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Lean Daily Improvement at Southwestern Behavioral Healthcare helps to provide more timely care for patients with personality disorders

Patients diagnosed with personality disorders are able to receive better and faster treatment from Evansville-based Southwestern Behavioral Healthcare, Inc. (SBH) due to changes in therapy protocols that create customer value, eliminate inefficiencies, and enhance process flow. 

Through funding provided by the Great Lakes Practice Transformation Network, Purdue Healthcare Advisors (PHA) was able to facilitate a lean Rapid Improvement Event (RIE) at SBH in 2018 that targeted care to patients with personality disorders, a group of mental illnesses that involve long-term patterns of unhealthy and inflexible thoughts and behaviors that can lead to serious problems with relationships and work.

PHA Lean Advisor Chris Chapman and a handful of SBH staff members gathered in the summer to develop a game plan for the RIE, in which a cross-functional team spends two-to-four days analyzing a process, identifying inefficiencies, brainstorming improvement ideas, implementing countermeasures, and establishing better methods. Quickly the lean team determined that group therapy rather than individual therapy was a better fit for patients with personality disorders for several reasons including higher quality of care, greater capacity for treatment, and reduced customer wait time. One of the benefits of servicing these patients via group therapy included increased client participation in Dialectical Behavioral Therapy (DBT), which is the gold standard for personality disorder treatment.

“These patients were waiting an average of 18 days from the completion of their assessment appointment to their first treatment appointment,” said SBH’s Director of Adult Services Elizabeth Arnold (pictured right). “That’s a really long time if people are in crisis.”

Persuading patients that group therapy would be a better fit for their mental health issue was an important part of their plan. “We thought if we could sell them on the group therapy right from the get-go, they would really like it and get more out of treatment,” Arnold said. “We created advertising materials, frequently asked questions (FAQs), and testimonials, and every client left their assessment with a brochure about the benefits of coming to group therapy.” Arnold said only two of the approximately 300 patients opted for individual therapy over group.

We envision this snowballing into bigger improvements for our patients.


Once the program went live in July, the team saw an almost immediate improvement in access for their target patients. “We can get them from assessment to group therapy, where they receive the gold standard of care, within about nine days,” Arnold said. In addition, the change has opened up access for other types of patients who need therapy.

Overall, the number of SBH’s 2,000 clients who receive care through group therapy has increased since the RIE from 11- to 25-percent.  Group therapy attendance has dramatically improved, as well, to more than 82 percent. “We envision this snowballing into bigger improvements for our patients,” Arnold said.

So, how do the patients feel about this new protocol? “We actually had to grow group services in one of our locations from three to nine groups because so many people were involved in group and really liked it,” Arnold said. The treatment program can last six-to-twelve months to help people stabilize and get the skills they need to successfully manage stress and relationships.

Sustaining the change required the team to use Lean Daily Improvement (LDI) to hold the improved metrics without causing a major disruption in workflow. “People can backslide into old habits, so we used LDI to monitor assessments on a daily basis. Anytime somebody was not following our standards of care, we would let them know, and they would correct it the following day,” Arnold said, adding that the first month consisted of 10 corrections, but only two corrections were required in the following months.

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