The Future Waits No More-Behavioral Health Gets Lean

“Whatever you do, or dream you can, begin it. Boldness has genius and power and magic in it.”
-Johann Wolfgang von Goethe

It was a wonderful report-out today. I would like to thank everyone for your efforts. I am deeply moved and grateful for your willingness to contribute your skill, spirit and dedication to redesign our behavioral health service. The silence and darkness that has surrounded our behavioral health system is no more. You have brought us from silence to voice, from darkness to dawn. I look ahead with great excitement and anticipation. I encourage everyone to go and see (Genchi Genbutsu, 現地現物) the amazing work done by the team this week posted in the hospital lobby.

Keep an eye out for visible change in our behavioral health services, because it has arrived!

I want to share reflections from Teresa Pasquini. She is an amazing change agent and partner in our journey to excellence.
Here is her post-

On March 17th, a Behavioral Health Collaborative convened at Contra Costa Regional Center to begin a journey back to the future and on to a new frontier. This team effort was the dream of many Contra Costa County Community members who strive to change the way we treat one of our most vulnerable populations.

Born out of a vision of hope and the Healthcare Partnership, we brought together consumers, family members, law enforcement officers, ambulance drivers, nursing staff, medical staff, and administrative support to learn and teach about how to impact a Behavioral Health redesign at Contra Costa Regional Medical Center. We needed change agents to bring improved care and supports to all of our Community partners. That day was a gut level sharing of lived experiences that framed the work performed during the Behavioral Health Value Stream Mapping Event this week.

With stop watches and clip board in hand, this team of ambulance drivers, law enforcement, consumers, family members, nurses, therapists, psychiatrists, and clerks entered the ER and the CSU with the eyes focused on patient care only. We watched voluntary and involuntary consumers enter the ER, triage, medically clear, and move to the CSU. We watched what a consumer experiences as they enter the Crisis Stabilization unit from beginning, middle and end.

We watched the charge nurses and RNs scurry from one end of the unit to the next, the therapists arming the phones in search for beds, consoling and advising family members, and brainstorming with their colleagues on ways to get the services necessary for the patient as soon as possible. We timed the Psychiatrists assessment and consultation process to determine medical necessity to continue treatment and observed disposition orders given.

And we saw waiting, a lot of waiting. It was our job to find ways to reduce all non value time that was creating waste, duplicating efforts, and restricting patient care. After the Time Observations, data collection, and calculations were complete, we had our current state mapped.

Next, during our brainstorming session, we threw out old attitudes, debated and challenged the obstacles that exist in the current state, and made suggestions for building an ideal future state. We had become an amazing community team with open hearts and minds. We were told to think Big and Blow up the Box. Our ideas reflected our diversity of experiences and perspectives. No idea was excluded or judged.

The Report Out today in our hospital lobby demonstrated the power and magic that can occur when we lay down the tools that don’t work and pick up new tools that will help us bring improvement to the quality of care we provide our consumers. It was an awesome showing of humanity and social justice in motion.

Today the community celebrated the beginning of a one year Behavioral Health Improvement Process that will save lives. As the result of the Value Stream Mapping, more consumers and families are going to experience more value added care. The staff is going to feel more satisfied with their ability to provide care to their patients, and the community is going to move one step closer to healing. A community driven, consumer and family centered, collaborative process helped us dispel myths and rumors about the “mysterious” world of psychiatric care at Contra Costa Regional Medical Center.

A community team went to the Gemba (work place) and saw what the care of our psychiatric patients currently is at CCRMC. It really wasn’t mysterious; it was good medical care that is being provided in a system that needs improvement. On May 10, 2010 a new community team will convene to begin a rapid quality improvement event (Kaizen) that will take us one step closer to the future.

A week ago my son was a patient in the CSU. He has been there many times in the past ten years, but this time was different because of the consumer and family centered improvement efforts. He was only held for a couple of hours, this time. When discharged he told me that he was treated well. When I told him that I was coming to work at the hospital with a team of people who were going to make this process more accessible, accountable, and appropriate, he said, “Mom, my case manager told me that you believe in miracles.” That made him smile and proud of me. I love seeing my son smile. I don’t know about miracles, but I do believe in this process and I know that change is here.

Teresa Pasquini