Our Two Cents – Perhaps the most positive and optimistic report in a long history of dour and dingy documents plopped out of the Oregon State Hospital this week –
Excellent! All fixed. Turns out bricks and mortar, charming lists, graphics and more gobbledegook faux-business lingo evoke good psychiatric care. Everyone go home – watch TV. Go home – watch TV.
Here’s the truth. We don’t believe in or expect miracles. There are still many people at OSH who should – by Federal law – be in far less restrictive quarters. Decades of mistreatment branded the OSH a dangerous place – not a safe place – for persons sick with mental illness. Good things seem to be happening after over 100 years of lies and abuse – but it will take more than PR fluff to change Oregon minds.
OSH gets a clean bill of health, Salem Statesman Journal, July 23, 2011
Improvements at the Oregon State Hospital are placing the hospital on track to rebound from its troubled history and become a world-class psychiatric facility, state-hired consultants said in a new report.
Kaufman Global, an Indiana-based consulting firm, said the Salem psychiatric facility “has taken great strides over the past seven months and is improving with each passing day.”
In a final report capping the $2 million consulting project, the OSH consultants said: “The picture that emerges is of an organization that has come a long way in a short time, and is now firmly on the path to improvement, headed toward excellence.”
The consulting report points to a dramatic turnaround in the workplace culture at the 128-year-old institution — long plagued by revolving-door leadership, turmoil and other chronic problems, including obsolete facilities, understaffing and high-profile cases of patient abuse.
“Hope is displacing despair, praise is offsetting criticism, and possibilities are supplanting impossibilities,” the report said.
With solid leadership, OSH now has the tools, talent and “playbook” necessary to evolve into a world-class organization, according to the consultants.
However, they also cautioned that it won’t be easy for the hospital to maintain the current momentum.
“The next phase in the project will present an equally large hurdle,” the report said. “Building on the foundations that have now been laid, but without the on-site presence and counsel of Kaufman Global, and — barring anything unforeseen — without the ‘burning platform’ provided by public controversy or leadership change, Oregon State Hospital will now be expected to continue its drive toward Hospital Excellence using internal resources and learned processes. In our experience, this is a critical juncture in the transformation of any organization.”
Hospital chief touts ‘lean’ tools
OSH Superintendent Greg Roberts, who took the hospital reins in September, links much of the hospital’s recent progress to the consulting team’s push for improvements based on “lean” tools and techniques.
Initially devised by Toyota, lean methodology widely is used in the private sector to streamline processes and cut waste.
It took time for the hospital’s work force to embrace lean techniques, Roberts told the Statesman Journal in an interview last week.
“We struggled a bit to figure out how the principles of lean methodology applied to a state psychiatric hospital,” he said.
The turning point came around February or March, Roberts said.
“There was a moment in time when it just clicked,” he said. “People got it, they understood it, they liked it, they valued it, all the way down to the unit level. From that point on, things really began to take off pretty quickly.”
Roberts touted the success of various projects spurred by lean methodology — from an accelerated hiring process for psychiatrists to streamlining how patient privileges are determined to pruning the number of hospital committees from more than two dozen to about six or seven.
In the wake of Kaufman Global’s departure, Roberts said, the hospital plans to create an in-house team to spearhead further improvements, applying methods instilled by the consultants.
“I think we’ve really accomplished a lot of significant things in a short period of time, but we have a lot more to do,” he said. “I think we should all be excited about what’s coming.”
New hospital nears completion
The reported turnaround comes as Oregon’s main mental hospital is entering the home stretch on a parallel improvement track: construction of a new 620-bed, $280 million replacement hospital.
In mid-August, more than 200 patients are scheduled to move into Trails, a three-story, 183,344-square-foot section of the new hospital.
Plans call for the entire facility, totaling 870,000 square feet, to become fully operational by the end of the year.
Gone are dozens of run-down, outdated hospital structures — stark symbols of decades of neglect. The old buildings were razed to clear the way for the new hospital, located south of Center Street NE on the sprawling OSH campus.
The first 104-bed section of the new hospital, called Harbors, opened in January.
By some accounts, Harbors got off to a rocky start.
Patients grumbled about irritating noise levels in the new building; staff vented about poor planning, patient outbursts and excessive reliance on mandated double shifts to plug staffing gaps.
Roberts said most of the early kinks in Harbors have been ironed out.
He envisions a much smoother start up in Trails: “First of all, we have the benefit of learning from the process of moving into Harbors to make the necessary changes for Trails. It’s all come together very well. In fact, the decision was made to move in one day because the preparation has been so thorough.”
Aug. 16 is the designated move-in date for 216 patients who are scheduled to occupy nine residential units in Trails.
These patients will leave behind cramped quarters within an outdated 1950s-era structure, called the “50 Building.”
In some areas of the obsolete building, as many as five patients are jammed into rooms designed for two.
Patient privacy and living conditions will markedly improve in Trails, which has one-person and two-person rooms, hospital officials said last week while leading a tour of the facility.
Trails is designed to provide patients with expanded treatment hours at centralized malls and offer them relaxing features, such as sensory rooms equipped with comfortable chairs and soft lighting.
Patient Kathryn Gerke, housed on Ward 50I in the dreary 50 Building, said she looks forward to a fresh start in Trails.
“The whole situation at the Oregon State Hospital just has a sense of doom about it,” she said. “It’s depressing. If you come here with a depression diagnosis, it’s really not going to help you.”
In contrast, the new facility promises to “make that go away” because it will have “more of a care overtone to it,” Gerke said.
“I’m hopeful about it,” she said. “It’s a real hospital.”
Though many patients are eager to pack up and move to Trails, they also fret about adjusting to new routines.
The top patient concern, as revealed by a recent survey conducted by the hospital: Who’s going to be my roommate?
Progress amid federal scrutiny
A multitude of flaws and failings at OSH were spotlighted in January 2008, when the U.S. Department of Justice issued a scathing report that criticized nearly every facet of patient care and hospital conditions.
The Civil Rights Division of the agency called for the state to make sweeping improvements or risk being hit with a federal lawsuit that could place the hospital under court control.
In November, on the eve of the dedication of the new hospital, federal officials put the state on notice that they were expanding the investigation to examine how long patients stay at OSH and whether the state provides adequate community-based mental health programs and services for people coming out of the hospital and those at risk of being institutionalized.
Federal officials have not publicly commented on the current status of the investigation.
However, the U.S. DOJ’s top civil rights official, Thomas Perez, came to Salem recently to discuss Oregon’s approach to mental health care with Gov. John Kitzhaber.
“The primary focus of the meeting was community mental health,” Christine Miles, Kitzhaber’s press secretary, said last week in an email to the Statesman Journal that confirmed the meeting.
Kitzhaber’s private meeting with Perez at the Capitol marked a departure from the stance taken by former Gov. Ted Kulongoski, who snubbed a request by the feds for a high-level meeting.
In back-and-forth correspondence between state and federal lawyers, Oregon attorneys have touted concerted efforts to improve both the state hospital and the community mental health system.
The new consulting report could bolster the attorneys’ assertions about a new and improved OSH.
It describes how hospital workers vented frustration, anger and resentment, then rolled up their sleeves and got to work on reform-minded initiatives.
“From the beginning there has been no silver bullet capable of transforming the entire organization,” the report said. “Out of necessity, Oregon State Hospital was forced to attack every cultural issue head-on, concurrently, with all its energy.”