Capacity Planning

Capacity Planning / en Fri, 25 Apr 2025 20:18:25 -0500 Fri, 21 Feb 25 15:07:30 -0600 Hospital Capacity Management Consortium professional membership group joins AHA /news/headline/2025-02-21-hospital-capacity-management-consortium-professional-membership-group-joins-aha The <a href="https://www.capacitymanagement.org/">Hospital Capacity Management Consortium</a>, a professional membership group for hospital capacity management leaders, is now part of the AHA. The HCMC was originally founded in early 2020 during the COVID-19 pandemic. The group consists of nearly 1,000 leaders representing 42 states and over 170 health care organizations across the U.S.&nbsp; “We are excited to welcome the Hospital Capacity Management Consortium as a new professional membership group of the AHA,” said Jen Porter, AHA senior vice president of field engagement. “We look forward to elevating the profession of hospital capacity management leaders to grow and expand their offerings to the hospital field, with the goal of enhancing patient care and optimizing hospital operations.”&nbsp; Fri, 21 Feb 2025 15:07:30 -0600 Capacity Planning Addressing Mental Health Disparities Among Racial and Ethnic Minorities /advancing-health-podcast/2024-07-17-addressing-mental-health-disparities-among-racial-and-ethnic-minorities Access to quality mental and physical health services can be a complex challenge, but for individuals of color&nbsp;and people with severe or chronic mental illnesses, finding treatment can be exceptionally hard.&nbsp; In this conversation, Tracey Lavallias, executive director of behavioral health at Penn Medicine Lancaster General Health, discusses potential solutions to make access easier for patients, including cultural competency training, medical interpreter services, and most importantly, integration of mental and physical health services.<hr><div> &nbsp;</div><div class="raw-html-embed"> <details class="transcript"> <summary> <h2 title="Click here to open/close the transcript."> View Transcript &nbsp; </h2> </summary> 00;00;00;17 - 00;00;29;27 Tom Haederle Access to quality mental and physical health services can be a challenge for many people, even those with good health insurance and plenty of care providers nearby. However, for individuals of color, various ethnicities, and people dealing with severe or chronic mental illness, finding the treatment they need is even a steeper hill to climb. 00;00;30;00 - 00;01;00;27 Tom Haederle Welcome to Advancing Health, a podcast from the �� Association. I'm Tom Haederle with AHA communications. Studies have shown that among individuals diagnosed with a severe or chronic mental illness, black people are less likely to seek out treatment than whites, often facing barriers such as cost, transportation and even provider bias. In this podcast hosted by the AH's Rebecca Chickey, senior director of Behavioral Health; Tracey Lavallias, executive director of behavioral health with Penn Medicine, 00;01;00;27 - 00;01;23;19 Tom Haederle Lancaster General Health, talks about the steps Penn Medicine has taken to increase access to care among underserved patient populations. They include cultural competency training, help with language barriers and most importantly, integration of mental and physical health services that are more likely to flag a problem and direct a patient to the care they need. Let's join Rebecca and Tracey. 00;01;23;22 - 00;01;56;11 Rebecca Chickey Thank you Tom. Indeed, it is an honor and a privilege to be here today with Tracey. Tracey and I are going to be talking about the value of integration. And when I say integration, I mean integrating physical and behavioral health, in particular the value of integration as it relates to improving access to care for historically underserved patient populations: individuals of color, various ethnicities, as well as individuals with severe and persistent or chronic mental illnesses. 00;01;56;14 - 00;02;27;29 Rebecca Chickey Often you may think of disorders or conditions such as schizophrenia or bipolar disorder when you think of someone with a severe or chronic mental illness. All of those patient populations that I've just mentioned often struggle even more than others to improve access to care. And Tracey has experience and expertise in having seen the value of integration and how it can reduce stigma and increase access to care. 00;02;28;01 - 00;02;53;12 Rebecca Chickey So enough about me. I'm going to turn now to Tracey and say, Tracey, can you share with the listeners a couple of things. One: What are the realities of the challenges of accessing mental health services and treatment for addiction for individuals of color as well as, what are some of the reasons for those challenges? 00;02;53;15 - 00;03;28;08 Tracey Lavallias Well, first of all, Rebecca, thank you for having me. I appreciate the opportunity to discuss this very important topic. We have been on this journey at Penn Medicine for a long period of time. And one of the things that you mentioned was the disparity amongst individuals of color versus individuals who are white. So I'll give you a little bit of information that we found. That even when diagnosed individuals are diagnosed with a mental health disorder, Hispanics and blacks are traditionally less likely to seek mental health treatment than whites. 00;03;28;11 - 00;03;53;02 Tracey Lavallias This has been highlighted in many studies and it certainly has manifested in our particular environment here. There are a variety of barriers to receiving mental health care for individuals of color, some reports. We did a recent study here in our community about the stigma associated with mental health. Recently there was a campaign called Five Signs that helped to reduce that. 00;03;53;02 - 00;04;16;24 Tracey Lavallias But we're still not at the level of where individuals can speak about mental health in the same way that we speak about physical health. And that has been exacerbated in the, communities of color. Also, biases of providers. Interestingly enough, we spent a great deal of time just having a campaign to reduce the biases of our provider community. 00;04;16;27 - 00;04;39;26 Tracey Lavallias we focused on our emergency department here. We've also focused on our treatment providers. We've instituted things such as cultural competency to try to reduce those barriers. In many cases some of our communities of colors have poor health literacy. We do have a large immigrant population. And so, as you know, mental health means different things to different individuals. 00;04;39;29 - 00;05;05;17 Tracey Lavallias And the interpretation of mental health is perceived differently in certain cultures. So that's an issue. Sometimes its poor insight into navigation. And our mental health system, particularly in state of Pennsylvania, is not easy to navigate. So in some cases, being able to navigate the health system and the insight into navigating a health system calls for some concern for those populations. 00;05;05;20 - 00;05;32;22 Tracey Lavallias There's geographic inaccessibility. And what I mean by that is poor transportation. In many cases, these individuals don't have an opportunity to access it because of not having transportation and the right means. And then there's other things like linguistic, or as I stated earlier, just cultural barriers. And so in many cases, the language is not being spoken in a way that can be communicated in order for these individuals to receive care. 00;05;32;23 - 00;05;47;04 Tracey Lavallias So, you know, those are the realities that we deal with on a regular basis. And some of the things that we work to try to reduce, to make sure that those individuals have the same level of access that our white patients do. 00;05;47;07 - 00;06;21;16 Rebecca Chickey Well, it's particularly timely that we're having this discussion now, Tracy. For the listeners, we are releasing this podcast in the month of July, and July is Minority Mental Health Awareness Month. And the challenges that Tracy just described, I will share, just briefly, a personal journey. I am white, and I had a family member who was suffering from major depression and had what I would call the the "golden egg" of health plans and many connections. 00;06;21;16 - 00;06;54;11 Rebecca Chickey I've been in this field for over 30 years, and so I know the chiefs of psychiatry at stellar organizations across the country. And even so, trying to get treatment for my family member, it took over two months to get in to see a psychiatrist. And even then, they did not take my health insurance. As an individual who is connected, reasonably educated in trying to navigate the mental health system as well as having, you know, stellar health insurance 00;06;54;13 - 00;07;23;04 Rebecca Chickey thanks to the �� Association, it was still a struggle. We want to talk about the value of integration. But first I want to ask you about another patient population. As I mentioned earlier, those with severe and persistent mental illness, chronic mental illness. I don't know if the listeners know this, but, individuals with chronic mental illness usually die somewhere between 15 and 25 years earlier than individuals without schizophrenia or bipolar. 00;07;23;06 - 00;07;45;29 Rebecca Chickey And you may jump to the conclusion that that might be due to higher suicide rates. Indeed it is not. They die most often from their physical illnesses, which they are not taking care of because of lack of access to both physical health and mental health services. So can you speak a little bit to that? Because that's also a health disparity. 00;07;46;01 - 00;07;52;17 Rebecca Chickey And, I wonder how you have been addressing that and what you know about their challenges and the realities. 00;07;52;20 - 00;08;18;03 Tracey Lavallias Yeah. Rebecca, you bring up a really important point, and I appreciate the conversation around this. And in fact, we, try to stress this issue locally and any opportunity we get to kind of speak about this. But these are preventable diseases. In many cases, the individuals with serious mental illness, interact with and die from earlier than the same population 00;08;18;05 - 00;08;59;03 Tracey Lavallias that does not have a serious mental illness. Things such as, you know, cardiovascular disease, diabetes and, you know, complying with insulin. These are different types of things that are preventable. The largest percentage of care in our particular - in any network - is through primary care. And we have found that individuals with serious mental illness do not seek this level of care out, as much as they should. In particularly those, as you spoke about earlier, those that are in minority communities, they have not access the primary care services as much as we would like. 00;08;59;03 - 00;09;30;17 Tracey Lavallias In many cases, those individuals seek care in traditional mental health or inpatient environments. In many cases, we found them in our emergency department. So the fact of the matter is that individuals with significant severe mental illness do not access their primary care as often. And then you add on top of that those individuals that are communities of color access - those primary care resources and less. 00;09;30;19 - 00;09;44;19 Tracey Lavallias And subsequently it leads to those factors that cause premature death. Cigarette smoking, things of that nature or diet and those types of issues that can be addressed if they went to a primary care physician. 00;09;44;21 - 00;10;01;01 Rebecca Chickey So now that we painted a unfortunately fairly bleak picture for the listeners here, let's give them a bit of light, a bit of hope. How can and does integration help to reduce these disparities? Give me some examples. 00;10;01;04 - 00;10;35;25 Tracey Lavallias What we found here, in fact, what my doctoral dissertation was done on our primary care offices here ... we did a study on &nbsp;- this is going back, maybe seven years ago now. And we utilized four primary care sites here. And we went to look about three different factors, actually, we were really focusing on. First factor was, was there a reduction in the issues that we just spoke about, some of those issues that were preventable. 00;10;35;28 - 00;11;03;09 Tracey Lavallias Did they actually comply with the primary care physicians, recommendations for those individuals that were receiving integrated care within a primary care practice? And the other components that we spoke about, we wanted to see if there was a reduction in the emergency room utilization of those individuals that received primary care and mental health services within the primary care practice. 00;11;03;11 - 00;11;29;06 Tracey Lavallias And the last factor that we focused on was, whether or not those individuals sought care in our emergency department. Remember I spoke about traditionally those individuals sort of surfaced in our emergency department due to the lack of primary care resources. The study found that we have 50% reduction in those individuals receiving care, under primary care integration. 00;11;29;06 - 00;11;55;25 Tracey Lavallias So they're less likely to come to the word see department. There was a significant reduction of stigma in the primary care office, based on the fact that these individuals did not seek services or receive services under the umbrella or title of a mental health facility. There was more compliance with the recommendations of their medication management or the recommendation of their primary care physician. 00;11;55;27 - 00;12;22;13 Tracey Lavallias And this was primarily based on the fact that they may have been depressed. There may have been other factors that, were focused on their mental health issues that caused them not to take their physical health medication. So the fact that we were integrating care within a primary care office and allowing these services to be seen as seamless, really improve the quality of care for those individuals. 00;12;22;15 - 00;12;45;15 Tracey Lavallias And as a by-factor of that, there was a significant increase in provider satisfaction. So not only did the patients get better and services delivered in a more quantitative fashion, but the provider satisfaction just increased. So I think that's the positive side of integrating mental health into your primary care offices. 00;12;45;17 - 00;13;15;21 Rebecca Chickey So I'm going to emphasize again, some of the key points you just said. One, with all the workforce challenges that are out there right now, if you can improve provider satisfaction, that is a positive impact. Equally, perhaps even more importantly, what you said is that you improved patient outcomes. That's what we got into healthcare for in the first place, right, is to improve individual's quality of health and ability to live their best lives. 00;13;15;23 - 00;13;31;23 Rebecca Chickey You reduced stigma through integration and then, I'm going to connect the dots here. So please keep me honest if this is not the case. But you said you reduced visits to the emergency department by around 50%, and so that's correct? 00;13;31;24 - 00;13;33;00 Tracey Lavallias That's correct. Yeah. 00;13;33;03 - 00;13;57;07 Rebecca Chickey And every emergency department visit, it's not the least costly level of care, I will say. And so you have you're reducing the total cost of care for that individual as a whole. And you're also improving access to other emergency services because the emergency room is not treating someone who could have been treated in a lower level of care. 00;13;57;09 - 00;14;10;25 Rebecca Chickey Well, is there a story that you might want to share for the listeners? Of course, not identifying a name, but is there a story that you might want to share to, illustrate this on a on a personal level? 00;14;10;28 - 00;14;42;02 Tracey Lavallias We had an individual and I spent a lot of time with this individual, and he was a parent of a individual that was a chronic behavioral health patient. And what I mean by chronic symptomology had become so severe that she would cycle through our emergency department on a regular basis. This situation all escalated up to our CEO and CEO sent the information to me. 00;14;42;02 - 00;15;10;28 Tracey Lavallias So I had several conversations with the parent of this individual who was really reaching out for help and really didn't have the ability or capacity because he had been dealing with this particular issue for such a long period of time. It manifested in complaints. But really, when you drill down and you had a more conversation, it was about access and the fact that this individual had not accessed our services within our PCP. 00;15;11;00 - 00;15;35;23 Tracey Lavallias One thing led to another, and I'm shortening the story because of the time frame. But imagine this situation went on for about six months. We began to build a bridge with the parent who in fact begin to build a bridge with the daughter. We connected this daughter with our integrated care within our primary care offices, they're currently in all our primary care offices now. 00;15;35;23 - 00;16;06;13 Tracey Lavallias So we integrated them based upon the location that was closest. She immediately connected with the therapist there. There was less of a stigma associated with the services that she received. And, she just got better, significantly better, throughout the course of time. Her parent was a conduit because she was limited linguistically and really reached out to us to talk to us about the care that they received in this environment. 00;16;06;15 - 00;16;37;17 Tracey Lavallias The therapist, the integration of the primary care doctor, addressing the physical health needs. She became much more compliant with her physical health medication which was a conduit to her being in the emergency department as well. So I point that story out just to say that that is probably one that came to my attention, but that's the norm for what we've what we have seen in our primary care offices when we integrate our mental health clinicians there. 00;16;37;19 - 00;16;50;22 Tracey Lavallias And has been certainly a positive outcome for the system because these individuals are receiving timely care and just getting better, Rebecca. And so I'm really, really proud of the work that they've done there. 00;16;50;25 - 00;17;09;23 Rebecca Chickey I think what you just described was truly patient centered care. So thank you for doing that and for sharing that story. As we close out the podcast today, is there a call to action that you'd like to perhaps challenge or encourage the listeners to consider doing? 00;17;09;26 - 00;17;29;07 Tracey Lavallias A couple things? One thing that I would say is that you had, alluded to this earlier. There are significant challenges from a workforce perspective to be able to keep up with the amount of patients that need health care. So in the medical field, you can see it nationally that there's just not enough providers, not enough individuals going into the field. 00;17;29;09 - 00;17;53;14 Tracey Lavallias So I encourage those who have an empathy for this population to go into this field, contribute in any way that you can to this population so that these individuals will have the same quality of life that we've grown accustomed to. The second thing that I would say is we talked about the disparity between the physical health and the mental health, and really trying to close that gap as relates to stigma. 00;17;53;17 - 00;18;32;18 Tracey Lavallias We talked a little bit about it earlier. I would like to prioritize things such as mental health first aid. You know, we get first aid in many of our jobs that we go into, particularly in the health care field, and it's a way to sort of prevent the physical issues if you're so encountered and trying to stabilize the patient. The same things are taught as it relates to mental health first aid, the ability for individuals, loved ones, family members, friends to engage with individuals because in most cases, they're the ones that see them first to be able to do some of their first aid, mental health, first aid, things that can stabilize the 00;18;32;18 - 00;18;46;21 Tracey Lavallias patient prior to them engaging with the system. It would broaden our ability to have access, and it creates the opportunity to reduce stigma. So in those cases, I think that would be my two calls to actions. 00;18;46;24 - 00;19;12;24 Rebecca Chickey Thank you so much. I think I'm about to quote Maya Angelou, but as you were saying that, this quote came to mind: "Once you know better, do better." And that would be my call to action. So as we close this out, there are a number of resources, around the value of integration, the value of integrating physical and behavioral health that can be found at 00;19;12;26 - 00;19;28;14 Rebecca Chickey www.aha.org/behavioral health. This podcast will be available there and of course on AHA's Advancing Health podcast. Tracy, thank you so much for the work that you do and your willingness to share your insights and expertise with us today. 00;19;28;16 - 00;19;35;14 Tracey Lavallias Thank you so much, Rebecca. I appreciate you the opportunity to discuss this important topic. And I'll see you soon. 00;19;35;17 - 00;19;43;21 Tom Haederle Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts. </details> </div> Wed, 17 Jul 2024 00:14:16 -0500 Capacity Planning Behavioral Health Workers in the Field /behavioral-health-workforce-perspectives <div class="raw-html-embed">.module-typeC { height: 100%; } .panel { margin-bottom: 30px; padding: 20px; border: 1px solid #eee; } @media (min-width:768px) { .rowEqual_768 { display: -webkit-box; display: -webkit-flex; display: -ms-flexbox; display: flex; flex-wrap: wrap; } .rowEqual_768&gt;[class*='col-'] { -ms-flex: 1; /* IE 10 */ flex: auto; width: calc(50% - 6px) /*Adjust % for the number per row, will override the bootstrap - Also needed for Safari*/ ; margin-bottom: 25px; } } <h3> Behavioral Health Care Workforce Videos </h3> <div class="rowEqual_768"> <div class="panel module-typeC"> <div class="panel-heading"> <h4> Perinatal Psych Nurse &amp; Perinatal Bereavement Coordinator </h4> </div> <div class="panel-body"> June 2024 Shannon, perinatal psych nurse at Ascension Alexian Brothers Behavioral Health shares the value of her work as well as the joy that it brings her and the patients she serves. </div> </div> </div> to here^, paste below, and update with new video URL and text. //--&gt; <div class="col-md-6"> <div class="panel module-typeC"> <div class="panel-heading"> <h4> Giving Back to the Community with Tracey Lavallias </h4> </div> <div class="panel-body"> July 2024 Tracey Lavallias, executive director of behavioral health at Penn Medicine Lancaster General Health, shares how being an administrator in behavioral health has allowed him to give back, and change the lives of individuals with behavioral health conditions. </div> </div> </div> <div class="col-md-6"> <div class="panel module-typeC"> <div class="panel-heading"> <h4> Perinatal Psych Nurse &amp; Perinatal Bereavement Coordinator </h4> </div> <div class="panel-body"> June 2024 Shannon, perinatal psych nurse at Ascension Alexian Brothers Behavioral Health shares the value of her work as well as the joy that it brings her and the patients she serves. </div> </div> </div> <div class="col-md-6"> <div class="panel module-typeC"> <div class="panel-heading"> <h4> Psychiatrist </h4> </div> <div class="panel-body"> June 2024 Dr. Frank, Chair of Psychiatry at Henry Ford Health, shares the appeal of being a psychiatrist, as the brain is “the last frontier. </div> </div> </div> <div class="col-md-6"> <div class="panel module-typeC"> <div class="panel-heading"> <h4> Community Health Worker </h4> </div> <div class="panel-body"> June 2024 Shannon, community health worker at Montefiore, shares how connecting patients with vital services such as housing, and transportation, helps patients reach their highest potential for health. </div> </div> </div> </div></div> Wed, 26 Jun 2024 15:19:57 -0500 Capacity Planning Finding the Right Words: The Role of Peer Support with Mental Health /advancing-health-podcast/2023-05-24-finding-right-words-role-peer-support-mental-health For health care workers, finding the right words to support a colleague struggling with their mental health or thoughts of <a href="/suicideprevention/health-care-workforce" title="Suicide workforce">suicide</a> can be challenging. According to Luci New, assistant professor of Nurse Anesthesia at Wake Forest University School of Medicine, the best thing you can say to a struggling colleague is simple: “I care about you.” <hr /> <div><a href="https://soundcloud.com/advancinghealth" target="_blank" title="Advancing Health">Advancing Health</a> · <a href="https://soundcloud.com/advancinghealth/finding-the-right-words-supporting-the-mental-health-of-your-workforce" target="_blank" title="Finding the Right Words: The Role of Peer Support with Mental Health">Finding the Right Words: The Role of Peer Support with Mental Health</a></div> <div>&nbsp;</div> <div>&nbsp;</div> <details class="transcript"><summary> <h2 title="Click here to open/close the transcript.">View Transcript &nbsp;</h2> </summary> 00;00;01;04 - 00;00;20;12 Tom Haederle For health care workers finding the right words to support a colleague struggling with their mental health or with thoughts of suicide can be challenging. They want to help. But the stigma surrounding the discussion of mental health concerns, along with the fear of potentially saying the wrong thing to the struggling colleague, can deter health care workers from checking in with each other. 00;00;21;08 - 00;01;07;20 Tom Haederle But according to Luci New, assistant professor of nurse anesthesia at Wake Forest University School of Medicine, the best thing you can say to a struggling colleague is simple. I care about you. Welcome to Advancing Health, a podcast from the �� Association. I'm Tom Haederle with AHA Communications. In this podcast, Luci joins Jordan Steiger, senior program manager of clinical affairs and workforce at AHA, to share how her organization is using a peer support model and QPR...that's “Question, Persuade, Refer” suicide prevention training 00;01;07;25 - 00;01;30;29 Tom Haederle to empower and educate the workforce to respond to colleagues who are experiencing mental health concerns or suicidal ideation. This work is part of an ongoing AHA initiative to support hospital and health system leaders in their efforts to enhance the mental well-being of the health care workforce and prevent health care worker suicides. 00;01;31;16 - 00;01;43;20 Tom Haederle The work of the initiative has been captured in a newly released guide from AHA titled "Suicide Prevention Evidence Informed Interventions for the Health Care Workforce." And now let's join Jordan and Luci. 00;01;44;05 - 00;02;02;24 Jordan Steiger Thanks, Tom. So, Luci, we're really excited to have you with us today. You are such an expert in this field and in this space, and I think you are going to be able to help our membership really understand the issue of suicide prevention a little bit better today. Could you just tell us a little bit about your connection to workforce well-being and suicide prevention? 00;02;03;06 - 00;02;31;23 Luci New Yes. And first of all, thank you for having me, Jordan. It's an honor to have been selected as part of this collaborative. It's a passion I've had for many years and I just am grateful to be able to share a little piece of my contribution to this vital topic. So I when I was pursuing my doctoral degree, I became passionate about second optimization and peer support programing, and that is what I pursued for my doctoral work. 00;02;31;23 - 00;03;00;23 Luci New And I implemented a pilot peer support program at the facility of which I was employed as a full time CRT. And again, the intention of the organizational leadership group time and 100% grassroots efforts because one's friends and more people want to buy into the program. Our facility leader and the hospital where I was employed said, Hey, there's a survey on suicide prevention from the �� Association, maybe you can fill this out.&nbsp; 00;03;01;13 - 00;03;21;24 Luci New And so I filled it out, not thinking that I would be selected, but I was and very honored to have been selected for that. And then coming back this year as well to part to participate in the collaborative of everyone putting their money where their mouth is, you know, let's do something about it. 00;03;21;24 - 00;03;45;27 Luci New But with second victimization encompasses so much more than just being involved in an adverse event. When you look at the down stream effects of being involved in adverse events or medical error, there are certain trajectories that we all go through. Anyone in health care, it's not just physicians or nurses. It can be anyone that's working inside the hospital at the time. 00;03;46;19 - 00;04;20;07 Luci New And so my passion has grown and extended to other areas as well. Burnout, suicide prevention, I think. And unfortunately, all in health care probably know of someone that has attempted or died by suicide. And certainly we want to prevent that from occurring. And we have to is multi-layered. We have to look at mental health conditions, mental wellness and get started on getting these efforts implemented across the country. 00;04;20;24 - 00;04;33;08 Jordan Steiger Absolutely. It's a vital topic and we're really excited that we have your expertise to help the collaborative along. Tell our listeners what the collaborative is like. What have we worked on so far? What have you learned from it? 00;04;33;16 - 00;05;04;12 Luci New Well, I've been in each time it's it's exciting connecting with people from across the country. Of course, we're looking at based on a report that was released last fall, on looking at the drivers of suicide, stigma and job related stressors and access and those to find likelihood of a mental health condition or of suicide. And so we're looking at how to mitigate those barriers for health and the health care workforce can definitely make an impact down the road. 00;05;04;12 - 00;05;33;22 Luci New And that's why I had implemented a peer support program. I selected the job related stressors because I actually had already and I got ahead of the game before I even knew this was going to be a collaborative group. Because as in my faculty, where I'm a faculty member, we actually do a suicide prevention training every year for all faculty, staff and our learners and the nurse anathesia program. 00;05;34;04 - 00;05;56;20 Luci New So I took a suicide prevention course and became an instructor in that course. So as I was taking that course last fall, I thought, wow, we really need to incorporate this into our peer support programing. And so when we got a letter asking for us to return, I thought, I've already got something, yah! And so it was kind of easy and easy. 00;05;56;24 - 00;06;28;27 Luci New So like for us and the current facility I'm working with, they started their implementation process last fall and the force behind them really aggressively starting to seek out peer support. And this was related to a suicide of one of their colleagues. And so they have chosen to honor this this teammate by having the name in this person's memories and so approach the CNO. 00;06;29;15 - 00;07;04;27 Luci New So that facility and she says, oh, yes, come in because because, you know, suicide prevention was why we first were kind of really pushing towards going ahead and getting this peer support program developed. So it was not a tough decision on what to do. Of course, there are barriers and we recognize that and the networking that we do in that group, there's challenges, of course, with and including in my own organization, we have three people that do our peer support training, our EAP director and my long standing partner in crime who's a CRNA. Dr. Bernadette Johnson, is her name. 00;07;04;27 - 00;07;27;19 Luci New I want to give her credit as well. We were implementing pilot peer support programs, so we joined forces in creating this peer support program. And so there begins to be an exponential increase in the desire of different facilities and departments that while we want the peer support program in and it's like you can't do it fast enough because these resources are certainly needed. 00;07;27;19 - 00;07;49;14 Luci New So I've enjoyed the networking and got lots of great ideas. I mean, we're all very sharing with each other and share what we have. I mean, why reinvent the wheel for anything? And I've really loved Speaker, simply proud to share their passion and their expertise on the different subjects related to suicide. 00;07;50;03 - 00;08;07;08 Jordan Steiger Great. Thank you for sharing that. And I know, yeah, you've had your peer support programs going for a while. I think you're ahead of the game, which we love to see. I know one of the things that you've incorporated is QPR training. Could you tell our listeners a little bit about what QPR is? 00;08;07;24 - 00;08;34;13 Luci New Yes, QPR is a program. It's been around for a long time. I was surprised. I first took the what they call a game keeper training, which is kind of like if you equate it to CPR, QPR and the gamekeepers kind of like someone that just has the basic life support skills. But QPR, they have an instructor level, which is a course that you can play online. 00;08;35;02 - 00;09;11;25 Luci New It goes through the history of QPR or history QPR, yes, but the history of suicide and shares different cultural beliefs and values around the history of suicide. And then it goes through specifics of conducting this training because of course it is a very heavy topic and it it really summarizes everything into a one hour course to just equip people to be able to have the courage to ask someone, are you thinking of hurting yourself? 00;09;11;25 - 00;09;39;17 Luci New Because so many times we don't know what to say to someone. You know, we know someone's struggling and so we think we don't have the words to say or something to say might make them feel bad or feel worse or really go through with hurting themselves when actually by ignoring and just walking away, they're even wrestling with more intense emotions or more like nobody cares or nobody. 00;09;39;24 - 00;10;08;27 Luci New You know, everybody thinks that because I made this medical error that I really should be in practice. And so by not being able to do it or at least find someone, you know, if you know someone's struggling to be able to go and say, hey, we have this peer support program here, or hey, we have these resources that might be helpful to you because I care about you and what you're going through and because a lot of people don't know the resources are there. 00;10;09;07 - 00;10;42;13 Luci New A lot of organizations have an abundance of resources. People aren't aware of those resources, or they may think they're not a benefit for being an employee there or finding resources. Sometimes a lot of health care organization and trauma can be challenging to navigate sometimes, especially for someone like me who's not very tech savvy and you're trying to find information and it can be difficult to find and you're afraid or embarrassed by the stigma, right, of reaching out and asking someone or telling someone, I need help. 00;10;42;19 - 00;10;45;15 Luci New I'm struggling and I need someone to help me. 00;10;46;03 - 00;10;57;29 Jordan Steiger So what I'm hearing from you now is just thinking about empowerment, thinking about education, making sure people have the resources in their hands, and just encouraging them to speak up. Could you tell us what QPR stands for? 00;10;58;25 - 00;11;30;28 Luci New Yes. Is question persuade and refer. It's been around since the eighties. I was surprised that it has the longevity that is, that it has had. And and again, I guess when you look at the statistics for suicide, they have gradually increased over the years, especially since 2000. I think they've steadily increased. They dipped a little bit, I think in 2021, but now they're they're increasing again. 00;11;31;00 - 00;11;47;10 Luci New So it is certainly a great program. I mean, it's not just for health care, civic organizations and houses of worship or faith schools, first responders. It's not just tailored specifically for health care workers. 00;11;47;21 - 00;12;09;16 Jordan Steiger I think that approach makes a lot of sense. And it sounds like there are community benefits to training on QPR as well as benefits to health care workers. We know that health care workers are at a point right now after the pandemic is slowing down, the public health emergency has ended, but those mental health effects from being a caregiver during these last few years are not going to just go away. 00;12;09;16 - 00;12;11;17 Jordan Steiger So this sounds like a really great approach. 00;12;12;05 - 00;12;36;00 Luci New Yeah, and there's actually research that I did for a paper looking at the workplace challenges and the risk of substance use in the health care workforce. And one of the things that I wrote about was COVID. And we we like I think we're all kind of a little bit happier because we're like, yes, it's done. It's behind us. 00;12;36;11 - 00;13;18;05 Luci New But really, when you look at the lingering effects of especially for so many those on the frontline, our ICU nurses, they saw so many sick patients and and there was exposure to a lot of patients dying and ... that certainly contributes to seeing that day in and day out is certainly can weigh on your emotional state and a lot of those ICU nurses I think were exposed to very traumatic experiences. &nbsp;Saw them very early in their career and more abundant than than what is seen over long periods of time for other people. 00;13;18;16 - 00;13;30;28 Jordan Steiger Absolutely. I think the support that we're going to provide now in the next few years is going to be critical, especially for that younger workforce. What positive outcomes have you seen from this project so far at your organization? 00;13;31;18 - 00;14;01;17 Luci New Well, the positive outcomes, we have almost hit our benchmark because we've done two peer support training sessions since we started our action plan, we have one tomorrow as well. And the feedback we've gotten from our surveys, we do have tracking metrics. One of our tracking metrics is on if you provide peer support, what is the reason for providing that peer support, whether it's a medical error or a near miss? 00;14;02;01 - 00;14;33;16 Luci New And we do have one of our boxes that can be tracked is suicide, and that could even be from a patient as well. I mean, because certainly that's a traumatic event too. But as far as some of the comments we have received from doing the training, people said it was done well. They had never heard of this training and they hope they never need it, but they're glad they have that skill set in addition to their peer support skills, and that it was incredibly helpful. 00;14;33;28 - 00;14;59;21 Luci New And then one person stated, which this really makes a lot of efforts that you in time that you commit outside even your normal work time and environment. One of the persons commented that I'm ready to help my peers. A good friend and mentor of mine at one point said, if you help one person, its successful, we have to help people. 00;15;00;03 - 00;15;03;26 Luci New But you want to do more. Of course you want to get out there for everyone. 00;15;04;16 - 00;15;11;26 Jordan Steiger Luci, as we wrap up, what is your big takeaway? What do you want our listeners to know about suicide prevention or the work that you're doing? 00;15;12;25 - 00;15;45;10 Luci New Don't be afraid. Don't hesitate. You know, sometimes its as simple as saying, I care about you and I care what you're experiencing. Let's go see what options or resources there are to help you through this. A lot of times when people get to that point of despair, you do think that that nobody understands and you might not understand 100% what someone's going through, but you can just say, I care about you. 00;15;45;26 - 00;16;06;15 Jordan Steiger I think that's something everybody listening to this today can commit to doing. It's four very simple words: I care about you. I think that's very powerful. Luci, thank you so much for joining us today and for sharing your insights. We're so happy to have you as part of our AHA collaborative, and we're looking forward to our continued work together. 00;16;07;02 - 00;16;24;01 Luci New Yeah, thank you again for having me so much. And again, it is such an honor to be working side by side with so many people that have this same passion about promoting and developing plans to help reduce suicide in our health care workforce. 00;16;24;28 - 00;16;36;08 Jordan Steiger If you're interested in learning more about our suicide prevention work for the health care workforce, please visit aha.org/suicideprevention/healthcareworkforce. 00;16;36;19 - 00;16;58;12 Tom Haederle Development of this product was supported by Cooperative Agreement ck202003 funded by the U.S. Centers for Disease Control and Prevention, CDC, the National Institute for Occupational Safety and Health. The contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC or the Department of Health and Human Services. </details> Wed, 24 May 2023 10:54:49 -0500 Capacity Planning Burnout: The New Pandemic /news/blog/2023-05-23-burnout-new-pandemic <div class="container"> <div class="row"> <div class="col-md-8"> Health care has always been a demanding profession, and the effects of the last few years have meant that health care workers have been asked to do more with less. Expectations have been higher than ever, while money, support staff and even basic rest and recuperation have not kept pace. That means that the field is now facing what could be a new pandemic: burnout. Burnout is not just feeling tired or stressed; it is a condition that affects the brain in very real, noticeable ways. It affects decision-making skills, memory, the ability to focus and even fine motor control – abilities that are vital at every level of the health care field. Combined with the stressors often found in health care, such as working night shifts, working for extended hours, intense working conditions, and sleep and food deprivation, burnout puts the mental and physical health of our workforce at risk. This graphic uses science to give a roadmap to reduce burnout and risk of medical error in organizations. It is imperative to recognize that health care is a unique field in that it requires emotional, physical and cognitive labor, often all at the same time. If a nurse is physically exhausted, they cannot provide emotional support to their patients. If a doctor is emotionally depleted due to job (or any) stressors, they will not be operating at the top of their cognitive skill set. Hospitals and health systems also must be aware of the “shadow work” that goes into health care – those duties that aren’t part of anyone’s job description, but can fill their day. While they are not reflected in metrics or on operational dashboards, they take time away from patient care, such as searching the EMR to accommodate for interface changes, documentation burdens that don’t add to care delivery or prior authorization requirements. Changes in staffing can further add cross coverage challenges. Fortunately, burnout is both avoidable and reversible when hospitals and health systems are willing to take the steps to grow a culture in which every worker has access to ways to decrease stress. Primary coping is taking away the factors causing the stress. Secondary coping is finding ways to deal with the remaining factors that cause stress. Both are needed. Interventions that focus upon helping the individual with resilience are helpful but important to recognize that health care workers start off being more resilient than the average worker. Hence organizational or systemic interventions to improve the work environment are also needed. Organizational health also leads to worker health. A structural focus on employees’ well-bring, clear processes and workflows, and a commitment to organizational justice are all factors that, when incorporated into a hospital’s organizational alignment, create a work environment in which employees (and therefore patients) can thrive, because they know they are valued and their work is respected. Over the past few years, we have asked so much of our health care workforce. Now is the time for hospitals and health care systems to identify and enact the structural changes that will protect them, our patients, and the workforce in general. Elisa Arespacochaga, AHA and Michael R Privitera, M.D. Professor Emeritus of Psychiatry, University of Rochester Medical Center &nbsp; </div> <div class="col-md-4"> <a href="/system/files/media/file/2023/05/workforce-flow-infographic%20%28002%29.pdf" target="_blank"><img alt="Science Based Strategies to Promote Well Being" data-entity-type="file" data-entity-uuid="a30227b3-66f0-46f2-93ca-9a76ca802550" src="/sites/default/files/inline-images/science-based-strategies-to-promote-well-being-image.png" width="626" height="809"></a> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2023/05/workforce-flow-infographic%20%28002%29.pdf" target="_blank" title>Download the PDF</a></div> </div> </div> </div> Tue, 23 May 2023 12:26:35 -0500 Capacity Planning Chair File: Leadership Dialogue — Addressing the Behavioral Health Crisis with Jesse Tamplen of John Muir Health /news/chairpersons-file/2023-05-22-chair-file-leadership-dialogue-addressing-behavioral-health-crisis-jesse-tamplen-john-muir On this episode, I talk with Jesse Tamplen, vice president of behavioral health services at John Muir Health, located east of San Francisco, and a member of the AHA Committee on Behavioral Health. Jesse and I discuss behavioral health challenges in the U.S. and how hospitals and health systems are actively developing and advocating for solutions to help patients, families and health care professionals. Jesse emphasizes the increased need for more acute care behavioral health beds for children, adolescents and adults. For example, in California, there are fewer than 100 acute psychiatric beds for children under age 12, and John Muir Health has 10 — or 10% — of those beds, Jesse notes. He stresses the importance of ensuring that “when kids need to access that critical, lifesaving care, they can remain in their community.” Hospital and health systems are playing an increasingly more important role in providing behavioral health care, whether in their own facilities or by helping patients connect with community resources. “This is an exciting area,” Jesse observes. “After the pandemic, some of the stigma and discrimination of mental health decreased … and [it] allowed more innovation to come forward.” John Muir Health partnered with local and state organizations to create a behavioral health navigator program so people receive appropriate care and treatment as well as preventive services. Jesse and I also discuss how hospitals are better integrating behavioral health care services with physical health services — and the need for adequate reimbursement to cover the cost of care. The “challenge of low reimbursement puts a huge impact on our ability to recruit [behavioral health care workers],” Jesse explains. I hope you find these conversations interesting and insightful. Look for them once a month as part of the Chair File. Watch the episode. Listen to the podcast. <hr /> <div><a href="https://soundcloud.com/advancinghealth" target="_blank" title="Advancing Health">Advancing Health</a> · <a href="https://soundcloud.com/advancinghealth/leadershipdialogue-may-mixdown" target="_blank" title="Leadership Dialogue Series: Addressing the Behavioral Health Crisis with John Muir Health">Leadership Dialogue Series: Addressing the Behavioral Health Crisis with John Muir Health</a></div> &nbsp; <details class="transcript"><summary> <h2 title="Click here to open/close the transcript.">View Transcript &nbsp;</h2> </summary> 00;00;00;28 - 00;00;39;05 Tom Haederle Hospitals and health systems are playing an increasingly important role in providing behavioral health care, whether in their own facilities or by helping patients connect with community resources. It's a positive trend, but the need for behavioral health resources is great, and the gap between needs and resources remains wide. Welcome to Advancing Health, brought to you by the �� Association. 00;00;39;15 - 00;01;09;14 Tom Haederle I'm Tom Haederle with AHA Communications. In this leadership dialog series podcast, John Haupert, president and CEO of Atlanta-based Grady Health System and the 2023 chair of AHA’s board, is joined by Jesse Tamplen, vice president of Behavioral Health Services at John Muir Health. That's near San Francisco. Tamplen notes that in all of California, our most populous state, there are fewer than 100 acute psychiatric beds for children under the age of 12. 00;01;09;26 - 00;01;32;06 Tom Haederle John Muir Health has 10% of those beds. It's a nationwide situation. The two leaders discuss how hospitals are working with local and state organizations to create new pathways to appropriate care and treatment, as well as preventive services. And they review the role of adequate reimbursement to cover the cost of behavioral health services. With that, let's join John and Jesse. 00;01;33;11 - 00;02;03;28 John Haupert Good afternoon and thank you, everyone for joining me today for another leadership dialog session. I'm John Haupert, president and CEO of Grady Health System in Atlanta, Georgia, and also chair of the board of trustees of the �� Association. I'm very much looking forward to our conversation today as we talk about the critical issue of behavioral health, an issue that has only worsened during the past few years since the pandemic, but has long been &nbsp;stigmatized as well as underfunded. 00;02;04;28 - 00;02;32;21 John Haupert With the mental health crisis in our country worsening, the hospital field is finding itself more active in developing an advocate for solutions to help patients and families, as well as also our own caregivers who have seen increased rates of anxiety and burnout. At Grady, like other organizations, we are working to build a stronger infrastructure to meet all behavioral health needs of those we serve. 00;02;33;06 - 00;02;54;15 John Haupert And as a matter of fact, Grady Health System is the largest provider of mental health services in the state of Georgia outside of the prison system. I am very pleased to introduce my guest today, Jesse Tamplen, an expert in this area, who will offer his insights on some of the most pressing challenges currently facing our behavioral health system. 00;02;55;29 - 00;03;27;07 John Haupert Jesse is the vice president of Behavioral Health Services at John Muir Health, a not for profit health system organization east of San Francisco. John Muir Health offers both inpatient and outpatient treatment programs across the entire spectrum of care for children, adolescents and adults who have psychiatric or behavioral problems. And Jesse also serves on AHA's Committee Behavioral Health. Welcome, Jesse. 00;03;27;07 - 00;03;30;03 John Haupert It's an honor to have you join us today. 00;03;30;23 - 00;03;34;09 Jesse Tamplen Good morning, John. It's a pleasure to be here and have this conversation with you. 00;03;34;27 - 00;04;03;12 John Haupert So, Jesse, let's go ahead and dive into a few questions so that you can share your views on several different issues surrounding mental health, behavioral health, and how health systems are bridging the gap. We know that the pandemic only worsened the longstanding challenges our nation faces around access to adequate behavioral health services. What trends have you seen over the past few years, particularly in the period post-pandemic? 00;04;04;08 - 00;04;37;19 Jesse Tamplen Thank you. As you mentioned, we know that there is a behavioral health challenge with people, children, adolescents and adults receiving care in the United States pre-pandemic. Post the pandemic, we've seen the incidence rates of self-harm, suicide, substance abuse, anxiety, depression, eating disorders increase dramatically. Where we're seeing that impact many times within the system the most is in our primary care settings.&nbsp; 00;04;37;19 - 00;05;03;12 Jesse Tamplen When it becomes very acute, it comes into our emergency rooms and then our med surge acute care hospitals. If a hospital emergency room is fortunate enough to be associated with an acute psychiatric hospital, they're able to get patients the care that they need. But many times that I think people have seen throughout the country that we have a lack of acute care, behavioral health beds in the United States. 00;05;03;20 - 00;05;30;28 Jesse Tamplen And unfortunately, when people become acute, they often stay in our emergency rooms waiting to get care. We do everything we can to make sure that people can go back to either their primary care provider or find specialty mental health providers. But we know that we're in short supply within that workforce. So those have been some of the clinical challenges that have been impacting the the community and the patients that we serve. 00;05;31;22 - 00;05;47;00 John Haupert I was really pleased to see that you all offer psychiatric behavioral health services to children and adolescents as well. What are your views on the availability of mental health services for children and adolescents? 00;05;47;19 - 00;06;21;14 Jesse Tamplen There's opacity for children and adolescents. The Children's Hospital Association for America mentioned that we are just at a, you know, a crisis in youth mental health. In California, one of the largest states, there's less than 100 acute psychiatric beds for kids under 12 years old. John Muir Health has ten of those. So we represent 10% of all of the states, the ICU level of care for youth. &nbsp; 00;06;21;14 - 00;06;46;22 Jesse Tamplen We have 24 adolescent beds and John Muir, 20 years ago made the commitment to youth and adolescent mental health to make sure that kids would not be sent out of their communities to receive treatment. So we're very fortunate in our local community that when kids need to access that critical lifesaving care, they can remain in their community. Across the country and through the state of California, 00;06;47;04 - 00;07;18;09 Jesse Tamplen many times you don't have those services within your community or your health system. So those kids who need care, who need to be as part of their family are many times sent four or five hours away from home. John Muir is a local nonprofit where we serve our community. But when it comes to our acute psychiatric hospital, we are an anchor institution for all of Northern California and many times the state for our youth and adolescent specialized psychiatric inpatient treatment. 00;07;18;25 - 00;07;45;16 John Haupert Wow. Know, that's a stunning number to hear that in a state the size of California, there's 100 beds available for those services. But at the same time, as you and I know, we shouldn't be stunned because nationwide, the amount of inpatient care available for pediatric and adolescent patients is woefully underfunded and available. So let's move on to another question. 00;07;45;27 - 00;08;09;20 John Haupert Hospitals and health systems are playing an increasingly more important role in providing behavioral health care, whether in their own facilities or by helping patients connect with the resources available in their community. Can you share with us any short term collaborations you've seen that are successful in meeting the behavioral health needs of a community or even longer term solutions we should be talking about? 00;08;10;10 - 00;08;37;27 Jesse Tamplen Yeah, this is an exciting area. After the pandemic, some of the stigma and discrimination of mental health decreased in talking about it and allowing people to really share their behavioral health. And I think and the pandemic really allowed more innovation to come forward where we've had some very exciting partnerships with our state in California and locally, our local health jurisdiction, is we've created... 00;08;38;10 - 00;09;01;27 Jesse Tamplen it started off as a substance abuse, a navigator in our emergency room just supporting the opioid crisis. And then that really evolved into a behavioral health navigator. We know that there's not enough preventative services in the community. And so no matter where people are getting services, many times when they become acute, you hear everybody say, if you become acute, go to your local emergency room. 00;09;02;04 - 00;09;28;10 Jesse Tamplen And our emergency rooms are already strapped with the care that they're providing and COVID 19. So we've created a behavioral health navigator that supports those patients, both substance abuse and psychiatry. Many times they're people with lived experience or they have professional education, working with the emergency room team, the family and the community to get the person that care that they need to be able to access care. 00;09;29;03 - 00;09;54;08 Jesse Tamplen Not only do we keep them in the emergency room, but they're able to float up into our medical hospital. And many times, if they are following up with our own primary care, they will go support that individual into primary care. It's been incredible to have that that behavioral health navigator for our patients because we're meeting them anywhere they are in our health care system and helping them navigate the complexity of getting services. 00;09;54;22 - 00;10;26;24 Jesse Tamplen One of the challenges in behavioral health, you may know the service that somebody needs, but they're are significant waitlists. It doesn't exist in your community. So you really need an expert navigator to support the patients. And so that's one area that we have been using are behavioral health navigators. And then we partner with our fire departments. Right now we're doing an innovative project with one of our local fire departments where they're looking to not have a police first response, but a fire response to behavioral health care. 00;10;26;24 - 00;10;35;06 Jesse Tamplen So we're working with them to create a new clinical pathway. So those are two innovative programs that we're currently working on. 00;10;35;26 - 00;10;58;10 John Haupert I thank you, Jessie, and I'm so pleased to hear you bring up the topic of navigators and behavioral health, particularly navigators that have a lived experience with behavioral health issues, have been there, done that. So not only are they navigating for the patient and getting the care that the patient needs, but they're also also serving as a peer support individual for that person. 00;10;58;10 - 00;11;13;22 John Haupert And that's really great. So I know top of the list for many is better integrating and coordinating behavioral health services with physical health services. Any thoughts, advice or maybe wishes that you can share on this type of integration? 00;11;14;19 - 00;11;44;23 Jesse Tamplen This is where I'm passionate about. I think for us to really move the needle on the health inequities in behavioral health, we need to treat physical medicine and psychiatric medicine the same. We need to treat it clinically, which many people want to do, but we also need to treat it economically. The reimbursement in those areas. One area that I would love to share with you is that in hospitals, John Muir has two acute care medical hospitals and one acute care psychiatric hospital. 00;11;44;23 - 00;12;10;14 Jesse Tamplen And we have a transfer center. And as you know, the transfer centers, when you need a bed, when you need specialized care, referring provider calls up the transfer center to find the best care for them within the hospital. Over the last year and a half, we wanted to make sure that we integrated both physical and psychiatric medicine. So we integrated the transfer center with our acute care psychiatric hospital. 00;12;10;20 - 00;12;39;12 Jesse Tamplen So now there's one number for anybody to call to get inpatient treatment. And not only does it create easier access and decreases the stigma and discrimination for people seeking care and providers seeking care, but it's an upstream area where we're working with our workforce also to say we're not treating physical medicine and psychiatric medicine different because we know that we don't have enough beds in California for psychiatric patients. 00;12;39;21 - 00;13;02;10 Jesse Tamplen We are so we know they end up in our emergency rooms, which is not the best care or in our medical hospitals, which is not the best care, but we're still going to treat that. So if we start with a transfer center, develop those clinical pathways, it's part of the education model that we're increasing care clinical protocols no matter what setting you are within that, within the hospital needing care. 00;13;02;19 - 00;13;13;24 Jesse Tamplen So that is an area that I'm very excited about and we've had unbelievable success over the last year with integrating our transfer centers, both physical and psychiatric. 00;13;14;11 - 00;13;39;13 John Haupert Well, that that's a fantastic approach. And it's interesting in the evolution of health care in our country that we have separated those two mental and physical health aspects of an individual, when I always refer to it as whole person care. If I'm a primary care physician, I need to be able to evaluate not only the physical, but are there mental health issues at present as well. 00;13;39;13 - 00;14;11;21 John Haupert And let's treat all of that together. And I so appreciate the work you're doing around that. There have been long been issues around inadequate reimbursement, as you just mentioned, for behavioral health services, as well as significant shortages of behavioral health workers. Those challenges have likely only worsened over the past few years. Can you explain for our audience how poor reimbursement drives shortages of behavioral health workers, and how does that have an impact on inequities within our health system? 00;14;12;10 - 00;14;36;02 Jesse Tamplen Thank you. And when you get into behavioral health economics, it's almost like you have to have a Ph.D. in economics because it's not a simple: two plus two equals four. I wish it was. And so what we know is many times behavioral health is either capitated or their stringent authorizations, or in physical medicine, you can show up to any emergency room and be treated. 00;14;36;10 - 00;15;08;00 Jesse Tamplen But many times, if you're on government insurance, especially at a local health jurisdiction, you have to go to your county of origin to receive care. So your zip code is determining your access and ability to receive care. We also know if your zip codes determining that it's increasing health inequities. And so one of the challenges that we have is the mental health reimbursement does not cover the cost of care, especially in a hospital system that wants to provide whole person care as you mentioned. 00;15;08;00 - 00;15;32;04 Jesse Tamplen I'm a big proponent that to integrate physical and psychiatric medicine, you need to be part of a hospital system that runs emergency rooms, that runs surgery, that runs primary care, specialty cardiology, because that's where you're going to be taking care of the patients and you're going to have a system and a leadership group and clinicians who know how to take care of the whole person. 00;15;32;22 - 00;16;00;16 Jesse Tamplen When you carve that out, then you start having standalone behavioral health programs, which there's nothing wrong with that. But when you look at the health inequities that you are talking about &nbsp;- when you're diagnosed in the United States with serious mental illness, you're dying 25 years younger than the average population. And it's not due to your mental illness, it's due to preventable health conditions, obesity, diabetes, cardiovascular care. 00;16;00;27 - 00;16;24;04 Jesse Tamplen How we carve out our reimbursement and we say we want to treat all person care. When you carve out that reimbursement and your providers and your workforce are just focusing solely on behavioral health, but then they're excluded from providing that primary care, that whole person care. Making sure you're managing somebody's diabetes or obesity or you're not part of a system that has that knowledge. 00;16;24;12 - 00;16;55;14 Jesse Tamplen You see the impact of that stigma and discrimination. And it's one of the reasons why people are dying 25 years younger in the United States with a serious diagnosis. When we look at reimbursement behavioral health providers, you look at our BSN, our Bachelor of Science in nursing, large education, financial investment of time investment becoming a psychiatrist, significant financial time investment, becoming a social worker, a psychologist, a marriage, a family counselor. 00;16;55;22 - 00;17;17;01 Jesse Tamplen So people want to follow their passion, provide whole person care. They've taken out the student loans. They made the time investment. And then when they're looking at where do they want to practice? They look at the level of reimbursement and they're like, I may not be able to pay off my student loans because of the reimbursement. So many of them will go into private practice. 00;17;17;10 - 00;17;39;19 Jesse Tamplen So in behavioral health, you really see kind of a two tier system where you have private practice, where people are taking cash because they don't want to deal with the carve out reimbursement in private practice, which we want to support. But being part of a hospital, we're looking to recruit our professionals. Our professionals are on call 24 hours a day, seven days a week, providing critical care. 00;17;39;23 - 00;18;02;22 Jesse Tamplen And the challenge of reimbursement puts a huge impact on our ability to recruit. We know recruiting for health care workers across the country is a challenge now. In behavioral health it's even more exacerbated not only because of the low reimbursement, but additionally, after the COVID 19 pandemic, there was a huge investment in digital health specifically and behavioral health. 00;18;03;01 - 00;18;35;00 Jesse Tamplen Behavioral health, many times it's not a procedure medicine. It's cognitive medicine. Cognitive medicine goes nicely, virtually. So there's a huge drain on the behavioral health workforce. If you're a psychiatrist or if you're a nurse, if you're a counselor, to be able to provide online therapy counseling, which is incredible for a work life balance. But when you're providing ... when you're an anchor psychiatric institution, not only in your community, but across the state for children and adolescents, that exacerbates the workforce. 00;18;35;08 - 00;18;55;15 Jesse Tamplen And a lot of that drop is driven by the reimbursement that we're getting for behavioral health, which is vastly underfunded. I think in March of last year, 2022, the General Accountability Office just highlighted how mental health reimbursement is underfunded in the United States. 00;18;56;17 - 00;19;39;27 John Haupert Well, Jesse, thank you for that answer. You touched on so many important points. And I'll be honest, I had not heard before that significant lifespan difference for patients with chronic mental health conditions, that really is tragic. And it really points to the issue of having separated the two and underfunding mental health across the board. So one last question, Jesse, a challenge I'm hearing more and more about is the growing administrative burden, a huge piece of this, as in prior authorizations. Some state Medicaid programs are trying to reduce the burden behavioral health workforce teams face, and there's talk of other efforts. 00;19;40;13 - 00;19;50;14 John Haupert But how are you managing that? Are there solutions you all have been able to work through with your state Medicaid program or commercial insurers to to reduce that burden? 00;19;51;15 - 00;20;36;29 Jesse Tamplen That is a great question. And many times to patients, it is an offstage challenge that they don't know until they face it. Prior authorization for behavioral health is significantly overburdened. Then you are is significantly overburdened because of the carve out. And I'm going to highlight some of the challenges that people may not be aware of, and I'll tell you what we're working on with the �� Association, California Hospitals Association with our local municipalities ... is one of the areas that I try to bring education to is when somebody comes to our emergency room, we know our emergency rooms, they're our to support the most vulnerable and their most critical time of need. 00;20;37;08 - 00;21;04;05 Jesse Tamplen And when any other outpatient service can't take care of somebody, they send them to our emergency room to see that receive that care because we're there 24 hours a day, seven days a week to care for the members of our community. Well, if you have a cardiac condition and you go into the emergency room and it's a life threatening condition, regardless of your payor, socioeconomic status, race, ethnicity. 00;21;04;28 - 00;21;33;16 Jesse Tamplen If you have urgent and emergent care, you get admitted into the psychiatric hospital and then you work on all of the authorizations. If they have insurance, not insurance afterwards. We have a federal law, Empala, that really supports that level of care and that level of access. The challenge with reauthorization and behavioral health is many times when it comes to Empala people don't feel that Empala oversees behavioral health. 00;21;34;09 - 00;22;02;27 Jesse Tamplen We know that it does from the Centers for Medicaid and Medicare Services. But when an individual comes into an emergency room and they need care, many times it's requiring pre-authorization, but it's an emergency care. And that reauthorization could take five, six, eight, nine hours. And so people are talking about the lack of beds in the community for psychiatric beds, behavioral health, which is true. 00;22;03;07 - 00;22;29;21 Jesse Tamplen But they also what what they're not talking about is the burdensome of pre-authorization where we're delaying care, because if it is a Medicaid program, a local health jurisdiction or a commercial insurance program, they're requiring authorization or they're going to deny that care. Many times we will the hospital or admit that person. But then on the back end, we get denials. 00;22;29;21 - 00;22;54;01 Jesse Tamplen We have to fight with authorization because we said that's the right thing to do because we need to get the person to the specialized care that they need. And so for me, when I really look at what are things that we can do to really help provide whole person care, integrate physical and psychiatric medicine, many of it is following the guardrails that the regulations are already in there and making sure that they are enforced. 00;22;54;08 - 00;23;24;02 Jesse Tamplen That's also what the General Accountability Office mentioned last March in their report is that there's regulations on the books. But when it comes to behavioral health, not everybody always follows those rules. So I've been working with the California Hospital Association, our local health jurisdiction and the state, to really make sure that we know that when somebody comes into our emergency room, we do not look at their financial status and we get them to the specialized care that they need in-patient. 00;23;24;15 - 00;23;50;18 Jesse Tamplen And for people who are not familiar with this, they may say, wait a minute, this is what's always supposed to happen. But there's been a long precedent, a community standard where people require pre-authorization, which backs up our emergency room. But most importantly, it delays critical lifesaving treatment to people with acute psychiatric or addiction medicine challenges. And the worst situations of this is what is called the ping-pong effect. 00;23;51;00 - 00;24;09;26 Jesse Tamplen I don't know if you've heard of the ping-pong effect before in behavioral health, but somebody comes into your emergency room. They're like, oh, we're not quite sure if this person needs inpatient treatment. Our attending ED physician says, yes, they do. Then somebody says, send them to our psychiatric emergency services. And so we're like, but we have an open bed available. 00;24;10;09 - 00;24;30;21 Jesse Tamplen But they say, send them to ours. We send them to theirs. They're like, oh, we agree with you. And then they send them back to your acute psychiatric hospital. Not only is it a burden on that patient and delaying care, but you're using ambulances, you're using people's times. The cost is coming up. But because behavioral health is carved out, the costs are in different domains. 00;24;30;27 - 00;25;04;09 Jesse Tamplen So people are not seeing that total cost or focusing on that total care. So I'm kind of a zealot when it comes to making sure that we have access in our emergency rooms to lifesaving care for acute psychiatric hospitals. And I've been in the field for over 25 years. I've made some progress, but it's still a fight. And I think right now, with behavioral health being in the spotlight after the COVID 19 pandemic, we can really start driving some of those quality measures which we have in the physical health side many times. 00;25;04;15 - 00;25;18;07 Jesse Tamplen But I feel all parties are mainly government health insurance, are coming together to really drive for, you know, drive that forward. So I'm hopeful, but we're not quite there yet on the issue. 00;25;19;06 - 00;25;49;05 John Haupert Well, Jessie, you really have done a fantastic job today in getting the points across that we need to be focused on. There's a very real reason that HHS has has targeted specific issues within society and health to assure funding for and behavioral health is one of those. I want to thank you for joining us today. I appreciate you sharing your insights on how we can best support behavioral health services and integrate treatment and the whole person care. 00;25;49;29 - 00;26;16;07 John Haupert I know this is a topic that can benefit everyone listening, and I encourage anyone who may be struggling with feelings of anxiety or depression to please reach out to someone who can help. You can visit AHA.org and AHA's Physician Alliance website for additional resource is focused on stress coping and mental health for health care workers. Until next time. 00;26;16;07 - 00;26;23;09 John Haupert Thank you, everyone, for joining us today. I hope you'll be back next month for our next leadership dialog. Thank you. </details> Mon, 22 May 2023 12:25:29 -0500 Capacity Planning Increasing Support for Health Care Workers' Mental Health and Well-being /advancing-health-podcast/2023-05-09-increasing-support-health-care-workers-mental-health-and-well-being Health care workers are stressed out, stretched out, burned out and leaving the profession in truly alarming numbers. It doesn’t have to be this way and there are opportunities to make workplaces engines of mental health and well-being. Three experts make the case that the physical and mental well-being of our workforce is best for patients, makes good business sense, and is actually a precondition for delivering top notch medical care. <hr /> <div><a href="https://soundcloud.com/advancinghealth" target="_blank" title="Advancing Health">Advancing Health</a> · <a href="https://soundcloud.com/advancinghealth/increasing-support-for-health-care-workers-mental-health-and-well-being" target="_blank" title="Increasing Support for Health Care Workers Mental Health and Well-being">Increasing Support for Health Care Workers Mental Health and Well-being</a></div> &nbsp; <details class="transcript"><summary> <h2 title="Click here to open/close the transcript.">View Transcript &nbsp;</h2> </summary> 00;00;01;00 - 00;00;39;10 Tom Haederle Put your mask on first. That's especially good advice for doctors, nurses and other caregivers. It's another way of saying: you've got to take care of yourself before you can deliver your best effort to your patients. But self-care is not always a natural instinct or something that comes reflexively to our health care workforce. And that needs to change. Welcome to Advancing Health, a podcast from the �� Association. 00;00;39;17 - 00;01;12;16 Tom Haederle I'm Tom Haederle with AHA Communications. It's been widely reported for some time now that our health care workers are stressed out, stretched out, burned out, and leaving the profession in truly alarming numbers. It doesn't have to be this way. There are opportunities to make workplaces engines of mental health and well-being. In today's podcast, three experts to make the case that the physical and mental well-being of our workforce is best for patients makes good business sense and is actually a precondition for delivering topnotch medical care. 00;01;12;27 - 00;01;29;12 Tom Haederle Rebecca Chickey, AHA'’s senior director of behavioral health, moderates our discussion. She's joined by Dr. Arpan Waghray, CEO of Providence Well-Being Trust, and her AHA colleague, Elisa Arespacochaga, AHA vice president of clinical Affairs and Workforce. 00;01;30;19 - 00;01;57;15 Rebecca Chickey It's my honor today to welcome Elisa Arespacochaga from the AHA, vice president of Clinical Affairs and Workforce, as well as Dr. Arpan Waghray, who is the CEO of Providence Well-Being Trust. They are here to join me today to talk about a very serious situation, and that is the need to increase the support of health care workers, mental health and well-being. 00;01;57;21 - 00;02;25;20 Rebecca Chickey Even prior to COVID, there were some challenges in this area, and COVID has taken that to another level. Dr. Waghray, at Providence and while at Wellbeing Trust, has been working diligently to improve access to services, to reduce job stressors, to reduce the stigma that many health care workers have in relating to seeking treatment for or even admitting that they might need mental health. 00;02;26;02 - 00;02;52;00 Rebecca Chickey And Elisa Arespacochaga at the AHA has been leading this work, particularly focusing on what are the best practices to reduce physician burnout, and that has now expanded to the entire workforce. So it's my honor to welcome both of the speakers today. I'm just going to reiterate for the listeners a couple of the key facts that I indicated earlier. 00;02;52;20 - 00;03;24;11 Rebecca Chickey First of all, the research shows that mental health challenges for our workforce has intensified, as I mentioned, since the onset of the COVID 19 pandemic in 2020. Health workers report that they've been stressed out, stretched too thin, as well as being emotionally and physically exhausted. In the fall of 2022, the U.S. Surgeon General, Dr. Vivek Murthy, shared a framework for the workplace, mental health and well-being to provide a foundation that workplaces can build on. 00;03;24;20 - 00;03;50;07 Rebecca Chickey So this is not isolated to any one part of the country. We see this crisis happening across the U.S. As Dr. Murthy's stated, as we recover from the worst pandemic we have ever seen, we have the opportunity and the power to make workplaces engines for mental health and well-being. So I've got two questions to kick this off to Elisa and Arpan. 00;03;50;20 - 00;04;04;03 Rebecca Chickey The first one is why is it important for employers, but particularly hospital and health system leaders, to focus on mental health and well-being? Dr. Waghray I'll give that first one to you. 00;04;04;14 - 00;04;22;03 Arpan Waghray Sure. Well, thank you so much for having me, Rebecca, and for allowing me to be a part of this really important discussion. I also want to thank the �� Association for a lot of stellar work that's happened. And hopefully we'll be talking about some of these things that have really made an impact. You know, it's a great question. 00;04;22;13 - 00;04;41;07 Arpan Waghray And I'll start by quoting J.W. Marriott, because I think he captures the essence of this really well. He said once when asked, what's your business strategy? He said, Well, I take care of my people. My people take care of the customers, and the business takes care of itself. So to answer your question, I would say there are three parts to it. 00;04;41;07 - 00;05;11;20 Arpan Waghray There are three reasons that come to mind. I mean, first, I hope that you would want to care for your people primarily because you love the people who work for you or work with you. Second, it makes a lot it makes good business sense. The impact, absenteeism, presenteeism, retention, so on, so forth. Third, and this is more pertinent to health care, the mental health and well-being of the workforce is a precondition to delivering excellence with compassion, not just a priority. 00;05;11;28 - 00;05;21;04 Arpan Waghray So I would say that these are the top three reasons in my mind to make sure that every employer, every CEO starts paying attention to this. 00;05;21;21 - 00;05;25;24 Rebecca Chickey Thank you. Great points. What would you like to add to that? 00;05;26;15 - 00;05;51;22 Elisa Arespacochaga Thanks so much, Rebecca. And as you mentioned, I've been working on this issue for quite a while, starting with physicians, but across the workforce. And I think one of the things that physician and physician leaders who've been studying this work and studying burnout and the impact of their own well-being and mental health on their patient care have really been able to pinpoint is a direct correlation between their own well-being and the well-being of their patients. 00;05;52;03 - 00;06;23;04 Elisa Arespacochaga And there is a close connection. You cannot provide the best care if you yourself are not well. And so creating those opportunities for everyone on the clinical team to support their own well-being is, as Arpan mentioned, is good business sense. It's also why they're there. They're there to care for people. So giving them those tools to be able to take care of their own well-being, their own mental health, not only allows them to reconnect to their purpose, to why they're there. 00;06;23;13 - 00;06;50;08 Elisa Arespacochaga It also gives them the gas in the tank, if you will, to be able to think about how to innovate, how to drive the next type of care, the next care delivery system, because they have that, you know, well, that they can keep refilling of their own well-being. So I think there are a lot of different areas. But the supporting the mental health and well-being of our own team members is probably, you know, one of the paramount challenges that came out of the pandemic. 00;06;50;18 - 00;07;05;12 Elisa Arespacochaga We have a team that's very, very dedicated. They are the ones who run into the fire, but they they're exhausted. As you mentioned, they've been doing this for three years. So creating more opportunities to support them and support their wellbeing is a huge requirement for our field. 00;07;05;28 - 00;07;25;16 Rebecca Chickey Thank you. I'm going to quote someone. It's not quite as eloquent as what Arpan said, but that is summarizing part of what you said, Elise, and that is put your mask on first. I don't know if I should credit United, American, Southwest Airlines, but all of them tell you, put your mask on first and then you can take care of others. 00;07;25;16 - 00;07;48;17 Rebecca Chickey And that's one of the key messages I heard from both of you. Unfortunately, sometimes, though, that's not a natural instinct to put your mask on first, right? Particularly if you're caregivers, if you're someone who has gone into the health care workforce, that's more than likely part of your motivation, if not your key motivation, to being in that field is to help others, as both of you mentioned. 00;07;48;20 - 00;08;15;05 Rebecca Chickey And so we want to put it off. We want to help others first is often what I hear. Unfortunately, in addition to that natural instinct to take care of others before you take care of yourself, there's the stigma that surrounds psychiatric and substance use disorders, or even just that tipping point between burnout and feeling stressed out. 00;08;15;20 - 00;08;29;03 Rebecca Chickey And so I'm wondering, and Elisa I'm going to kick this to you first - how has the stigma surrounding addressing mental health issues in the workplace shifted since the COVID pandemic? Have you seen any change? 00;08;29;17 - 00;08;57;11 Elisa Arespacochaga Thanks, Rebecca. We certainly have. I think, as part of a an overall wave and change in the social comfort with addressing mental health issues, we've also seen a certain level of openness and comfort with addressing some mental health issues. You know, sort of broadly across health care. But we still have so many situations where addressing your own mental health is stigmatized as a caregiver, as a provider of care. 00;08;57;19 - 00;09;30;18 Elisa Arespacochaga We have had the privilege of working with the Dr. Lorna Breen Foundation for a number of years and been a founding member of their all in for well-being efforts. And there is still a very clear in some cases misconception in some cases not, but belief that based on many of the licensing and credentialing and application forms, that admitting on paper to seeking help for a mental health disorder, that they are, you know, somehow going to jeopardize their careers. 00;09;30;26 - 00;09;59;13 Elisa Arespacochaga So we are working with the foundation and others to try to address some of those challenges, to try to really correct some of those stigmatizing language and questions that are in some of our applications, both at the hospital and health system level, at the credentialing level, at the state licensing level, trying to move forward beyond that stigma that if you need support for your mental health or did at some point in the past, that somehow that changes your ability to provide care to your patients. 00;09;59;24 - 00;10;10;11 Elisa Arespacochaga So while we've seen it moving slowly, unfortunately, and particularly in the case of Dr. Lorna Breen, not fast enough. So we're continuing to push forward. 00;10;10;26 - 00;10;23;10 Rebecca Chickey Thank you, Elisa. And just for the purpose of the listeners, can you say the name of the foundation again? So if they'd like to Google that, they can go there to find some of the resources that AJ has contributed as well as others in this effort? 00;10;23;19 - 00;10;33;08 Elisa Arespacochaga Oh, absolutely. The Dr. Lorna Breen Foundation, &nbsp;as well as "all in for health care well-being" are two phrases you can Google to find these resources. , 00;10;33;26 - 00;10;54;08 Rebecca Chickey Wonderful. Dr. Waghray, what's your perspective? Because as a geriatric psychiatrist, really working in the field and on such a strong, large system as Providence Health, along with your work at the Wellbeing Trust? What's your perspective on the impact that COVID has had on stigma? 00;10;54;22 - 00;11;15;18 Arpan Waghray Yeah, I mean, I love the way Elisa called out the core issues over there. I mean, and I think you started us off that way too, Rebecca. You think about it. Help seeking behavior doesn't come naturally to those in health care, right? So they suffer in silence. And unfortunately, we see the tragedies that Elisa described. And there's so much more to be done. 00;11;16;04 - 00;11;44;24 Arpan Waghray Now, come back to your question. If I reflect on this and look at the last few years of the pandemic, if there was a silver lining, for me it was that the conversations around mental health started to become more normalized at every level of the organization. And I think that was a refreshing change. You know, if we think about it, in the past, there was a culture in health care where you were always told that if you can't take the heat, get out of the kitchen. 00;11;45;05 - 00;12;04;05 Arpan Waghray Well, that's been flipped on its head. And now we're intentionally asking us asking ourselves the question, does the kitchen really need to be that hot all the time? So there's a fundamental shift in how we're approaching these things. So I do feel more hopeful. There's a lot more way, you know, ways for us to go, though. 00;12;04;23 - 00;12;30;21 Rebecca Chickey Absolutely. I sometimes call it the sliver of the silver lining of the COVID epidemic. And that is that more people realize that depression, anxiety, substance use disorders just doesn't happen to that person over there. I often say to people, you know, it is one in four or one in five Americans, depending upon which research you look at that in every year has a psychiatric or substance use disorder. 00;12;30;21 - 00;12;48;10 Rebecca Chickey So if you're in the room listening to this with a group of colleagues, look around the room, some of your colleagues or maybe even yourself may be struggling. I'm going to move now to which we pointed out some of the problems, the big changes that have happened, the impact that stigma can have. So let's get down to the nitty gritty. 00;12;48;11 - 00;13;05;08 Rebecca Chickey What are some of the small changes, or large changes if you want to go down that route, that a health care or health system leaders can implement to start making the mental health and well-being of their employees and their workforce a priority? Dr. Waghray, I'll pitch that to you first. 00;13;05;27 - 00;13;35;07 Arpan Waghray Sure. Thanks, Rebecca. I would say that it starts with building on our prior comment of normalizing the conversation and setting a tone from the top. And I can now probably pivot to an example of how we approach this at Providence, and hopefully that will help your listeners. We did two things. So when I started the pandemic, as you're aware, we admitted the very first COVID positive patient to one of our hospitals in Everett, Washington, and our leaders recognized that we need to be prepared. 00;13;35;15 - 00;14;09;23 Arpan Waghray There was a sense of urgency to ensure that people are in care. I mean, we, of course, focused on the physical PPE, but very quickly we also started thinking about what's the psychological equivalent of the PPE, that what do we do to ensure that people are well. So we did two things. One was making sure that any one of our workforce and we have 120,000 caregivers across our seven state region, anyone raises their hand and wants help for themselves, that we have a process to seamlessly guide them to the support and help they need based on their needs and preferences. 00;14;09;29 - 00;14;32;27 Arpan Waghray So this doesn't mean that everybody is referred to a psychiatrist or therapist. It's really based on what their needs and preferences. Sometimes it's self-help, sometimes it's spiritual help, sometimes it's therapy, sometimes it was child care. There could be so many different things. But having a process that seamlessly gets people to what they are, that was job number one and I can share a little bit more about how we've gone through that and and the successes. 00;14;32;27 - 00;14;52;02 Arpan Waghray And it's been something that she then took on and and helped build something even more robust than what we had done. So that was one part. The second part builds on the prior comments that we had that many of those in health care who might need the help the most are probably suffering in silence. So how do we create a proactive. 00;14;52;07 - 00;15;21;09 Arpan Waghray So in addition to the responsive reactive approach, how do we create a proactive approach to lean in and support those who might be suffering in silence? So this is where we partnered with the American Foundation for Suicide Prevention, a program that was built out of UCSP and created a process where it started with the top. So Dr. Rod Hochman, our president and CEO, started by talking about why mental health is important, why he cares about his mental health and what he is going to do about it. 00;15;21;15 - 00;15;41;27 Arpan Waghray And that set the tone and almost gives permission for leaders to start thinking about this differently. Then what we did is, you know, people are used to annual dental checkups, annual physicals. We said, well, how do we proactively send an annual mental health checkup that's anonymous, confidential, that touches different domains that people can can understand what they're doing in the comfort of their home. 00;15;42;06 - 00;16;06;23 Arpan Waghray And on the backend, these are reviewed by our therapists and a personalized response is given to people. And when people need higher levels of support that they're connected to, to a higher level of care. So these were two big approaches. The front door to seamlessly guide people when they need help and they're raising their hands and then creating a process that's built in to support those who need the help the most. 00;16;07;19 - 00;16;29;19 Rebecca Chickey That's fantastic. Truly. Thank you, first of all, for taking on all that extra work when you were in the midst of dealing with and on the front end or the bleeding edge, as I sometimes call it, of the COVID pandemic. Miind you, to the listeners, this was all work that was being done prior to any of the vaccination, and that came a year, year and a half later. 00;16;29;21 - 00;16;50;26 Rebecca Chickey So thank you for doing that. Alisa, what are some small changes that health care leaders can take? I know that AJ has done some research lately with the Centers for Disease Control on preventing suicide, obviously in the health care workforce, but tell the listeners what are a few things that they can take back to their own organization. 00;16;51;22 - 00;17;17;06 Elisa Arespacochaga Absolutely, Rebecca. And we have a an entire series of resources from the front end of how do you create a wellbeing program, which I strongly believe has to be at the system level, at the organizational level, you have to bring in and understand that you need to create supports across the system. You also need to talk with your frontline teams about what it is that they need. 00;17;17;21 - 00;17;39;20 Elisa Arespacochaga And as Arpan mentioned, you have to have multiple approaches. One approach will not work for every single member of your team. You have to have different ways to reach them. But from that, all the way to the research that you really led around, what are those interventions that can most help hospitals and health systems prevent suicide in their own workforces? 00;17;39;20 - 00;18;04;06 Elisa Arespacochaga And as a result of that work, you published a report with 12 interventions. And I know you're leading a great collaborative now this year to really understand what works and what doesn't work. Again, you have to have a suite of resources that people can pull in what works for them. The other piece I want to mention is some great work that started at Providence, and that is the stress meter. 00;18;04;16 - 00;18;39;09 Elisa Arespacochaga So we took that front door, as you called it, and really created a resource that organizations in hospitals across the country can access and download for their own organizations to have access to. What are those immediate potential resources that could support someone who is having distress? And those options give everyone, you know, the option from everywhere, from, you know, I just need to talk to someone, a peer, a colleague, to, you know, what are the resources that might be available to me when I need something a little more advanced. 00;18;39;18 - 00;18;57;28 Elisa Arespacochaga So I think there's sort of a suite of resources that have really been curated to put that opportunity in front of health system leaders to address the broad spectrum of activities, but also to pick and choose those that will most help their workforce. 00;18;58;28 - 00;19;20;09 Arpan Waghray Rebecca If I may build a little bit, because I think I want to emphasize this so the listeners can understand the amazing work that the �� Association has led here. You know, there are some health systems that have a lot of resources and they're able to allocate financial resources to this. But that's not the luxury that many of our small, smaller hospitals have. 00;19;20;21 - 00;19;52;23 Arpan Waghray And what the �� Association has done over here is so powerful that there is a process that allows every hospital, every system, irrespective of what your resources are, to be able to do something that is meaningful for your workforce by leveraging this this beautiful tool. And it has the best science. You know, a lot of research that the AHA team led to really understand and make sure that these are vetted best practices and they're all free resources. 00;19;53;01 - 00;20;12;22 Arpan Waghray So I think it's it's just so powerful. And one more thing that I wanted to call out was, you know, when we think about what can health systems do? You know, when when I reflect back, I think everyone in health care is used to CPR. They recognize that when you know somebody is on. Well, you know, that's a familiar approach that we take. 00;20;12;22 - 00;20;36;01 Arpan Waghray And what we did was we said, well, if one of your colleagues is struggling, how do we give you the tools, the emotional equivalent of CPR and can we build in that training so that you're comfortable identifying people, your colleagues, when they're struggling, ask them questions around, you know, suicidality. And so which can be really hard if that's needed, and then guide them and support them. 00;20;36;10 - 00;20;57;29 Arpan Waghray And I see this because no matter how many resources we put out there, many people who need the resources might not ever get to that point where they're able to avail them. And when we did this and we put this out there, you know, voluntarily, we had 40,000 of our caregivers complete the training and be prepared. I mean, it just tells you how health care workers think. 00;20;57;29 - 00;21;07;25 Arpan Waghray I mean, what if you called that out? You know, you go ahead. This is your calling. When you go into this field, you want to help others and you want to help ypur own. So I just wanted to make sure that we were calling that out as well. 00;21;08;08 - 00;21;28;01 Rebecca Chickey Know our pain. And thank you so much for that. And I want to just reiterate what Alisha said a little bit earlier, not only the suicide prevention guide, that if you want, you can Google HRA Suicide Prevention Guide for Health Care Workforce, and it will take you right there. This is free and available to all, as is AHA's stress meter. 00;21;28;07 - 00;21;57;16 Rebecca Chickey That is a tool that Lisa mentioned that was earlier created at Providence. We took that fabulous idea of centralizing some key vettted resources that can be anyone can use the stress meter to check in every day on themselves and really determine where they feel. Are they good today? And if so, keep going or are they having a moderate struggle? 00;21;57;16 - 00;22;22;06 Rebecca Chickey This is not a diagnostic tool, but it's a way to quickly access resources that may help any individual. I actually gave the stress meter link to my niece, who's in her first year of medical school. So it's anyone who can access this and hopefully keep the stress at a manageable level. But if not, it also takes you to resources when you're in a crisis. 00;22;22;14 - 00;22;51;24 Rebecca Chickey So thank you for the compliments, Arpan, and thank you for sharing and being a part of both of those products. And one thing I also want to reiterate, the message ... actually two things. One, size does not fit all. You know, one of the key reasons I think this question said small changes in employer can make is because if you start small in that way, you can build on your success instead of trying to put it off with a big project. 00;22;52;03 - 00;23;21;27 Rebecca Chickey And you said the first things that Dr. Rod Hoffman did was to speak from the top to get leadership involved. And he took that leadership and he spoke out. It's only one step. I'm not in any way saying it was a small step, but it's one step and it probably reverberated across your whole organization. Let me turn to this situation, because I know there are probably people listening to this who are saying, well, I work in a workplace that's not supporting my mental well-being at all. 00;23;22;14 - 00;23;41;01 Rebecca Chickey Do you have recommendations of, you know, what would you say? How would you guide that person? You know, they're frustrated. You're concerned about their mental health. Are there any ideas that you could share with the listeners to say, here's what they should do? Elisa, I'm going to hand that off to you first. 00;23;41;29 - 00;24;08;00 Elisa Arespacochaga All right. Well, I think there are a number of different things I would point to. Certainly looking for resources in your community as well. But I think one of the challenges that organizations face in looking at implementing programs around well-being and around supporting your mental health is a paralysis of doing the wrong thing, of not creating a sufficiently robust program or or not creating the right program. 00;24;08;00 - 00;24;44;11 Elisa Arespacochaga So I think looking for resources like those AHA has available to find opportunities to make those small changes. Start with, for example, what is the employee assistance program within your organization through HR? That may not be enough resources for what you need, but that's a place to start looking for those opportunities where we have most organizations may have some resource, but exploring what's available to start and then looking for ways to drive change in your organization and bring forward the conversation and bring it up. 00;24;44;11 - 00;24;58;09 Elisa Arespacochaga It's sometimes a challenge, but I think we the more we can have our teams really raising the issues that are a challenge will help the entire organization move forward and really heal. But let me turn it over to Arpan. 00;24;59;02 - 00;25;17;07 Arpan Waghray Oh, you said it so eloquently over there. I think it's those small things. I would say, you know, everything Elisa said, because first of all, you know, look, this is the number one health concern for most workers in health care, like musculoskeletal pain is the number one health concern for the employees of Amazon across health care, across the United States. 00;25;17;13 - 00;25;37;06 Arpan Waghray Mental health concerns do remain the top one and two: depression anxiety. So being chronically unprepared is not a strategy, at least not a good one. So we have to do something. And I think not getting stuck in the analysis paralysis mode and doing simple things, I would say simplify everything you're doing and then lighten it. So you really need to make sure that there are things that you already have. 00;25;37;14 - 00;25;58;05 Arpan Waghray Everyone does have something, and if you don't, there are resources like the �� Association has made available to you for free. So you already have access to these things. It's just organizing it and making it accessible through through your intranet pages, through QR codes in the nursing stations, making sure that the word is out there and you're just presenting it to everyone. 00;25;58;06 - 00;25;59;16 Arpan Waghray I think that would be an important first step. 00;26;00;09 - 00;26;35;02 Rebecca Chickey Thank you both. I'm going to add one other resource that is easily to do, and that is AHA has created now six, almost seven posters. We call it The People Matter, Words Matter Posters. And I think often people struggle to talk about or speak about treatment, mental illness, because they don't have the right words to say. They don't know what might be offensive or even if they know something is offensive, they might not have the right words for something that is caring and understand. 00;26;35;17 - 00;27;00;08 Rebecca Chickey And so we have developed a series of posters and it takes you through: How do you talk about substance use disorder? How do you speak about suicide? What's your perception of individuals with mental illness? And the reason I mention this is that they're free, they're downloadable and it gives you a workforce team, in this case hospital and health system workforce team members. 00;27;00;20 - 00;27;26;10 Rebecca Chickey The ability to normalize, I think, is the word that you used early on Arpan, normalize how you speak about it. And in fact, CommonSpirit has taken these posters and is rolling them out across their various hospitals and states and helping their managers, encouraging their managers to sit down with their team members and feel comfortable talking about behavioral health disorders. 00;27;26;15 - 00;27;48;17 Rebecca Chickey So that's one more small step that you can just start with one poster and see where it goes. So my last question that I asked focused on the challenges that a worker might have. I'm going to ask you now what challenges should an employer, a health care system leader, expect as they are implementing a new policy or program supporting mental health? 00;27;49;12 - 00;27;51;28 Rebecca Chickey So Arpan, I'm going to let you lead this one. 00;27;52;11 - 00;28;14;01 Arpan Waghray Sure. I think it's a really important question. It segueways nicely from the prior comments and questions and this is something we learned the hard way. Everyone is well-meaning and we want to come up with resources as that help our people and what we unintentionally do. And this is something that all health systems need to be thoughtful about is not create more confusion for your workforce. 00;28;14;11 - 00;28;36;04 Arpan Waghray You know, we add programs. I mean, we got to a point where we kept doing more and more things and and adding and stuff, and people were not able to even access the simplest things because it was just the entire repository of resources itself became confusing or could become confusing for people. And there was a point where people said, Please, no more, just don't add any more programs to what we have. 00;28;36;09 - 00;28;56;09 Arpan Waghray We already have. So so I would say that that's really important to, you know, simplify it and have, you know, an organized approach, not just adding more. The other thing I would say is that well-being needs to be something that becomes a part of your normal workday. It can't be this one other thing. If you just imagine how busy our nurses, doctors and frontline workers are. 00;28;56;09 - 00;29;21;28 Arpan Waghray And if you ask them to take time out to do one more thing, even if it's for their own well-being, that'll never work. So it needs to be incorporated in the normal workday, understanding, you know, what matters to people, what are the pebbles in your shoes? And then having clear other ways to help that at every level, at every team level, at every unit level, so that you then now start building a culture where well-being is a part of who you are. 00;29;22;07 - 00;29;34;01 Rebecca Chickey I love that. What is the pebble in your shoe? That's that is so relevant. I mean, seriously relevant. It's that what is that one or two things that are just so irritating. Elisa, to you. 00;29;34;23 - 00;29;56;13 Elisa Arespacochaga Just building on that, I would say ask your front line team. They know what the pebbles are. They can outline that. They can describe in great detail every single pebble. I think the other thing that leaders especially need to think about is this is not for the faint of heart. It is going to take time, culture change takes anywhere from three to five to seven years to really take hold. 00;29;57;00 - 00;30;20;04 Elisa Arespacochaga So don't be discouraged when the first five things you try only get you, you know, a tiny bit of a reaction or in fact, you know, you don't actually see your engagement scores change or some of your metrics moves because it's very hard to make the connection between the measurement and initial activities. Absolutely, you need to keep measuring. 00;30;20;05 - 00;30;40;23 Elisa Arespacochaga I'm not advocating that you don't measure what you do or you don't track, but it's not you know, it's not one of those indicators that's just going to shoot up through the roof as soon as you set up your first program and you're going to have to stick with it. So I encourage everyone to have the patience and just keep focusing on what are the things that the team tells you they need? 00;30;41;29 - 00;30;53;13 Rebecca Chickey Well, so as we wrap up this podcast, I'm going to ask each one of you to say one thing that you do to support your own mental health and well-being. 00;30;53;26 - 00;31;03;21 Elisa Arespacochaga One of the best ways I've found to support my mental health and well-being is to focus on family time, separate from work time, and protecting that as strongly as I can. 00;31;04;16 - 00;31;06;00 Rebecca Chickey Excellent. Arpan? 00;31;06;27 - 00;31;19;20 Arpan Waghray For me, it's the practice of gratitude every day. I use the three good things. What are the three good things that happened? And and I think, though, that is really, really grounding for me and helps me tremendously. 00;31;20;05 - 00;31;52;16 Rebecca Chickey Well, thank you both for sharing the tools and resources that are available and for sharing your time and expertise with us today and for encouraging others to help this movement to improve and enhance the way in which all employers, but particularly hospitals and health systems, support the mental health and well-being of our health care workforce. To learn more about the resources that AHA offers, visit AHA.org/behavioral health. </details> Tue, 09 May 2023 16:06:18 -0500 Capacity Planning Public health emergency ends but the mental health emergency continues /news/blog/2023-05-03-public-health-emergency-ends-mental-health-emergency-continues With the COVID-19 pandemic receding from the national headlines and public health emergency (PHE) winding down later this month, it’s imperative to reflect on the pandemic’s impact on mental health care in the United States, and how we must adapt to face the ongoing challenge of providing mental health care services to our communities. Many have dubbed the growing need of mental health services as the next pandemic. It’s clear that the COVID-19 pandemic has led to a boom in tele-psych services that is here to stay, although questions remain on what will be the effect of the elimination of the emergency edict. According to several surveys, mental health visits continue to be provided virtually (with estimates ranging from over one-third to over half of the visits), in contrast to other specialties where the majority of clinical encounters are returning to in-person care. While mental health services have long been offered via telehealth, and more so than for other service lines, large-scale uptake was stymied by limited reimbursement coverage, especially from governmental payers. That changed once the pandemic took hold, and thankfully that coverage has been extended at the federal level for the time being. Medicaid reimbursement varies from state to state, but all states cover some form of telehealth services. Prior to the pandemic, many providers were unsure if telehealth would be an effective way to provide behavioral health services. After three years, most are sold that the remote platforms are engaging enough and work -- and patients agree, because they continue to ask for those appointments. Telehealth care has also helped break down certain barriers that have long been a problem in health care. Geography, lack of free time and the cost of transportation are all access barriers erased by telehealth services across health care, and especially in behavioral health, where appointments can be difficult to obtain. Another barrier for providing telehealth care prior to the pandemic was restrictions on virtually prescribing controlled substances, including for patients under psychiatric care. The elimination of the public health emergency will again limit a provider’s ability to prescribe controlled substances to a patient they’re caring for through a telehealth platform. This would unfairly stop some patients from utilizing care remotely. The U.S. Drug Enforcement Administration (DEA) has proposed rules that will extend certain flexibilities, but the practice of prescribing controlled substances will be more restrictive than what the public health emergency has allowed, necessitating in-person visits for most patients in need of controlled substances like stimulants for Attention Hyperactivity Disorder (ADHD) or benzodiazepines like Ativan or Valium for anxiety or insomnia. During the pandemic, many states temporarily allowed practitioners from other states to provide telehealth services. This allowed patients in underserved areas, or with a need for specialty care, to reach providers they would otherwise not have had access to. As we build the care in the future, we need to solve for the issue of telehealth services stopping at state lines. Just as patients have embraced telehealth, caregivers have also found the service to be highly effective. As we shift toward a post-pandemic world, let’s not lose sight of all that we’ve learned about caring for patients during this difficult time, when demand for mental health services has risen to record levels. This demand isn’t going away, which is why we can’t limit how we care for patients. Beyond the impact on telehealth, the declaration of end of PHE also is a statement on returning to normal service. But as we settle into this new normal of the post-PHE world, we must continue to raise awareness for the ongoing need for mental health services. Our work is not finished. The pandemic laid bare the disparities in clinical outcomes in historically underserved communities. We must advocate for access to high bandwidth internet for all and for culturally competent telehealth for our diverse communities. Furthermore, we need to train more clinical professionals that are representative of the communities we serve. Even before the pandemic, we faced a limited workforce of trained clinical professionals. Our delivery care system needs substantial investments, especially in minority communities, to provide culturally competent care. The pandemic helped with decreasing stigma associated with accessing mental health care. We need to maintain this momentum by supporting easy access to effective care. We were fortunate enough to beat one pandemic; we can’t afford to slow down in our battle with the next one. Manish Sapra, MD, MMM is executive director of Behavioral Health Services at Northwell Health Wed, 03 May 2023 11:58:38 -0500 Capacity Planning The Growing Role of Emergency Departments in Behavioral Health Services /advancing-health-podcast/2023-05-02-growing-role-emergency-departments-behavioral-health-services The past five years have seen a rise in the number of people turning to their local hospital emergency departments for behavioral health and addiction services. To meet the growing need, some hospitals and health systems are creatively addressing this challenge and expanding their ED offerings. The results are already making a big difference in communities. &nbsp; <hr /> <div><a href="https://soundcloud.com/advancinghealth" target="_blank" title="Advancing Health">Advancing Health</a> · <a href="https://soundcloud.com/advancinghealth/the-growing-role-of-emergency-departments-in-behavioral-health-services" target="_blank" title="The Growing Role of Emergency Departments in Behavioral Health Services">The Growing Role of Emergency Departments in Behavioral Health Services</a></div> &nbsp; <details class="transcript"><summary> <h2 title="Click here to open/close the transcript.">View Transcript &nbsp;</h2> </summary> 00;00;01;07 - 00;00;39;15 Speaker 1 Over the past five years, there's been a documented rise in the number of people who turn to their local emergency departments to provide behavioral health services. The pandemic has only amplified the demand. To meet the growing need, hospitals and health systems are creatively addressing this challenge and expanding their offerings. Welcome to Advancing Health, a podcast from the �� Association. 00;00;39;25 - 00;01;05;26 Speaker 1 I'm Tom Haederle with AHA Communications. Headquartered in Minnesota, M Health Fairview has responded to the rising demand for ED-based behavioral health services with its "Empath" unit. That stands for Emergency Psychiatric Assessment, Treatment and Healing. Introduced in 2021, the model offers patients fast effective care in a calming environment, and that's already making a big difference in the community. 00;01;06;18 - 00;01;25;18 Speaker 1 In this podcast, Jordan Steiger, senior program manager of Clinical Affairs and Workforce of the AHA explores how Empath delivers the care patients need with Beth Hines, an executive with a mental health and addiction services and Women and children service lines at mHealth, Fairview. And now, to Jordan and Beth. 00;01;26;16 - 00;01;36;04 Steiger Thanks so much, Tom. Beth, thank you for being here today with us. Before we start, I was wondering if you could tell us just a little bit about you and your role at mHealth, Fairview? 00;01;37;02 - 00;01;49;09 Hines Sure. I am the senior executive accountable for mental health and addiction services for M Health Fairview, which is a partnership with the University of Minnesota rate. 00;01;49;23 - 00;02;03;02 Steiger So what we're here to talk about today is your Empath unit, which is a really unique way to provide mental health care to your patients and the population that you serve. So I was wondering if you could just explain what an Empath unit is. 00;02;03;15 - 00;02;20;23 Hines Sure. An impact unit is an emergency psychiatric assessment, treatment and healing area. So it's similar to an emergency department. But the entire unit is completely designed and dedicated for any type of crisis regarding mental health or addiction. 00;02;21;06 - 00;02;27;28 Steiger Great. And tell us a little bit about what your unit looks like. Like, what does that patient experience when somebody comes in? 00;02;28;15 - 00;02;53;22 Hines Yeah. So we wanted our Empath unit to be very, very different than a medical emergency room. So if you think of a medical emergency room, you are hearing sirens, usually loud noises. Your I.V. beeping that goes on. It can be a very loud and chaotic environment, which we know is not therapeutic when you're in a mental health crisis and so our Empath is designed. 00;02;54;10 - 00;03;37;23 Hines One of the things that we really wanted to hold as a guiding principle was a very open milieu, very relaxing environment. We have outside light, so making sure that we have access to natural sunlight. So anyone who is receiving care in the Empath is able to know if it's daytime or nighttime. We've got freedom of movement throughout the the whole entire space, and it's a very open space so people can get coffee or get drinks, make decisions for themselves in a way that you don't necessarily have the ability and agency to do in a medical E.R.. 00;03;38;06 - 00;04;08;15 Hines We have about 15 recliners that are circular around the outside of our impasse with, like I said, natural light coming in. And then we've got an area that we've got water and beverages. We have a sensory room that any individual could access if they want. Just a little bit of quiet time. We have a very open nursing station that's kind of central to the unit, but yet part of that unit.&nbsp; 00;04;08;15 - 00;04;16;12 Hines We also have the ability we've got a shower room. So if somebody wants to go and take a shower, they have the ability to do that, grab a blanket or grab snacks. 00;04;16;27 - 00;04;26;02 Steiger That sounds like an environment that is really conducive to healing and just being comfortable in a situation that can be really scary for patients coming into the hospital. 00;04;26;14 - 00;04;39;20 Hines Exactly. It's really wellness and recovery orientated. So really focused on that approach. And again, our patients have the ability to kind of continue to take care of themselves in that space as well. 00;04;40;04 - 00;04;47;10 Steiger It sounds like it. And tell me a little bit more about the types of psychiatric services you provide. 00;04;47;23 - 00;05;16;26 Hines We pretty much see anybody who would normally present to an emergency department in a crisis. And so our Empath is actually for individuals who are 18 and older and we see pretty close to 95% of any of the individuals presenting to an emergency room. So if they're medically cleared and they can walk and talk and eat, you can come in to to the Empath and receive services there. 00;05;17;10 - 00;05;28;07 Steiger That sounds like a really productive way to keep people out of the ED, which we know can be really stressful for people that are needing psychiatric services. What happens after somebody comes to your unit? 00;05;28;21 - 00;05;54;29 Hines Our unit is staffed by a multidisciplinary team with constant observation. And so they actually come in and we've got a licensed mental health professional. It could be a master's level social worker. It could be a Ph.D psychologist who actually does an initial evaluation. And then there's opportunities for reevaluation. And then we actually are able to access psychiatry services immediately. 00;05;54;29 - 00;06;40;10 Hines So if meds need to be started or changed, that can also happen immediately. We also offer groups, so therapeutic groups that we have open invitations to individuals to be able to come in and do some of that processing and therapeutic work right away in that Empath unit. Our average length of stay is about 24 to 26 hours. And so it's kind of almost borderline an observation stay, but it gives us enough time oftentimes to start that treatment and we're able to de-escalate and help our patients actually start on that wellness journey so that we can actually do some diagnosis and discharge planning with our patients and the families that present. 00;06;40;24 - 00;06;52;14 Steiger That sounds great. I mean, it sounds like that's a really productive way to to make sure that the patient gets to the right place after they come to see you. So how did this journey start for you and how did you launch this unit? 00;06;52;29 - 00;07;17;21 Hines So that's a great question. I do a lot of work with the University of Minnesota Masters in Health Care Administration program, and we actually had a student group of second year MHA students who needed a project to do to complete for graduation. And I asked them to try to tackle the problem of ED boarding, which is which is a pretty big problem to tackle. 00;07;17;21 - 00;07;40;24 Hines But it was a great group who came with a lot of research and came with one of the recommendations for us to consider actually starting an Empath. Our Empath was the first one that was opened in the state of Minnesota, so it was very innovative in in the suggestion and in the research that they actually presented. And we just took it and ran with it, which was great. 00;07;41;11 - 00;07;59;24 Hines My organization was very supportive of looking at how do we solve the ED boarding and how do we give just a different level of care that meets the needs of our patients who have a mental health diagnosis and is in crisis. So it was kind of an exciting way to start. 00;08;00;14 - 00;08;03;15 Steiger Absolutely. And how long has the unit been open? 00;08;03;28 - 00;08;05;17 Hines Been open about 18 months. 00;08;05;26 - 00;08;12;28 Steiger 18 months. So still pretty new. Is this something that is financially viable for your organization to continue? 00;08;13;21 - 00;08;40;08 Hines That's a great question. We still are actually getting paid as if it's an emergency department visit. And so we are working actually with our payers to help demonstrate some of the outcomes that we've been able to demonstrate with that first 18 months of the Empath and looking for our payers to actually pay us more appropriately for the type of care that's actually given in in our Empath units. 00;08;40;21 - 00;08;43;12 Steiger I'm sure that can be a challenging discussion sometimes. 00;08;43;12 - 00;08;45;22 Hines Yes. 00;08;45;28 - 00;08;51;11 Steiger What are some of the other barriers that you've encountered as you've launched and started to grow this unit? 00;08;51;28 - 00;09;20;18 Hines I would say the payer issues are probably the most significant and in the long term support of this program. Minnesota is known for not having enough psychiatry support, so we're a little challenged with making sure that we're hiring enough providers to make sure we're providing that 24 seven ability and access. We've been able to do that, but that that is a little bit challenging. 00;09;21;01 - 00;09;41;04 Hines However, on the flip side, doing something innovative is very attractive to providers and to staff. And so we've had we've had a lot of ability to attract really some great talent who are very interested in changing how we look at treatment of mental health in crisis. 00;09;41;26 - 00;09;53;20 Steiger You bring up an interesting point about workforce and, you know, attracting talent, I think is that's top of mind for so many organizations across the country right now. Thinking about how to be innovative sounds like it has really paid off for you. 00;09;54;05 - 00;09;56;25 Hines It has in that area. It has. Yeah. 00;09;57;08 - 00;10;12;12 Steiger So, Beth, you know, after learning about this program, it sounds like you're doing a lot of really innovative work that pays off for both your workforce and your patient population. But I'd love to know from your perspective why is this so important to you? Why does this work matter so personally? 00;10;12;13 - 00;10;41;14 Hines It matters to me because I started my entire career in providing psychiatric ER social work services, and so it's very near and dear to my heart. However, in a broader sense, we know that we're in a mental health crisis, and I think we have to really look at what the care model actually is. And I hear so often that the the answer is we need more inpatient mental health beds. 00;10;42;00 - 00;11;12;00 Hines I want to challenge that. I want to challenge that on the local level and on the national level. I think it's looking at the care very differently. And I think that providing care like this, an Empath unit, it's such a different experience for the patients going through the Empath versus going through a medical emergency department. This is incredibly patient focused and our results are speaking for themselves. 00;11;12;13 - 00;11;36;20 Hines But really, if if an individual, we can meet individuals where they're at with the care that they need to get better quicker and to avoid an inpatient mental health stay. Because we all know an inpatient mental health stay can be a very traumatic experience on the individual and on the family. And it can have lasting impact on individuals lives. 00;11;36;28 - 00;12;04;20 Hines And if you can avoid that, there's always going to be a certain amount of patients who flat out need an inpatient mental health stay. That's not the group that I'm talking about. There's another very large group that needs just stabilization, needs immediate treatment and intervention, and they need wraparound, very intensive discharge planning around programmatic care, like an intensive outpatient or a partial hospitalization. 00;12;05;00 - 00;12;30;02 Hines But it keeps them in the community and it keeps them able to be as independent as possible, yet getting the help that they need. And I think that's what really drives the work that I do and really the satisfaction to be a part of actually opening this first Empath for Minnesota. And for my organization, I can say it's reduced length of stay, it's reduced boarding hours. 00;12;30;02 - 00;12;56;08 Hines It's actually freed up medical beds for medical patients. So our mental health patients are getting appropriate care in a different unit. It's really actually decreased costs associated with psychiatric patient boarding. We had originally in that hospital where we opened our Empath, 42% of all patients who presented in that ED with mental health issues were actually admitted. Going through the Empath, we've reduced that down to 11%. 00;12;56;09 - 00;13;06;01 Hines Significant outcomes. And it's it's really the right treatment to help our patients become well. 00;13;06;22 - 00;13;21;06 Steiger But I think those results speak for themselves as to why this has been a great investment for your organization and something that I think a lot of other organizations could consider. As we wrap up here, are there any other things you'd like our listeners to know about your Empath unit? 00;13;21;22 - 00;13;46;18 Hines I would say it's a risk, but I would just encourage health care systems to consider very different ways of meeting their patients where they're at, particularly around mental health needs. And it's worth the risk. And the more health care systems that are actually providing a different care model, the better we all can band together to make sure that the right payment is also in place for that appropriate care. 00;13;47;00 - 00;14;07;08 Steiger Wonderful. Thank you so much. And thank you for your time today. I think this has been a really valuable discussion and something that our listeners are going to be able to take a lot away from. If you are interested in learning more about this program, we have a written case study on our website that goes into a lot more detail about the Empath unit at M Health Fairview. 00;14;07;16 - 00;14;16;14 Steiger You can access that by visiting www.aha.org/behavioral health. And Beth, thank you so much for your time today. 00;14;17;00 - 00;14;21;10 Hines Thank you, Jordan. It's just really exciting to talk about this care model. So thanks for your interest. </details> Tue, 02 May 2023 22:02:42 -0500 Capacity Planning The Next Wave of Emergency Preparedness in Health Care /news/healthcareinnovation-thursday-blog/2022-12-15-next-wave-emergency-preparedness-health-care <img alt="#healthcareinnovation Thursday" src="/sites/default/files/2019-11/innovation-blog-banner-900.jpg" /> In the midst of managing the impact of the COVID-19 pandemic, health care teams also have been dealing with natural disasters — including wildfires, hurricanes and severe flooding — along with mass casualty incidents. Threats to public health and safety are increasing. The nation’s public health and health care infrastructure should be designed to assess, respond and manage such threats well before they occur. But how does the field of first responders get there, together? In November, the �� Association hosted a panel session discussing the “next wave of emergency preparedness,” at Becker’s 10th Annual CEO + CFO Roundtable in Chicago. This session centered on three priority areas that health care leaders must address to prepare, respond and recover from future public health emergencies: strengthening cross-sector partnerships, building workforce capacity and resilience, and fostering a culture of preparedness. <h2>Strengthening Cross-sector Partnerships</h2> No sector works in insolation during an emergency. There are no competitors — only collaborators working toward protecting their communities. It is critical to establish strong cross-sector partnerships before an emergency occurs. Keneatha Johnson, senior director of safety and emergency preparedness at the Illinois Health and Hospital Association, likened it to a home mortgage. “You don’t want to be figuring out who your mortgage broker is on the day that your house forecloses. It’s the same thing in [emergency] preparedness.” In addition to creating and maintaining close relationships with public health, fire/EMS and law enforcement professionals, health care leaders should partner with nontraditional, trusted and influential organizations within their communities — such as religious organizations, civic groups and anchor institutions including universities or large companies. Strong cross-sector partnerships can support a more coordinated response and recovery while also providing value to all involved outside of an emergency. “It’s so important to have partners and to understand where and how an organization needs to decompress, or where and how to pull potential funding,” said Johnson. “The field collectively experienced COVID, and we all tried to figure it out together. [There were] no competitors, just compliments.” <h2>Building Workforce Capacity and Resilience</h2> Without a sufficient workforce, the health care field is unable to respond to the needs of communities, whether in emergencies or nonemergencies. Integrating resilience programs such as Stress First Aid and crisis leadership training into organizational workforce development plans are among several strategies that panel members encouraged leaders to prioritize. Mayer Bellehsen, assistant vice president of the behavioral health service line at Northwell Health, explained that before COVID-19 he wasn’t sure “how often the element of emotional support was considered when thinking about disaster preparedness.” He added, “Since COVID-19 though, behavioral health is increasingly a critical component of the safety operations and logistics.” Bellehsen, who also serves as Northwell Health’s director of the Center for Traumatic Stress, Resilience and Recovery, observed that what “the pandemic has perhaps really taught us is to come together across sectors and across departments and move to a ‘whole system’ approach for tackling complex issues.” <h2>Fostering a Culture of Preparedness</h2> The ability to prepare, respond and recover from an emergency starts within an organization. Normalizing a culture of preparedness and using key response concepts outside of an emergency provide an opportunity to educate and empower staff while bringing value to the goal at hand. But how can leaders foster and normalize a culture of preparedness? By engaging and investing in their organization’s emergency management program. Advice from the panelists included: <ul> <li>Meet with emergency managers.</li> <li>Review your organization’s response plans.</li> <li>Understand the strengths and gaps in your emergency management programs.</li> <li>Support and nourish partnerships with your local health care coalition, public health authority and other trusted community organizations.</li> </ul> The more prepared an organization is, the better equipped it will be to support the community when responding to an emergency. The AHA has released a new resource on disaster and emergency preparedness, <a href="/aha-clear/field-guide-for-emergency-preparedness">“Convening Leaders for Emergency and Response (CLEAR) Field Guide for Emergency Preparedness,”</a> which aligns input from seven national representative associations and unites the collective first responder system. This guide provides a set of common priorities, tangible strategies, real-world examples, resources and action steps that health care and public health can implement — together — to strengthen the nation’s emergency management systems. <a href="/aha-clear/field-guide-for-emergency-preparedness">Learn more and download the field guide.</a> Helena Bonfitto is a senior program manager and Benjamin C. Wise is senior program manager of communications strategy, both at the �� Association. Presented as part of Cooperative Agreement HITEP210047, funded by the Administration for Strategic Preparedness and Response (ASPR). The Health Research &amp; Educational Trust, an �� Association 501(c)(3) nonprofit subsidiary, is a proud partner of this Cooperative Agreement. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the Administration for Strategic Preparedness and Response (ASPR) or the Department of Health and Human Services (HHS). Thu, 15 Dec 2022 08:47:19 -0600 Capacity Planning