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9—Inpatient Affects
Everyone
Why getting decent inpatient help is good for families and
caseworkers.
L ets
suppose you are at the end of your tether working with a difficult
family member. You talk them into going inpatient to get their
medication adjusted. During the admission, staff behaves in an
amateur fashion and the family member slighted with insults or body
indicators. Your family member harbors rage and this spills out
after discharge.
Lets look at another situation. A case manager
decides her client needs hospitalization because the client is
getting difficult to manage, and she needs a  much-needed
break. During the admit, the staff demonstrate problems with
professional behavior from lack or training or accountability. The
client lies to get out of the hospital and is carrying a bad
experience back into the office of the case manager. The case
manager is frustrated because instead of getting the client back in
better shape, she now has more on her plate to deal with. This sort
of thing happens all the time.
I remember during one admit a code ‘blue’ was called. A
female staffer jumped up and ran out to respond to the call. When
she returned, she said to her friend, “I’m so pumped! I live for
take-downs! That is why I took this job!” Unfortunately, positions
like this allow the sadistic to act out their fantasies. Even though
it cannot be entirely screened out, the job environment can take on
a different kind of air that would frown on such attitudes. For
example, when a team effort is ongoing, and reflected on daily
basis, a comment like this would come off as team betrayal that
would jeopardize team efforts for success.
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10—Data
Reliability
| Data
reliability is important. Not only what is collected, but also
‘how’ it is collected. For example, at this time in
Riverside County Mental Health and for years past, there is no
documented procedure how various grievances are collected.
Depending on the payer, some are routed to Patient Rights’,
some to Quality Improvement at the hospital, and some to the
Quality Improvement Committee (QIC). And some end up sitting
on an inpatient supervisors desk and don’t get routed at
all, but ‘none’ are logged in a comprehensive database,
because there is no cohesive model for collecting the |
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grievances. The results end up being
scattered and of little value. This is problematic because
grievances identify areas for performance improvement that are
not getting addressed.
11—Nothing Changes, If Nothing Changes
To be objective, lets consider the impact on the department if
grievances were taken more seriously. Trends and patterns
would develop. This would lead to change and accountability.
Yet, under the current model that is already heavy with
documentation,
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it is likely that the requirement for
documentation would increase. This pseudo corrective measure
would impede improvement, since training; frequency of
training, and comprehension of the training material is not
the focus of current performance improvement.
Further, studies indicate that some individuals in
management will be resistant to change. They do not want their
comfortable apple cart upset. A change in performance may
invite unmotivated management to rise to new challenges, new
innovations. They might actually have to start applying
themselves.
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“Depending on the payer, some are
routed to Patient Rights’, some to Quality Improvement at the hospital,
and some to the Quality Improvement Committee (QIC). And some end up
sitting on an inpatient supervisors desk and don’t get routed at all,
but ‘none’ are logged in a comprehensive database.”
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