Addiction treatment provider, A Mission for Michael, innovates to improve patient safety
A Mission for Michael (AMFM) is a mental health treatment provider based in Southern California. Created in 2010 in response to a mental health tragedy in the life of one of the founders, AMFM opened as a private-pay, single-household treatment center and has since grown into a 13-household treatment program with close to 100 beds, providing insurance-covered treatment to patients with mental health and substance abuse needs.
In December 2020, VisibleHand sat down with the AMFM leadership team to discuss their organization’s patient safety journey and how VisibleHand’s solution has simplified and improved their processes and outcomes. Program Director, Dan Robinson, Safety Director Billy Mara, and Program Manager, Cassie Lizarraga shared their experiences from AMFM’s beginnings as a single household mental health treatment provider through their growing pains and safety challenges - and ultimately to their decision to work with VisibleHand.
Rising Client Acuity
AMFM has treated clients with dual diagnoses, e.g., psychiatric and substance abuse, since they opened 10 years ago. Recently, however, the California Department of Social Services granted AMFM a Community Care License (CCL), allowing them to accept clients with a primary mental health diagnosis. These higher acuity patients often come directly from inpatient psychiatric settings with double-locked door units and round-the-clock surveillance. Although these patients are discharged from hospitals as “no longer a danger to themselves or others”, they often require further treatment before reentering their communities. This change in acuity of incoming clients inspired AMFM to re-evaluate their safety measures for all clients and ultimately led to a partnership with VisibleHand to ensure safety across all levels of acuity, all households, all treatment programs, and all care coordinator teams.
Prior to VisibleHand, how did AMFM manage their safety processes?
The safety systems and processes at AMFM have evolved over time. Initially, the organization relied on care coordinators to have eyes on the clients at all times. As the organization grew and began treating higher acuity patients, they added a traditional hospital Q15 paper system: a paper form for documenting safety checks every 15 minutes. They also increased the number of care coordinators from one to two per household for peer-to-peer accountability. Each of those steps incrementally increased the safety of their facilities. But an underlying issue remained:
“Our goal is to keep the client safe, to know where the client is at all times. We have the paperwork over here. Then we have the clients over there. And those two things didn't seem to be connecting. How do we know that they're safe? That's the problem.” “We found the same problems that hospitals and other organizations like ours have... We couldn't say for sure if our staff were actually doing the rounds. There was a low level of accountability. Many times when we were doing it by paper, we could tell just by looking at the forms and looking at events that happened, that our care coordinators were probably sitting down at the end of their shift and filling the whole thing out.”
Not only was the paper system inadequate to track staff performance and ensure client safety, but it also did not give managers the ability to immediately fix any safety issues that came up.
“With paper, it’s a long window of time before you can see what happened. We probably had 16 hours before we could see something uploaded of what happened yesterday morning. That's not going to do anything [to help us]. The only thing that's going to do is either incriminate us if we did something wrong, or show us what we did, but with no solutions to how we can solve and improve the situation as it's happening now.”
Self-harm, elopement, and other safety events are a constant risk for inpatient and residential behavioral health treatment centers. Even the safest programs still experience incidents that they can learn from. AMFM wanted to avoid incidents where safety check documentation does not match the reality on the ground, e.g., safety forms indicating that a client has been checked on within the past 15 minutes while the client had actually eloped. AMFM has a very good safety record, but with the mounting challenges of rising acuity and their increased volume, they knew the status quo would no longer be sufficient. They required a new kind of solution for their changing needs.
What did AMFM look for in a solution?
Having surveyed their shifting operating environment and having identified their core safety issues, AMFM needed to find a solution that could achieve three primary goals:
“One, we wanted to make sure that clients were safe, and ensure we were notified if they left the residence. [...] A lot of times clients will be confused. So we need some way for us to be notified reliably if they're not on premises.”
“Two, there's the staff accountability component. We want to make sure that the staff are accountable and know that we are taking this very seriously, that client safety is our number one concern over all other things.”
“The third thing we were looking for was some sort of system where multiple people in leadership roles would be able to jump in and see on a dashboard, How are we doing right now? Where can we improve? What are our weak points? Information is critical in this kind of endeavor, for us to be bigger and better, and paper does not afford you that.”
Possible Solutions and Research
After trying paper safety checks, adding staff, and adding security to their households, AMFM began researching other options to improve client safety across their programs. They looked at barcode/scanner options and to other industries with similar tracking/safety needs.
“We knew there had to be some kind of technological way to do this. It seems obvious, we're in 2020, there's got to be a better way to do this. And then we started doing some research and found VisibleHand and a few others.”
“Overnight was a crucial time to make sure our staff were actually rounding. So initially, we looked at maybe putting a barcode on the bed, so we would know that they were scanning. Kind of like a security guard did in the old days with a lockbox kind of thing. But we quickly said, that's really not what we need, we need to know where the client is, so maybe some way to have them wear something that we could scan, like a barcode wristband. Hospital bands immediately came to mind. So that was kind of what I was going for initially.”
“We looked at the different competitors. We looked at you, VisibleHand. We looked at Guard One, which was actually for prisons. There was one other one that was similar to what you guys were doing with the platform, but the company wasn't friendly. So we didn't want to go with them.”
After researching different options for improved safety rounding and verification, AMFM chose to work with VisibleHand for several reasons.
VisibleHand is a technology company that has spent years working to improve and simplify processes in care facilities of all kinds. The technology is sophisticated and the staff interface is simple and easy to use and immediately improves safety outcomes. Additionally, VisibleHand’s technology expertise allows quick modifications of the system based on facility needs.
“We really liked how you guys position yourself as a tech company that works with healthcare, rather than a health company that spent a bunch of money to make some little tech solution. You're very receptive to feedback, and you're able to quickly modify your solution to make it work better. I had the very distinct feeling working with the other options that they would say, “Oh, that’s a good idea. I'm going to send that to this other team overseas, and they'll get back to us in two months and maybe we'll talk about it then. What?! You guys just give us an answer right away. So I like that a lot more.”
“It's a very simple interface and not convoluted. It's really user friendly, and I love that, because I'm not tech savvy. I was maybe a little uncomfortable at first, but then I saw how easy it was to use. [...] And for the staff, it's really easy to use. We have staff from the age of 21 to their upper 60’s and everyone has been able to just get it, use it, and go with it.”
“The other companies were giving us no assurance that they believed in their product. You guys said, “We don't need a lock-in contract. We want to earn your business every month. We believe in our product where we’re confident to do that. These other companies want two years locked in and we had no idea if the clients were even going let us do this. They could just refuse and then we’re going to be stuck in a contract?”
Because of the technology expertise, VisibleHand is able to pivot quickly to adapt the product to a facility’s changing needs.
“Flexibility [was important] because we're getting bigger and we hope to become a strong national player. But we still have that innovation side to us as a small to medium-sized business. So we like that flexibility and your team too… not just some corporate behemoth.”
Implementation and team adoption
It was only two months between AMFM’s first call with VisibleHand and full implementation of the system. The AMFM team received all necessary equipment (phones and Bluetooth ID bands) and participated in a single one-hour training call. From that point, the team was confident enough in the usability that they decided to train their frontline staff internally and go live just a few days later.
Frontline Staff Adoption
“The frontline staff were a little hesitant. But once we had one house do it, they all had buy-in. They were all excited about it and they loved how easy it was. Before, they used to hold a binder, and the binder had paperwork and they had to carry a pen. And now it’s a phone. The coordinators can hold it, they can clip it onto their belts or purses. They loved how convenient and how easy it was.”
“I think originally we had a little bit of the staff thinking we were tracking them. We want to make sure they're doing their job and accountability - that's part of it. But I think everyone is familiar with a cell phone and just having the new technology and seeing how it works was actually kind of fun for the staff. Not looking at it as if we're trying to track them to make sure they're doing their job, which is a part of accountability, but I think they were enjoying using it more than carrying around the binder, that they misplaced all the time.”
“On behalf of the program managers, we love it. It helps us a lot when you give us that summary of who’s doing what they’re supposed to be doing and who’s not. Then we can keep our care coordinators accountable and ask them what's going on.”
The secure bands are very hard to remove, which makes them good for high-risk patients, but they feel more institutional, and not every client needs that level of security. The fitness bands are equipped with the same Bluetooth technology that the secure wearables use. But they have bonus features like sleep tracking and step tracking that can help AMFM be more proactive about patient health in addition to safety
“Most of our clients come from hospitals, so they already have bands on. We add the beacon and make it very clear to our residents that this is for us to ensure their safety. At the same time, many are psychotic and so we had to weigh that.”
"I love the Fitbit, by the way. I think it's awesome. The clients love it. We love it. It's just so much nicer and so much less institutional than the secure patient ID bands. When we use the Fitbit, we can show our clients that we're concerned for their health. Not just their safety here, but actually their health, and this can help track that. That gets more buy-in to be a part of this, because they like wearing the Fitbit. It’s cool, you know. And so from the patient compliance standpoint, it’s great." "Now that our clients are all wearing the Bluetooth ID bands it’s much easier with new patients coming in because when they see everyone wearing them it’s now just what we do."
Since they began working with VisibleHand, AMFM is achieving great results on their investment in safety and accountability. There are the immediate and obvious benefits of improving compliance and patient safety, but there are also other benefits. AMFM shared feedback they received from recent Joint Commission and state audits. They are also seeing the impact on census as they have been able to positively differentiate their services from others in their market.
Compliance and accountability
“I think our biggest, immediate great thing is that we have that visibility that we want now. So even if there are problems, we're able to correctly identify them. I know that I feel better knowing that we have this system in place, we know that things are actually getting done. [...] I know I sleep better at night because of this, for sure.
“When you're having a busy day, you would see CC's filling in the entire sheet at the end of the day. And [VisibleHand] does not allow you to do that. So that's what I do love about it, because I know that the CC's are doing what they're supposed to be doing when they're supposed to be doing it.”
Joint Commission Audit
"We actually just had a Joint Commission audit and they asked about our suicide prevention. I was able to say, “Well, actually, our organization uses this thing called VisibleHand.” And he thought it was a great idea. So it was cool. He didn't look at the system specifically, but we did tell him about it and he thought that that was fantastic and a good safety measure to put in place."
"The state loves it, too. They were like, “Wow! It’s magic.” They thought it was really cool. We have a consistent interface with them, and I know that they really like that we have this kind of system in place. Anything to increase the safety of the clients, the state will love."
Most clients come for treatment because their families want them to be healthy and happy and to be able to transition back to family and community life. But families want to be sure their loved ones will be well cared for and safe. AMFM has a great track record and has the licenses to show for it, but families want assurance, not just licenses.
“VisibleHand is one way we can assure parents that their loved one is in a place that's safe. You can say you have all the licenses and accreditations you want. But [families] don't know what all these acronyms mean. When we tell them, “Hey, we have this technology called VisibleHand that allows us to ensure that we are within five feet of your loved one every 15 minutes,” that's something tangible that a concerned mother will latch onto. They’ll say, “Wow, that's really cool. That's a lot better than this other place that has a piece of paper or that doesn't do it at all.”
Where does AMFM go from here?
AMFM used VisibleHand to solve their safety challenges related to patient acuity, scaling, and accountability. Their safety events have decreased, and they plan to continue partnering with VisibleHand moving forward. But where do they go from here?
Their immediate goals are to continue to maintain and improve the standardized safety practice they have honed as they expand their services and size. As they acquire and build new programs and facilities, they will be able to quickly integrate those operations with the safety standards they have refined over time.
AMFM is also interested in adding more health and clinical data into the platform - which tightly aligns with VisibleHand’s services. The ability to monitor activity, movement, and sleep of their clients, as well as other health data from the fitness band, can have tangible impact on care and outcomes.
“We hope to continue growing and adding households, using this as we roll out. I would love to do more with health metrics. The type of information we could share with clients and with staff and management.”
“We would also like to utilize more robust reporting and compliance information. So that we can really home in on specific instances and patterns and easily see them… The more data, the better. “
Final Thoughts from AMFM:
“We’re in a great place and heading in a good direction. The interactive experience dealing with VisibleHand and refining each other's processes is probably one of the things I like most so far about this relationship. I think the product is great and we want to keep growing together.”