Behavioral Health Stakeholders Fuel Design Thinking Process

By Melissa Goodwin

Transferring patients suffering behavioral health crises from Emergency Departments (EDs) in hospitals from coast to coast into proper care is a largely manual process involving many stakeholders.

But as the Innovation Lab and Bon Secours Mercy Health (BSMH) seek to prevent potential complications and delays in this widespread process, it isn’t just about upping any one department’s efficiency. It’s about expediting help for patients and their families, who are scared and confused yet are too often kept waiting for a placement.

Design thinking is the Innovation Lab’s methodology of choice for such complex healthcare problems, a six-step approach for holistically assessing a situation that focuses on solving the right problem. Right now, we’re working on a solution within the behavioral health (BH) transfer process. While we’re searching for a solution to specifically introduce to our member system, we hope our innovation can ultimately serve other hospital systems nationwide that are dealing with this shared challenge.

Earlier this year, we kicked off our design thinking with the “Planning and Research” stage, analyzing data on BH transfers in American hospitals. That data outlined how universal the issue truly is and helped us develop a plan for stakeholder engagement.

Moving on to the “Empathy” phase, we interviewed behavioral health patients, families and healthcare providers to learn about their transfer experiences. Their input informed a list of questions for us to ask during virtual discussions with BSMH stakeholders, including ED staff, behavioral healthcare providers and Conduit Health Partners (CHP), BSMH’s medical transfer facilitator.

We then kicked off the “Definition” stage by gathering stakeholders for a facilitation session to pinpoint our project’s target problem. We ultimately identified this problem statement: “How might we build more efficiencies into the current behavioral health transfer process?”

While this problem statement is simple at first sight, coming up with it required hours of conversation, data aggregation and study. And the process of brainstorming and eventually prototyping a solution is even more involved.

The questions we asked

We began the “Definition” stage of design thinking by asking stakeholders three questions:

• What makes your job difficult?
• What concerns you most about the transfer process?
• What problems did we not address or identify?

Hospital ED visits from patients undergoing behavioral health crises have increased over the last few years. For ED staff, finding the right care center for just one of these patients means exchanging information with their transfer center and behavioral health facilities. As we learned from national and local healthcare data, while a manual system is necessary to capture the diverse, varying needs of each BH patient (rather than the rigid standardization of digital platforms), it can also lead to inconsistencies or missing information. In other words, the term behavioral health covers a wide range of conditions, and the needs of every patient and family is very unique.

ED employees identified this as their greatest challenge, followed by staffing shortages and the steep curve in implementing department change. They also noted the difficulty of placing certain patients and the lack of available beds in behavioral healthcare centers. (Sometimes, beds listed as available really aren’t because there’s not enough staff to manage them.)

Staffing challenges concerned all stakeholder groups, and behavioral health staff put it first. They also find a lack of community resources, pressure to keep costs low and certain regulations all restrict their productivity. Manual information transfer methods, and their resulting inconsistencies, also pose challenges for this segment.

Transfer centers, meanwhile, can only transfer patient information to one admitting facility at a time by phone. Further, the accepting facilities can’t always immediately respond to calls and faxes, forcing patients and their families to wait even longer.

Narrowing down a problem statement

After the facilitation, we compiled our data into graphs, affinity maps and Venn diagrams to determine which problems are most significant for all stakeholders.

The manual transfer process, as discussed, presents a major challenge to stakeholders for various reasons: It restricts workflow for Emergency Department staff and the transfer center, while behavioral health staff suffer from informational inconsistencies. Participants also found that best practices for behavioral health intake and transfer haven’t been adequately established between stakeholder groups.

Brainstorming solutions

After the “Definition” stage, we began the “Ideation” stage by reconvening our stakeholders for help in identifying possible solutions. We held two sets of virtual brainstorming breakout sessions, each with questions that encouraged creative, collaborative thinking among participants. They already employ creative thinking on the front lines every day to find in-the-moment solutions to transfer issues, so we knew they would be reliable partners in brainstorming a lasting remedy.

First was a seemingly counterintuitive question: “What’s the worst way to solve this problem?” While it might not immediately warrant a viable solution, this question brought particiant’s guard down a bit, assuring them that there are truly no bad ideas. It also warmed them up to the improvisatory environment that fuels great brainstorming sessions.

Other questions sessions included “If you had to build a solution with no money and had one week, what might you create?” This was followed by “If you had unlimited funds and resources, what would you create?” Brainstorming with specific confines and then broadening the options forced participants to engage their minds in opposite ways, exercising scrappy resourcefulness followed by unbridled imagination.

Finally, two questions during the next brainstorming sessions asked participants to stretch their imaginations again. One asked them to look ahead two years — when their “perfect, elegant solution” has entered the market — and determine what key features make that solution work so well. We then focused on present-day resources, asking participants to look at current options and how we could dramatically improve them.

Next steps

Now, in the “Prototype and Test” stage, we’re spending 60 days asking subject matter experts where real-world opportunity might exist in the long list of possible solutions participants suggested. Combining the sprawling, anything-goes nature of stakeholder brainstorming with data and industry know-how will bring us closer to eventually determining the right, best solution.

For our stakeholders, the brainstorming of the “Ideation” stage was the most fun part of the design thinking process so far, as it can often be. But what came before during the “Definition” stage, even if a tad tedious, was crucial to making this current part of the process so productive.

By laying the groundwork and making sure the problem was well-defined before brainstorming solutions, we realized how many smaller-scale issues make up the larger problem. Further, we’re prepared to patiently and exhaustively pursue the solution in the “Prototype and Test” stage so that patients’ lives can be improved with utmost care and comprehensiveness.

Melissa Goodwin is national director of the Innovation Lab.