New York State Office of Mental Health

New York Office of Mental Health.

The New York State Office of Mental Health (NYSOMH) has long employed performance improvement tools to comply with hospital accreditation standards. In 2010, the OMH Executive Deputy Commissioner noticed an alternative being deployed on the western end of the state: Lean Six Sigma (LSS). The results from its usage in Erie County government, fueled by TCIE’s work in providing education and assistance, impressed her. Since then, NYSOMH has used the data-driven methodology to increase efficiency in its psychiatric centers and mental health programs that serve more than 730,000 people annually. A TCIE data expert was deployed to lead project coordination, provide consultation and statistical analysis, and mentor candidates enrolled in web-based Green Belt and Black Belt training. About 40 employees across the organization – from the Albany-based central office to all 23 psychiatric centers – have been or are in the process of being certified by the University at Buffalo and are expected to complete at least one process improvement project per year. These projects are supported by two NYSOMH employees, serving in newly created positions, who are responsible for managing improvement efforts and escalating their reach. The following project is one example of how the LSS methodology has been used in a NYSOMH-operated hospital to create efficiencies and actualize savings.

Dr. Rebecca Leland, director of the Psychology Department and ASL/Deaf Services Specialist at Rockland Psychiatric Center (RPC) in Orangeburg, aimed to cut spending on American Sign Language (ASL) freelance interpreter services while maintaining the quality of care for the deaf patients who require it. The $2.5 million spent to deliver services in 2013 was influenced by a lack of centralized service coordination and freelance norms. Professionals seasoned in interpreting for mentally ill people command large blocks of time and often decline one- or two-hour commitments. This scenario has resulted in scheduling conflicts and RPC paying for ASL interpreters who are utilized, on average, for only 35 percent of their scheduled time. Leland says the comprehensive approach of LSS enabled a major review of a complex system “that would have melted to chaos without that structure.”

The Approach

  • Conducted ASL interpreter scheduling audits, tracking the hours and how they were spent, to detect:
    • Downtime vs. service time
    • Two types of downtime: “waiting” (interpreter is on stand-by and his/her presence is necessary) and “unscheduled/not working” (interpreter’s presence is unnecessary)
  • Exerted greater control over “unscheduled/not working” time by:
    • Centralizing scheduling, coordination and quality control for ASL interpreter services under an interpreter coordinator
    • Prioritizing timeliness of services for patients accompanied by ASL interpreters, thereby decreasing unnecessary waits and idle interpreter time
    • Replacing live contractors from the night shift with an on-call video remote interpreting (VRI) service after data analysis determined interpreter underutilization during overnight hours
    • Eliminating contractor travel to outside medical appointments – sometimes three hours away – by informing providers of their legal responsibility to provide on-site ASL services

The Impact

  • Slashed overall ASL interpreter expenses by $1.3 million annually, a result of decreasing interpreter hours by 52 percent while still meeting the needs of service recipients
  • Saved $282,585 annually by employing overnight VRI services
  • Lowered “unscheduled/not working” time from 65 percent to 46 percent
  • Increased patient satisfaction and care – and patients’ ability to engage in treatment – by improving interpreter availability
  • Raised amount of time spent on direct care service from 24 percent to 37 percent
  • Reduced confusion and “scrambling around” among staff by implementing standard work amid an environment of many moving parts