Latest / Becker’s Healthcare - Clinical Leadership Podcast / Unlocking Behavioral Health: Insights from Stephanie Weatherly, DNP, PMH RN-BC, FACHE

Transcript

Unlocking Behavioral Health: Insights from Stephanie Weatherly, DNP, PMH RN-BC, FACHE · Becker’s Healthcare - Clinical Leadership Podcast

0:00
Hi, everyone, and welcome to the Becker healthcare
0:02
care podcast.
0:04
I'm Mackenzie Bean, Av and managing editor of
0:07
Becker hospital review.
0:09
Today, I'm thrilled to be chatting with Stephanie
0:12
Wet, who is a chief Clinical Officer of
0:14
Psychiatric Medical Care.
0:16
Stephanie. Thank you so much for joining me.
0:18
How are you doing today?
0:20
I'm doing well, Mckenzie. Thanks for having me.
0:23
Of course.
0:25
I'm really excited to dig into our conversation
0:28
today,
0:29
and and tap your
0:30
expertise on the top topic of behavioral health
0:32
care and leadership. I know,
0:35
improving access to behavioral. A health care is
0:36
a tech priority for many of our readers
0:39
and listeners today with those
0:41
needs growing nationwide
0:44
before we dive into the conversation though, I'd
0:46
love to have you introduce yourself, and tell
0:48
us a bit more about your background.
0:51
Sure. I'd love to.
0:53
Stephanie Weather. I am a nurse by background.
0:57
I have my doctorate in nursing from Walden.
1:00
So
1:01
came up through
1:02
the it kind of an interesting
1:04
path. I actually became a nurse because I
1:07
was a homeless mid midlife apprentice and moved
1:10
to a state where
1:11
late was not,
1:13
licensed or legal. And so I just decided
1:15
to become a nurse wise and, like, happens.
1:18
So a lot of us. That's that's not
1:19
the path I ended up walking.
1:21
But but it intervene into the nursing profession
1:24
and eventually into nursing leadership.
1:27
Primarily in my career, I've done a lot
1:29
of
1:30
executive nurse leadership, quality, it as well as
1:33
leadership in the quality arena.
1:35
And then lots of extensive experience with the
1:38
behavioral health leadership led me to my current
1:41
role, this as Chief Clinical Officer for psychiatric
1:44
medical care,
1:45
we're a company that provides behavioral health expertise
1:48
to around 03:50
1:50
hospitals in 38 states.
1:53
So I get a real bird's eye view
1:54
of the behavioral health needs nationally,
1:57
the needs of patients across the country and
2:00
kind of trends around behavioral health. So it's
2:01
an exciting
2:03
company an exciting career for someone in clinical
2:06
leadership?
2:08
Absolutely. And I think your perspective is so
2:10
valuable. Like you said, having that bird's eye
2:13
view and seeing
2:14
national trends and what hospitals and health systems
2:17
across the country are doing to really
2:20
improve care in this area?
2:22
On that note, can you share some examples
2:24
it tell a little bit more about some
2:26
of the innovative programs or initiatives
2:28
that's
2:29
medical is implemented to improve,
2:33
outcomes for behavioral patients?
2:35
Sure.
2:36
We're super passionate about outcomes. We're we're passionate
2:39
about evidence based care, and that's really what
2:41
outcomes are. You know, did you follow evidence
2:43
based care practices
2:45
to see improvement in patient outcomes.
2:48
It's a challenge often in the behavioral health
2:51
arena. We're not as hard wired around evidence
2:53
based practice. You know, it's not like a
2:55
knee placement where we all know. You go
2:57
in. You enter on this day. You do
2:58
this exact treatment on this day, We provide
3:01
this exact medication and these,
3:03
intervention. And we know without a doubt that
3:06
the patient going to have this outcome the
3:08
vast majority of the time.
3:10
In behavioral health, there's a lot more triggers
3:13
to pull to impact how a patient is
3:16
going to improve.
3:17
So 1 of the things that we did
3:19
to try to look at all of those
3:20
different
3:21
areas is we created our own platform
3:24
for outcomes measurement.
3:27
And in doing so, we invested a lot
3:29
of capital into doing that to ensure that
3:31
we are looking at evidence based testing for
3:34
our patients. That's 1 of the ways you
3:35
measure in the behavioral health arena. We look
3:38
at tools that are evidence based to see
3:41
how the patient is on arrival at during
3:44
specific times
3:45
during their treatment and then at discharge so
3:48
that we can see patients improvement.
3:51
Some interesting things that we discovered in doing
3:53
this, it it allowed us to look at
3:55
both micro and macro
3:58
parts of the system and treatment that patients
4:00
were getting.
4:01
So 1 of the examples that comes to
4:03
mind
4:04
is we noticed
4:06
that there was a team that was really
4:07
struggling and their patient outcomes weren't where we
4:09
would expect them to be looking at the
4:11
national data.
4:13
And,
4:14
you know, immediately, your gut instinct as well,
4:16
there must be an issue with the people
4:18
providing treatment.
4:19
So, you know, we actually had some observations
4:22
done. We observed the group therapy. We observed
4:25
individual therapy. We observed the patient's treatment process,
4:28
and all of that was really rock solid.
4:31
So like okay, Well, what's going on. So
4:33
we dove into the actual testing process itself
4:36
with the patient.
4:38
And what was interesting is that the culture
4:40
of this team
4:42
had conveyed to the patient that these tests
4:44
were kind of burdensome them
4:46
And so we were able to work with
4:49
that team and really explain to the. It's
4:51
kinda like you know, Mackenzie, if you went
4:53
today to an north a pe doctor, and
4:55
they wanted to take X rays, and they
4:56
wanted to start you physical therapy,
4:59
You wouldn't look at the X rays as
5:00
a burden. Right? It's it's a it's a
5:02
test that's going to tell you whether you
5:04
need this certain intervention and process. And the
5:07
behavioral health arena, a lot of times our
5:09
patients can feel that does tests our burden
5:12
to figure out you have already answer these
5:13
questions. 5 people asking these questions.
5:16
So we really worked as a out a
5:18
scripting and how do we impact those so
5:20
they understand the importance of this test.
5:23
And it was amazing within a 3 month
5:25
period doing recheck, we found the patients actually
5:29
looked worse the very next time we tested
5:31
them because they understood the importance of answering
5:33
the test honestly
5:34
and with truth about how they were doing.
5:37
And then as over the period of the
5:38
next 3 to 6 months, we saw a
5:40
huge increase in improvement in these patients. And
5:43
was a really great lesson that we learned
5:44
on a micro level that we took macro
5:47
to our whole company
5:48
and hardwired some processes so that all of
5:51
our patients understand the importance of these tests
5:54
in their progress.
5:55
Because we set their goals and we set
5:57
their discharged all around their progress. So that's
6:00
just 1 example of how we implemented improvement
6:03
around patient outcomes to really drive patient improvement.
6:07
Yeah. I I think that's such a powerful
6:10
example of
6:11
the important role that
6:14
culture and, you know, patient education can really
6:17
play in this work and how important it
6:19
is for to really take the time and
6:20
do the due diligence to understand
6:23
what are obstacles, both staff members and patients.
6:26
So it's great to hear those improvements.
6:29
I'm curious, you mentioned that was
6:32
shared
6:34
across
6:34
the company. So when that really a an
6:37
example from a specific hospital that you were
6:39
working with?
6:42
So that was 1 of our specific locations.
6:44
At Len mentioned earlier were in 03:50
6:47
locations. That was occurring in 1
6:49
particular
6:50
location. But we... I'm just such a believer
6:52
in systems.
6:54
And when you learn something, you kind of
6:56
make the assumption that if it's happening here,
6:58
it probably happening in other places, and so
7:00
we can all learn from each other. And
7:02
so that's that's what I meant by that.
7:04
We've been rolled that out in that process
7:06
for how we train
7:07
our staff and how we communicate the testing
7:10
to our patients
7:12
into,
7:13
a nationwide practice.
7:16
Yes.
7:18
Very magnified results.
7:20
Let's shift if gears a bit and talk
7:21
about
7:22
your specific
7:24
leadership experience.
7:26
I know you are in your chief clinical
7:29
officer role now.
7:30
What would you say are the biggest challenges
7:32
you're encountering when comes to leading a team?
7:36
We definitely face a lot of challenges around
7:38
multi site leadership. And I think that's trans
7:42
to whomever is listening to this today.
7:44
It's very difficult for any clinical leader to
7:47
have their finger on the pulse of everything
7:49
happening that's under their purview view at 1
7:51
time. Whether we're in in my case or
7:53
you're in 38 states or whether you're in
7:56
a single
7:57
building
7:58
you're, you know, you're not aware of what
7:59
every clinician is doing at every minute.
8:02
Some of the things that specifically
8:05
I've encounters lack of frequent contact with staff.
8:08
So, you know, it's kind of inability to
8:10
oversee on a day to day basis, what
8:12
teams are doing, frequent clinical drift is a
8:15
a term I kind of coined and it's
8:17
just where people start out, everybody starts out
8:20
following your processes and rules and then over
8:22
time if you don't have enough touch points
8:24
or oversight, people drift kind of from the
8:27
mid line of what they're supposed to be
8:28
doing.
8:30
And then I'm sure something thing that everybody
8:32
can relate to hiring newly licensed staff members.
8:35
And we're all
8:36
in a place today where
8:38
you're not often looking at 20 resumes to
8:40
find the best fit for a position. You
8:42
might only have newly,
8:44
licensed graduates
8:46
whether it's registered nurses,
8:49
therapist,
8:51
even physicians
8:53
to choose from. And so how do you
8:55
engage and train
8:57
newly licensed staff members. So,
9:00
you know, some of the things we've created
9:03
to try to make
9:05
that better, we created our own
9:07
Emr platform. So across those 350
9:10
locations, we can have people documenting
9:13
in a way that it's transparent
9:15
to
9:16
clinical leadership, what's going on. We have the
9:18
ability to see into that, which I think
9:20
so important
9:22
creating training systems. So how do you onboard
9:24
your staff and how do you keep staff
9:26
current in their field In the behavioral health
9:28
field, I think it's just so important
9:31
if if you were working in critical care,
9:33
you wouldn't go into critical care and think
9:36
in 2 weeks, somebody can become an expert
9:37
in that.
9:39
I think there can be a mis perception
9:42
in the acute care environment that behavioral helps.
9:45
Everybody will say they handled behavioral health patients
9:48
because
9:48
if our patients our behavioral health. It's throughout
9:51
our care environment and the care continuum,
9:54
but we are a specialty, and so we
9:56
need to invest in that. You know, are
9:57
we encouraging our staff to become certified nurses
10:01
around behavioral health. And
10:03
in whatever their specialty pre is
10:05
encouraging them to become board certified.
10:09
The other thing is just making sure that
10:13
we have consultation calls,
10:15
so we do a monthly clinical training specific
10:18
to behavioral health for any clinician within our
10:21
company, and then we do a consultation call
10:23
to talk about difficult cases,
10:26
persistent problems that are seeing across the board,
10:29
know whether it's dealing with difficult patients, discharge
10:31
planning process,
10:34
you know, whatever that could be for that
10:36
specific location,
10:38
we wanna make sure we're supporting our team.
10:41
And then a big thing,
10:42
I think to kind of overcome these leadership
10:44
challenges is always asking why you know, as
10:47
a clinical leader, you get asked
10:50
annoying question today, and it can become easy
10:53
just to give an answer.
10:55
But 2 things happen when we do that
10:57
when we give the answer of course, we're
10:58
not
10:59
encouraging people to learn to answer questions themselves.
11:01
But more specifically than that,
11:04
we're sometimes missing why they were asking the
11:06
question. And when you ask that why,
11:09
you might uncover a lot of things you
11:10
weren't aware of. And so
11:13
I almost never answer questions. I always ask
11:15
for more information first
11:18
to make sure that I'm getting the full
11:20
picture and you'll be surprised what you learned.
11:24
I'm sure. I love that approach. Do you
11:27
find that
11:29
employees often can land on the answers themselves
11:31
after you ask some additional questions?
11:35
I do think so that. I think most
11:37
people
11:39
they lack the confidence
11:41
to tell you that you they've already formed
11:42
the answer a lot of times, but it
11:44
can be easy for a frontline staff member.
11:46
They just wanna to get the answer and
11:47
move on. Because they have so much on
11:49
their plate. So it can become very easy
11:52
to become the question answer.
11:54
But
11:55
if we wanna really grow our staff. It's
11:57
it's kinda like, you know, when I have
11:59
4 adult children now, but when they were
12:01
young, you know, so much easier just to
12:03
load the dishwasher myself.
12:05
Then to teach them to load it took
12:07
twice as much time. But in the long
12:09
run, you know, they wouldn't be very productive
12:11
I had done that for them. So
12:14
Absolutely. It goes back to the deep the
12:16
man fish outage. Right?
12:19
Exactly.
12:20
Wonderful.
12:22
I think you you you almost hinted at
12:24
this a bit in some of your examples
12:26
from the
12:27
organization.
12:28
But I'm curious if you can speak a
12:30
little bit more to How specifically you're working
12:33
to create a culture
12:35
of continuous improvement and innovation
12:38
among your teams.
12:41
Really good question.
12:44
1 of the things that we do is
12:45
every year in October, I send out an
12:47
email to all of our staff members
12:49
and request
12:51
their thoughts on forms, process change, policy change.
12:56
We typically get somewhere between 02:50
12:58
to 300
13:02
potential for improvement suggestions every year.
13:05
And we like to call through those. Sometimes,
13:07
you know, we can always
13:09
act on them if there's a regulatory reason
13:11
or a compliance reason that we're doing something.
13:14
But the people who are closest to the
13:15
patient, they often know how to fix the
13:18
problems that we might not even have the
13:19
answers to. So I love actually just as
13:21
simple as that sounds asking people. Ask for
13:24
their suggestions.
13:26
And then follow ups on them. We
13:28
take from October to December to go through
13:30
those and in January, we do roll of
13:33
changes based off of the staff
13:35
process
13:36
suggestions.
13:37
The other thing we do is that we
13:39
have a process every month where our teams
13:41
perform self audits on their documentation. And then
13:44
we perform quarterly una
13:46
oversight audit
13:47
so that we can ensure that the teams
13:50
themselves know what's going on in their chart
13:52
and that we as of the corporate team
13:54
know what's going on in those records.
13:57
Based off of those audits, we do performance
13:59
improvement plans with the team. So the teams
14:01
are aware of. It's an open book test.
14:03
I'm really big on that.
14:05
You, we all know the standards that we
14:08
are being accredited by through our accreditation bodies.
14:11
But should be an open book test for
14:12
the teams. They should know what we're gonna
14:15
look at, They should know what they should
14:16
be looking at so that we can all
14:17
be successful.
14:19
And then we, of course, have a safety
14:21
culture for... Through incident reporting to make sure
14:24
that we encourage people to notify not even
14:27
just incidents that near misses.
14:29
And if you're in the behavioral health arena,
14:32
I would give you this 1 thing to
14:33
take away with you from today's
14:35
call,
14:36
which is the debrief process.
14:38
If you want to change your culture
14:41
debrief,
14:42
debrief, debrief. So we normally behavioral health pretty
14:45
common to do an immediate debrief after something
14:47
happens.
14:48
You know, is everybody okay? Is everyone safe?
14:52
What do we think happen in this moment.
14:54
But I would encourage you to do a
14:55
debrief process 3 or 4 days after an
14:58
incident occurs.
14:59
To really dive into
15:01
what worked well, what didn't work well. It's
15:03
not punitive in any way it's a chance
15:05
for the team who is who were there
15:07
at that incident to look at it with
15:09
fresh eyes, kind of a little bit of
15:10
a detached guy
15:12
because that's really going to help you
15:15
change,
15:16
things that we may or may not have
15:17
been able to change through just talking to
15:20
people, letting the people who have that lived
15:22
experience come in and talk through it. And
15:24
having experts at the table, whether that experts
15:27
in behavioral health, experts in a physical incident,
15:30
if it was something that happened physically,
15:32
gets everybody at the same table and we
15:33
can talk about how we wanna do things
15:35
different than next time.
15:37
Right know that can be
15:39
so powerful to
15:41
how folks have their voices be heard and
15:43
then no. The organization is really acting on
15:45
some of the suggestions. That come out of
15:49
Well, Stephanie, the last question that I have
15:51
for you is,
15:53
what is your advice for aspiring chief clinical
15:56
officers. What do you wish maybe you knew
15:58
earlier in your role,
16:00
what wisdom would you pass on?
16:02
Well, I'm gonna start out by being cheesy
16:04
and tell you a quote,
16:07
I'm 1 of those people that loves quotes,
16:08
and this quote is from Florence Nightingale. And
16:11
it says let whoever is in charge, keep
16:13
the simple question in her head.
16:16
Not how can I always do the right
16:18
thing myself
16:19
but how can I provide for this right
16:21
thing to always be done?
16:24
And that truly is how I try to
16:28
aspire
16:29
to lead.
16:30
And what I would recommend for for anyone
16:32
that is leading, it's its systems.
16:35
The very first when I my first role
16:37
in leadership, I was an assistant director of
16:40
Nursing.
16:41
And my
16:43
administrator
16:44
was a systems focused thinker and he really
16:47
impacted my leadership journey.
16:50
Where human beings taking care of humans.
16:52
And so there's inherent risk
16:55
we're going to screw up. Right? We're going
16:57
to mess up because we're human.
16:59
So as a leader, you have to create
17:00
systems for your team to succeed.
17:03
And to prevent failure. And I'm sure everybody
17:05
that's listening. This has probably been on a
17:07
culture of safety journey and knows this swiss
17:09
cheese model
17:10
So so we have to create backup up
17:12
to the backup,
17:13
so you have to look at... When you're
17:15
thinking of implementing something. From the very first
17:18
step of it being... Of it touching a
17:20
staff member to when it touches to patient
17:23
to when the patient discharge, are you looking
17:25
at the whole thing and where can it
17:26
fail
17:27
And so before we even roll it out,
17:29
how can we ensure that when those failures
17:31
happen, the failure not going to touch the
17:33
patient. So that's probably my number 1 thing.
17:36
The second would be that you have to
17:38
create systems for yourself as a clinical lease
17:40
leader to be successful.
17:43
Crisis management is the number 1 job of
17:46
a clinical leader. You're a constantly managing crisis,
17:49
but you have to balance that as the
17:51
leader
17:52
with daily pass that have to be completed
17:53
for you to be successful and for you
17:55
to perform your role. It can be really
17:57
easy. Most of us come into clinical work.
18:01
Because we have heart for care getting.
18:04
And so it can be really easy to
18:05
be pulled in a million directions by a
18:07
million problems.
18:09
And you have to protect yourself and your
18:12
ability to do your job. And that means,
18:14
you know, setting boundaries, it means having time
18:16
where your office stores closed and you have
18:18
a sign on it, you know,
18:19
email text me and I'll come... When I
18:21
have a minute, I'll outcome find you because
18:23
you have to do the job role that
18:25
you have to do and not do everybody
18:26
else's job, and that can be really hard
18:28
for new clinical leaders.
18:30
And then lastly, I would say do what's
18:32
right for your patients and the rest will
18:34
work itself out.
18:36
And if you keep that at the core
18:37
of what you're doing that you're here to
18:39
serve the patients, you'll find that you can
18:42
figure out a solution for most anything.
18:46
Absolutely.
18:47
I don't think that was a a cheesy
18:50
at all. I I love that quote, Stephanie,
18:52
I think you you should very point that
18:54
remarks. And I just appreciate your time today
18:57
to join us on the podcast. This has
18:59
been such an a informative of discussion. And
19:01
I feel like our listeners have,
19:03
glean so many bits of wisdom done from
19:05
you. So thank you so much.
19:07
Thank you for having me It's been my
19:09
pleasure.
19:10
Wonderful.
19:11
And listeners, you can catch more of Stephanie
19:13
at our upcoming clinical leadership forum at the
19:16
Becker Ceo Cfo Round table, November eleventh to
19:20
14 in Chicago. We do have some limited
19:23
space available for attendees and sponsors.
19:25
If you're interested in joining, please contact us
19:28
at
19:29
at health dot com to learn more.