Behavioral Health Workforce, SIFs, Burnout, and more...

A Necessary Step to Bolster the Behavioral Health Workforce

While Massachusetts and its hospital community have made progress expanding treatment services and available beds for behavioral health patients across the state, the state’s healthcare system faces a persistent shortage of behavioral healthcare workers. Now, MHA-endorsed priority legislation is proposing a step to help resolve the issue.

From January 2015 through the end of 2017, more than 1,100 licensed beds for psychiatric and substance use disorder services have been added to the Massachusetts healthcare system. An additional 500 new beds specifically reserved for treating individuals with both substance use disorder and mental health disorders are anticipated to open in the next five years. And the state’s effort to address the opioid epidemic depends on a skilled clinical workforce with knowledge of behavioral health issues.

Yet, while the state has a respectable “licensed capacity” for behavioral health services, its “staffed capacity” of psychiatrists, psychologists, behavioral health-trained nurses, and other such caregivers is lacking.

SD1490/HD3633, An Act Establishing a Behavioral Health Workforce Commission, sponsored by Sen. Cindy Freidman (D-Arlington) and Rep. Liz Malia (D-Boston) would create a 23-member panel to look into the issue and make recommendations.  It would have a specific mission, involving: assessing the current workforce landscape by service type, setting, and geography; identifying existing barriers; and assessing how commercial and public behavioral health wage rates affect the ability to recruit and retain behavioral health providers.

The commission will look at, among other things: loan forgiveness and scholarships for all providers in the behavioral health field; the inclusion of behavioral health curriculum earlier in medical training and education; creating programs to encourage registered nurses to work in psychiatric settings; increasing the number of psychiatric clinical sites for nursing students; and expanding the scope of practice for mental health clinicians and psychiatric nurse practitioners. Its report and recommendations would be due no later than one year from passage of the law.

“Workforce is part of every conversation between the hospital community and policymakers when discussing the overall behavioral healthcare landscape in the commonwealth,” said Leigh Simons Youmans, MHA’s Director of Behavioral Health & Healthcare Policy. “We believe this legislation will provide a sharp focus on this issue, with a distinct roadmap for progress.”

According to the proposed legislation, the commission would be composed of representatives from state government, the psychiatric community, hospitals, physicians, social workers, registered nurses, psychologists, addiction experts, and insurers among others.

U.S. Attorney Lelling Says NO to SIFs

Support for exploring the feasibility of operating supervised injection facilities (SIFs) in Massachusetts to help combat substance use disorder has been growing in recent years, but last week the top federal law enforcement official in the state – U.S. Attorney Andrew Lelling – wrote a Boston Globe op-ed in which he essentially said, don’t even think about opening one. 

A SIF is a facility where people can inject illicit drugs under the supervision of trained staff. The theory is that by providing a safe site, those using illegal drugs won’t transmit infections through dirty needles, are less likely to overdose, won’t commit crimes to support their addiction, and will be closer to people who can steer them towards recovery – among many other benefits.

A legislatively mandated commission is soon expected to release its report on SIFs. Most recently the mayors of Cambridge and Boston travelled to Canada to view how one of the few existing SIFs is working. Others in the health field have shied away from SIFs, instead stressing other interventions to help those with substance use disorder, from expanding the use of medication for addiction treatment in communities, to the certification and coverage of recovery coaches, and the potential use of test strips to gauge the presence of deadly fentanyl in injectable drugs.

Those other strategies may now gain prominence following Lelling’s op-ed last week in which he wrote, “These (SIF) sites are a terrible idea and, more important, they are illegal … Promoters of supervised injection sites need to understand that, short of legislative reform, any effort to open an injection site in Massachusetts will be met with federal enforcement.”  In the recent past, Lelling indicated that despite federal marijuana prohibitions, his office would respect the state’s law that legalized specific quantities of marijuana, saying that his drug focus is on opioids, fentanyl, and international drug cartels. But, as the Globe op-ed showed, Lelling is drawing a line with SIFs, writing, “Heroin and fentanyl are not pot brownies.”

Betsy Lehman Center Takes a Look at Physician Burnout

The January edition of the Betsy Lehman Center’s monthly newsletter, Patient Safety Beat, features a story by Dr. Diane Shannon that examines some of the current thinking and approaches to the challenge of physician burnout. In January, the Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, the Massachusetts Medical Society, and MHA released this paper that focuses on the pervasive problem of physician burnout – a syndrome involving one or more of the symptoms of emotional exhaustion, depersonalization, and diminished sense of personal accomplishment. Physicians experiencing burnout are more likely than their peers to reduce their work hours or exit their profession.

The Betsy Lehman Center’s newsletter article notes MHA’s Caring for the Caregiver initiative, which includes a focus on gratitude for clinicians’ work, workforce safety, and well-being. The newsletter, which is dedicated to sharing patient safety news and information for use by organizations across the state, also features two articles on an extensive multi-media project by Boston Medical Center, called “Ok to Proceed?,” which uses video, illustrations, text and case studies, to make patient safety principles and lessons more accessible to a variety of learners.

Nationwide Data: Safety Improves; Mass. Data Updated

According to a new preliminary report from the Agency for Healthcare Research and Quality, hospital-acquired conditions (HACs) declined by 13% between 2014 and 2017, preventing an estimated 20,500 deaths and $7.7 billion in healthcare costs. The drop in HACs included a 37% decline in C. difficile infections and 28% decline in adverse drug events, which are two of the 11 harm reduction targets for Hospital Improvement Innovation Networks (HIIN). MHA is coordinating a 10-hospital HIIN in Massachusetts throughout 2019.

In related news, the most recent hospital-specific data (July 2017 to June 2018) relating to pressure ulcers and hospital falls is now available on the PatientCareLink website. By viewing the data, one can see how a hospital compares to its peers. Visit PatientCareLink, then the “Healthcare Provider Data” tab, then click on Massachusetts Hospital Data, and then Individual Hospital Performance Measures.

Three Palliative Care Webinars

Honoring Choices Massachusetts – the non-profit focused on the rights of every adult to direct their healthcare choices and make a care plan throughout their lives – is offering three webinars on palliative care.
“What is Palliative Care?” is a six-minute video that explains the concept.

“Palliative Care: Aligning the Team Around the Patient” is a 30 minute webinar for consumers, providing a framework for the five stages of serious illness.

Another 30-minute webinar is for providers and features key questions to ask to open a meaningful discussion with patients. The consumer and provider webinars feature Elizabeth J. Collins, M.D., Palliative Care Medical Director, Lahey Hospital & Medical Center.

To access the webinars and other offerings from Honoring Choices Massachusetts, visit here.

Transition: Dr. Torchiana

Dr. David Torchiana, the president & CEO of Partners HealthCare System and a member of the MHA Board of Trustees, last week announced his retirement, effective at the end of April.  Torchiana has been the head of Partners since March 2015. Previously, he led the Massachusetts General Physicians Organization, and before that he had a notable career as a cardiothoracic surgeon at Massachusetts General Hospital.  Among the notable achievements during his tenure at Partners was the systems acquisition of Mass. Eye and Ear.  As an MHA Board member since 2016, “Torch’s” insights into the pressing healthcare issues of the day received consideration not just due to the size of Partners within the Massachusetts healthcare environment, but also to his deep knowledge of medicine, hospital operations, and the cordial way in which he presented his views.  MHA wishes him well on his next endeavor.

Lean in Healthcare Certificate Program - Emerson Hospital

Today more than ever, hospitals are challenged to improve quality and reduce costs as they deliver better care to patients. At the same time, healthcare workers are faced with broken processes, as well as equipment and supply issues that frustrate patients and staff alike.  This intense, 8-day course provides participants with hands-on experience learning and applying both the technical science and social science of “Lean.” The technical science of Lean focuses on learning and applying Lean tools and techniques, while the social science aspect of it focuses on people and organizational development. Both are necessary for an effective Lean implementation. This inspirational and informative course is taught and facilitated by experienced Lean in Healthcare practitioners, and runs on successive Wednesdays beginning March 6 and ending May 1 (with April 17 skipped).  It will be held at Emerson Hospital in Concord so participants can get real-life, hands-on experience in addition to their classroom instruction. SPECIAL BONUS: If you send three employees from your organization, the fourth attendee participates for free.  Learn more, including registration details, by visiting here.

John LoDico, Editor