New Hampshire Hospital: Robert MacLeod, Chief Executive Officer

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Current trends in healthcare all seem to revolve around the mantra of “do more with less.” For most facilities this involves re-evaluating processes and finding ways to become more efficient. As a public psychiatric inpatient hospital, New Hampshire Hospital has had to retool its care plans to adjust to a changing landscape during the past two decades.

In the 1990s, New Hampshire Hospital had 220 beds and about 800 annual admissions. Today, the hospital has 152 beds and about 2,500 annual admissions, with many more complex cases. The average length of stay has dropped to seven days, whereas in the past, patients may stay weeks at a time.

Changing the delivery of mental-health care

“Mental-health care is going to look different as we know more about mental-health diseases and how to treat them,” said Chief Executive Officer Robert MacLeod. “We have to place more focus on shorter hospital stays and a care plan that gets people back into the community. We need an internal view and an external view, working with community health centers and other community providers.”

Most patients are admitted to New Hampshire Hospital involuntarily. This requires a large amount of legal work to be done by the hospital, as patients have a right to a hearing within three days of arriving. If a petition is granted, they can be kept at the hospital for 10 days. Patients must be evaluated and treated within that span. New patients are assigned a treatment team consisting of a psychiatrist, a registered nurse, a social worker, a mental-health worker, a recreational therapist or an occupational therapist, and a medical doctor if needed.

A growing trend in providing psychiatric care is incorporating substance-abuse treatment. MacLeod said about 50 percent of the population comes in with substance use or abuse problems in addition to their mental-health issues. Historically, the hospital has kept the two problems separate, but now treatment must incorporate substance-abuse treatment into the care plan.

MacLeod said providers also give more consideration to how medical issues affect mental health, and the hospital has had initiatives going on involving metabolic diseases and their influence on mental health.

As with all organizations, patient safety and quality are extremely important at New Hampshire Hospital. Ensuring the proper identification of patients before administering medications or any other treatment is paramount.

At a psychiatric hospital, patients come in distraught, disoriented, confused, or sometimes angry and are not always able to articulate who they are or their medical history, including current medications. Infection control, suicide prevention, and falls prevention are major safety initiatives going on at New Hampshire Hospital.

The hospital has succeeded in providing safe, quality care to patients and maintains Joint Commission Accreditation. Using the Global Assessment Functioning score to measure patient improvement, MacLeod said that most patients come in with a score of about 30 and leave with a score around 70.

Finding ways to do more with less

Budget cuts are increasingly common among government-funded services, and in 2012, the hospital had to reduce its staff by 200 employees. Although challenging, MacLeod said the organization was able to downsize without disrupting services and without damaging staff morale.

New Hampshire has been implementing Lean Six Sigma principles as well to improve efficiency. For example, the hospital saved about $1 million annually by consolidating warehouse services.

Currently, the hospital has Lean initiatives going on in the admissions/discharge process, billing and reimbursement, and the civil-commitment process, which is defined as people who are dangerous to themselves and others. The hospital is also working on ways to improve public safety such as notifications of discharges.

Developing strategic partnerships

In the 1980s, New Hampshire Hospital faced a crisis point in its ability to provide care, and out of that was born a partnership with the Geisel Medical School at Dartmouth College. All psychiatrists at the hospital are also faculty at the medical school, and every resident of the medical school spends two months working at the hospital. A number of medical students also perform their third-year psychiatry rotation at the hospital as well.

With some uncertainty as to what the future holds, MacLeod emphasizes the importance of providing quality mental-health care.

“Mental health affects other parts of health and is as important as anything else we do in healthcare,” he said. “Mental illness hits almost every family in one way or another. Our goal is to take away the stigma. We want to get people who need help admitted, get them healthy, and get them back out in the community.”

-by Patricia Chaney

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