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Quicker forensic movement will result in expedited mental health treatment

IN BRIEF: At Northcoast Behavioral Healthcare, some forensic patients are treated and discharged back to jail, while others are treated and eventually discharged to the community through a careful process that involves numerous steps and court approval. A Kaizen team analyzed every aspect of forensic admission and movement, intent on maintaining process integrity while increasing efficiency, to ensure that patients receive needed mental health treatment expeditiously.

SIMPLY BETTER: The new process has 36 steps -- compared to 122 steps with the previous process, for a 70% reduction.

STREAMLINING IN ACTION: The number of decision points was cut from 25 to 6 (76% reduction), handoffs from 37 to 6 (84% reduction), and loopbacks from 14 to 6 (57% reduction).

SMART USE OF RESOURCES: Once in place, the new process will require about 1,895 fewer work hours per year -- time that can be redirected to other areas where staff are needed.

After an intense week of work, the team had transformed its process into a model of simplicity. These "before" and "after" process maps tell the story.

Northcoast Behavioral Healthcare is a 260-bed facility located in Northfield, Ohio. About three-fourths of its patients are forensic, and each person in this group is further categorized as a pre-trial or post-trial forensic patient.

For patients admitted for pre-trial purposes (such as restoration to competency), the treatment focus is to stabilize the patient, provide the court with an opinion, and discharge back to jail.

For patients admitted for post-trial purposes (such as persons found Not Guilty by Reason of Insanity), the treatment focus is also to stabilize the patients -- then to progress the patient through increasing levels of movement toward discharge to the community. In all cases, forensic patients cannot be discharged without court approval, which requires a multitude of internal and external steps.

Needless to say, the process of forensic movement -- from when Northcoast receives a referral from court to when the patient is discharged or returned to jail or prison -- needs to be done effectively with each and every patient.

When team members start generating improvement ideas, they first do it individually. Then the ideas are pooled to find common ground and consensus. Here, individuals are documenting their ideas.

It also should be done efficiently, and that's where Northcoast identified an opportunity for improvement. The forensic movement process had become inconsistent and bulked up with overlapping steps -- while in other cases, important steps seemed to be missing. Ideally, forensic admissions and subsequent movement should unfold quickly so that patients can expeditiously receive the mental health treatment they need.

A Kaizen team took on the challenge during an intense week of work. Team members analyzed the current process, identified improvement measures, created a new process, and developed a set of action plans to ensure implementation.

The team's detailed map of the current approach to forensic movement revealed 122 process steps, 37 handoffs, 25 decision points, and 14 loopbacks -- showing a clear need for improvement. The team responded by designing a streamlined process that gets the job done with just 36 steps (a 70% reduction), 6 handoffs (84% reduction), 6 decision points (76% reduction) and 6 loopbacks (57% reduction).

With the new process, the team moved toward a paperless system, creating a single "snapshot" database to track patient data and internal movement -- and provide accurate, instant reports. This would replace the multiple tracking databases used previously.

The team endorsed having the Admissions Department assume all patient admissions, to reduce the unintended duplication of services among hospital departments. To shorten the time to submit court reports, the plan called for using the existing Microsoft Outlook calendar with reminder alerts to ensure timely report submissions and easier scheduling.

Overall, the Kaizen event helped team members clarify stakeholder roles along with policies and procedures -- an improvement in itself that will ensure effective use of staff resources.

The improvements will ensure a wiser use of resources over the long term. According to team calculations, the new process will require about 1,895 fewer work hours per year -- time that can be redirected to value-added work activities.

Download a 1-page fact sheet
Download a 2-page article
Download the team report-out
All downloads are in PDF format

This report was published August 23, 2013. Projected and actual results may have changed since then. For the latest info, contact the Ohio Department of Mental Health & Addiction Services or LeanOhio.

    OhioMHAS contact:
    Laura Brooks

Ohio Department of Mental Health & Addiction Services
Northcoast Behavioral Healthcare
Forensic Movement
June 2013

Team members
Team members: Laura Brooks (Clinical Services Director and Team Leader), Ingrid Morton, Jack Brannan, Harriet Perantinides, Anne McLain, Pam Phillips, Michael Berger, Sarah Feher, Debra Zieja