Aligning our Processes around the Patient

Posted on October 10, 2012 by


The Psych Services / DAJD value stream has completed its first of several improvements aimed at aligning people, processes, materials, and information flow toward the customer, the KCCF and RCJ jail psych patients. Viewing the customer as the patient alone, as well as balancing patient requirements with DAJD and JHS stakeholder requirements for safety, security, and suicide prevention, represents a fundamental shift in thinking. This is a tough transition in philosophy for both divisions, but absolutely essential for lean management to work.

Put into practice, we will be implementing standard work on the front lines in our Intake and Receiving units that aligns core work with psych patient requirements. Our patients arrive in ITR in a variety of mental states, risks of self-harm / harm to others, and immediate needs. The mental health assessment as an interview will allow nursing and corrections staff to move beyond a previously prescribed series of yes / no questions, towards a conversation that de-secalates, understands needs, assesses risk, and determines critical level of MH care downstream. The team arrived at this from research that suggests an interview format solicting critical MH history, assessing protective / risk factors, and exploring suicide ideation is highly effective. It is exciting to see how this event will lay the foundation for fundamental improvements in MH care delivery, access, and care delivery further downstream.

From a people perspective, it unlocks the true potential for clinical staff in ITR to do what they do best, while complying fully with NCCHC standards. If our hypothesis works, not all psych patients will fit into a generic psych category. Our own psych patients have even told us (and I paraphrase) “there are folks here that need higher frequency of provider and psych interaction, crisis prevention, and treatment than me!” The vision to segment psych patients into the red, yellow, green, and non-psych pathways will contribute to more standard care and security as both clinical and non-clinical staff have a common terminology and process for problem-solving. There are significant hurdles ahead, but with the right level of engagement and an openness to change, we can a little bit better every day.