Fayette Companies, a behavioral health organization in Peoria, has been in the pursuit of quality using process improvement for several years now. This news is good for patients in need of behavioral healthcare: process improvement is beginning to change the field in general, and most importantly, the services that patients receive.

You may be asking, first, what behavioral health is, and secondly, who is Fayette Companies?
Behavioral healthcare encompasses treatment for depression and other mental health disorders, as well as substance abuse. These problems take on many forms, and the cost to the overall health system and our broader society is staggering. Recent studies looking at chronic health conditions cite depression as one of the top five issues in terms of the number of people affected and the cost to society.

Fayette Companies is the parent company for White Oaks, a substance abuse treatment services provider; the Human Service Center, which provides treatment for the serious and persistently mentally ill; and Behavioral Health Advantages, an outpatient counseling center. Fayette Companies has been serving the Peoria area through its various programs for the past 30 years, but Fayette President Mike Boyle has begun to chase quality improvement very seriously over the past six years.

In 2003, Fayette applied to participate in a Robert Wood Johnson Foundation-sponsored project aimed at addressing access to and retention in substance abuse treatment—two serious problems for the behavioral health field. This project was developed in partnership with the Federal Center for Substance Abuse Treatment and sought to teach behavioral health providers process improvement to address systems issues that impact a provider’s ability to engage individuals in treatment for what evidence shows is an adequate dose. David Gustafson, an engineering professor from the University of Wisconsin, began with less than 30 providers and has continued to grow this initiative to what is now referred to as NIATx—the Network for the Improvement of Addiction Treatment. The network now includes over 1,000 providers and reaches all 50 states. Many in the field see this as a true “movement.”

Like many other forms of process improvement, the principles that this network has promulgated are centered on a rapid change model, data-driven decision making and consumer input. Fayette Companies initially embraced process improvement as a way to address the NIATx aims, but has used this approach to focus on changing systems as a foundation to drive the pursuit of quality for the patient. Don Berwick, president and CEO of the Institute for Healthcare Improvement, aptly points out that, “Every system is perfectly designed to get the results it achieves.” In other words, poor results or excellence is determined by the system’s design. Fayette Companies’ takeaway has been to learn a method for looking at and changing systems if the data doesn’t show the results we know patients need. We began to recognize very quickly that once the organization has success in changing a system, staff become both empowered and excited about the next “systems” problem to be solved.

So how do we know the systems changes we make are truly impacting the care that our patients receive?
A chief tenet of the process improvement model that Fayette Companies has been using is the recognition that the patient’s perceptions and needs are “true north” as we pursue quality. A “change” project begins and ends with an assessment of the patient’s perceptions and needs around the care he or she is receiving. Once a particular system or process for needed change is identified, the organization performs a walk-through of the process from a patient/family member perspective to gain insight into the ways in which the patient/family is positively or negatively impacted by the system. This focus on the patient’s experience from the beginning allows the team to clearly see the system’s ultimate impact— direct and indirect—on the individuals it was designed to assist.

Many organizations are astonished by the stark contrast that they observe between what they believed they were accomplishing and how the patient/family may have been experiencing the care. Still, this is precisely the information the organization needs to affect serious change. Assessment of the patient’s perceptions and needs is further accomplished in myriad ways, but often includes focus groups, patient surveys and the inclusion of patients on a particular change team. The over-arching goal is to design systems of care that are not only patient-centered, but also patient-driven. If patients have a voice in the design of the systems that are in place to assist them, they can truly start to be drivers in their own recovery.         

Next steps
Fayette Companies has become very involved in the NIATx national network and the diffusion of process improvement throughout the field. Serving as coaches for provider organizations and consulting with states and federal behavioral health authorities are some of the ways that Fayette Companies has put Peoria on the map in terms of leadership in process improvement in behavioral health. Still, while state and federal authorities on behavioral health recognize that to fix health care, we must teach providers to evaluate and change systems, ultimately providers must be held accountable for improvement and quality.

Provider accountability is beginning to take root in a variety of ways, one of which is being driven by voluntary benchmarking among providers. Fayette Companies began benchmarking with other providers in the state about two years ago and its president is on a steering committee to design the first national benchmarking collaborative for substance abuse treatment providers. It would seem though, that the way to ensure accountability is for the whole system to move much more aggressively towards payment for a specified level of performance on specific indicators. Fayette Companies embraces these opportunities and recognizes that “pursuing quality for the patient” will mean a continual commitment to both accountability and improvement. iBi