Welcome to the Becker's Healthcare podcast. I'm Chris
Sosa, your host, and I'm thrilled to be
joined today by doctor Kelly Sandberg, chief medical
quality officer and a pediatric gastroenterologist
at Dayton Children's,
and his colleague, doctor Katie Winter, division chief
of psychiatry
at Dayton Children's.
Kelly and Katie, thank you for joining us
today.
Pleasure to be here. Thank you.
Wonderful.
So for those in our audience who are
maybe not familiar, could you please introduce yourselves
and give us a little bit about your
background? Kelly, let's start with you.
Hi. I'm Kelly Sandberg. I've been a quality
officer at Dayton Children's for the last, almost
twelve years now.
I've been involved in developing some of the
infrastructure for quality improvement, process improvement, quality assurance,
and, currently developing an institute of quality and
safety.
And Katie. Great. Hi. Thank you so much
for having us.
My name is Katie Wenner. I'm the chief
of psychiatry here at Dayton Children's.
My training is primarily in child and adolescent
psychiatry and then also adult psychiatry.
And most of my clinical time is spent
on the inpatient mental health unit.
Excellent. Thank you for sharing that, Kelly and
Katie. So we have you on the podcast
today to discuss everything. Well, maybe not everything,
but the important things most important things Dayton
Children's is doing in reducing mental health readmissions.
So there are a lot of different ways
we can go. But let's just start with
what initiatives on that front have been successful.
Kelly or Katie, just take it away.
Alright. So,
we have done a lot here at Dayton
Children's. Things have really changed in the last,
actually since 2019.
That is when we opened our inpatient unit.
And in that time, we realized pretty quickly
that we did have a problem with the
remissions,
and kids kinda coming back and not getting
what they needed out of the first time
around.
And so we actually did publish a paper,
looking at some of our initiatives that we
did in quality improvement on the unit.
And so some of the things that we
did here were, remission programming. So
most inpatient units will do the same programming
kind of over and over. We're like Groundhog's
Day. You wake up. You go to groups.
You do the same kind of groups. The
next day, you wake up and do groups,
maybe a little bit different, but similar topics.
So what we looked at was trying to
come up with a more individualized plan for
the kids that came back to us to
really be able to
better understand what didn't hit the mark, what
problems did we not address last time they
were here, and then how do we make
changes so that we're not doing the same
thing over and over again expecting different outcomes.
One of the other initiatives that we looked
at were, follow-up phone calls. So this is
something that is pretty simple, but when families
are here on our unit,
or in any hospital setting, they're in crisis.
And so it is very challenging for them
to be able to absorb all the information
that and everything that's going on around them.
So what we started doing was when a
family leaves, we try to give them a
call anytime between twenty four hours or seventy
two hours after they leave just to review
how, you know, the discharge information that they
have. Can you make the follow-up appointments? Were
you able to get your medications?
Just to problem solve to make sure there
are no issues that we might be able
to
address before another crisis,
appears.
We also looked at our group structure itself.
So part of our quality improvement was collecting
data of why are these kids coming in.
And what we found was
conflict. There was conflict at home. There was
conflict at school. There was conflict with peers,
teachers, and kids did not have the tools
that they needed to be able to deal
with that conflict.
So we added conflict management into all of
our groups for every child to ensure that
they had the communication skills, the empathy, and
anger management
to try to better deal with what was
going on in their lives.
And then the last one that we really
looked at was
a remission checklist, and this was really just
a way to standardize what we were doing
and make sure that no matter who you
got assigned to your treatment team, you got
the same options for aftercare,
available to you.
Katie, thank you for taking us through all
of that. And so I have follow-up question
on that.
Just given when you started in 2019, was
there a certain
model from another department, another health system, hospital,
anything like that that you look to? Or
tell us a little bit about how you,
built that program with those four steps that
you mentioned.
Yeah. So, I will say our collaboration within
mental health, we are a small group
of mental health providers across the country. And
so, there are children's hospital collaboratives
that, we get together with. Ohio is wonderful
and that we have five pediatric hospitals that
we talk to on a pretty regular basis
about
what they're experiencing, how they did things.
And so we
we went to a lot of these hospitals.
We observed what they were doing.
We've reached out. We asked questions.
And so we leaned very heavily on others'
learnings
and trying to make the best program that
we could make.
Makes total sense. Kelly, Katie, so next question
I have for you is now that you've
come as far as you have,
how do you think Dayton Children's is going
to be able to build on the success
that you've had?
So,
obviously, as I mentioned, we started this back
in 2019,
and it has been a process. The world
has changed quite a bit in that time
period.
And our families have changed, what the needs
of the kids in our community have changed,
and then the resources have also changed.
So
despite that, we are still doing pretty much
every one of those initiatives, but we've expanded
them.
And so I'll take the phone calls for
instance.
The phone calls we started off on our
unit, but now we do them throughout all
of pretty much Dayton Children's. But one of
the places that we really expanded to, first
off, was our crisis center. And our crisis
center is, kind of like a psychiatric emergency
room,
where two thirds of those kids actually go
home.
And so we are now calling them to
make sure that they understand
what discharge instructions, making sure that they're able
to get into those providers so that they're
not into another crisis.
As we I already mentioned, the collaboration
piece is is huge.
We have been working with all of the
Ohio hospitals.
You know, how do we continue to move
forward and make sure that we are taking
ideas and sharing ideas when it works. And
then I will say the other piece of
this
project that I feel like was really just
eye opening was
that it's not difficult to put quality improvement
into pretty much every practice, routine practices. So
it has now become part of
our leadership,
on the mental health unit,
where we use things like the tools we
had, the checklist, standardizations,
and we built dashboards. That way, we can
monitor and make sure we're running an efficient
system that is providing
the care that we need to provide.
Chris, another thing, as we're talking about building
on success, you know, Katie has talked a
lot about inpatient, and she just mentioned the
crisis center just a second ago. But she,
of course, is in charge of a lot
more than just those two areas as well.
She does,
intensive outpatient.
They have an outpatient day treatment program. They
have counseling services. They have other things. So
part of the reason why,
you know, there there's a broader system and
a broader support in place that does support,
the work that's going on in both the
crisis center and the inpatient unit.
I I think,
also that and Katie, correct me if if
I'm speaking out of turn here, but there
are are plans
to, expand,
the mental health, beds. And so, you know,
if we've been successful, then we should be
able to,
help the community by expanding,
you know, that resource,
as well as offering community additional resources with
respect to mental health and,
starting to tackle some of the social drivers
of of health.
Yes. I I agree that we have been
able to expand, and and I don't wanna
say there was every part of it was
easy. But the actual patient care piece of
it, the how to make sure that we
are doing the same things in one location
or with 24 beds versus 48 beds once
we get there. I feel because we have
become more efficient, it's become an easier system.
So that expansion has not been taxing on
the teams.
It's been easier to ensure that we are
doing, you know, the same thing and that
we have fidelity in what we're doing. So
I very much appreciate you qualifying and clarifying
that, Katie. I'm sure thankfully, I don't think
our listeners hear this and think, oh, this
was easy. I think they understand very much
so that any part of the job that
that you both are doing and others in
your position are doing is is very difficult.
But I do certainly, you know, there there's
much to be said for the way you
laid it out.
Katie, I do wanna follow-up with you on
something. So
obviously, no one can monitor all the phone
calls that are happening and that I mean,
between the two of you. But
when you're taking in the feedback at Dayton
Children's,
what have you heard from patients that says
to you, hey. This is really working for
us and for them, more importantly.
So I will say just today,
I had,
been reviewing. We we do,
patients can, you know, review us and give
us scores. And one of the comments actually
was about the phone calls
and how they felt so much wrap around
from our
team that they were calling just to check-in
on their child
and to make sure that they really had
the tools available to them that they needed.
And so it was really nice to just
kinda see that full circle,
that what we're doing does matter to the
families.
No doubt. No. That's wonderful to hear.
Lastly, I simply wanna ask you both, just
given your experience now since 2019 and and
stretching back further if you prefer.
What advice do you have for other health
systems, other organizations who are looking to launch,
similar initiatives? So, Kelly, let's start with you
there.
I think from a system standpoint,
especially from,
you know, the mental health standpoint, objectively listening
to frontline leaders.
And in that in this case, you know,
it it's not just doctors and nurses, but
it's also the therapists and the community health
workers and others,
to understand
kind of the pain points and understand what
it is that we're trying to do.
And then, you know, at some point along
the way, you know, I'm not a mental
health provider, but yet I I can serve
as a as a sounding board and someone
to check assumptions against.
So Katie had mentioned,
you know, something about conflict management.
That was not initially inherent until we had
some robust back and forth discussions and questions
and answers.
And so having kind of, someone who's not
necessarily a subject matter expertise, but perhaps,
you know, an expert in quality improvement or
process improvement,
or safety can be really helpful.
I think also finding the key stakeholders in
the community, whether they be from other surrounding
hospitals,
in the community or as, Katie has mentioned,
you know, the children's hospitals have a lot
of great collaboratives.
You know, a lot of us are dealing
with the same challenges and the same
restraints.
And so just understanding what others are doing
and listening and agreeing that we're here to
take care of, you know, patients, take care
of kids.
Those, you know, key stakeholders in the community
could also include, you know, organizations that support
homelessness or group homes or seeing how, you
know,
homelessness
or group homes or seeing how, you know,
and understanding what their challenges are so that
we could better,
you know, work together for, for the kids.
And then finally, you know, working with appropriate
government leaders to ensure that they understand,
the realities of of providing care,
in 2026.
It's an ever changing landscape and if they,
you know, if the decision makers in government
don't have,
a clear line of sight into what's going
on, especially in the mental health spaces,
we're really,
kind of a a two hit on that,
where we're first hit from, you know, not
having the need needed resources, but also not
having the understanding when,
you know, legislation is brought forward.
Makes a lot of sense, Kelly. Thank you
for laying out all those steps, on from
the operational standpoint. It's very, very helpful. Katie,
I'm looking forward to hearing what you add
to this as well.
Yeah. I I feel like my answer to
kinda how to give advice to this, is
probably
very simple. It's sometimes just jumping in, finding
something that you're passionate about, and then finding
a mentor.
So Kelly was the mentor in this. Kelly
has been the cheerleader in this despite not
being,
a mental health, you know,
practitioner. He has encouraged us to really, you
know, jump in, look at the data, and
really get together and think of what can
we do.
As he mentioned, resources aren't always available, but
there are small changes, things like a phone
call that don't take a lot of resources
that you can make a difference.
So I just encourage people to really just
think about what
problems they feel like they have in the
system and see how, you know, even that
small change might actually make a big impact.
Excellent advice to be sure no one can
do any of this all by themselves. And
clearly, you guys have gotten a long way,
looking not only to each other, but, other
people,
who have been very helpful.
Kelly, Katie, thank you so much for being
on the podcast today.
Thank you very much, Chris. It's been a
pleasure. Thank you.