Wednesday, February 27, 2013

When the doors of the mind open

I’ve often wondered why the psychiatric wards are the most drab and depressing parts of hospitals.  After all, you’d think that the architects and interior designers would be instructed by the facilities administrators to brighten things up for those patients suffering from mental illness and for the clinical staff who take care of them.  But no.  You know, even from the outside of the ward, that this is an unpleasant environment.  The door to a locked ward, with at best a small window looking in and out, is placed at the end of a dark corridor, surrounded by a wall colored in institutional gray or green, and often with no sign indicating what is inside.  Hope is quashed.

That despair is precisely what Teresa Pasquini, the mother of a young man with mental disease, noticed at Contra Costa Medical Center in Martinez, CA.  She notes: “The doors of the psychiatric units were seen as the hospital’s property and a way to control access.  Visitors were also controlled, and the mysterious world of the psychiatric units were misunderstood and often feared.  The entry into this emergency service was bare and unwelcoming.”

But change was possible, through a broadly inclusive Lean behavioral health rapid improvement event.  She explains:  “The Lean process takes you away from the meeting room and puts you on the front line of care observing each process.  This allows you to recognize what is waste and what has value.  Lean lets you see across the silos of the system and recognize the delays, the redundancies and harm.”

Indeed, while much of the focus of Lean is often on waste attributed to classical manufacturing concepts like excess transport, inventory, and waiting, those of us engaged in Lean often point out that one of the key wastes is “the waste of human potential.”  Unfortunately, if there is ever a part of a hospital that is likely to feature the waste of human potential--both of staff and patients--it is in the mental health areas.

Look at this simple result.  Teresa explains:  “With the help of a community partnership and three mental health consumers, who designed and painted the entrance to the psychiatric emergency area, this door now symbolizes the commitment to patient and family partnership and to co-producing a more welcoming and accessible experience for all who come here for care.”


e-Patient Dave said...

Yes. The transformation reminds me of the famous remaking of the entry to Beth Israel's ICU, years ago - before your time there, I think - as I recall, it was so "us-centered" (all about the institution) that the doors had a 4 foot wide STOP sign on them.

Nice that they painted the walls around the prison-style door! I do like it. Next step - fix the door itself. :)

Nancy Thomas said...

So often the simplest things make the biggest positive difference.....

Anna Roth said...

This is one of my favorite visuals at the medical center! What we didn't do was take the "real" before picture. The stark one you see was after it occurred to us we needed to record this. It was actually even worse than what you see. This was the only entry in the entire medical center that said "No Visitors." We also had, prominently displayed and much to my embarrassment, a sign reminding "visitors" they would be "subject to search" on entry. Even worse, we had a firearms and weapons warning posted!

The day the door came down was a very special day for me and our medical center. The consumers decided to paint on my birthday and invited me to join them as a birthday surprise. Brenda Crawford, an amazing patient advocate and driving force of our system improvement, and Dave Kahler, NAMI Board member and father, worked tirelessly with consumers. They created the design, picked colors and recruited a team to transform the entry. They arranged for someone to lead the PES (then CSU) entry redesign efforts. This skilled team leader was very talented, precise and extremely professional. As the day progressed, I learned that he was homeless and for a very long time (years) had been living out of his car. I was humbled that someone who many of us may think has little or nothing to give, gave us more than he will ever know. I asked him what made him want to do this work with us. I will never forget his answer. He said, "No one has ever asked me to help and I can." I've since learned that the experience that day changed his path. He went on to re-establish a connection with support. He has been in his own apartment and is a strong contributor at Mental Health Consumer Concerns.

The door is one of my favorite stories and examples of change you can see and feel. Though I can never quite explain it, I do know that more than the door has been transformed through this process.

Thank for sharing!

Brian Tse said...

From Facebook:

That's interesting. I never thought about applying the Lean concept to mental health patient care!

rose king said...

INSPIRING jump ahead. The consumers knew how to say "come on in." So often, the system itself is the primary source of stigma, starting with the facility.