Lean Behavioral Health ─ The Kings County Hospital Story

Lean Behavioral Health: The Kings County Hospital Story is the first lean book that focuses entirely on behavioral health. Using the principles of the Toyota Production System, or lean, the contributors in this groundbreaking volume share their experience in transforming a major safety net public hospital after a tragic and internationally publicized event.

As the largest public healthcare system in the United States, the New York City Health & Hospitals Corporation adopted lean as the transformational approach for all of its hospitals and clinics. Kings County Hospital Center, one of the largest providers of behavioral health care in the country, continues on its transformational journey utilizing lean's techniques. While not every event was fully successful, most were and every event, including failures, increased the knowledge base about how to continually improve quality and safety. Having made major changes, Kings County Hospital Center is now recognized as a center for transformation and quality receiving high marks from oversight agencies.

This volume begins by describing the basic principles of the lean approach-adding value, eliminating waste, and tapping the organization's line staff to create and sustain dramatic change. An overview of the use of lean from a quality improvement perspective follows. Lean tools are applied to many services that comprise the behavioral health value stream and these stories are highlighted. The experts in identifying waste and adding value are the line staff whose voices are captured in the clinical chapters. Insights learned by event participants are emphasized as teaching points to provide context for what has worked or has not worked at Kings County Hospital Center.

While the burning platform at Kings County Hospital Center was white hot and while the Department of Justice scrutinized its quality of patient care, the application of lean methods and tools has transformed the hospital into a potential model for behavioral health programs facing the challenges of the present healthcare environment. It is a must-have story for clinicians, administrators and other leaders in the mental health field devoted to improving quality and safety at their hospitals and clinics.

Joseph P. Merlino is the chief executive for behavioral health services and Director of Psychiatry at Kings County Hospital Center, where he leads the transformation efforts of one of the largest public hospitals in New York. Previously he was Director of Psychiatry at Queens Hospital Center. He is also Professor of Psychiatry at the State University of New York - Downstate Medical College and Adjunct Professor of Psychiatry and Behavioral Sciences at New York Medical College. He received a Master's Degree in Public Administration from Baruch College, City University of New York. Dr. Merlino is on the Board of Directors for the Group for the Advancement of Psychiatry where he chairs the Committee on Administration and Leadership. Dr. Merlino is a Distinguished Fellow of the American Psychiatric Association and a member of the American College of Psychiatrists. He is a past president of the American Academy of Psychoanalysis and Dynamic Psychiatry.

Joanna Omi is chief innovation officer and senior vice president for organizational innovation and effectiveness at the New York City Health and Hospitals Corporation (HHC). Ms. Omi provides leadership and operational guidance to Breakthrough, the HHC Enterprise-wide Improvement System. She is responsible for the development and adoption of lean throughout HHC's various healthcare facilities and corporate offices. Prior to her current position, Ms. Omi was HHC's Senior Assistant Vice President for Corporate Planning and HIV Services. In this capacity, she led the Corporation's planning efforts and managed special projects, including the Corporate Ambulatory Care Restructuring Initiative, the Community Health Care Demonstration Project, HIV/AIDS programs and development of the first federally qualified health center on Staten Island. Previously, Ms. Omi was Executive Director of the New York City HIV Health and Human Services Planning Council, served as Senior Policy Analyst for Budget and Legislation in the Mayor's Office on Health Policy, and directed HIV/AIDS and prenatal programs in the Bay Area.

Jill Bowen is the senior associate executive director and chief of staff for Behavioral Health Services at Kings County Hospital Center. Trained as a clinical psychologist, receiving her master's degree and doctoral degree in clinical psychology at the Derner Institute for Advanced Psychological Studies/Adelphi University. Her work has included direct care as a member of an interdisciplinary acute care clinical team and increasing supervisory work in clinical and forensic psychology. She was the Deputy Director and unit chief of the Forensic Psychiatry Service at Kings County Hospital Center before moving on to work in senior administration within Behavioral Health, focusing on strategic planning and process improvement. She has been employed at Kings County Hospital Center for the past 26 years and has played a significant role in the transformation of the services provided in the Behavioral Health department across the continuum of care.