"A Productivity Press Book."

One in five U.S. adults experiences a mental illness within a given year. With over 550,000 people working to support this underserved community, the mental health care system has grappled with inadequacies and shortcomings in safety, quality, and care delivery. There is a wide range of problems, from access-to-care issues, errors, to complications stemming from poor care. Our country is also on an unsustainable path as our health care expenditure keeps growing. To add to all of this, we are facing a rampant epidemic of burnout amongst healthcare workers. Modern advancements introduced with many promises, such as electronic medical records, newer medications, or advanced treatments, have created unique challenges when ushered into a highly regulated health care system. What does it take to provide patients with everything they need --the right quality of care, at the right time, and at the right cost --to keep them healthy? Which process steps add value? Which steps are wasteful? A widely accepted fact is that a conservative 30-50% of every step in the mental healthcare process does not help patients feel better or stay better. When considering delays in care, workarounds, excessive documentation, an overuse of auditing, and so forth, the care system has moved highly skilled clinicians away from providing value as administrative tasks continue to encroach on their time. There is a clear need to rethink and redesign the system of care. This book is a primer for understanding the current state of the mental health system and the performance improvement skills and leadership acumen needed to address existing challenges. Sheppard Pratt Health System, an award-winning and the leading institution for mental health in America, provided the focus on mental health care and became the laboratory for this body of work over eight years. They hired a seasoned systems thinker with improvement expertise to work with mental health professionals and solve some of their most complex and chronic problems. The book is a result of the collaboration between a practicing psychiatrist in a leadership role and the systems engineer. Working together, they demonstrate how to think about redesigning care and redefining the nature of work to enhance value for both the people served and the health care workforce. They crafted a multi-pronged approach towards culture change at Sheppard Pratt, including a course on 'Learning to Improve,' which introduced staff to a performance improvement methodology. There are several vignettes interwoven throughout the book that describe the complexities and constraints of the system. Solving some of these challenges creates a new paradigm of work while minimizing waste and enhancing value.

Intro -- Cover -- Endorsements -- Half Title -- Title Page -- Copyright Page -- Contents -- Forewords -- Preface -- Acknowledgments -- About the Authors -- Introduction -- Contributors -- 1. The Need for Performance Improvement Methods in Mental Healthcare -- I. A Focus on the Mental Health 'System' of Care -- II. A New Paradigm for the Mental Health System -- III. The Burden of Mental Illness -- IV. The Connection between Behavioral Health and Overall Health -- V. Current State: Access to Care (And Its Impact on Society) -- A. Boarding in the Emergency Room -- B. Homelessness

C. Mental Illness in Jails -- VI. Current State: Safety -- VII. Current State: Quality -- A. Underuse -- B. Overuse -- C. Misuse -- VIII. Current State: Delivery of Care (Fragmentation of Care) -- IX. Current State: Cost/Waste -- X. Current State: Morale/Workforce Challenges -- XI. A Call for a Better System -- A. Crossing the Quality Chasm -- B. The Quadruple Aim -- XII. Forces of Change -- A. Moving Away from the Model of a 'Cottage Industry' -- B. Technology -- C. The Voice of the Patient -- XIII. Learning from Our Context (Groundbreaking Improvement Efforts in Medicine)

XIV. The Need to Reinvigorate and Redesign Mental Healthcare -- References -- 2. Value and Waste in Psychiatry -- I. Value -- A. Value and the Patient -- B. Value and the Family -- C. Value and the Organization -- D. Value and the Provider -- E. Value and the Payer -- F. Value and the Government -- G. Value and the Continuum of Care -- H. Value Added, Value Enabled, and Waste -- II. Waste -- A. Eight Forms of Waste -- 1. Overproduction -- 2. Defects -- 3. Waiting -- 4. Transportation -- 5. Motion -- 6. Extra Processing -- 7. Inventory -- 8. Non-Utilized Talent -- B. Waste Walks

C. Constraint Management -- D. Waste in Psychiatry -- E. Within Treatment Waste -- F. Between Treatment Waste -- G. The Cost of Waste -- References -- 3. Developing the Healthcare Workforce for Performance Improvement -- I. A Newer Approach to Work -- II. The Development of an Improver -- A. Developing Awareness -- B. Fostering an Improvement Mindset -- C. Acquiring Performance Improvement Knowledge -- 1. Appreciation for a System -- 2. Knowledge about Variation -- 3. Theory of KnowledgeContinuous -- 4. Psychology -- D. Applying and Practicing Improvement Skills

E. Developing Performance Improvement Skills into Routine Habits -- III. Preparing the Medical Professional to Learn Performance Improvement Skills -- References -- 4. Improvement Methods for Mental Health Organizations -- I. Plan-Do-Check-Act Cycle -- II. Standard Work -- III. PDCA vs. Research -- IV. A3 Thinking -- A. Plan -- 1. Project Title -- 2. Business Case -- 3. Project Y -- 4. Scope -- 5. Project Management -- 6. Measure -- 7. Observation -- 8. Process Map -- 9. Sub-Process Map -- 10. Time and Motion Study -- 11. Spaghetti Diagrams -- 12. Measurement for Improvement

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