healthcare system,” says Camis Malim, the organization’s executive vice president for medical services. “They weren’t getting the help they needed.”

The San Antonio facility’s ongoing effort toward becoming a behavioral healthcare center of excellence began with an evaluation that revealed a number of broken internal processes. For example, one issue was the lack of integration among medical, mental health and administrative personnel because there was little to no overlap.

“There was a long history of medical providers being separate from case managers, therapists and administrative staff,” says Malim. “We realized that we needed to knit all of these processes and people together to complete integration.”

The effort involves using the centers of excellence framework in a way that meshes with the momentum of the Center for Health Care Services. The ultimate goal is to provide both medical and psychiatric care to create a total healthcare home for patients.

However, while the organization is moving toward outcomes-based metrics, the state of Texas continues to focus on process-based metrics.

“We worked with the state to get leeway to switch focus,” says Malim.

For example, the center wanted to move away from measuring whether a patient is getting a certain number of hours of therapy and, instead, move toward measuring whether the patient is receiving the necessary treatment.

Other improvements focused on customer service and patient input. To address this, the organization now includes customer service questions on each patient’s chart so that providers are prompted to ask those questions at the end of each visit.

“We are evaluating the service patients receive so that we can see what works and what didn’t,” says Malim.

Keeping the pace

Such efforts to improve care, quality and outcomes are just the beginning for behavioral healthcare organizations. Following the five elements within the framework isn’t a one-time event.

“Any successful organization in today's behavioral healthcare climate needs to constantly be adapting,” says Rothenberg. “There is no time for resting on your laurels.”

Malim says that if change is to occur within behavioral healthcare organizations, it must involve the support of and input from everyone in the organization.

“We make sure everyone owns the process so anyone can investigate and resolve an issue,” she says. “That is our most powerful tool and it has led to improvements by leaps and bounds.”

Join us

The National Council for Behavioral Health’s annual conference in Orlando April 19 to 22 will include a track on organizational excellence. Read more here:

https://bit.ly/1DbRvDZ