When the doors of the mind open

I’ve often wondered why the psychiatric wards are the most drab and depressing parts of hospitals.  After all, you’d think that the architects and interior designers would be instructed by the facilities administrators to brighten things up for those patients suffering from mental illness and for the clinical staff who take care of them.  But no.  You know, even from the outside of the ward, that this is an unpleasant environment.  The door to a locked ward, with at best a small window looking in and out, is placed at the end of a dark corridor, surrounded by a wall colored in institutional gray or green, and often with no sign indicating what is inside.  Hope is quashed.

That despair is precisely what Teresa Pasquini, the mother of a young man with mental disease, noticed at Contra Costa Medical Center in Martinez, CA.  She notes: “The doors of the psychiatric units were seen as the hospital’s property and a way to control access.  Visitors were also controlled, and the mysterious world of the psychiatric units were misunderstood and often feared.  The entry into this emergency service was bare and unwelcoming.”

But change was possible, through a broadly inclusive Lean behavioral health rapid improvement event.  She explains:  “The Lean process takes you away from the meeting room and puts you on the front line of care observing each process.  This allows you to recognize what is waste and what has value.  Lean lets you see across the silos of the system and recognize the delays, the redundancies and harm.”

Indeed, while much of the focus of Lean is often on waste attributed to classical manufacturing concepts like excess transport, inventory, and waiting, those of us engaged in Lean often point out that one of the key wastes is “the waste of human potential.”  Unfortunately, if there is ever a part of a hospital that is likely to feature the waste of human potential--both of staff and patients--it is in the mental health areas.

Look at this simple result.  Teresa explains:  “With the help of a community partnership and three mental health consumers, who designed and painted the entrance to the psychiatric emergency area, this door now symbolizes the commitment to patient and family partnership and to co-producing a more welcoming and accessible experience for all who come here for care.”