According to the Mental Health Risk Retention Group (MHRRG), the most common liability claims made against community mental health centers (CMHCs) are related to sexual misconduct, patient violence, suicide, and medication errors. These claims can lead to expensive lawsuits, patient injuries, and damaged reputations.
Many underfunded and understaffed CMHCs, damaged by national budget constraints, don't have the necessary resources or manpower to implement company-wide quality improvement initiatives that can lessen or eliminate these risks. But Lakeside Behavioral Healthcare, based in Orlando, Fla., has created a company culture built upon quality improvement, which has led to their receipt of two Negley Awards in 2009 and 2010.
Lakeside's award-winning initiatives-“Minimizing Medication Errors” and “Preventing Sexual Misconduct in the Workplace”-are just small pieces of a broader quality improvement program, one that is rooted in Lakeside's organizational values and instilled in new staff members the moment they begin their careers at the CMHC.
Creating a system of quality care
When Diana Lee “D.” Jackson, vice president of quality and risk management, began her career at Lakeside in 1989 as the executive assistant to the executive director, Lakeside's 30 individual programs operated independently. These silos developed their own practices, processes, and standards for delivering care.
Jackson took over the quality and risk management department in 1992, just in time to spearhead Lakeside's accreditation process with the Commission on Accreditation of Rehabilitation Facilities (CARF).
“I went through all the offices and procedures for CARF, and I identified that every little program area did its own very unique thing,” Jackson says. “It was very repetitive for programs. They never communicated with each other.”
She recognized that the key to developing a system of care was to unite the different program areas under one company-wide approach, with one way of monitoring “what we did and how we did it.” Jackson created the Performance Improvement Committee (PIC), a strategic, governing body to oversee Lakeside's company-wide quality standards and practices.
With the PIC in place, Jackson established five additional standing committees (see figure). Each would oversee a specific aspect of the company and ensure organizational commitment to Lakeside's six Pillars of Excellence (Environment of Care, Professional Staff, Services to Clients and Families, Corporate Leadership, Resource Development, and Community Awareness) and to Lakeside's foundational values, or “Rocks” (Accountability, Customer Service, Communication, Teamwork). These five tactical committees are:
Consumer and Environmental Safety Committee. Representing the Environment of Care pillar, this committee is made up of representatives “from front-line staff to the vice president,” as well as the risk manager, says Jackson. Infection Control and CLIA/Waived Testing are sub-committees reporting to the Safety Committee.
Clinical and Ethical Practices Committee. This committee, made up of clinical supervisors, directors, and managers, represents the Services to Clients pillar and oversees company-wide practices for providing treatment. The committee evaluates each practice and then develops staff-education projects to improve them. Pharmacy, Training, Peer Review Teams, and the Psychiatric Emergency Interventions (PEI) Review Team are subcommittees reporting to this committee.
Compliance Committee. The Compliance Committee represents the Resource Development pillar, ensuring that contract regulations and rules are followed throughout the organization. Its subcommittees include the Service Event Review Team, the Contract Review Team, and Document Imaging.
Staff Relations Committee. This committee is responsible for maintaining the welfare, morale, and health of Lakeside's employees and holding up the organization's foundational values, or “Rocks.”
Privileging Committee. The Privileging Committee represents the Professional Staff pillar and oversees the privileging and credentialing process for all new, independent practitioners for Lakeside's hospital unit.
All tactical committees and sub-committees meet regularly, usually once a month. They review trends, identify problem areas, and recommend improvement activities, which are then reported back to the PIC monthly.
“One of the things that goes along with the PIC is the performance assessment system, which is a very intricate plan for how we measure outcomes for each of our clinical programs and the processes of each program,” Jackson says. “Each program has established a plan for their area, and they measure those on a monthly basis.”
From those measurements, the PIC creates detailed reports. Then, using data from the reports, the PIC identifies areas for strategic improvement. The result is a company-wide initiative, such as the “Minimizing Medication Errors” program.