Hi, everyone, and welcome to the Becker healthcare
care podcast.
I'm Mackenzie Bean, Av and managing editor of
Becker hospital review.
Today, I'm thrilled to be chatting with Stephanie
Wet, who is a chief Clinical Officer of
Psychiatric Medical Care.
Stephanie. Thank you so much for joining me.
How are you doing today?
I'm doing well, Mckenzie. Thanks for having me.
Of course.
I'm really excited to dig into our conversation
today,
and and tap your
expertise on the top topic of behavioral health
care and leadership. I know,
improving access to behavioral. A health care is
a tech priority for many of our readers
and listeners today with those
needs growing nationwide
before we dive into the conversation though, I'd
love to have you introduce yourself, and tell
us a bit more about your background.
Sure. I'd love to.
Stephanie Weather. I am a nurse by background.
I have my doctorate in nursing from Walden.
So
came up through
the it kind of an interesting
path. I actually became a nurse because I
was a homeless mid midlife apprentice and moved
to a state where
late was not,
licensed or legal. And so I just decided
to become a nurse wise and, like, happens.
So a lot of us. That's that's not
the path I ended up walking.
But but it intervene into the nursing profession
and eventually into nursing leadership.
Primarily in my career, I've done a lot
of
executive nurse leadership, quality, it as well as
leadership in the quality arena.
And then lots of extensive experience with the
behavioral health leadership led me to my current
role, this as Chief Clinical Officer for psychiatric
medical care,
we're a company that provides behavioral health expertise
to around 03:50
hospitals in 38 states.
So I get a real bird's eye view
of the behavioral health needs nationally,
the needs of patients across the country and
kind of trends around behavioral health. So it's
an exciting
company an exciting career for someone in clinical
leadership?
Absolutely. And I think your perspective is so
valuable. Like you said, having that bird's eye
view and seeing
national trends and what hospitals and health systems
across the country are doing to really
improve care in this area?
On that note, can you share some examples
it tell a little bit more about some
of the innovative programs or initiatives
that's
medical is implemented to improve,
outcomes for behavioral patients?
Sure.
We're super passionate about outcomes. We're we're passionate
about evidence based care, and that's really what
outcomes are. You know, did you follow evidence
based care practices
to see improvement in patient outcomes.
It's a challenge often in the behavioral health
arena. We're not as hard wired around evidence
based practice. You know, it's not like a
knee placement where we all know. You go
in. You enter on this day. You do
this exact treatment on this day, We provide
this exact medication and these,
intervention. And we know without a doubt that
the patient going to have this outcome the
vast majority of the time.
In behavioral health, there's a lot more triggers
to pull to impact how a patient is
going to improve.
So 1 of the things that we did
to try to look at all of those
different
areas is we created our own platform
for outcomes measurement.
And in doing so, we invested a lot
of capital into doing that to ensure that
we are looking at evidence based testing for
our patients. That's 1 of the ways you
measure in the behavioral health arena. We look
at tools that are evidence based to see
how the patient is on arrival at during
specific times
during their treatment and then at discharge so
that we can see patients improvement.
Some interesting things that we discovered in doing
this, it it allowed us to look at
both micro and macro
parts of the system and treatment that patients
were getting.
So 1 of the examples that comes to
mind
is we noticed
that there was a team that was really
struggling and their patient outcomes weren't where we
would expect them to be looking at the
national data.
And,
you know, immediately, your gut instinct as well,
there must be an issue with the people
providing treatment.
So, you know, we actually had some observations
done. We observed the group therapy. We observed
individual therapy. We observed the patient's treatment process,
and all of that was really rock solid.
So like okay, Well, what's going on. So
we dove into the actual testing process itself
with the patient.
And what was interesting is that the culture
of this team
had conveyed to the patient that these tests
were kind of burdensome them
And so we were able to work with
that team and really explain to the. It's
kinda like you know, Mackenzie, if you went
today to an north a pe doctor, and
they wanted to take X rays, and they
wanted to start you physical therapy,
You wouldn't look at the X rays as
a burden. Right? It's it's a it's a
test that's going to tell you whether you
need this certain intervention and process. And the
behavioral health arena, a lot of times our
patients can feel that does tests our burden
to figure out you have already answer these
questions. 5 people asking these questions.
So we really worked as a out a
scripting and how do we impact those so
they understand the importance of this test.
And it was amazing within a 3 month
period doing recheck, we found the patients actually
looked worse the very next time we tested
them because they understood the importance of answering
the test honestly
and with truth about how they were doing.
And then as over the period of the
next 3 to 6 months, we saw a
huge increase in improvement in these patients. And
was a really great lesson that we learned
on a micro level that we took macro
to our whole company
and hardwired some processes so that all of
our patients understand the importance of these tests
in their progress.
Because we set their goals and we set
their discharged all around their progress. So that's
just 1 example of how we implemented improvement
around patient outcomes to really drive patient improvement.
Yeah. I I think that's such a powerful
example of
the important role that
culture and, you know, patient education can really
play in this work and how important it
is for to really take the time and
do the due diligence to understand
what are obstacles, both staff members and patients.
So it's great to hear those improvements.
I'm curious, you mentioned that was
shared
across
the company. So when that really a an
example from a specific hospital that you were
working with?
So that was 1 of our specific locations.
At Len mentioned earlier were in 03:50
locations. That was occurring in 1
particular
location. But we... I'm just such a believer
in systems.
And when you learn something, you kind of
make the assumption that if it's happening here,
it probably happening in other places, and so
we can all learn from each other. And
so that's that's what I meant by that.
We've been rolled that out in that process
for how we train
our staff and how we communicate the testing
to our patients
into,
a nationwide practice.
Yes.
Very magnified results.
Let's shift if gears a bit and talk
about
your specific
leadership experience.
I know you are in your chief clinical
officer role now.
What would you say are the biggest challenges
you're encountering when comes to leading a team?
We definitely face a lot of challenges around
multi site leadership. And I think that's trans
to whomever is listening to this today.
It's very difficult for any clinical leader to
have their finger on the pulse of everything
happening that's under their purview view at 1
time. Whether we're in in my case or
you're in 38 states or whether you're in
a single
building
you're, you know, you're not aware of what
every clinician is doing at every minute.
Some of the things that specifically
I've encounters lack of frequent contact with staff.
So, you know, it's kind of inability to
oversee on a day to day basis, what
teams are doing, frequent clinical drift is a
a term I kind of coined and it's
just where people start out, everybody starts out
following your processes and rules and then over
time if you don't have enough touch points
or oversight, people drift kind of from the
mid line of what they're supposed to be
doing.
And then I'm sure something thing that everybody
can relate to hiring newly licensed staff members.
And we're all
in a place today where
you're not often looking at 20 resumes to
find the best fit for a position. You
might only have newly,
licensed graduates
whether it's registered nurses,
therapist,
even physicians
to choose from. And so how do you
engage and train
newly licensed staff members. So,
you know, some of the things we've created
to try to make
that better, we created our own
Emr platform. So across those 350
locations, we can have people documenting
in a way that it's transparent
to
clinical leadership, what's going on. We have the
ability to see into that, which I think
so important
creating training systems. So how do you onboard
your staff and how do you keep staff
current in their field In the behavioral health
field, I think it's just so important
if if you were working in critical care,
you wouldn't go into critical care and think
in 2 weeks, somebody can become an expert
in that.
I think there can be a mis perception
in the acute care environment that behavioral helps.
Everybody will say they handled behavioral health patients
because
if our patients our behavioral health. It's throughout
our care environment and the care continuum,
but we are a specialty, and so we
need to invest in that. You know, are
we encouraging our staff to become certified nurses
around behavioral health. And
in whatever their specialty pre is
encouraging them to become board certified.
The other thing is just making sure that
we have consultation calls,
so we do a monthly clinical training specific
to behavioral health for any clinician within our
company, and then we do a consultation call
to talk about difficult cases,
persistent problems that are seeing across the board,
know whether it's dealing with difficult patients, discharge
planning process,
you know, whatever that could be for that
specific location,
we wanna make sure we're supporting our team.
And then a big thing,
I think to kind of overcome these leadership
challenges is always asking why you know, as
a clinical leader, you get asked
annoying question today, and it can become easy
just to give an answer.
But 2 things happen when we do that
when we give the answer of course, we're
not
encouraging people to learn to answer questions themselves.
But more specifically than that,
we're sometimes missing why they were asking the
question. And when you ask that why,
you might uncover a lot of things you
weren't aware of. And so
I almost never answer questions. I always ask
for more information first
to make sure that I'm getting the full
picture and you'll be surprised what you learned.
I'm sure. I love that approach. Do you
find that
employees often can land on the answers themselves
after you ask some additional questions?
I do think so that. I think most
people
they lack the confidence
to tell you that you they've already formed
the answer a lot of times, but it
can be easy for a frontline staff member.
They just wanna to get the answer and
move on. Because they have so much on
their plate. So it can become very easy
to become the question answer.
But
if we wanna really grow our staff. It's
it's kinda like, you know, when I have
4 adult children now, but when they were
young, you know, so much easier just to
load the dishwasher myself.
Then to teach them to load it took
twice as much time. But in the long
run, you know, they wouldn't be very productive
I had done that for them. So
Absolutely. It goes back to the deep the
man fish outage. Right?
Exactly.
Wonderful.
I think you you you almost hinted at
this a bit in some of your examples
from the
organization.
But I'm curious if you can speak a
little bit more to How specifically you're working
to create a culture
of continuous improvement and innovation
among your teams.
Really good question.
1 of the things that we do is
every year in October, I send out an
email to all of our staff members
and request
their thoughts on forms, process change, policy change.
We typically get somewhere between 02:50
to 300
potential for improvement suggestions every year.
And we like to call through those. Sometimes,
you know, we can always
act on them if there's a regulatory reason
or a compliance reason that we're doing something.
But the people who are closest to the
patient, they often know how to fix the
problems that we might not even have the
answers to. So I love actually just as
simple as that sounds asking people. Ask for
their suggestions.
And then follow ups on them. We
take from October to December to go through
those and in January, we do roll of
changes based off of the staff
process
suggestions.
The other thing we do is that we
have a process every month where our teams
perform self audits on their documentation. And then
we perform quarterly una
oversight audit
so that we can ensure that the teams
themselves know what's going on in their chart
and that we as of the corporate team
know what's going on in those records.
Based off of those audits, we do performance
improvement plans with the team. So the teams
are aware of. It's an open book test.
I'm really big on that.
You, we all know the standards that we
are being accredited by through our accreditation bodies.
But should be an open book test for
the teams. They should know what we're gonna
look at, They should know what they should
be looking at so that we can all
be successful.
And then we, of course, have a safety
culture for... Through incident reporting to make sure
that we encourage people to notify not even
just incidents that near misses.
And if you're in the behavioral health arena,
I would give you this 1 thing to
take away with you from today's
call,
which is the debrief process.
If you want to change your culture
debrief,
debrief, debrief. So we normally behavioral health pretty
common to do an immediate debrief after something
happens.
You know, is everybody okay? Is everyone safe?
What do we think happen in this moment.
But I would encourage you to do a
debrief process 3 or 4 days after an
incident occurs.
To really dive into
what worked well, what didn't work well. It's
not punitive in any way it's a chance
for the team who is who were there
at that incident to look at it with
fresh eyes, kind of a little bit of
a detached guy
because that's really going to help you
change,
things that we may or may not have
been able to change through just talking to
people, letting the people who have that lived
experience come in and talk through it. And
having experts at the table, whether that experts
in behavioral health, experts in a physical incident,
if it was something that happened physically,
gets everybody at the same table and we
can talk about how we wanna do things
different than next time.
Right know that can be
so powerful to
how folks have their voices be heard and
then no. The organization is really acting on
some of the suggestions. That come out of
Well, Stephanie, the last question that I have
for you is,
what is your advice for aspiring chief clinical
officers. What do you wish maybe you knew
earlier in your role,
what wisdom would you pass on?
Well, I'm gonna start out by being cheesy
and tell you a quote,
I'm 1 of those people that loves quotes,
and this quote is from Florence Nightingale. And
it says let whoever is in charge, keep
the simple question in her head.
Not how can I always do the right
thing myself
but how can I provide for this right
thing to always be done?
And that truly is how I try to
aspire
to lead.
And what I would recommend for for anyone
that is leading, it's its systems.
The very first when I my first role
in leadership, I was an assistant director of
Nursing.
And my
administrator
was a systems focused thinker and he really
impacted my leadership journey.
Where human beings taking care of humans.
And so there's inherent risk
we're going to screw up. Right? We're going
to mess up because we're human.
So as a leader, you have to create
systems for your team to succeed.
And to prevent failure. And I'm sure everybody
that's listening. This has probably been on a
culture of safety journey and knows this swiss
cheese model
So so we have to create backup up
to the backup,
so you have to look at... When you're
thinking of implementing something. From the very first
step of it being... Of it touching a
staff member to when it touches to patient
to when the patient discharge, are you looking
at the whole thing and where can it
fail
And so before we even roll it out,
how can we ensure that when those failures
happen, the failure not going to touch the
patient. So that's probably my number 1 thing.
The second would be that you have to
create systems for yourself as a clinical lease
leader to be successful.
Crisis management is the number 1 job of
a clinical leader. You're a constantly managing crisis,
but you have to balance that as the
leader
with daily pass that have to be completed
for you to be successful and for you
to perform your role. It can be really
easy. Most of us come into clinical work.
Because we have heart for care getting.
And so it can be really easy to
be pulled in a million directions by a
million problems.
And you have to protect yourself and your
ability to do your job. And that means,
you know, setting boundaries, it means having time
where your office stores closed and you have
a sign on it, you know,
email text me and I'll come... When I
have a minute, I'll outcome find you because
you have to do the job role that
you have to do and not do everybody
else's job, and that can be really hard
for new clinical leaders.
And then lastly, I would say do what's
right for your patients and the rest will
work itself out.
And if you keep that at the core
of what you're doing that you're here to
serve the patients, you'll find that you can
figure out a solution for most anything.
Absolutely.
I don't think that was a a cheesy
at all. I I love that quote, Stephanie,
I think you you should very point that
remarks. And I just appreciate your time today
to join us on the podcast. This has
been such an a informative of discussion. And
I feel like our listeners have,
glean so many bits of wisdom done from
you. So thank you so much.
Thank you for having me It's been my
pleasure.
Wonderful.
And listeners, you can catch more of Stephanie
at our upcoming clinical leadership forum at the
Becker Ceo Cfo Round table, November eleventh to
14 in Chicago. We do have some limited
space available for attendees and sponsors.
If you're interested in joining, please contact us
at
at health dot com to learn more.