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De-Risking Behavioral Health: Uncovering the Hidden Economics of Patient Safety · Becker's Healthcare Behavioral Health

• 0:00
  - Hello, everyone. This is Erica Spicer Mason with
• 0:02
  - Becker's Healthcare. Thank you so much for tuning
• 0:04
  - into the Becker's Healthcare podcast series.
• 0:07
  - Today, we're going to talk about how behavioral
• 0:09
  - health leaders can better understand
• 0:11
  - and control the true economic costs of patient
• 0:15
  - safety
• 0:15
  - by moving beyond traditional observation models.
• 0:18
  - And joining me for this conversation, we have
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  - Todd Hajrick with us, and he's the CEO
• 0:23
  - of LEO.
• 0:25
  - Todd, welcome to the podcast. Thanks so much
• 0:27
  - for making time for Becker's today.
• 0:29
  - Glad to be here. Thank you so much,
• 0:30
  - Erica.
• 0:31
  - Thrilled to have you. And before we get
• 0:33
  - into the conversation, would you like to share
• 0:35
  - just a little bit more about yourself and
• 0:37
  - your work in health care?
• 0:39
  - Yeah. Happy to. I'll I'll keep it pretty
• 0:41
  - brief. But just as you said, Todd Hatrick,
• 0:43
  - I'm the CEO of of of LEO.
• 0:45
  - And we are a health care technology company,
• 0:47
  - tops spun out actually at Oxford University.
• 0:50
  - Myself, I've spent over twenty years in health
• 0:52
  - care technology.
• 0:54
  - I was part of leadership team over at
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  - Ascena Health and a business in the veterinary
• 0:58
  - health space called Covetrus.
• 1:00
  - Also was a CEO of a of a
• 1:02
  - remote patient monitoring company called,
• 1:05
  - Optimize Health, a venture backed business back in
• 1:07
  - COVID and when RPM was a different thing.
• 1:10
  - Really, if you look at where I've spent
• 1:12
  - my time, it's it's really focused on the
• 1:13
  - intersection of clinical care
• 1:16
  - and health care delivery. And what I'm excited
• 1:18
  - to talk with you about today is a
• 1:20
  - bit of what we've learned as you look
• 1:21
  - at that within
• 1:23
  - behavioral health and specifically our business, which is
• 1:26
  - focused on creating safer environments, better outcomes,
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  - and effortless compliance
• 1:30
  - working with our partners.
• 1:32
  - A lot of what we've seen in Day
• 1:33
  - of Your Health is is pretty interesting. So
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  - happy to have this conversation.
• 1:37
  - Yeah. Well, sounds like you're the perfect person
• 1:39
  - to walk us through it, Todd. And I
• 1:41
  - really do wanna start there what you mentioned,
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  - this area of focus that Leo has, and
• 1:45
  - that's the inpatient behavioral health experience.
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  - I think when leaders talk about patient safety
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  - and inpatient behavioral health, it tends to be
• 1:54
  - framed as something clinical,
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  - as well as an ethical obligation.
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  - But I know that there's a financial dimension
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  - to that work as well. So from your
• 2:03
  - point of view, how do the costs of
• 2:05
  - keeping patients safe show up across a hospital's
• 2:08
  - books, and how well do most organizations actually
• 2:10
  - understand what they're spending there?
• 2:13
  - Yeah. Excellent question.
• 2:15
  - And just to make sure that our listeners
• 2:17
  - understand where I'm coming at this from, so
• 2:19
  - what LEO does is we are a safety
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  - and compliance platform for inpatient behavioral health, as
• 2:23
  - you said, and and we focus on both,
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  - working with facilities in The US and UK.
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  - And so we have experience with with dozens
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  - and dozens of facilities and and thousands of
• 2:32
  - patient beds across both locations. And and what
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  - we've seen
• 2:36
  - is that,
• 2:37
  - actually, the cost of safety shows up as
• 2:39
  - a reactive labor spend, not a planned investment.
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  - So most organizations
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  - underestimate what they're spending.
• 2:46
  - When you're building an operating budget, you're looking
• 2:48
  - at nursing costs. Right? You're you're thinking about
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  - how you're gonna staff a unit. You're not
• 2:52
  - thinking about
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  - what safety costs are specifically.
• 2:56
  - Now that's not to say that
• 2:58
  - facilities aren't thinking about staffing to safe levels.
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  - The challenge, though, is that the planning exercise
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  - looks very different from the actual operating environment.
• 3:07
  - The staffing gets deployed very differently once you're
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  - in
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  - it. And so so why that gap is
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  - hard to see is that the safety cap...
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  - Its cost are scattered.
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  - They sit and sitter labor, the cost of
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  - having a one to one interaction with a
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  - with a patient,
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  - responses to incidents,
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  - and and and a behavioral health unit, unfortunately.
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  - Incidents are something that happens a a decent
• 3:27
  - percentage of time. You've got liability costs. You've
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  - got staff turnover in behavioral health. Actually, behavioral
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  - health is the highest staff turnover rates in
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  - all of health care. That's five different places.
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  - So, therefore, you don't really have one line
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  - you can look to from a safety perspective.
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  - Let me give you an example.
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  - If you have a high risk patient, what
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  - you're gonna do is you're gonna take a
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  - staff member, and you're gonna have them move
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  - off the floor, stop focusing on therapeutic care,
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  - and they have to sit with them. Now
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  - that may be three hours,
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  - six hours.
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  - That's expensive.
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  - It's arguably a blunt instrument taking one person,
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  - seeing across from another person. And
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  - as you face all these staffing challenges,
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  - it doesn't scale. Right? It's not scalable. So
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  - what we found is
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  - that sitter, the cost of a sitter, if
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  - you will, that person sitting there,
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  - 404...
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  - You know, mid 4 hundreds to mid $500
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  - per day. That... If you look at that
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  - across a facility, and a unit a unit
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  - tends to have somewhere between 15, 20 beds.
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  - That's 8 to $10,000... 8 to $12,000 per
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  - bed. Right?
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  - That is
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  - a multibillion
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  - dollar budget,
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  - spend, I should say, that people just don't
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  - see.
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  - And we're not... In in behavioral health, unfortunately,
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  - it's not just the labor cost, the staffing
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  - shortages.
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  - Right? But we're seeing tens of millions of
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  - dollars in increased liability costs.
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  - So what's happening is that
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  - most organizations will say, here's the cost of
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  - my
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  - student labor, my my nurse is, my med
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  - techs, my behavioral health technicians,
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  - not what the actual safety cost because it
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  - sits in a bunch of different places, and
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  - you only encounter it today in a reactive
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  - way.
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  - A really helpful example, Todd. So thank you
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  - so much for illustrating that for us. And
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  - I'm just thinking about
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  - the sheer amount of the cost that this
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  - can add up to that you've outlined and
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  - how we're already seeing behavioral health service lines
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  - under an immense amount of strain. So I
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  - think understanding
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  - where all of these financial implications can live
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  - is so important.
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  - So so in that vein, can you also
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  - elaborate a bit more on the concept of
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  - patient liability and grievous loss? Where does that
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  - fit in, and why should leaders pay attention?
• 5:36
  - Yeah, Erica. And I'm glad you brought that
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  - up because it it it... It's something that
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  - we basically...
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  - A term we coined
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  - for exactly what we're talking about here. Right?
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  - Which is
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  - as a behavioral health operator, whether operating inpatient
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  - psych facility, part of a larger acute hospital,
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  - or or stand alone,
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  - stand alone operations,
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  - because these costs are scattered, it's hard to
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  - see them. So
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  - by, establishing PLGL, right, patient liability and grievous
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  - loss,
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  - it is an easy way to aggregate those
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  - costs into one number, sitter costs,
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  - sentinel event liability,
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  - incident response,
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  - staff churn... Turnover due to traumatic events.
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  - Bring that all together one place. And when
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  - you do that, you can actually see
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  - what you may be able to do from
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  - an investment
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  - and impact
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  - in what a safer environment could look like.
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  - Right?
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  - As they say, you can't manage what you
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  - can't see. And so what PLGL does is
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  - provide that visibility.
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  - And to be clear,
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  - the costs
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  - are not going away. There are costs there
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  - that are already
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  - established.
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  - This is about seeing them
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  - rather than in multiple scattered places
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  - under one line attributed to a single cause
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  - and ensuring that you've got that visibility so
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  - you can do something about it.
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  - Yeah. Really helpful.
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  - And so, Todd, let's let's go ahead and
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  - bridge that with the operations piece.
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  - The core model for observation and psychiatric care
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  - really has not changed much in deck... In
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  - in decades,
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  - really. So I'm curious what you see as
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  - the limits of the current approach that most
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  - organizations take to observation,
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  - and what's at stake for both patients and
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  - organizations
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  - when when this approach no longer works in
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  - their favor?
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  - Yeah. So so walking to behavior health, this
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  - is something that struck me as
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  - as an approach that has been around for
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  - decades, and no one really knows why. So
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  - the standard model for operating in a behavior
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  - health facility is a person walking
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  - around the hall and checking on patients every
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  - fifteen minutes. It's called q 15 rounding, and
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  - that has been unchanged, as I said, for
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  - decades.
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  - And, actually, when a patient first presents, when
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  - they first arrive,
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  - if you don't have an actual
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  - care plan in place, it's called the q
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  - five. So if you check every five minutes.
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  - But if you think about that type of
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  - approach
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  - even at that frequency,
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  - at any moment,
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  - a patient on a unit is observed
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  - arguably single digits. Right? So the rest of
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  - time, a patient is arguably potentially
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  - in crisis sitting somewhere
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  - unwatched
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  - in a facility, yet you have a q
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  - 15 approach that is designed to prevent that.
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  - There's a disconnect there.
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  - What that does is... Let's talk about it
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  - in two places. First of all, what's it
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  - take for patients? Right? Issue with falls, issue
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  - with self harm, acute deterioration.
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  - Right?
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  - When that happens, if you look at the
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  - data, that happens... We've we've we've seen it
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  - happen, you know, if you look at some
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  - of the clinical data about eighty percent of
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  - the time. Unfortunately, that happens
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  - between rounds
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  - at night
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  - when your staffing's the thinnest. Right? The... You're
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  - operating 24 by seven.
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  - Oftentimes, staffing shortages mean you have to bring
• 8:55
  - in temp labor at night, and that's unfortunately
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  - when bad things happen.
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  - So that's
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  - impact of potential patients. Let's talk about the
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  - organization. Right?
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  - Every time a gap occurs, it creates a
• 9:08
  - possibility of a sentinel event. Right? And the
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  - sentinel events, as we've seen across the entire
• 9:13
  - industry,
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  - those cost of liability
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  - are going up.
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  - And as I also mentioned, the staff retention
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  - is an issue. Something bad happens at night
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  - to a staff member, whether full time or
• 9:26
  - agency,
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  - they're not gonna stick around. Witnessing serious harm
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  - is the number one driver of burnout in
• 9:34
  - this industry.
• 9:35
  - What gets me the most, though,
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  - is that when you visit an inpatient
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  - psych unit, the staff's incredible. Right? They are
• 9:42
  - devoted to caring for what is arguably
• 9:46
  - incredibly vulnerable patients at patients
• 9:48
  - at a very challenging moment in their lives,
• 9:51
  - and you have staff there that are devoted
• 9:53
  - to getting them to get better.
• 9:55
  - So
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  - we have incredible staff, very challenging patients, and
• 10:00
  - a staffing model built reality that arguably doesn't
• 10:03
  - exist today.
• 10:05
  - Yeah. Todd, I appreciate how you broke that
• 10:07
  - down into the the patient impact, organizational impact,
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  - and then, of course,
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  - how it affects staff too. The consequences of
• 10:14
  - a staff member understanding that, you know, just
• 10:17
  - a a lapse in time that they weren't
• 10:19
  - present and a a a harmful patient event
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  - happened, you know, while they were technically under
• 10:24
  - their watch, but they weren't able to see
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  - it in time. I mean, that that has
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  - to have quite an impact on a staff
• 10:30
  - member and appreciate how you connected that to
• 10:32
  - what you're seeing in burnout too.
• 10:35
  - So that approach has its gaps.
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  - So I'm curious.
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  - If you were to Literally. Sorry. It literally
• 10:42
  - has its gaps. Absolutely.
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  - So I'm curious, in your view, what does
• 10:46
  - that different,
• 10:47
  - more sustainable approach look like? What does it
• 10:50
  - make possible operationally and financially, and and where
• 10:53
  - does technology fit in?
• 10:55
  - Yeah. So so first of all, you can't
• 10:57
  - manage what you can't see. So let's talk
• 10:59
  - about how you get started. Right? So the
• 11:01
  - first thing you need to do is understand
• 11:03
  - what PLGL is. Right? And the number way
• 11:05
  - to number one way to do that is
• 11:07
  - to look at your sitter spend. And the
• 11:09
  - number sitting there,
• 11:11
  - you can find it,
• 11:13
  - but a lot of systems haven't done that.
• 11:15
  - So so if you're if you're, you know,
• 11:16
  - if you've got, you know, budget responsibility,
• 11:19
  - you're part of the financial team,
• 11:21
  - what does your sitter spend look like? Right?
• 11:23
  - And then look at what has happened over
• 11:25
  - the last couple years from a Sentinel event
• 11:27
  - perspective, whether it's an event or hopefully a
• 11:30
  - near miss that didn't lead to an actual
• 11:32
  - event. Right? And
• 11:34
  - when did those happen as we're just talking
• 11:36
  - about that? My hunches and my strong assumption
• 11:38
  - is that that happened in those gaps in
• 11:40
  - observation.
• 11:42
  - When you look at that spend, then think
• 11:44
  - about
• 11:45
  - what could change
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  - operationally and financially
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  - if you were to leverage something like innovation
• 11:51
  - to enable a patient to be watched
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  - continuously
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  - through technology
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  - without needing
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  - someone sitting in that hard plastic chair
• 12:01
  - watching more. Right?
• 12:04
  - So so understand your number.
• 12:07
  - Understand what the impact look like, think about
• 12:10
  - innovation, and what happens if you took that
• 12:13
  - safety spend and leverage innovation instead.
• 12:16
  - And
• 12:17
  - we've seen it. Our partners have seen it.
• 12:20
  - What happens is a couple things.
• 12:22
  - On the floor of that unit,
• 12:24
  - you shift your staff time from constant physical
• 12:27
  - observation,
• 12:28
  - again, that hard plastic chair with someone sitting
• 12:31
  - in it at 2AM
• 12:33
  - staring at a patient,
• 12:35
  - to actually being able to focus on therapeutic
• 12:37
  - care. Right? You shift from watching harder, watching
• 12:40
  - more, to watching what needs to be watched.
• 12:42
  - Mhmm. Then all of a sudden, from a
• 12:44
  - financial perspective,
• 12:46
  - you're moving from what is predominantly been a
• 12:48
  - reactive, unpredictable spend
• 12:50
  - into something that you can plan for, and
• 12:52
  - it's a fixed cost.
• 12:54
  - And most importantly, and we're talking about financial,
• 12:56
  - we're talking about labor, let's also talk about
• 12:57
  - the clinical impact. Right? If you catch deterioration
• 13:00
  - early, right, if you catch someone
• 13:02
  - leaving a bed potentially falling, right, or catch,
• 13:06
  - god forbid, wrong person, wrong room,
• 13:09
  - you have gotten ahead of what could potentially
• 13:11
  - become a sentinel event. Right? And that arguably
• 13:15
  - is the thing that has the highest cost,
• 13:17
  - highest cost to patients,
• 13:18
  - highest cost to the loved ones around those
• 13:20
  - patients, highest cost to staff, and ultimately, the
• 13:24
  - highest cost to the operator who's operating that
• 13:25
  - facility. If you can get ahead of that,
• 13:28
  - the game has changed. So, ultimately, this isn't
• 13:31
  - about watching
• 13:32
  - patients
• 13:33
  - harder, patients more.
• 13:34
  - It's using innovation to understand
• 13:37
  - that your staff and your patients are safe
• 13:40
  - without needing someone sitting there watching every second
• 13:44
  - to prove that.
• 13:46
  - Yeah. And, Todd, I'm curious. You know, in
• 13:48
  - your in your work at LEO, have you
• 13:50
  - seen
• 13:51
  - an organization
• 13:52
  - put this approach and this technology to work,
• 13:54
  - and how have you seen that play out
• 13:56
  - for them? I would love to hear any
• 13:58
  - examples or or success stories that that come
• 14:00
  - to mind for you.
• 14:02
  - Yeah. Yeah. We we are we are fortunate
• 14:05
  - that we have been able to contract with
• 14:07
  - some amazing health care organizations,
• 14:10
  - both in The US, as well as in
• 14:12
  - The UK.
• 14:13
  - And, we've got a number of customers. I
• 14:16
  - I won't I won't name them out specifically
• 14:18
  - right here, but what... I I I still
• 14:20
  - remember
• 14:21
  - a wonderful chief nurse. We brought our system
• 14:23
  - live.
• 14:24
  - We went, we went on a call with
• 14:26
  - her about a month after we went live,
• 14:28
  - and she turned to us and said, do
• 14:30
  - you realize that you prevented
• 14:32
  - four sentinel events last last month, the first
• 14:35
  - month you're live?
• 14:37
  - So so by going ahead
• 14:39
  - and changing the way you can approach how
• 14:42
  - you think about safety,
• 14:44
  - you can do things such as
• 14:46
  - preventing
• 14:47
  - arm in a way that you as an
• 14:49
  - operator
• 14:50
  - haven't thought about before.
• 14:52
  - Yeah. No. It's it's a really powerful effect.
• 14:54
  - And,
• 14:55
  - Todd, I've really enjoyed learning more about LEO,
• 14:58
  - the work that you're doing, and and really
• 15:00
  - the
• 15:00
  - the many ways that sentinel events and the
• 15:03
  - inpatient behavioral health space, kind of this cascade
• 15:06
  - effect it has on not just financials, but
• 15:09
  - operations,
• 15:10
  - staff,
• 15:11
  - staff well-being, and then, of course, patient well-being.
• 15:14
  - It's been a very educational conversation. But before
• 15:16
  - I let you go, anything else that you
• 15:18
  - think is important or that is important for
• 15:20
  - our listeners to take away from the conversation?
• 15:23
  - Yeah. I think just a just a a
• 15:25
  - couple closing points here. Right? So
• 15:28
  - one thing we lead with when we have
• 15:29
  - conversations with potential partners is that innovation does
• 15:32
  - not replace
• 15:34
  - a nurse or clinical care. Right? It removes
• 15:36
  - the requirement that a human be physically present
• 15:39
  - every second to know that a patient's safe.
• 15:41
  - Right? So we're actually helping a team augment
• 15:44
  - what they're doing to focus on therapeutic care.
• 15:46
  - I think that's I think that's point number
• 15:48
  - one. Point number two is that, especially from
• 15:50
  - a listener perspective,
• 15:51
  - and this is something that after spending decades
• 15:53
  - in health care I've seen, behavioral health is
• 15:56
  - different, and innovation in behavioral health presents a
• 15:59
  - unique set of challenges
• 16:01
  - and requires unique and specific approach. Right? And,
• 16:03
  - therefore, as you talked earlier,
• 16:05
  - you can actually, using innovation,
• 16:07
  - align both the ethical case for it from
• 16:09
  - a therapeutic and clinical impact and the financial
• 16:13
  - case from a patient safety. Those two things
• 16:15
  - are an intention. They point in the same
• 16:18
  - direction. And there are great companies.
• 16:20
  - I believe that we at Leo are are
• 16:22
  - are one of those that are introducing generally
• 16:25
  - innovative solutions that are making a real impact
• 16:27
  - on the problem. So at the end of
• 16:29
  - the
• 16:30
  - day, the staffing shortages aren't going away.
• 16:33
  - Organizations that learn how to extend safe observations
• 16:37
  - using
• 16:38
  - technology such as ours
• 16:40
  - are going to be able to not just
• 16:41
  - deliver great care today, but deliver great care
• 16:44
  - in the future. And those are ones who
• 16:46
  - we are proud to partner with and looking
• 16:47
  - forward to continue to work with. So thank
• 16:49
  - you, Erica.
• 16:50
  - No. Well, thank you, Todd. Again, it's been
• 16:52
  - a wonderful conversation, and I appreciate you shedding
• 16:55
  - some light on a very important area of
• 16:57
  - clinical care. So thank you again.
• 16:59
  - Thank you.
• 17:01
  - And we'd also like to thank our podcast
• 17:03
  - sponsor, Leo.
• 17:04
  - Listeners, be sure to tune in to more
• 17:06
  - podcasts from Becker's Healthcare by visiting our podcast
• 17:09
  - page at beckershospitalreview.com.