Friday December 14, 2007

Task Force Issues Recommendations for Improvements at Psychiatric Center

Wilmington – The Governor’s Task Force on the Delaware Psychiatric Center (DPC) met for the final time on Friday to discuss and adopt a list of recommendations for improvements at the DPC. The recommendations will be incorporated into a report to be presented to Governor Ruth Ann Minner.

Created by Governor Minner in August, the nine member group of volunteers from the patient advocate and healthcare fields, community and legislative branch met frequently over the last three and a half months as a group and in smaller subcommittees. They were charged with identifying best medical practices for patient care, program improvement, and community placement options, and to provide recommendations on issues, such as hiring procedures, training, professional development opportunities for staff, and the need for a new facility.

The Task Force’s top recommendations from among a list of more than 80 focused on creating several levels of oversight for the state hospital, changing its organizational structure, making significant staffing improvements, enhancing the Performance Improvement Unit, expanding and enhancing community services, and building a new DPC facility.

Specifically, the Task Force recommends that the DPC create a high level Oversight Committee to provide input toward improving operations at the hospital. The Committee would include a mix of DHSS staff, physicians, health care professionals, patient advocates, and community experts in performance improvement and management.

The report says, “The need to restore public confidence in the DPC is critical. This (Oversight Committee) would assist DHSS in assuring transparency in operations and help staff draw upon the expertise of skilled community leaders to assist in difficult processes that address the quality of patient care.”

The Task Force suggested the Oversight Committee be comprised of several subcommittees. An additional recommendation made at the meeting was to combine a Patients Rights and a re-instituted Human Rights Committee that would report back to the larger body.

Other committees recommended by the Task Force to provide additional levels of oversight include: elevating the status and responsibilities of the current Performance Improvement (PI) Committee to include the implementation of the DPC’s Plan of Correction to the Centers for Medicare and Medicaid Services (CMS) report; instituting a Department-wide Morbidity and Mortality Review Committee; and creating a Transformation Committee to revise the DPC’s philosophy, vision and goals to facilitate progress toward a system of care that is recovery oriented and is embedded in the hospital’s ongoing culture.

A high priority recommendation from the Task Force is that the DPC should hire an experienced Hospital Administrator “Coach” to assist the hospital for at least six months with new organizational processes until after a new Hospital Director is hired. This Coach would be a constant source of support and direction as change and top level staff transition occurs.

Also in the area of staffing came several key recommendations. First and foremost the Task Force recommended the re-organization of the DPC operational structure. The report notes that the current “matrix” structure is outdated, and doesn’t function effectively. Restructuring would allow for clear lines of authority and responsibility. Some of the structural changes include: hiring a Hospital Director with clinical experience in the behavioral health field, ensuring the Chief Psychiatrist is not a full time attending physician so that he/she can concentrate on leadership duties, revising job descriptions to highlight required educational experience and clarify the duties of each position, and reclassifying the position of Unit Director to that of Nurse Director. The Task Force feels the person in this latter position should have clinical and administrative experience.

Another priority for the Task Force was highlighting the importance of the Performance Improvement Unit in the successful operation of the hospital…stressing that it is critical for the DPC to hire a well experienced Director, a process already underway according to agency staff. Additionally the Task Force indicated the DPC’s Performance Improvement Plan needs to be should be updated with clear expectations and said that filling top staff positions with experienced individuals who understand the PI process is key. It recommended appropriate benchmarks be identified and tracked as a way to improve processes which “need to be implemented to encourage a culture of reporting and of safety that is non-punitive. Staff must feel free to report near misses a well as variances so that opportunities for improvement can be identified as well as addressed.”

Furthermore, the Task Force recommends the legislature investigate revising state code to mandate criminal background checks and drug testing for all state employees working in health care settings. A variety of recommendations on making training more accessible to staff, ensuring that direct care staff spend a minimum number of hours each day with patients, improving treatment options offered to patients and developing a substance abuse treatment program for patients were also offered.

Topics of concern throughout the extensive review process were the issues of seclusion and restraint use, as well as the reporting of allegations of abuse or neglect. The Task Force is calling for DPC staff to attend national training to reduce the use of seclusion and restraints. Members also want the DPC to automatically notify patient advocates with the Disabilities Law Program of any allegations of abuse or neglect, as well as add a section to the reporting form, known as the PM – 46, that specifically prohibits retaliation against those who report such allegations.

Task Force members called for the state to “minimize the use of institutions and maximize community supports” by recommending the rapid expansion and enhancement of community programs. It recommended when possible that the DPC provide for the placement of 50 individuals per year for the next several years in the community. These individuals may either be current patients at the facility or those who are in the community who might avoid hospitalization if the proper combination of services there were available. The Task Force noted that placement of patients in the community can generate additional Medicaid funding revenue whereas Medicaid funding cannot be generated for DPC for patients placed at the hospital. Additional recommendations for funding support in the community included dedicating a minimum percentage of DHSS’s budget to provide increases for service providers who have not seen any in years. Task Force members stressed that “no growth in community allocations, except when there is a crisis, is not acceptable.”

Finally, a key recommendation of the group is for the state to move forward with the construction plans for a new DPC facility. “The current Center’s buildings are outdated, costly to maintain and in need of ongoing expensive maintenance.” However, members suggested a more detailed, independent actuarial study be conducted to determine the most appropriate size and number of beds for the hospital before proceeding with construction.

Additionally, “The Task force urges an independent analysis of the cost factors involved for this new facility by a consultant with no vested interest in the eventual construction, similar to the procedure followed with the construction of the new State Courthouse.”

A new facility seems essential if Delaware is to maintain its accreditation,” notes the report. Loss of accreditation by the hospital would result in the loss of approximately $4 million dollars, while moving ahead to improve treatment options and centralize many services under one roof could result in over $400-thousand in annual savings according to DHSS staff.

During the public comment section of the meeting patient advocates and members of the community thanked the Task Force for its thoughtful and thorough work. Additionally, Division of Substance Abuse and Mental Health Director Renata Henry also expressed her appreciation for the Task Force’s work saying “we have a clear path set out for us. I am particularly grateful for the Task Force’s work in the area of Performance Improvement.”

A copy of the Task Force’s final report will be made available via its website which can be found at www.dpctaskforce.delaware.gov next week.