Enhancing Performance in Hospital-Based Inpatient Behavioral Health Units

Behavioral health programs across the U.S. have struggled with operational efficiency and financial challenges for many years, regardless of whether they are freestanding hospitals or health system-based. The COVID-19 pandemic exacerbated these issues significantly, and many of these challenges still remain.

Workforce Availability Issues

One major contributing factor to efficiency and financial challenges relates to workforce availability associated with staffing inpatient units and outpatient behavioral health programs. Clinical psychologists, registered nurses, and other unlicensed direct care staff, including mental health technicians and security staff, experienced significant burnout during the pandemic, and many left the workforce due to very difficult working conditions. This relatively permanent loss of qualified staff continues to result in difficulties in staffing units with experienced licensed and unlicensed clinical and support staff.

As a result, hospitals have been forced to resort to temporary staffing agencies to provide minimum levels of staff coverage, particularly for registered nurses and mental health technicians staffed on inpatient behavioral health units. These temporary personnel are significantly more costly than hiring qualified permanent employees.

Additionally, staffing units with continuously rotating temporary agency personnel often has negative consequences. Agency staff are often inexperienced and unfamiliar with specific policies and procedures that provide guidelines for effective patient care management, quality of care, and patient throughput. This lack of knowledge and experience often drives up average lengths of stay.

High staff turnover hampers the development of cohesive patient care teams that understand their respective roles in ensuring patient and staff safety and their contributions to the team’s overall effectiveness. A significant potential consequence of ineffective team-based care can increase the number of incidents of patient aggression and have a detrimental effect on overall inpatient unit safety. The result is a continuous cycle of increasing staff dissatisfaction and continuous high levels of staff turnover.

All these factors also contribute to quality of care and financial performance challenges.

Tactics for Addressing Workforce Challenges

An important way to improve staff competencies and morale is for all levels of hospital leadership to support investment in formal staff training programs. These include role-based training programs specific to job types, including clinical psychology, nursing, mental health technicians, security staff, and other support staff. These types of education and training programs go beyond the typical education modules that most hospitals already offer and require staff to participate in on a periodic basis. They address topics like the following:

• Admitting and discharge planning procedures
• Job function education designed to allow staff to function at their highest level of licensure, education, and training
• Case conferences
• Unit staffing procedures
• Management of patient aggression, including de-escalation and restraint/seclusion training programs

Robust, team-based education programs are essential to fostering the development of cohesive teams, building the trust necessary for staff to work well together, and clarifying roles and responsibilities. Commitment to ongoing education, training, and oversight develops a culture of teamwork, creating a working environment where the focus is on providing the highest quality patient care and reducing the need for mental health crisis intervention.

Developing Comprehensive Education Programs

One approach to developing a comprehensive team-based education program might include a triad approach that includes a clinical psychologist, a clinical nurse specialist, and a mental health technician. These three are provided the resources and time needed to develop and implement a program that is inclusive and allows all levels of staff to feel that they have a voice in creating the trust and culture change needed to work together as a cohesive team.

This type of education program must be ongoing, championed by organizational leadership, and supported by facilitators who collaborate effectively to foster a culture of commitment at all staff levels. Frequent oversight, ongoing education, and observational sessions will help to ensure success. They will include team-based review of adverse incidents to identify improvement opportunities, focusing on learning rather than disciplinary action.

These programs may be integrated into a hospital’s quality improvement plan but should remain separate and distinct to maintain their focus on enhancing care rather than just meeting regulatory reporting.

Moving Forward

Running a behavioral health hospital comes with unique challenges, particularly in fostering cohesive, supportive teams and reducing staff conflict. While culture change is a long journey, it begins with a firm commitment to building trust among staff and improving patient care quality and outcomes. For support and guidance in navigating these challenges, contact our healthcare consulting team. With deep experience in behavioral health, we can help you successfully navigate the road ahead.

 

Randall Autry
Senior Advisor – Contractor, Healthcare Consulting

Randall Autry is a senior advisor – contractor of healthcare consulting with Katz, Sapper & Miller’s Healthcare Resources Group. Randall helps healthcare organizations succeed by leading consulting engagements for hospitals, health systems, and behavioral health organizations, particularly related to strategic plan development and performance improvement.