Health Services Risk Management Strategic Plan

La Amistad Behavioral Health Services Risk Management Strategic Plan

Our team chose to work within the substance abuse and mental health arena of healthcare with a facility in Orlando, Florida called La Amistad health. Our mission was to assist La Amistad in implementing a new Risk Management program that would help the facility reduce the overall number of incident reporting. Within our first few meetings with the organizations leadership team, we were able to gain the needed information to assess where the problems lied and where we could lend a helping hand. We performed a GAP and SWOT analysis to assist us in the formation of a new policy for La Amistad’s risk management department. Both of the analysis conducted proved to be helpful, and gave us a basis for what changes needed to be made. Upon giving to the leadership team they proved to be receptive to our findings. We worked with senior level leadership to understand the financial implications of our plan, and were able to come up with a strategy that wouldn’t be too hard on the organizations pockets, but would still help them see the changes that are much needed.

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Through our research we learned that La Amistad had a good leadership structure, which simply needed to be further included in the education and implementation of best risk management practices. Therefore, we formulated a suggested governance structure to help them do so. Another important part of risk management is understanding your market, La Amistad currently offers a lot of treatment options that surrounding facilities do not. Therefore it is important for them to really make sure their patients, employees, shareholders and community feel as if they can entrust them with taking care of their loved ones. Continuous risk management occurrences don’t help display that. The facility has an overall obtainable mission, vision and values that permits them to achieve their strategic goals if followed as written. We decided to give the risk management team 4 obtainable goals that over a 3 year time period could be implemented if followed as proposed.  In order the goals included, gain proper support from upper management, development of a solid risk management framework, proper communication and education to all staff and patients, and lastly managing those risk on a strategic level. The action plan given details how long each goal should take, and includes an objective to match. The objectives take everyone within the facility into consideration, while making the task one specific departments responsibility. As a team we endeavored to give La Amistad a fool proof plan, that could be implemented whether senior leadership changed or not.

La Amistad Behavioral Health Services is a residential healthcare facility that provides mutually; mental health and substance abuse treatment services for persons aged 12 and above. The facility is located just outside of Orlando, FL, and has been servicing those who reside in the central Florida area for over 40 years. La Amistad also offers both partial hospitalization programs (PHP) and outpatient programs. La Amistad Behavioral Health Services is fully accredited by The Joint Commission (TJC) and licensed by the State Florida Agency for Health Care Administration.

To decrease possible losses, healthcare facilities like La Amistad employ healthcare risk management professionals to assess and manage risks and liabilities. It is the job of a risk manager/director to make sure both patients and staff are safe. But also to react to claims of clinical malpractice, address patient complaints, and comply with federal and state regulations. While their primary responsibility is to protect the hospital’s interests, risk managers’ efforts contribute significantly to the quality of patient care. And as we all know, patient care has to be at the forefront of every employees mind within a successfully run healthcare facility. Within its leadership team; La Amistad has a Director of Risk Management that has had the pleasure of working with the facility in different capacities for 12 years. As a professional, the Director of Risk Management has over 30 years of trained experience inside the mental health and substance abuse realm of healthcare.

From an external environment perspective the role of risk management within an organization plays a major part in ensuring the rehabilitation team can really focus on a patient’s recovery. It is important to always make sure occurrences involving patients and their well-being are handled in the most efficient and lawful manner. “The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that in 2014, almost 8 million American adults battled both a mental health disorder and a substance use disorder, or co-occurring disorders. Drug abuse and addiction cost American society close to $200 billion in healthcare, criminal justice, legal, and lost workplace production/participation costs in 2007, the Office on National Drug Control Policy (ONDCP) reports.” (americanaddictioncenters.org, 2017) With each day more and more facilities are being opened around the nation to facilitate the need for persons struggling with addiction. To ensure all patients who choose La Amistad are able to concentrate on their road to recovery a “bullet-proof” risk management structure is necessary.

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Productive risk management adds to the reaching of La Amistad’s objectives through a continuous review of its policy and procedures. It is essential for risk management to be cohesive with the facilities governance structure and ultimately become a part of its formation methods, at both the operational and strategic level. La Amistad currently has 11 individuals that are a part of their multidisciplinary leadership team. By having a strong risk management process in place the process is able to assists senior leadership in making informed decisions, prioritize, and come up with the best action plan for the overall best patient care experience.

Support from senior leadership is the most important attribute to an effective governance structure. “Capacity for change implementation is a critical success factor as the health care industry is faced with ongoing demands for change and transformation because of technological advances, market forces, and regulatory environment”. (Spaulding, Kash, Johnson, & Gamm, 2017) One of the most important aspects of governance is leadership’s commitment to the foundation.  It needs to be understood amongst staff that the CEO has a commitment to the facility and the implementation of the revised risk management policies and procedures. Because La Amistad currently has a risk management director, it is suggested that the director be provided a risk management coordinator to help with the implementation and overall facilitation of the new risk management plan. Next, looking into the development of current risk management framework and how it needs to be fixed. Both the director and coordinator of risk management will look into things such as the extent and range of issues within the facility, support and expertise available to assist employees in daily interactions, and proper documentation. Upon completion of the proposed policy, it will be presented to the senior leadership team. “As the nature of work becomes more complex, teams have become necessary to ensure effective functioning within organizations. The healthcare industry is no exception. As such, the prevalence of training interventions designed to optimize teamwork in this industry has increased substantially over the last 10 years”.  (Hughes, Gregory, Joseph, Sonesh, Marlow, Lacerenza, Salas, 2016). Within communication and education, a committee comprised of different department employees will be responsible for communicating the about the issues faced and the overall application, along with assisting everyone acquire proper risk management skills through La Amistad provided in service training. Throughout each implementation phase of any provisions made, senior leadership, the risk management department and committee with the instrumental.

La Amistad today; strives to be a facility that because of their knowledge and passion for addiction and mental health naturally is everyone’s top facility choice for treatment and recovery. Everyone including: past patients, patient families and friends, and even outside physicians. Within the next few years the facility hopes to help staff and families realize their commitment to continuous improvement, and service excellence all while still helping employees become who they see in the near future. La Amistad is aware that they as well as their employees benefit from the continuation of education. The guiding principles of the facility rely heavily on service excellence, helping all employees, earning the trust of its patients and families, remaining positive in the midst of  adversity, always being a team player, helping out co-workers when possible, and always giving the service patients deserve, which means being professional and prompt with every interaction.

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Our strategic plan focuses solely on the risk management department, and the productivity in its current practices. The risk management department has a duty to patients and families to ensure that while under the care of La Amistad all necessary precautions are taken ensuring a safe, productive road to recovery, this is and remains the mission of the risk management department. The department in the future strives to become an integral part of every employee’s job, from the custodial staff, all the way to clinicians and senior leadership. Success within risk management will require an all hands on deck approach that the facility wants to progress to.

La Amistad’s risk management department see’s most of their occurrences during times where there is a shortage in staffing. Together, Leon and I were able to come up with 4 obtainable objectives for the facility to try to accomplish over a set time period.  Though it cannot be reaffirmed enough, risk management has the potential to reduce patient hazards by effectively training all employees, boosting strong communication among them, providing counseling services for those working with patients, and conducting randomized competency test.

To really help assess business needs and understand where the break is within policy/procedures, communication and execution, we felt as if the first step would be to conduct a competency test that helps us capture where staff understanding of risk management policy and procedure lye within the facility.

Within 1 year of the formation of a new risk management plan, the following steps would need to be taken: the new policy would need to be communicated verbally and sent to all staff with written acknowledgment upon receipt; awareness would need to be raised about managing high occurring risk, proper communication and open discussion about the issues in managing those risk, a performance management process to be implemented. Upon successful completion of the short term goals, within 2 years: all employees would need to  acquire the skills needed for risk management within La Amistad, and a process for recognition, rewarding employees and even write-ups. Within 6 months of implementation a reduction in the overall amount of occurrences that happen should be drastically decreased, this can be measured by the number of documented instances within that time period. When speaking with senior leadership, it was expressed that even a reduction of 25% less documented risk management occurrences would be considered a success, especially within the adolescent group. The risk management department will improve and apply suitable tools and indicators to guarantee the ongoing review of risks to fulfill La Amistad and national standards. The department will also certify its practices by observing and studying that the risk management process is well-organized and current in meeting the purposes set out on the revised policy. Applicable tools of measurement will be determined. Because the risk management process is a management process that is heavily audited to verify compliance the measurement will happen quarterly.

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La Amistad is in the process of determining what conditions, characteristics and factors are important within their market. The facility services a special market that not everyone one can just jump into. When assessing the facility from a market analysis stand point it is important to look at not only market trends, but also growth rate, size and profitability. As previously stated, the market for mental health and substance abuse facilities is solid, the United States population will always need help on their road to recovery.

The facilities primary market entails both shareholders, investors, employees, patients, the local community and partners. La Amistad currently partners with Tricare (military insurance) to provide in patient options, and their behavioral health loan servicer Prosper Healthcare. Partnerships with organizations like the one mentioned above help ensure longevity for La Amistad. These are guaranteed referrals from outside sources within the community. Many physicians within the community refer their patients to the facility based on previous patient’s experiences. Employees who have positive experiences with senior level management and enjoy the service they provide to the community are a key part of our primary market. Employees who have daily interactions with patients are the reason for patient success. Which brings us to our last but most important demographic within our primary market… our patients. Patients or customers are your most important free walking advertisement, and should be the main demographic you are trying to please.

Our secondary market includes our competitors, social pressure groups, the government and regulatory agencies. Partnering with regulatory agencies not only helps solidify your credibility to your current market and shoes that you have the support of regulating bodies. From the outside looking in, is displays you are doing things as practice requires you by law. Within Las Amistad’s secondary market, they have little to no interaction with federally funded programing. Why this is important is because, normally institutions that accept governmental insurance are able to pull in more patients, because the money is guaranteed based on patient diagnosis. In the future this is something La Amistad should look into deeper. Social pressure groups are another demographic that have the opportunity to push an organization to the next level if contacted with opportunities to help their specific community.

La Amistad currently accepts private pay and all major insurance coverage including Military coverage with Tricare. Tricare at this time is only covering active duty personnel and dependents from 6^th grade to high school. Within recent years and the many changes that come annually with healthcare coverage, the facility has seen a rise in cost of co-payments, and the overall percentage of treatment that is being covered based on diagnosis. La Amistad because of this has partnered with American Healthcare Lending to provide potential patients another source for treatment payment. American Healthcare Lending recently was bought out and has sense changed their name to Prosper Healthcare Lending. Though this has not been updated on La Amistad’s website, they still use Prosper Healthcare as their primary lender. The lender provides specialty lending for behavioral health which is rare. Because La Amistad also offers private pay options that receive discounted rates when paid before treatment has been completed, many clients who aren’t able to pay with their own resources and don’t have insurance coverage choose Prosper Healthcare Lending.

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In the foreseeable future from a financial standpoint La Amistad will not have any problem remaining successful. What the facility currently does is, require all patients’ insurance information to be verified before admittance for treatment. Upon verification the patient is also required to pay a portion of their co-payment (if not all) before treatment can begin. Each separate form of payment for treatment has a different set of rules that must be followed to make sure the facility is being properly compensated for its services. The facility has a business office that consists of not only a billing department, but a collections department as well. The collections department at this time has a debt collection rate of 84% funds recovered.

The Substance Abuse and Mental Health Services Administration (SAMHSA) statistics prove that unfortunately substance abuse and mental health are a battle that, though we consistently try to win will be a continuous fight within our nation’s future. In 2016 SAMHSA states that on mental health expenditures they spent $28,514, 735, 678 that includes on persons with Medicaid and inpatient facility programs, with $394,800,000 of that specifically being spent within the state of Florida alone. With that being said, La Amistad will have no problem from a stability aspect remaining relevant. Just like any other aspect of healthcare, substance abuse and mental health will always have a home within the business realm, as every community with continuously need assistance in their attempt to stay mentally healthy.

Within a 15 mile radius of La Amistad there are 16 other substance abuse and mental health facilities. Of the 17 facilities mentioned, 3 of the facilities offer comparable services to La Amistad. The comparable services include inpatient options and servicing both the community’s adult and adolescent population. Most organizations interested in being an industry top pick for patients look into things like search engine strategy. La Amistad is no different. When you search for mental health and substance abuse facilities in the zip code of 32751, (the zip code of the facility) on the popular search engine Google, La Amistad’s website is the first amongst your selections of mental health facilities.

A huge cost advantage for La Amistad is the fact that they offer inpatient opportunities for both adolescents and adults. While, we did mention that there were facilities with comparable services, none offered inpatient services for both subgroups on one campus. Convenience is a big necessity for families, and La Amistad offers that. Family treatment/ therapy and residential treatment/therapy are also offered on the same campus. Having a loved one admitted into treatment for mental health or substance abuse is not only costly but stressful, when taking on potential patients; the convenience of everything being on one campus is desirable to say the least. La Amistad was the only facility that offered inpatient services within 15 miles that accepted Tricare as well. Because the United States Military does have an Army and National Guard base in Orlando, this is a cost advantage that no other facility at this time can compete with. Leon and I were extremely impressed with the amount of services offered through La Amistad and how, they have attempted to become a one stop shop so to speak, for those struggling with addiction, because of that, we found it hard to find many cost disadvantages that are being experienced by the organization. As we all know, cost disadvantages also affect strategic decisions. We did come across a facility that offered services in more areas within Florida. The facility we found offered services in 19 different counties throughout the state. After over 40 years of successful treatment of the Orlando community, La Amistad has had no expansion into other counties. From a geographical standpoint because of their proven success within central Florida and the surrounding counties it includes, offering services in west, north and south Florida would allow the facility to help more people and inevitably make more money because of the expansion into other areas.

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As a group we have come to the conclusion that La Amistad thrives because of its patient satisfaction, which interprets to recurring business and good word of mouth exposure throughout the community. With this in mind, it makes brilliant business sense for the facility to continuously strive to find and make steady use of sterling patient service strategies. La Amistad’s executive team has a service leadership model, which allows them to listen attentively to the needs on the floor amongst front line employees. Employee’s feel as if for the most point their requests are being met, which in turn calculates to them serving La Amistad’s patient population with the same thoughtfulness and devotion they feel as if they receive. Service strategy plays an important role in patient satisfaction, therefore by ensuring that staff members who have every day interactions with patients are being listened to naturally render from a service level, needs are being met from an employee perspective and a patient perspective as well.

To be stagnant in your current market can easily lead to the loss of potential patients in the future. It’s well known within the corporate arena, that it costs more to gain a new patient than maintain a relationship with an existing one. From a strengths standpoint as previously stated in the beginning of the paper, La Amistad offers a lot of programs and specialties that facilities within a 15 mile radius don’t offer, along with partnerships with 3^rd party payment options when faced with the question of affordability. La Amistad has the ability to network with outside providers to ensure they are able to offer their potential patients endless opportunities to ensure treatment is obtained.  Our group sees this as a major strength that hasn’t seemed to be mastered within the area of Orlando that La Amistad services. La Amistad is the only inpatient adolescent program within its 15 mile radius that also provides a learning academy for children aged 12-18 while overcoming addiction or mental health. Based off of our interactions and observations with the facility, we only see the need for a more hands on approach in regards to documentation and alleviation of incidence reports received by the risk management director. The key to retaining the facilities current market relies heavily on their ability to modify their current practices and make sure all staff has a deeper understanding of the importance of risk management. When reviewing the facilities rating on the popular search engine more than two-thirds of the reviews are positive, and of those that aren’t an incident occurred within the facility. Our group went through the negative reviews and the persons who left them. When asked by the facility for the background information on some of the occurrences it was easy to see where there was a clear mix-up. One that could have been easily been fixed with proper risk management training. Our group looked for opportunities for growth and future success in different illustrations within their need for an update to risk management policy and procedure.

Chapter 14 in our Walston textbook goes over the importance of strategic leadership, within positioning it is detrimental for organizational growth. We learned that “many leaders have difficulty adopting a new perspective of the world and new assumptions, especially when old assumptions have served them well. (Walston, 2015) With La Amistad that seems to be the case, after 40 years of proven success, the idea of growth opportunity seems foreign. With sayings such as “why fix something that isn’t broke”, trying to convince a leadership team to look into expansion or even different markets can be extremely tough. When trying to identify growth opportunity for La Amistad we looked into each stakeholder’s profile, to really identify how we could help each as much as possible. As mentioned previously La Amistad has the ability to grow tremendously within the state of Florida. Because the facility has serviced the Orlando area for over 40 years, they have now gained trust within the community. By networking at events targeted in the mental health and substance abuse community, throughout the state they could easily conduct an analysis to see whether or not there would be a return with the possibility of expansion. Because La Amistad is not a state funded facility, but offers adolescent services they cater to a specific niche of the population that not all facilities have seen success in. Many cities here in the state of Florida have healthcare systems specifically geared toward children. For instance, Jacksonville, Florida has both Nemours and Wolfson’s children’s hospital. Networking plays a major role, in retaining potential patients outside of the Orlando area. Our team has a little over 5 years of experience within the substance abuse and mental health area of healthcare, and can attest to the importance the referral system. With some successful organizations even employing community liaisons who have the specific job of making sure the organization has a presence in not only the community where the facility is, but in surrounding areas as well. Another facet of mental health and substance abuse awareness that seems to be an area of lacking within the facility is community outreach. Being well known within your community for doing simple acts of kindness, or even partnering with non-profit agencies to assist those in need, is a great way to gain a better understanding of what your community needs and how your facility as well as the community can benefit from it.

La Amistad is in a league of their own in regards to the services they render to the patients at their facility and what they offer in the Central Florida area. However as with anything else there are always risk that a company can be affected by. Our team completed a Gap Analysis as well as the SWOT analysis to assess business risk.

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While we reviewed the results of our GAP analysis we determined that one of the biggest areas of concern for our stakeholders that wasn’t being properly met was in the most important arena of services provided, and that is patient services. A lot of the worries we had in regards to reviewing La Amistad’s structure was their staff, and the amount of training received before entering the floor. We determined the senior leadership of La Amistad was well organized and capable; however the direct care employees are at no time properly staffed on the floor nor were they ever properly trained.

Upon having open discussions with the Directors of Nursing, Human Resources, Mental Health Technicians (MHT) and Risk Management about current practices, we were able to gain a lot of helpful feedback. Employees who decide to move on from employment with the facility are required to complete an exit survey. The directors did report that a few of the exits surveys mentioned it was hard for the lower staff to feel connected with senior leadership during times of implementation, and even during new hire orientation. It is our opinion that the lack of adequate staffing ultimately will not only effect the staff but naturally patients too.

While discussing this issue with staffing with the Human Resource Director, they mentioned that recruitment is something they are actively working on as part of their yearly goals. The director, along with human resource support staff have been attending college / career fairs and providing the community with information about current job opportunities within the facility. It was stated one of the obstacles that seem hard to overcome is available work hours. La Amistad is has fully staffed all full-time positions and only have availability for part-time employees. This year they have noticed by attending college fairs, they are able to attract both psychology and sociology undergraduate students interested in entry level opportunities.

La Amistad is not state funded and rely on the patient’s private insurance or private pay funds; because of this they don’t run the risk of being drastically effected by the Federal or State government being too involved. There are roughly 16 other facilities in the surrounding area of

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La Amistad that cater to both adults and adolescents (only 3 service both, like La Amistad), in addition to providing acute and in patient services. This creates some competition for La Amistad because a few of them are state funded, which run relatively cheaper for overall treatment. La Amistad ultimately is being forced to find new ways to captivate their current market, and even looking into other potential markets.

As we have previously mentioned in this strategic analysis risk management is a major weakness. It is very difficult for an organization to fulfill multiple services if they are to properly staffed to implement those services or even to ensure the quality of the services rendered. In addition to the hiring of more employees we found it quite concerning that they don’t provide proper support to a portion of their direct care staff, these staff members are critical because they have the most interactions with patients. Providing more in-service training for the new employees early is going to have to become a requirement before interacting with patients. This will provide the employees with the opportunity to start understanding more about mental health and substance abuse, and how La Amistad wants to service their community. Organizations traditionally complete a performance review 90 after hiring, we would like to mitigate this weakness by requiring a 60 and 120 day review after hiring; followed by a 180 and then an annual review. A component of the 120 and 180 review would be for the employee to be evaluated on how they are performing as well as the employee to review the company.

The demographics of La Amistad’s patient population is a little bit different than most in patient mental health and substance abuse facilities. Out of 15 intake calls into the admission department they generally clinically assess about 9 of these patients in person, and about 6 out of the original 15 patients are actually admitted. With the surrounding facilities offering similar services at a much lower price, it is definitely something that makes La Amistad have to market itself to be more appealing to the patient population they want to attract so they can increase the amount of potential patients that will enter the program. Insurance companies will be an external threat for any healthcare organization, the length of stay has decreased for a lot of health care organizations over the last 10 years. Insurances companies are fighting even harder now to be critical of the services they are paying for and what they deem is an appropriate length of time for these services; Utilization review and Psychiatrist are working hard to have as many services covered as possible by the companies.