Latest / Becker's Healthcare Behavioral Health / Building and Sustaining NYC Health + Hospitals’ Behavioral Health Workforce with Omar Fattal, MD, MPH

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Building and Sustaining NYC Health + Hospitals’ Behavioral Health Workforce with Omar Fattal, MD, MPH · Becker's Healthcare Behavioral Health

• 0:00
  Welcome to Becker's Healthcare Podcast. I'm Ella Reuter,
• 0:03
  your host, and I'm thrilled to be introducing
• 0:05
  our guest today, doctor Omar Fattel.
• 0:08
  He has worked in public health for over
• 0:10
  a decade and currently serves as the system
• 0:12
  chief of behavioral health at NYC Health and
• 0:15
  Hospitals,
• 0:16
  the largest provider of behavioral health services in
• 0:18
  New York City.
• 0:19
  Doctor Fattell, thank you for joining us today.
• 0:22
  For those in our audience who may not
• 0:24
  be familiar with you and the work that
• 0:26
  you do, could you please introduce yourself and
• 0:28
  tell us a little bit more about NYC
• 0:29
  Health and Hospitals?
• 0:31
  Yeah. Thank you so much, Ella, for having
• 0:33
  me. And,
• 0:34
  as you mentioned, my name is Omar Fattal.
• 0:35
  I'm a psychiatrist
• 0:37
  and, assistant chief of behavioral health at NYC
• 0:40
  Health and Hospitals.
• 0:41
  We are the largest provider of behavioral services
• 0:44
  in New York City,
• 0:45
  delivering almost 60
• 0:47
  of all the mental health and substance use
• 0:49
  services here in the city.
• 0:51
  This translates to serving around 80,000 New Yorkers
• 0:54
  every single year, and we do this across
• 0:56
  our whole continuum of services,
• 0:59
  which includes crisis services, emergency services,
• 1:02
  inpatient
• 1:04
  and outpatient,
• 1:05
  and in community programs.
• 1:07
  Our mission is to serve all New Yorkers
• 1:09
  without exception.
• 1:11
  Well, wonderful. Thank you so much for that
• 1:13
  introduction.
• 1:14
  Today, we will be diving into NYC Health
• 1:17
  and Hospitals behavioral health workforce strategy.
• 1:20
  First, I want to start off with some
• 1:22
  results the health system has seen after investing
• 1:25
  into programs and initiatives.
• 1:27
  First, the system's vacancy rates across all behavioral
• 1:30
  health disciplines dropped to 6% compared to the
• 1:32
  national average of 14%.
• 1:35
  The health system has hired about a 100
• 1:38
  psychiatrists, nearly 20 psychiatric nurse
• 1:41
  practitioners, and more than 400 social workers since
• 1:44
  January
• 1:45
  2024.
• 1:46
  And lastly, their loan repayment program has awarded
• 1:49
  more than $6,000,000
• 1:51
  to 200 clinicians tied to a three year
• 1:54
  service commitment.
• 1:55
  Those clinicians supported more than one hun 110,000
• 2:00
  patient visits annually.
• 2:02
  Another initiative
• 2:04
  provides staff with financial assistance to enroll in
• 2:06
  nursing school in exchange for a three year
• 2:08
  commitment.
• 2:09
  First, I wanted to start off, NYC Health
• 2:12
  and Hospitals has reduced behavioral health turnover
• 2:15
  to 8% while the national average is over
• 2:17
  30%.
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  From an enterprise perspective, what fundamentally
• 2:21
  changed in how the system approached the workforce?
• 2:25
  Yes. That's a very good question.
• 2:27
  For us, honestly, the biggest thing that we,
• 2:31
  did is really focus on workforce as its
• 2:34
  own strategic priority.
• 2:36
  I'm a big believer in the saying, you
• 2:38
  know, what you, nurture grows, what you focus
• 2:41
  on
• 2:42
  ends up growing. And, you know, we applied
• 2:44
  that same concept to workforce in the sense
• 2:46
  that in the past, you know, I've seen
• 2:48
  heard a lot of people talk about workforce,
• 2:50
  but kind of,
• 2:51
  you know, talk about it, but then not
• 2:52
  necessarily do something about it or be passive
• 2:55
  about it or expect other people to work
• 2:57
  on it. What we did, a couple of
• 2:59
  years ago is put out our strategic
• 3:01
  plan for behavioral health for NYC health and
• 3:04
  hospitals, and that includes
• 3:05
  and we we call it the behavioral blueprint.
• 3:07
  It includes,
• 3:08
  six strategic priorities. And as you can imagine,
• 3:12
  you know, most of our strategic priorities are
• 3:14
  related to access because access is the ultimate
• 3:16
  goal, and that's the one thing that we
• 3:17
  really, really needed coming out of COVID. There
• 3:20
  was a mental health crisis. We have the
• 3:21
  opioid,
• 3:23
  crisis. We have the crisis for adolescent and
• 3:25
  children mental health. So we people needed access
• 3:27
  to services,
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  and that was our goal. And that was
• 3:31
  for inpatient, for outpatient, for,
• 3:33
  you know, special populations.
• 3:35
  But we insisted on having workforce
• 3:38
  be a strategic priority in and of itself
• 3:41
  to be able to focus on it. And,
• 3:43
  you know, we think that that
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  honestly was the basis of what led to
• 3:47
  these results that you mentioned earlier. And our
• 3:49
  strategic plan within that strategic priority so not
• 3:52
  only we named it as a strategic priority,
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  but we came up with a comprehensive strategic
• 3:57
  plan to be able to deliver on that
• 3:59
  strategic priority. And that strategic plan has three
• 4:02
  pillars,
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  and that's another key,
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  difference is, you know, in the past, you
• 4:07
  know, we might have seen a focus only
• 4:09
  on recruitment or a focus on,
• 4:12
  training or, right, in in a bit of
• 4:14
  a disjointed way. And the nice thing about
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  having a strategic plan and thinking about this
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  work in a comprehensive way is to be
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  able to focus on these three pillars in
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  parallel because our experience and I think other
• 4:25
  people's experience
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  is that if you're only focusing on recruitment
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  and bringing in new people,
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  but then you're losing people on the other
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  hand, then obviously you're not getting a net
• 4:36
  increase in your workforce. So we wanted to
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  tackle those two issues
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  simultaneously
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  so we can make sure that the people
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  that we're recruiting,
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  we're keeping them, and they're growing in our
• 4:46
  system.
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  So just very briefly, those three pillars, as
• 4:50
  I mentioned, are recruitment,
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  training,
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  and retention.
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  And under recruitment, you know, you've mentioned some
• 4:56
  of our initiatives and, you know, we we've
• 4:59
  been doing a lot. And I just wanted
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  to highlight a couple of examples under each
• 5:03
  pillar to give you a taste and a
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  sense of the things that we've been working
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  on. So for recruitment,
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  we've been, very, very focused on recruitment campaigns.
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  We have been able to distill
• 5:16
  our
• 5:16
  main selling point for working at NYC Health
• 5:19
  And Hospitals is our mission that I mentioned
• 5:21
  earlier, is caring for all New Yorkers without
• 5:23
  exception.
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  And that's a very big mission. And in
• 5:26
  our case,
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  it's truly what we do. You know? Sometimes
• 5:29
  I know there are, you know, there are
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  sometimes,
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  statements or missions that are stated that don't
• 5:34
  necessarily translate into everyday impact or everyday reality.
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  In our case at NYC Health and Hospitals,
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  everyone,
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  will will see for themselves the minute they
• 5:45
  start working here as we truly live that
• 5:47
  mission every single day. And us being able
• 5:49
  to capture that through the voices of people
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  who work here,
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  and people in leadership roles has resonated with
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  a lot of people who really are attracted
• 5:58
  to this kind of mission. So we've been,
• 6:00
  working a lot on recruitment,
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  campaigns,
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  but also we've been getting creative in the
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  ways we've been recruiting.
• 6:07
  We have not spared any means. You know?
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  We started with digital, then we expanded to,
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  you know, social media to out of home,
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  which we experimented with, and then finally, we
• 6:16
  added cable. So we have not left any
• 6:19
  stone unturned in, in terms of using every
• 6:22
  modality that we have to be able to
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  get the word out there. But, also, we
• 6:26
  did not only rely on,
• 6:28
  people joining from the outside.
• 6:30
  We focus on our own pipelines. So one
• 6:33
  example of that is our peer academy. Our
• 6:36
  peer academy is a program that we administer
• 6:38
  ourselves,
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  and it takes people with lived experience, whether
• 6:41
  it's mental health or substance use who want
• 6:44
  to be peer specialist.
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  And we actually put them through this program.
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  We expose them to,
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  you know, real life internships in our facilities.
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  We give them didactics, and we prepare them,
• 6:55
  and we coach them on how to interview
• 6:58
  and how to apply for a job. And
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  we've been able to graduate more than a
• 7:02
  100 peers through this program, and most of
• 7:04
  those peers took jobs in our system.
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  Moving on to training.
• 7:10
  That's our second pillar. And training, you know,
• 7:13
  is both for retention, but also for recruitment.
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  One example under training is our psychiatric physician
• 7:19
  assistance
• 7:20
  program.
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  We've had a chicken or egg situation with
• 7:24
  psych PAs.
• 7:25
  Historically, we did not have a lot of
• 7:27
  psych PAs, or I would say we didn't
• 7:29
  have any psych PAs in our system. We
• 7:31
  had only one facility that had used them.
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  So we our chiefs were reluctant to hire
• 7:36
  psych PAs because
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  they don't have them, and they don't have
• 7:39
  psych PAs to supervise the new PAs that
• 7:41
  you're gonna hire.
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  But then if you don't have them, then
• 7:44
  how are you gonna get them? Right? So
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  it was a little bit of a chicken
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  or an egg. And this program that we
• 7:49
  started was meant to break that chicken and
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  egg by providing a comprehensive
• 7:54
  three year program
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  that meets, physician assistants even as students
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  to expose them to behavioral health,
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  then give them training,
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  then
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  end with one year fellowship, which we started
• 8:07
  last year, where they spend a whole year
• 8:10
  doing behavioral health work and getting wrap around
• 8:13
  didactic supervision, mentorship
• 8:15
  to prepare them,
• 8:17
  to be able to become the next generation
• 8:19
  of PAs who will then in the future
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  supervise and mentor
• 8:22
  the new PAs that we would be hiring.
• 8:24
  And then lastly, on the retention, you mentioned
• 8:26
  that, earlier, our BH for NYC loan repayment
• 8:30
  program
• 8:31
  has been really the cornerstone of our retention
• 8:34
  efforts, and this has been
• 8:36
  really, an amazing and very popular program.
• 8:39
  It was made possible through, very generous donations
• 8:42
  from philanthropy. It started with a $1,000,000 donation,
• 8:46
  and then we got a larger donation from
• 8:47
  the Black Family Foundation that really helped carry
• 8:50
  that program
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  to where it is now. And,
• 8:53
  that program, the gist of it is to
• 8:55
  be able to give loan repayment grants in
• 8:57
  return for three year
• 8:59
  service commitment, and that has been really very
• 9:01
  helpful for us.
• 9:03
  Yeah. I know we talked about earlier how
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  work life balance is very important, especially,
• 9:08
  for behavioral health clinicians these days.
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  I'm also wondering, at your scale, workforce efforts
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  can fail because they're fragmented.
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  What did you have to do to standardize
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  or centralize to make this work across the
• 9:21
  system?
• 9:22
  Yeah. This is definitely something that we observed
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  early on, and I would say the fragmentation
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  in our case as
• 9:28
  a large system,
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  and I did not mention this in the
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  introduction, but we are a very large system
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  in the sense that we have 11 acute
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  care facilities and more than 30 community men
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  community,
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  health centers.
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  And, fragmentation can happen at the level of
• 9:45
  departmental fragmentation in the sense that you have
• 9:48
  HR,
• 9:48
  finance, program,
• 9:50
  leadership really not being on the same page,
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  and a lot of things
• 9:54
  fall between those cracks.
• 9:56
  The second fragmentation is fragmentation within the system,
• 9:59
  let's say, between those 11 facilities or between
• 10:02
  the system leadership
• 10:03
  and the facilities. And what we've done is
• 10:05
  really work on both
• 10:07
  fronts.
• 10:08
  So for
• 10:09
  HR and finance, what we did early on,
• 10:11
  and that was one of the reasons why
• 10:13
  having strategic plan was very helpful because we
• 10:16
  were able to bring everyone around the same
• 10:17
  table and look at the same plan and
• 10:20
  look at the same goals and same objectives
• 10:22
  and, kind of have consensus around where we're
• 10:24
  going with all of this. So we did
• 10:26
  a lot of prep work with our finance
• 10:29
  colleagues who've been very amazing and supportive, and
• 10:32
  our HR colleagues who've been very, very supportive
• 10:34
  as well. But it helped having a shared
• 10:37
  vision and having shared,
• 10:39
  understanding at the level of the numbers and
• 10:41
  the vacancies and the right? So that they
• 10:43
  knew what was happening. And we did a
• 10:45
  lot of also preemptive work in the sense
• 10:48
  of preparing everyone
• 10:50
  on what to expect and what's coming so
• 10:52
  they're not surprised when they see them, and
• 10:54
  they really appreciated that a lot.
• 10:57
  The second work that we did was more
• 10:59
  at the level of the system in general.
• 11:01
  And to your point, you know, a lot
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  of things can go bad when you're,
• 11:05
  fragmented because you can have
• 11:07
  duplication of efforts or confusion
• 11:09
  or waste of resources.
• 11:11
  What we've done is really
• 11:13
  centralized the scaffolding and the support and the
• 11:16
  structure, but not the people
• 11:18
  in the sense that we definitely standardize data.
• 11:21
  You can't do this work without data. You
• 11:23
  can't drive this plane completely blind, and you
• 11:25
  really need to know how many vacancies you
• 11:27
  have. And for every program that we have,
• 11:29
  you have to keep track of, is it
• 11:31
  working? Is it not working? You know, you
• 11:33
  have to plan where to put your attention.
• 11:35
  So we really worked on creating a whole
• 11:37
  data infrastructure that captured
• 11:40
  our programs, our vacancies, our positions, and that
• 11:43
  has been obviously very helpful, continues to be
• 11:45
  very helpful to keep an eye also on
• 11:47
  retention.
• 11:49
  What we also did is standardize the processes
• 11:51
  and workflows.
• 11:52
  We we do a lot of work with
• 11:54
  other external partners, including having students
• 11:58
  in any discipline spend time with us for
• 12:00
  internships, for all kinds of, experiences.
• 12:04
  And, we've standardized all of that in the
• 12:06
  sense that we have, you know, the same
• 12:08
  contract that we use everywhere, but also we
• 12:10
  have centralized intake process. So if you're an
• 12:13
  NP student or you're social works social work
• 12:15
  student
• 12:16
  looking for placement, instead of you having to
• 12:19
  contact 11 different facilities, now we have a
• 12:21
  centralized
• 12:22
  way of, applying and having your application process
• 12:26
  and interviews and all that stuff is streamlined.
• 12:28
  And lastly, which I think is the most
• 12:31
  important part is having a team,
• 12:33
  a dedicated team that is focused on this
• 12:36
  work. And I think that that has helped
• 12:38
  a lot because, you know,
• 12:40
  to going back to what I mentioned earlier,
• 12:42
  if you're gonna have a strategic priority and
• 12:44
  you have a strategic plan, you need dedicated
• 12:46
  people who are focused on making sure that
• 12:49
  they deliver on the results of this plan
• 12:51
  that you put together.
• 12:53
  Yes. That's so incredible. And and I'm really
• 12:55
  curious too from your leadership
• 12:57
  perspective.
• 12:58
  What were the hardest decisions to make in
• 13:01
  terms of investment trade offs
• 13:03
  or patience in order to get these results?
• 13:07
  I think in our case, honestly, the biggest
• 13:09
  and hardest decision was
• 13:11
  deciding whether we,
• 13:13
  quote, unquote, shelter in place or expand. You
• 13:16
  know? Starting this work
• 13:18
  a couple of years ago, we were coming
• 13:19
  out of COVID. And, you know, I don't
• 13:21
  know if you still remember. It's been a
• 13:23
  while, but with COVID, it's still, left a
• 13:25
  big impact on all of us. And we
• 13:27
  were decimated by COVID in the sense that
• 13:29
  we've lost more than 200 psychiatric beds that
• 13:32
  were turned into medicine beds,
• 13:35
  from a workforce. So services wise, we we've
• 13:38
  lost a lot of momentum. And workforce, we
• 13:41
  we lost a lot of people during COVID
• 13:43
  for so many reasons, like everyone
• 13:45
  knows by now.
• 13:47
  So the big decision was, do we
• 13:50
  try to just fill in the small gap
• 13:53
  that we had and just try to get
• 13:55
  back to
• 13:57
  where we were, or do we expand? Because
• 13:59
  at the same time, we were faced by
• 14:02
  not only needing to go back to the
• 14:04
  level of service that we have before, but
• 14:05
  there was a big mental health crisis that
• 14:07
  we were facing as a city, and there
• 14:09
  was an increase in demand for services. And
• 14:12
  simultaneously, we were trying to get back to
• 14:14
  where we were, but also expand our services.
• 14:17
  And, the reality is there was a lot
• 14:20
  of financial opportunities that presented itself at the
• 14:22
  same time.
• 14:23
  So the question was, do we take advantage
• 14:26
  of these opportunities
• 14:28
  and expand
• 14:29
  while knowing that we were down. Right? And
• 14:31
  that was a big,
• 14:33
  risk
• 14:34
  versus just kind of, like, saying no to
• 14:36
  expansion
• 14:37
  and delaying things. And we decided to go
• 14:40
  all in
• 14:41
  for two reasons. One is because we really
• 14:44
  felt the sense of obligation and the sense
• 14:46
  of responsibility to the city
• 14:48
  to meet that need, and we felt that
• 14:50
  it was not really a choice for us
• 14:51
  to not be able to respond and grow
• 14:55
  and meet the need. And the second reason
• 14:58
  is more practical, and I've seen this a
• 14:59
  lot in the past, and I've seen it
• 15:01
  myself working
• 15:03
  in some environments. Sometimes in an environment of
• 15:05
  scarcity,
• 15:06
  what happens with especially workforce is if you
• 15:09
  don't have enough,
• 15:11
  then what people end up doing when they're
• 15:13
  cutting or they're not being, you know, very,
• 15:17
  focused on growth is you end up cutting
• 15:19
  or
• 15:20
  filling, like, backfilling small amounts or small but
• 15:24
  what ends up happening is that the people
• 15:25
  that you have end up burning out, and
• 15:27
  then they end up leaving because then they
• 15:28
  have to work more, and they have to
• 15:30
  work harder and do other people's jobs. And
• 15:32
  then you end up losing more people, and
• 15:34
  then you lose more people in that. Right?
• 15:35
  So you end up in this vicious
• 15:37
  kind of, negative cycle where it ends up
• 15:40
  being very,
• 15:42
  you know, unhelpful situation.
• 15:44
  But what we did is instead
• 15:45
  expand.
• 15:47
  And, ironically, when you expand and add more
• 15:49
  people, you end up retaining more people because
• 15:51
  the people that you have are feeling better,
• 15:53
  and they're happier with their job, and they're
• 15:55
  more satisfied. And then they go tell other
• 15:57
  people
• 15:58
  that this is a good place to work,
• 15:59
  and that created more a positive spin on
• 16:02
  the whole situation. And, honestly,
• 16:04
  in a way, it was a risk that
• 16:05
  we took, but I feel like, now looking
• 16:07
  at the results, I think it paid off.
• 16:10
  Yeah. I was going to say that all
• 16:11
  in investment really had a return,
• 16:14
  in terms of data and numbers, so I'm
• 16:17
  sure you're very happy to see that. And
• 16:19
  I'm curious too for other behavioral health leaders
• 16:21
  that are listening,
• 16:22
  what is the one mistake systems consistently make
• 16:25
  when they try to fix workforce challenges?
• 16:29
  I think there are a few things that,
• 16:31
  you know, from my from our own experience
• 16:33
  that I could
• 16:34
  share. I think one of them is the,
• 16:36
  you know, the cliche of walk the walk
• 16:38
  and, like, you know, I don't know how
• 16:39
  you say it. Walk the talk. Don't talk
• 16:41
  the talk, but, you know, walk the walk.
• 16:44
  And in that sense,
• 16:45
  you know, going back to what I said
• 16:47
  about the strategic priority, which is if you're
• 16:49
  really concerned about workforce and if you truly
• 16:52
  believe
• 16:53
  that
• 16:54
  access is workforce and workforce is access, without
• 16:57
  workforce, you truly do not have any services.
• 17:00
  If you truly believe in that,
• 17:02
  then you have to show that you believe
• 17:04
  in that. And showing that you believe in
• 17:06
  something
• 17:07
  goes beyond saying it. It it involves having
• 17:09
  people dedicated to doing this work, having
• 17:12
  financial resources dedicated to this work, and having
• 17:15
  basically programs
• 17:17
  that are supporting this work. So I feel
• 17:18
  I feel like this is, one big part
• 17:20
  of it.
• 17:21
  And connected to that is planning ahead. So
• 17:25
  one thing that I've seen a lot in
• 17:26
  the past is,
• 17:28
  business plans or programs
• 17:30
  that barely have any money in them
• 17:33
  for any overhead or any staffing.
• 17:36
  So you look at the budget, and it's
• 17:38
  all going to salaries and staffing or a
• 17:41
  little bit to capital, right, or to some
• 17:44
  minor overhead expenses.
• 17:46
  But the question is, where's the money in
• 17:48
  the budget in the first place towards recruitment
• 17:52
  and professional development and retention? Right? That should
• 17:54
  be baked in from the beginning. Because if
• 17:56
  I'm gonna have a program that's gonna depend
• 17:58
  on hiring
• 18:00
  50 people or a 100 people,
• 18:02
  I need to plan ahead and factor in
• 18:03
  money from the beginning that it's gonna cost
• 18:06
  me a little bit of money to be
• 18:08
  able to recruit those people. So that's something
• 18:09
  that we changed, and we started baking in
• 18:13
  allocation for these activities from the beginning
• 18:16
  so that we can, you know, find the
• 18:18
  resources to do them. And the last one
• 18:20
  I mentioned earlier, but I think it's worth
• 18:22
  repeating, which is collaboration.
• 18:24
  You really I mean, you can't do anything
• 18:26
  without collaboration, obviously, and I think everyone knows
• 18:28
  that. You know, you can't do anything anywhere
• 18:30
  without collaboration. You have to collaborate at some
• 18:32
  level with someone.
• 18:34
  But, definitely, there's
• 18:35
  no more true case
• 18:38
  than workforce. With workforce, it cannot be done
• 18:40
  without collaboration.
• 18:42
  And I would underscore collaboration with finance, collaboration
• 18:45
  with HR, and true collaboration. Collaboration that involves
• 18:48
  partnership
• 18:50
  and really being on the same page and
• 18:52
  planning ahead. I think a lot of the
• 18:53
  mistakes is waiting for that approval
• 18:56
  10 steps down the line, and then someone
• 18:59
  saying, well, I didn't know about this. Right?
• 19:01
  So that that is the most common mistake
• 19:03
  is people finding out very late. Well and
• 19:06
  what we've done in our case
• 19:08
  is really bring everyone to the table from
• 19:11
  the beginning. At the beginning of any program,
• 19:13
  at the beginning of any initiative,
• 19:15
  bring in all the stakeholders, definitely HR and
• 19:18
  finance, and walk through the whole thing together
• 19:20
  and make sure everyone is on the same
• 19:22
  page, everyone is in agreement. And then you
• 19:24
  go through the steps of implementation, and it
• 19:26
  makes everything go smoother. It's still gonna be
• 19:29
  challenging, obviously, but it makes it easier.
• 19:31
  Well, thank you so much for pointing out
• 19:34
  those tips and tricks and really how to
• 19:36
  make it work. Doctor Fatel, thank you so
• 19:38
  much for sharing more about NYC Health and
• 19:41
  Hospitals behavioral health workforce strategy
• 19:44
  from your enterprise perspective.
• 19:46
  Thanks to our listeners for tuning in to
• 19:48
  the Becker's Healthcare Podcast, and we will see
• 19:50
  you next time. Thank you so much for
• 19:52
  having me.