Productivity and Lean in the Delivery of Mental Health Services

The scale of the potential productivity challenge in mental health was highlighted in the King’s Fund report published at the end of 2010. Whilst the scale of the productivity opportunities are vast, the problems of realising them are equally vast.

Whilst it is possible to make improvements within an organisation’s own sphere of influence, the real productivity gains are only realised when organisations work together. For Mental Health this normally means working across health and social care boundaries and will often involve the third sector as well. No one should under-estimate the challenges this presents, particularly when the relationships between organisations are strained.

Shifting the setting of where care occurs, and indeed strengthening community based options, means changes to commissioning models and that affects the distribution of funding and often resources, for example moving a secondary care clinicians into a community setting to enable them to provide outreach support rather than staffing in-patient facilities causes the need for change in the funding structure of two and possibly more organisations.

Carla Bickley, Head of Specialist Mental Health Services at Wolverhampton City PCT commented, “The biggest improvements in mental health support comes when we are able to work across organisational boundaries to design the most effective pathways for service users. Increasingly service users have complex needs that require a different way of working to ensure success and by working across organisations we can minimise delays and costs whilst also improving the quality of care provided.”

Realising the productivity improvements in Mental Health needs a coordinated and strategic approach and this generally needs the application of concepts such as Transformation Mapping and Lean to bring a consistent focus to the problems. The benefits of undertaking Transformation Mapping, which is a way of bringing together all the strands of what would otherwise appear as a disjointed strategy and then putting together the requisite implementation plan, is that is allows people to coordinate activities and agree priorities.

Throwing unstructured ‘Rapid Improvement Events’ and tactical activities such as the ‘Productive’ series for Mental Health at the problem can actually make things much worse and create a legacy of bad feeling, especially when working across multiple organisations, many of whom will have different targets and objectives. You only have to annoy partners a few times before you lose their support for your improvement efforts and then the problems become significantly harder to tackle in mental health.

It is possible to make a step-change in the way mental health services are delivered but it needs coordination, consistency and the effective application of concepts such as Lean at a strategic level, linking together all the strands of improvement in mental health. Before this can be achieved there is a need to focus on creating a compelling need that spans multiple organisations, something that is easier to write than it is to achieve. Sitting above all of this is the need for effective sponsorship at a senior level. Together, this creates the right package needed to realise the productivity challenge in mental health, Without it, the challenge becomes exponentially more difficult.

A Conceptual Approach to Community Health Screenings For Hospitals

The heart of a community’s care is at its most trusted hospitals. In the same way that blood flows into and out of the heart, your hospital’s message should flow out into the community with grass-roots marketing efforts in order to bring patients back into your hospital for care. By this I mean that a hospital’s marketing efforts should not only focus on drawing patients into their facilities with billboards and magazine ads, but go beyond basic marketing efforts and into the community by offering free health screening events. In my experience working with one of the best hospitals in the South, I came to discover an effective system for coordinating free community health screenings that significantly increased patient volume to the hospital. What I have discovered is a concept, and I will explain the most successful way to develop your own community screenings program so that it will become a consistent source of revenue to your hospital, and build long-term patient loyalty.

In my experience working with a hospital in the South, I coordinated a community outreach program that offered free EKG testing. These tests were taken at free community events and were later confirmed as normal, borderline, or abnormal in the hospital’s clinical database and were stored as baselines for each of the patients who attended the community events. In notifying the attendees of their results by mail, the attendees received a confirmed copy of their EKG which they could keep for their own records. The EKG program increased volume and accounted for $6M in hospital charges from June 2008 to August 2009. The EKG program brought in $2.5M in second quarter 2008, $1.6M in fourth quarter 2008, and $1.9M in first quarter 2009. This data was last updated in August of 2009.

There are many reasons why the EKG test is the most effective for driving volume for cardiac procedures, and generating revenue in total hospital admissions. These reasons include the nature of the EKG test itself, CRM and the process of event planning, and the follow-up that creates patient loyalty.

The first and most important reason why the EKG test is ideal for community events is because of the simple nature of the test itself. With the EKG test, the result can only be 1 of 3 things – abnormal, borderline, or normal. The EKG tests can be taken at the community event, the results can be processed at the hospital, and the confirmed results can be mailed to the attendee within 2 weeks of the community event. The fact that the EKG result comes in the form of a single paper report makes it easy to mail, and can be stored in a person’s medical file for their own records.

If an attendee receives abnormal or borderline test results in the mail, they are also likely to follow up if given a call to action. From my experience in coordinating this campaign for over a year, 9% of EKG tracings were found to be abnormal, 11% were borderline, and 80% were normal. Out of 875 guests that received EKG’s among 9 community events between February and April, there were 181 borderline or abnormal results. Among these 181 people, 162 people followed up with the hospital’s call center for either a physician referral, an inquiry about the result, or a request for information from agencies that help the uninsured.

With a screening such as a carotid ultrasound, the spectrum of abnormality is more diverse – it is more complex and too specific of a test for a community offering. Also, an ultrasound machine is usually costly, and if a hospital’s marketing department does not purchase its own equipment, there is a risk of damage in borrowing machinery from the hospital, if the event is held offsite. EKG machines are relatively inexpensive in comparison if they are being used for the purpose of offering free tests as a community outreach program. The hourly cost of an ultrasound technician in comparison to a medical assistant is also a factor to consider.

With a screening such as a full lipid panel, results are sensitive, so participants are advised to fast for the best results. An EKG test does not require fasting. EKG tests usually take less than five minutes on average. That means more EKG’s can be done at events with less staffing.

The idea of storing EKG’s as a baseline is also a marketable service – patients are made aware that if their EKG tracing is stored at your hospital, then heart care is readily available to them at your hospital too.

Another important step to creating a successful community EKG program is to advertise the events through direct mail and coordinate the process of booking appointments for these events. Research is performed to select the best zip codes in the community that have the highest household income to increase the likelihood of attracting a favorable payor mix to the events. A mailer should also be targeted for people who have the highest incidence of heart disease – those aged 45 and up. Once a direct mailer goes out, appointments can be booked for a full day. With 2 EKG technicians and 2 machines, over 100 people can receive EKG screenings in an 8 hour day.

In my experience, the appointments were successfully booked through the hospital’s call center once the direct mailer reached homes. The information obtained through the call center is requested by the hospital’s marketing department, and usually includes basic personal information such as first name, last name, date of birth, phone number, and address. Any basic information can be requested from the guest by the call center. This information can be used for a few purposes.

The first purpose is that it keeps an appointment log for the day of the event. The second is that this information is later used to process and send the results of the screenings to the person’s house. The action of following up with the guest is the most important part of gaining patient loyalty.

Finally, by holding community events several times per year, there will be a loyalty group that forms a customer relationship with your hospital. In my experience, I have seen the number of loyal patients who regularly attended the hospital’s community events. In the campaign of EKG screenings held between February and April of 2009, 71 guests had previously attended the hospital’s community EKG events several months prior.

Building patient loyalty is simple, and there are multiple ways in which a hospital can do this creatively. A hospital should always follow up with guests who attended community screening events. Make sure that the results of their testing arrive in a timely manner. Make sure that the content of their results letter emphasizes the availability of care at your hospital. Think of creative ways to send the message of trusted care to the audience, and ways to keep them connected to you. One simple way of doing this is printing a patient identification card that includes the attendee’s MRI number. If a person was to return to the hospital’s emergency department with chest pain and present their patient identification card, the hospital’s EKG department can quickly access their baseline EKG for a comparison.

Another way of building patient loyalty is through the use of a “patient care coordinator.” Many hospitals implement a “patient care coordinator” who follows up with patients receiving serious care. In my experience, a patient care coordinator was successfully implemented in a campaign of community EKG screenings between June and July of 2008. During this campaign, attendees of the events who had borderline and abnormal results were contacted for follow up by a registered nurse. Of the 242 people who had non-normal results, 144 received physician referrals to seek follow up care. The remaining attendees were under the care of a cardiologist already, or declined to take action.

You might be thinking, “So if my hospital develops a free EKG program, I will have both long term patient loyalty and significant admissions within 3 – 6 months following a campaign of screening events?” The answer is a flat, simple yes.

If a hospital is interested in pursuing a community program that offers free health screenings, I strongly recommend structuring the program to involve free EKG testing. In comparison to other screenings, such as cholesterol testing and carotid ultrasound, EKG testing stands to show the most consistent success, and proves to be the most conducive for a community offering. It is a simple test that is non-invasive, and its simplicity allows several avenues for patient follow up. These avenues include uploading the EKG in the hospital’s database as a baseline, mailing a copy of the report to the attendee’s house after the event, and following up with the patient through the use of a patient care coordinator.

There are many more details that are involved in the development of an EKG program at a hospital. Those details may vary depending upon the resources available at your hospital. However, it is my belief that in working together as a team, any hospital can develop a successful community screenings program that will prove to be beneficial by producing revenue in the short term, and building patient loyalty in the long term.

By: Kevin Felker

Health Services Career Training Opportunities

Gaining a degree in health services can be done by enrolling in an accredited educational training program. There are a number of schools and colleges that provide students with the opportunity to earn the degree they desire in the field of health care. Students can enroll in a program to earn an undergraduate degree which includes an associates and bachelors, or a graduate degree which includes a master’s and doctorates level degree.

*Undergraduate Degrees

With an undergraduate degree program students who choose to pursue an associates level degree will be able to obtain their degree in as little as two years. An accredited associate degree program will allow students to study a variety of courses. Coursework may consist of studying:

  • Communication
  • Psychology
  • Sociology
  • Medical Terminology
  • Health Care Systems
  • Biology

With an accredited education at this level students can enter into careers as medical coders, billing specialist, transcriptionists, and much more. Students who wish to enter into a degree program at a bachelor’s level can do so and obtain their degree in four years. Students who earn a bachelors degree in health sciences can obtain careers in hospitals, nursing care facilities, physician’s offices, home healthcare, dental offices, and much more. With an accredited undergraduate degree students can find the employment they desire.

An accredited graduate degree is obtainable in the field of health services, and students can choose from masters or doctorates in the field. A master’s degree will allow students to enter into the career they desire with just two additional years of study. Coursework may include:

  • Planning
  • Health Systems
  • Finance
  • Public Health Policy
  • Human Resource Management
  • Economics of Health Care

Students who decide to pursue a degree at this level will be prepared for careers working in hospitals, physicians offices, nursing care facilities, ambulatory healthcare services, and much more. Students can enroll in a doctorates degree program once a master’s degree is obtained. With an accredited doctorates or PhD students will complete education with an additional four years of study. An accredited doctorates degree will prepare students for careers in research, teaching, nursing, mental health services, and many other related careers. By earning a graduate degree students will have the opportunity to enter into the workforce in the career of their dreams.

Although the levels of education vary, some may cover the same coursework. Students can also expect to learn a variety of skills in several areas no matter what level degree they choose. Students can study sociology, anatomy, economics, public health, accounting, and health policy. Areas of study may also allow students to learn healthcare administration, epidemiology, health regulations, health law, neuroscience, and abnormal psychology. Start by enrolling in a program to learn more about topics that will be covered in training.

When looking to enter into an educational program, ensure the program carries full accreditation. Agencies like the Accrediting Council for Independent Colleges and Schools ( http://www.acics.org/ ) can provide proof that the best education will be received. Students can learn more by requesting information about the school or college that best fits their educational need and goals. By enrolling in a health services education program students can start the path to a new career today.

DISCLAIMER: Above is a GENERIC OUTLINE and may or may not depict precise methods, courses and/or focuses related to ANY ONE specific school(s) that may or may not be advertised at PETAP.org.

Copyright 2010 – All rights reserved by PETAP.org.

Medical and Health Services Managers – Career Opportunities

Health services managers and medical managers coordinate, supervise, plan and direct health care services delivery. They may establish and implement policies, objectives, and procedures for their departments; evaluate personnel and work; develop reports and budgets; and coordinate activities with other managers. hey also may help formulate business strategies and coordinate day-to-day business.

There are about 250,000 medical and health services managers in the U.S. Almost half work in private hospitals, in offices of physicians or in nursing care facilities. The rest work mostly in home health care services, Federal Government health care facilities, ambulatory facilities, outpatient care centers, insurance carriers, and community care facilities for the elderly.

For general work in this field, a master’s degree in health services administration, long-term care administration, health sciences, public health, public administration, or business administration is normal. A bachelor’s degree is adequate for some positions. Physicians’ offices and some other facilities may substitute on-the-job experience for formal education.

Bachelor’s and post-graduate degree programs in health administration are offered by colleges; universities; and schools of public health, medicine, allied health, public administration, and business administration. In 2005, 70 schools had accredited programs up to the master’s degree in health services administration. As one seeks higher positions, they will need adequate experience and perhaps an advanced degree.

All States and the District of Columbia require nursing care facility administrators to have a bachelor’s degree, pass a licensing examination, complete a State-approved training program, and pursue continuing education. Some States also require licenses for administrators in assisted living facilities. Health information managers require a bachelor’s degree from an accredited program and a Registered Health Information Administrator (RHIA) certification from the American Health Information Management Association. A license is not required in other areas of medical and health services management.

Medical and health services managers must be able to:

o work long hours,

o spend considerable time walking, to consult with co-workers,

o manage expensive facilities and equipment and administer large staffs (depending on the facility one works at),

o understand finance and information systems and be able to interpret data,

o have strong leadership abilities,

o Have tact, diplomacy, flexibility, and communication skills.

Employment of medical and health services managers is expected to grow faster than average. If you have work experience in the health care field and strong business and management skills you should have the best opportunities.

How Much Do Medical and Health Hervices Hanagers Earn?

Median annual earnings of medical and health services managers were $67,430 in May 2004. Half of the managers earned between $52,530 and $88,210. The lowest salaries were less than $41,450, and the highest were more than $117,990.

A Day in a Medical and Health Hervices Manager’s Life:

On a typical day a Medical and health services manager will:

o direct activities in clinical areas such as nursing, surgery, therapy, medical records, or health information,

o manage personnel, finances, facility operations, and admissions,

o evaluate personnel and work; develop reports and budgets; and coordinate activities with other managers,

o maintain and keep the security of all patient records.

o coordinate day-to-day business of the clinic,

o work closely with physicians on many details,

o oversee personnel matters, billing and collection, budgeting, planning, equipment outlays, and patient flow,

o Engage in community outreach and preventive care.

I hope this article gives you a good idea of what is involved in the career of a Medical and Health Services Manager. Health care is the largest industry in the world. In the U.S. about 14 million people work in the health care field. More new wage and salary jobs are in health care than in any other industry. (Some figures from Bureau of Labor Statistics.)

Celebrating the National Health Service: Longevity of Disabled People

Historically the National Health Service is the crown jewellery of the welfare state in the UK. Its successes have become the envy of the world since its inception in 1948. The institution has improved and maintained the lives and health of the nation and its citizens. This is irrespective of sex, gender, ethnicity, age and disabilities. Health care has been free at the point of delivered. Yet, the service is paid for with National Insurance Contributions by the working population in the UK.

Despite its achievements and accomplishments, disabled people (learning and physical disabilities) were not seen as people with equal rights compared to non-disabled people. They were stigmatised and called different names such as the “mongos, cripples, loonies and handicapped”. Besides their castrations, they were locked up in “long stay hospitals” and had very little access to the community. Their life-expectancy was short, in many instances this determined by medical practitioners in the hospitals/homes who pegged it at 40-years-old, while many did not even have the privilege to live up to that age. Their needs were poorly managed and they had no choice of the services/care other than accepting what was available. Most were ill-treated and their outcry rose the issues of “Moral Integrity, Human Rights and Equal Opportunities” for all.

The plights of disabled people touched the hearts and minds of some members of the parliament and clergymen/women in the UK. The proponents for change exploited this opportunity and called for the abolition of the policies and legislation that supported segregation. This was widely supported by many pressure groups who lobbied their constituency members of parliament in the House of Commons. The protagonists sought for change and reforms of the National Health Service and the wider welfare services. This received “A Royal” shield and the birth of the “NHS and Community Care Act (1990). Since then reforms have not stopped but has gained momentum.

Thus, 1990 would be remembered by many people as a year of liberation for disabled people. It also marked the beginning of a road map for reforms in the wider welfare systems and normalisation of disabled people in the wider community. Normalising the lives of disabled people and their assimilation in the community has revived the general public’s attitudes and behaviours towards disabled people of different classifications. The reforms have made significant changes and improvements in the lives of this client groups as widely observed in practice and in the communities they live.

Reflecting on the attainments and realisations of the reforms, many disabled people now lives over 65-years-old and relatively in good health. Credits are due to the multitude of support systems such as advances in medical sciences, assistive technology, personalisation of services (Direct Payments, Cash for Care) and independent living. These have provided immerse opportunities and lifestyle for the client groups and their caregivers. For example, they are now able to access the community with their personal assistants and socialise with non-disabled people.

Similarly, health and social care professionals are now well educated in practice to understand and respond to challenging behaviours in children and adults with multiple pathology of disability. Every day, we see people with disabilities such as autism and attention deficit and they are expected to cope with their functional activities of daily living in a world, which can often seem bewildering and irrational. Most of the client groups (mild or severe disabilities) may need one form of support or the other therefore, it is imperative that their support systems are not interrupted in order not to confuse their retinue.

This can cause high levels of anxiety and stress, resulting in behaviours that can be difficult for other people to deal with. This could also offer significant trials to professionals who are involved in the provision of education, health and welfare services. Examining the unique tasks facing children and adults with disabilities, their conditions may exacerbate as they are ageing. This would tentatively present some dilemmas to professionals who are supporting them to attend their holistic needs. Thus, support plan or individual programme plans (IPP) for disabled people require continuous monitoring and appraisal of their needs as well as adequate financial and human resources.

The current reforms within health and social care sectors are threaten some of the achievements already made to safeguard the wellbeing of many service users. The danger is that as people with learning disabilities for instance are getting older, they may face the same physical and mental problems of all ageing people. Most would need increasing support to ensure they grow old in a society where their safety and dignity could be maintained. On the other hand, parents who are the main caregivers for their children with learning disabilities or those with physical infirmities may find it more difficult to cope as they get older. More than often, siblings and other relatives who take on this role struggle to find information they need because they have not been part of care giving.

Consequently, older persons with disabilities who do not have relatives risk a future of increasing isolation hence social work has changed to care management approach. They have little opportunities to rapport with service users as it used to be in the past. They are now responsible for care commission while service users have to source and appoint their own personal assistants and this could be a difficulty for many. Thus, the unanswered questions within the current welfare systems are who will protect the interests of the vulnerable if their parents are no longer able to? Would the local authorities’ social services departments perform dual roles of commissioning and care delivery therefore, what’s going to be the legal and financial implications for authorities?

In anticipation, adults with profound, moderate or severe behaviours who are living independently with their personal assistants may find it difficult in the long-run when they are aged. There are still many potential issues around; choice and control, managing their personal budgets and finances as well as maintaining health and safety around them. It is been observed in practice that supported or assisted housing is not always appropriate for older adults with disabilities, who might need assistance with physical activities for example, mounting stairs or getting in/out of the bath as well as preparing meals and other domestic chores. Conversely, generic homes for the elderly may not have resources or be suitable for the specific needs of people with challenging behaviours.

Longevity of disabled people needs to be celebrated owing to the NHS and community care reforms and continuous re-organisations of the industry.