“We've got to measure so that we can look at chronic illness outcomes on a quality continuum, much the same way they do in the manufacturing world.”
Position: President/Chief Nurse
Organization: Brighton Hospital
Location: Brighton, Mich.
Services: 132-bed substance use rehabilitation hospital offering inpatient programs for individuals (co-occurring disorders, medical and legal professionals, adolescents) plus outpatient, life-long recovery, education, and research programs.
Though she's becoming known for her leadership in quality and process improvement in one of the country's leading substance abuse rehabilitation hospitals, Denise Bertin-Epp's most valuable training occurred outside healthcare. After leaving Greenbrook Recovery Center to become Brighton Hospital's director of nursing in 1999, Denise found that her desire to drive change was at odds with Brighton's paper-based culture. At the time, she says, it was “a bad fit.”
So for two years, the ISO-certified, Six Sigma Green Belt (she also holds a bachelor's in nursing and a master's in healthcare administration) served as a quality consultant to Michigan's automotive, electronics, and manufacturing industries. “I worked in a couple of startup companies and became an ISO auditor. I was able to look at the process improvement methods used at a lot of non-healthcare companies. My husband Jack, who's an industrial engineer, used to talk about quality indicators like scorecards, benchmarks, or process improvement methods like kaizen exercises and fishbone (problem solving) diagrams. Ten years ago, those weren't things we used in healthcare. Yet, we use them now.”
Denise got a chance to put her knowledge to work at Brighton in 2003, when in the face of a declining census and growing financial concerns, she returned to take on the dual post of chief operating officer/chief nurse. The falling census led to falling revenues and pressure to cut programs. Not exactly a recipe for growth, Denise recalls. With board approval, she led efforts to stabilize operational, financial, and clinical indicators; implement creative clinical programs; revamp the hospital's organizational infrastructure; integrate medical and administrative leadership; affiliate with a nearby hospital system; and, finally, to drive 20 percent growth in each of two years.
Today, as president/chief nurse, Denise's process improvement and quality focus extend even further at Brighton, which has now implemented ISO, Lean, Six Sigma, and JCAHO certification facility-wide. “If we believe that this [addiction] is a disease, behavioral healthcare has to adopt the same standards that acute care uses-things like fall risk or suicide risk, for example. We've got to measure those indicators so that we can look at chronic illness outcomes on a quality continuum, much the same way they do in the manufacturing world. My leadership team here at Brighton are all Green Belts in Six Sigma. They've got to be able to do it.”
When it came time for Brighton to develop an electronic medical records system, Bertin-Epp and her team used the same approach. “We picked an ISO-certified vendor, one that used the same quality parameters [and] the same process improvement methods that we did.” While developing the EMR system, her team took on a host of concerns, including medication errors and the expense of clinical dictation. Targeted teams, using kaizen exercises, analyzed possible errors and inefficiencies, then designed processes to prevent them. With the system, which the Brighton team implemented $1.2 million under budget, medication errors fell 65 percent while template-based dictation cut clinician time dramatically.
Just three years later, Brighton Hospital and Medical Communications Systems are now launching ebhr, an electronic behavioral health record system, to the behavioral health industry. In this era of reform, when many in behavioral healthcare look warily to a future dominated by unfamiliar concepts and new terminology-EHRs, EBPs, comparative effectiveness, and more-champions like Denise show us that we have much to master, but little to fear. Photo by Judith Anderson