A program at Henry Ford Health System's Behavioral Health Services Department drastically reduced suicide rates by applying a Robert Wood Johnson Foundation (RWJF) care redesign initiative to target depression, according to a case study published on the NEJM Catalyst blog.
Executives at the Detroit-based health system chose to tackle depression care under the "Pursuing Perfection" initiative, a collaboration between RWJF and the Institute for Healthcare Improvement in which participants totally redesign all care processes. The proposal was radical from the start, write M. Justin Coffey, M.D, and C. Edward Coffey, M.D., who formerly worked at Henry Ford but now are associated with the Menninger Clinic in Houston. Since the initiative redesigns care with perfection in mind, the clinic's goal was zero suicides.
To achieve this outcome, leaders drew on the Institute of Medicine's 2001 Quality Chasm report, which identifies six features of perfect care: patient-centeredness, safety, timeliness, equity, effectiveness and efficiency. Initially, zero suicides was only the goal under the effectiveness heading, but it soon became the overarching goal for the entire project. This involved a multi-pronged strategy which includes improving care access and removing access to means of suicide. As part of its care redesign, staff dropped the fundamental notion that all mentally ill patients are at risk of suicide and eliminated screenings that wasted valuable time.
The most important strategy, however, was developing a "just culture" that held staff accountable for improvement. Over a decade, the system cut suicide rates by 80 percent, achieving the goal of zero suicides in 2009, the blog post notes. The initiative achieved these outcomes even as the suicide rate increased among non-psychiatric patients and within Michigan's population at large.
This February, the Joint Commission issued an alert outlining steps all healthcare providers must take to address suicidal patients, including reviewing medical and family histories and evidence-based screening for all patients. A month later a study was released that found emergency physicians often fail to ask suicidal patients about their access to firearms.
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