Robert E. Simpson Jr., MPH, DSW
President and CEO
If change is constant, then Robert Simpson, MPH, DSW, has certainly kept the pace. His examples in driving processes and achieving greater financial stability for Brattleboro Retreat in Vermont offer lessons the behavioral health community can learn from.
He's been the president and CEO since 2006, and among the major changes Simpson has designed is a fundamental push to streamline the admission process. With 45 to 50 beds, the hospital was turning away calls, while at the same time was struggling financially. Simpson saw an opportunity to optimize the process, allowing higher admission rates and better financial performance.
“To make changes in a hospital is very complex because hospitals are very conservative by nature,” he says. “It’s really critical when you make changes to give people a template for how you’re going to do it.”
For example, Simpson used a technique from the “Juran” principles to guide change at Brattleboro Retreat. He says that after WWII, Japanese manufacturers used the Juran quality management theory (created by businessman Joseph M. Juran) to identify explicit steps to create a culture for change. He wasn’t just muddling through the new workflow, mandating that staff complied, but rather, he drove a methodical process for change.
“The idea was to get to ‘yes’ to admit patients to our hospital, and we used Juran as our way to get there,” he says.
Simpson recommends that behavioral health leaders employ proven techniques of their own when driving change at their facilities.
The techniques Simpson used included:
• Reducing the amount of information collected from patients at admission, which speeded up the process and allowed clinicians to rely on the information collected in the emergency department or through the admitting source;
• Instituting a medical clinic with a primary care physician; and
• Leveraging the medical resources of physician assistants and nurse practitioners to extend the reach of the physicians in caring for patients’ medical needs.
“All of the medical supports allowed the hospital to get to a ‘yes’ position,” Simpson says.
The hospital went from fewer than 50 beds to 122 beds in a short period of time. In 2013, Brattleboro also recruited 228 new employees to handle the demand, he says. Staff training and education became a primary ingredient in the facility’s change-management process.
Like many BH professionals, Simpson says he has seen the devastation of addiction and mental health conditions within his own family. An industry professional since the 1970s, he also believes there are emerging opportunities to expand services to meet the emerging needs of today’s clients.
Under his leadership, Brattleboro Retreat launched three new treatment tracks for specific populations: LGBT; uniformed service providers such as police officers; and young adults.
“Stigma is rampant throughout the world,” he says. “And stigma drives a lot of my thinking for how to change the hospital.”
LGBT: He says there are very few dedicated LGBT psychiatric units in the United States, and the population experiences everyday challenges related to their lifestyles, which are compounded when a mental health or addiction condition is present. Units must be prepared to serve their comprehensive needs, for example, through staff training and population-specific environmental design.
Uniformed Service Workers: Simpson’s father was a veteran, so he says he understands the expectations of fortitude that are implied for service men and women and the personal burden those expectations create. First responders, fire, police and military members are trained for crisis situations but often experience heartbreaking events in the line of duty.
“We have hearts. We have souls. We are sensitive,” he says.
Simpson also saw firsthand the rationale beneath service men and women’s reasons to avoid acknowledging a behavioral health issue or seeking treatment. Their needs are distinct, and they share a common experience. Therefore, their treatment plans must be distinct and must allow for openness. For example, post traumatic stress is often an issue, and too many uniformed service workers tend to “gut it through” rather than seek help, he says.
“I understand the stigma those kinds of heroes feel in getting help—they don’t get help,” Simpson says.
Brattleboro Retreat’s uniformed service worker program is a partial hospital program that allows the clients to live in a Vermont inn in the mountains and receive treatment in the hospital setting during the day.
“We got a grant from Verizon for a mobile app to help folks stay in touch with each other, and it’s branded for our program,” he says. “It’s being field tested for the service worker population right now, but it has application for everybody.”
Emerging adults: For the emerging adults—those ages 18 to 26—the program at the retreat is based on patient-centered care and empowering the clients to find their paths and stay committed to treatment. Young adults often need additional skills to manage the growth of their thinking processes as they fully enter the adult world.
Simpson says research shows the parts of the human brain that are related to reasoning and emotional control are somewhat plastic and still developing until the age of 26. Brattleboro’s specialty program includes techniques to address the issues of experimentation among young people and helps clients examine the consequences of their actions proactively.