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Driven to improve

May 1, 2006
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Two approaches to ensuring service quality

Whether an addiction treatment center operates under the constant eye of payers and regulators or blazes an independent trail, the drive to improve quality in services and operations essentially comes from within. This year's two winners of the James W. West, MD, Quality Improvement Award from the National Association of Addiction Treatment Providers (NAATP) demonstrate the leadership and motivation needed to embed quality improvement into the daily culture throughout an organization. The award is cosponsored by

Behavioral Healthcare magazine (Vendome Group, LLC).

Talbott Recovery Campus, which has carved a niche nationally in the treatment of the addicted health professional, and Little Hill-Alina Lodge, known as a treatment site of last resort for the chronic relapser, approach the issue of quality from vastly different perspectives.

Operated by a subsidiary of hospital management company Universal Health Services, Inc., Talbott uses a data-driven approach reinforced by the periodic review of organizations such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Little Hill-Alina Lodge, on the other hand, is not JCAHO-accredited and hasn't worked with managed care companies since 1985, deciding then to accept only private-pay clients and to keep costs down through fund-raising from program alumni and their families. Its efforts derive exclusively from a desire to succeed with patients who have known only failure in treatment.

But in other ways, the features of these two organizations’ quality-improvement efforts bear quite a resemblance, involving a commitment from executive leadership, buy-in at all organizational levels, and a prevailing sense of never being satisfied with the status quo.

Atlanta-based Talbott is this year's West Award winner in the category of larger facilities (more than $8 million in revenue), while Blairstown, New Jersey–based Little Hill-Alina Lodge is this year's recipient in the smaller-facility category. Both organizations will formally receive their awards at NAATP's annual conference, to be held May 20-23 in Palm Beach Gardens, Florida.

Limiting Premature Departures


Talbott's CEO, Benjamin Underwood, emphasizes that performance indicators drive most of the organization's decision making. Data are collected from patients, families, and all staff on an ongoing basis. Clinicians are encouraged to offer suggestions from the moment they start working in the organization, adds Nancy Stockwell, director of clinical services.

About a dozen of Talbott's 80-plus employees sit on a Quality Council, which has monthly meetings with Underwood at the helm. Underwood calls this structure the “control center” for the organization's quality-improvement activities.

The NAATP award recognizes Talbott's activities around two of the Quality Council's ongoing agenda items. In 2004, Talbott set a goal to reduce program discharges against medical advice (AMA), as well as absences without leave. Factors contributing to this decision included the interruptions these discharges cause to clinical progress and the patient-safety and risk-management concerns these departures generate.

In 2005, after reviewing program data that indicated a high correlation between patients who relapse during treatment and patients who leave AMA, the organization added the goal of reducing the number of relapses among patients in treatment. Talbott proceeded to collect a great deal of data about people who left treatment, both from patient discharge statements and from patients who subsequently returned to the facility. What it found were some shortcomings in its treatment program's ability to reach certain patients.

“Some patients felt that some educational and specialized processes were missing from treatment,” says Stockwell. “Sexual issues for men weren't being discussed. There was no group specific to women's issues. Some wanted more information on parenting. These issues needed a forum.”

Development of new program components therefore became the cornerstone of the effort to reduce premature departures. This included the establishment of nine specialty tracks in areas such as gender-specific issues, anger, and grief, along with the creation of a 36-lecture schedule on recovery topics, delivered over a nine-week cycle. Other components of Talbott's strategy include refinement of case management services to ensure more individualized care, and more effective integration of 12-Step principles into everyday treatment.

“You've got to be willing to look at yourself and see what you could do differently, and that is hard,” Stockwell says. But the organization attempts to make this less threatening to staff through the supervision process. “We tell clinicians that they don't have to be perfect. We all learn as we go along.”

The programmatic changes took place as of this past October, and the organization has been able to collect data from patients in treatment both before and after the changes were implemented. Early feedback about the new program elements has been positive, and patients also are reporting recent improvements in treatment planning, according to administrators. Talbott has not yet collected formal data on the changes’ effect on AMA discharges.

Underwood says Talbott has been able to make these changes within the parameters of its existing operating budget. He believes a successful quality-improvement effort involves commitment at all levels of the organization.