1. Guam Hospital Mental Health Quality Brandon Ghaston, Amber Gunter, Pooja Kishore Quoc Le, Trina Lovegren Renee Castillo, Emily Vaughn

2. Introduction Agenda: Introduction Identify problems Discuss solutions Conclusion

3. Fishbone Diagram Waiting for Trina to give us corrected Fishbone diagram

4. Problem: Process Inefficiency

5. Overloaded staff – Psychiatrist and Psychologist – $180,000 vs. $56,000 Current staffing is not meeting community needs Improper use of resources – Psychs doing more work than needed Admin or nurses can do consult instead of doctors

6. Process Inefficiency Recommendations New Process flow chart (waiting for Trina to send)

7. Process Inefficiency Recommendations

8. Problem: Patients in ER who don’t need to be *Patients may exhibit more than one

9. Problem: Patients at ER who don’t need to be Overloaded ER – 49% of patients are “depressed” -waste of resources No education of other options – No insurance to use outpatient services Many patients are return patients – No insurance for prescriptions – Need medication for relief

10. Patients at ER who don’t need to be Recommendations Outpatient facility implemented to treat those who don’t need emergency treatment – Funded through money saved with new process flow – Will operate the same as ER People without insurance can receive service – Will work with ER to get patients where they need to be

11. Problem: Returning Patients at the ER No other options for the mentally ill No education about taking care of themselves without coming to ER. No information for family members ER doesn’t allow for doctor/patient relationship No insurance to pay for prescriptions – Come to ER for immediate and free meds

12. Returning patient at ER Recommendations Improve Information Systems – Expand EMR to all hospitals/facilities Provide information to patients while at ER – Patients will learn to take control of their illness Less ER visits Look into alternative care solutions – Reduce need for ER care just to get meds – Outreach facility

13. Problem: Lack of education & outreach Community – No outreach facility Outpaitent treatment Outpatient education programs – Group information sessions for family and patients Patients – Current process doesn’t allow for ongoing education or care Patients are never told of other options while at ER No follow up care or treatment Doctors and Staff – No time to education due to overload and inefficiency – Not enough doctors on staff at one time

14. Education Recommendations Community – Outpatient facility implemented Group info sessions Counseling Patient – Education pre-treatment and post-treatment Doctors and staff – Provide service at outpatient facility – On call procedures implemented

15. Marketing Campaign Market changes – Doctors: Standards, protocal – Community Fund Raising

16. Problem: No auditing or performance measures No quarterly reviews of doctors and staff to asses their outlook on treatment Staff lacks synergy and agreement No integration and team building – People aren’t working together No follow up on goals that doctor sets

17. Auditing Recommendations Implement reviews – Semi-annually for doctors – Quarterly for staff Staff meetings – Shift meetings – Departmental meetings Suggestion Box – Allows for flow of new ideas at no cost Integrate team building exercises – Build morale – Provide support Audit Dr/patient goals

18. Conclusion Timeline of implementing solutions (from Renee)