Starting Your Lean Journey in emergency Psychiatry improvement

Every great journey starts at the beginning. Everyone would like a “quick fix” to this complex problem, but unfortunately that does not exist. This will be a war won in small steps, one after the other. The goal will be to create systems that are much better for patients, easier for the staff, and provide organizational value.

This chapter will provide you with a series of tools to assist in guiding operational improvements. The solutions suggested here require a completely different mindset than the traditional model. It requires commitment to excellent patient care, focus on Lean healthcare methodology, and creation of a “community of scientists” focused on continuous improvement. This disciplined approach to improvement yields lasting results.

Change requires two key elements: process and culture. Process entails looking critically at every operation and the creation of care paths that standardize patient care and make it easy for staff to do the right thing. Patients with a psychiatric condition should be treated no differently than a patient with chest pain. Care plans should be individualized with medications and treatments tailored to the individual patient.

Culture—especially in this patient population—means we look at all traditional stereotypes, blow them up, toss them out, and then seek the same excellent patient care we give to our medical patients. The goal is to look at the patients as a whole and consider how changes affect each area of the care continuum: outpatient, the emergency department (ED), and inpatient.

By moving out of our silos we bring about change. We make more beds available to the community by treating patients in the ED and discharging them home when clinically appropriate. Patients who are treated with medication in the ED are better by the time they are hospitalized and have a shorter length of stay. Establishing linkages with the outpatient system means that more patients can be discharged home where they do better. Staff are happier and safer when patients are treated appropriately. Most importantly, psychiatric patients will receive the same excellent customized care we provide our medical patients.

Of all areas in emergency medicine, cultural biases are most evident in the care of psychiatric patients. As change is implemented, addressing these biases openly will be a crucial first step.

Change requires two key elements: creating a patient-centered culture and well-defined processes that are transparent to all staff. Examining every operation with the input of the frontline staff is critical for process improvement.

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