Management and staff at Yale-New Haven Psychiatric Hospital are always thinking… How can we do things differently? How can we do something better?
The management team at YNHPH confronted a persistent, if common problem among psychiatric facilities: We have a group of patients who are recurringly readmitted to the hospital. They have been diagnosed with a range of mental-health disorders, yet don't require permanent hospitalization. Instead, they are admitted, receive treatment, improve enough to be discharged, but then something gets worse in their lives and they return to the hospital. Primarily it's a frustrating cycle for those patients, but also a strain on the hospital's efficient delivery of services. We became determined to find a solution.
Investigating the Problem
William Hurt Sledge, MD, is the Medical Director at YNHPH. "My main role is shaping our services," he says succinctly. But Dr. Sledge, a faculty member in the Psychiatry department at Yale School of Medicine, also conducts research as a health services investigator, studying ways to improve the overall effectiveness of the hospital. Examining the conundrum of reoccurring admissions, he uncovered a common characteristic: These patients all are extremely hard to engage. "They're sensitive to the status differences between themselves and their care providers, and they don't like it," Dr. Sledge explains. As a result, they have trouble getting well enough to survive on their own.
Developing an Innovative Solution
Dr. Sledge received a research grant to study a group of such patients, but found it difficult to recruit them. Eventually, that made sense to him, considering their general distrust. He then devised an innovative approach. He enlisted several former patients who have similar mental illness but have progressed to the point of independence from the hospital. These "recovery mentors" were trained and given an active part in the study; they were randomly assigned to certain patients and routinely met with, and engaged, them. After several months, "we saw a significant reduction in those patients' hospitalization," Dr. Sledge reports. Encouraged, his next step is to document exactly why that innovation worked so that it might eventually be formally instituted. "There's an innovative quality and spirit at this hospital," he says. "How can we change, improve and modify our services so we can do an even better job?"