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Increasing inpatient beds: A team effort

May 1, 2009
by Tom Petrizzo, MSW, JD
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Multiple stakeholders work together to add beds in Northwest Arkansas

Many communities struggle with an inadequate number of inpatient psychiatric beds. This problem was particularly acute in Northwest Arkansas, a growing area of the state. To address this situation, multiple stakeholders came together to open a new 28-bed adult inpatient psychiatric unit at Northwest Medical Center-Springdale. This is a story about the importance of collaborating to meet a desperate community need.

The problem

Northwest Arkansas is a growing community comprised of four counties with nearly 450,000 residents and is home to the corporate headquarters of Wal-Mart Stores, Inc.; Tyson Foods, Inc.; and J.B. Hunt Transport Services, Inc. These large companies have fueled the area's economic engine and population growth to such a degree that locals call this situation the “Arkansas miracle.”

In the recent past, the adult inpatient mental health needs of Northwest Arkansas residents were served by a local hospital's inpatient psychiatric unit. However, that unit closed in 2002, lowering the area's bed capacity to fewer than 2 beds per 100,000 residents.

The local community mental health center, Ozark Guidance Center, has five contracted beds at a private, stand-alone psychiatric hospital in Fayetteville. When those beds were full, which occurred frequently, the mental health center sent patients to hospitals in Tulsa, Oklahoma (2 hours from Fayetteville); Joplin, Missouri (90 minutes); and Little Rock (3 hours). These distant choices separated patients from their local supports, families, and providers, and made continuity of care a real challenge.

In 2002, a county judge pulled together a panel of local leaders to discuss a solution. The group developed a blueprint to reopen the unit at a local general hospital. Yet after two years of intense study, planning, and discussion, the hospital initially chosen to operate the unit declined, citing financial and risk concerns.

In 2005, the Care Foundation, Inc., a local community foundation, stepped up to facilitate another series of meetings among community stakeholders, including representatives of three local hospitals, Ozark Guidance, and the University of Arkansas for Medical Sciences (UAMS) Psychiatric Research Institute. Out of this group, Northwest Medical Center-Springdale stepped up to host the inpatient unit on a vacant floor that was ready to be remodeled.

Northwest arkansas acute care mental health task force (left to right): cris arias, director of psychiatric services, washington regional medical center; michael hollomon, md, medical director, university of arkansas for medical sciences (uams) psychiatric research institute (pri)-northwest; lee christenson, chief operating officer, northwest medical center-springdale; tom petrizzo, msw, jd, president and ceo, ozark guidance center; judy smith, clinical manager, uams pri-northwest; jan huneycutt lightner, program officer, care foundation; laura tyler, phd, administrator, uams pri; michele stewart, chief operations officer/chief nurse executive, mercy health system of northwest arkansas; tom o'neal, consultant/facilitator, care foundation

Northwest Arkansas Acute Care Mental Health Task Force (left to right): Cris Arias, director of psychiatric services, Washington Regional Medical Center; Michael Hollomon, MD, medical director, University of Arkansas for Medical Sciences (UAMS) Psychiatric Research Institute (PRI)-Northwest; Lee Christenson, chief operating officer, Northwest Medical Center-Springdale; Tom Petrizzo, MSW, JD, president and CEO, Ozark Guidance Center; Judy Smith, clinical manager, UAMS PRI-Northwest; Jan Huneycutt Lightner, program officer, Care Foundation; Laura Tyler, PhD, administrator, UAMS PRI; Michele Stewart, chief operations officer/chief nurse executive, Mercy Health System of Northwest Arkansas; Tom O'Neal, consultant/facilitator, Care Foundation. Photographer: Greg Russell

Defining roles

A four-part plan was developed to make the unit a reality. First was defining the local stakeholders' roles (figure).

Figure. The stakeholders' roles and contractual relationships (as of press time).

  • Northwest Health System (parent of Northwest Medical Center-Springdale) is the unit operator and facility manager.

  • The UAMS Psychiatric Research Institute is the unit's medical director and staffs the unit with psychiatrists and residents.

  • Ozark Guidance is the local screener of patients needing inpatient care, the fiscal intermediary for start-up and operating funds allocated by the Arkansas General Assembly, and the purchaser of inpatient beds for uninsured patients.

  • The Care Foundation facilitates the stakeholder group and provided start-up funds.

  • Washington Regional Medical Center in neighboring Fayetteville and Mercy Medical Center in nearby Rogers are financial contributors to offset primary care needs of patients on the unit who do not have insurance or whose insurance does not cover their primary care needs.


The plan's second part was securing adequate funding to remodel the floor and sustain ongoing operations.