Transforming Mental Health Care: Applying Performance Improvement Methods to Mental Healthcare

One in five U.S. adults experiences a mental illness within a given year. With more than 550,000 people working to support this underserved community, the mental healthcare 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 and errors, to complications stemming from poor care. Our country is also on an unsustainable path as our healthcare expenditure keeps growing. To add to all of this, we are facing a rampant epidemic of burnout among 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 healthcare 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, and an overuse of auditing, 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, the award-winning, leading institution for mental healthcare in America, provided the focus on mental healthcare and became the laboratory for this body of work over the course of eight years. It 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 healthcare workforce. They crafted a multi-pronged approach towards culture change at Sheppard Pratt, including implementing 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.

Sunil Khushalani

Medical Director, Adult Service Line at Sheppard Pratt Health System

He is a Clinical Assistant Professor in the Department of Psychiatry at the University Of Maryland School Of Medicine. He got his medical degree from Mumbai University in India. He finished a psychiatric residency from the Department of Psychiatry at New York University Medical Center/Bellevue Hospital program. He is Board Certified in Psychiatry by the American Board of Psychiatry and Neurology. He is also a Diplomate of the American Board of Addiction Medicine. He also directs an inpatient unit and a partial hospitalization program at the Sheppard Pratt Health System. He has been a lean facilitator at Sheppard Pratt since 2009. He is the co-creator of a course at Sheppard Pratt on ‘Lean Problem Solving’ which has been offered to participants on the topic of Lean Performance Improvement Methodology, as they apply this learning to solve problems encountered within the Sheppard Pratt Health System since 2013. He has presented several workshops and lectures on applying Lean Methodology to problems encountered in mental health care settings. Since 2014, he has been a member of the patient safety workgroup of the APA council on quality care. In 2016, he was voted as a ‘Top Doctor’ by Castle Connolly and the Baltimore Magazine.

Antonio DePaolo, PhD

Director of Lean Transformation

Sheppard Pratt Health System

Antonio DePaolo, PhD is an accomplished Executive with 20 years of experience in operations, performance improvement, strategy deployment and corporate development. His leadership philosophy is a blend of situational and servant leadership to fully engage staff in executing the value proposition of an organization. He provides a solid foundation of customer focus to advance organizational alignment, communication, and collaboration thus achieving significant organizational improvement. He has a proven track record of leading cross functional resources and delivering on corporate objectives.

Mr. DePaolo is currently the Director of Lean Transformation at Sheppard Pratt Health System which consistently recognized as one of the nation's top mental health systems, offering psychiatric care for mental and behavioral issues. He holds a PhD in Applied Management and Decision Sciences from Walden University and a Masters of Engineering, Industrial Engineering from the University of Buffalo. He’s an experienced trainer in the principles of Lean manufacturing, Ergonomics and Change Management to name a few.