Clients and Families First and Always: Using Lean Methodology to Improve Access, Quality and Financial Sustainability in Mental Health Services Delivery within a Safety-Net Pediatric Academic Medical Center

Background: Nationwide, an estimated 4 million children and adolescents experience a serious mental health condition. 50% of all mental health conditions start by age 14 and only 20% of children identified with mental health challenges receives treatment. Early access to assessment and treatment is critical for children with mental health concerns. This presentation offers results from an intervention designed to improve access to quality services for families, while anchoring financial stability for UCSF Benioff Children’s Hospital Oakland (CHO), an ACS Pediatric Level I Trauma Center. The hospital’s mental health clinics see over 40,000 visits annually. Demand for services outstrips program capacity. Access to services, starting from first point of contact with the hospital, includes significant bottlenecks and wait times, creating unnecessary delays in treatment.

Method: CHO deployed Lean analytical and organizational intervention methods to address this issue. Cross-functional teams completed time-studies and work-flow descriptions. Metrics included: date of patient referral to clinical review; date of clinical review to new patient appointment; date of new patient appointment to assessment and completion of treatment plan. Interventions were developed and tested using a Plan Do Check Act rapid improvement model. Descriptive data were trended to show areas of improvement.

Results: The following goals were met:  50% reduction in lead time from referral to clinical review and elimination of defects in the referral process. This resulted in increased productivity for clinical review and a significant decrease in the time required to determine a plan of care and/or first appointment. This resulted in a direct margin of 3% for these safety-net services.