SALEM -- The Oregon State Hospital has made progress during a decade of change, but more can be done to improve mental health treatment, staff safety and fatigue, and the electronic records system, according to an audit released today by the Secretary of State’s office.
The most visible change to the hospital occurred in 2011, when the original structures on hospital grounds were rebuilt or replaced. The new facilities incorporated a centralized treatment model, also known as “treatment malls.” In this model, patients live on their units and attend group therapy classes in a different part of the hospital— similar to how a community college might operate. “The hospital’s adoption of treatment malls is part of Oregon’s move to mental healthcare that is recovery-oriented. This is important because people with mental illness can get better,” said Secretary of State Jeanne P. Atkins. “With this in mind, staff can help patients strive to live a self-directed life and reach their full potential through the recovery process.”
Internal changes have been less visible to the public.
The hospital now offers more group therapy options, and introduced strategies to create a safer environment for staff and patients. Hospital leadership is also working to reduce overtime and implement an electronic health record system.
“Our audit found that, though the hospital made significant improvements, there are additional actions the hospital can take to further improve safety and promote patient recovery,” said Gary Blackmer, director of the Oregon Audits Division.
The auditors found that cultural and organizational changes around safety have taken hold, but challenges remain. The hospital’s own data suggests that patient aggression towards peers and staff increased in 2014. Results from a 2014 survey indicate 40% of nursing staff surveyed were assaulted over the last year, and 43% felt unsafe in their jobs.
Improvement in treatment planning and therapy groups could also help patients recover. The auditors found that the hospital provides little guidance and training on conducting case formulations, an important tool clinicians use to identify patients’ treatment needs. The hospital could better align treatment planning and delivery by using patient’s treatment goals to inform its processes for designing, selecting, scheduling, and evaluating therapy groups offered on the malls.
The audit recommends management continue to address organization culture and training needs. It also recommends the hospital develop and document a plan for improving consistency of case formulations and integrating patient treatment goals with the treatment mall groups offered.
Although the hospital has reduced overtime, concerns remain around how it manages staff fatigue. The audit report recommends the hospital work to limit unscheduled absences, a major driver of overtime. The hospital should also develop strategies to manage the amount of overtime individual staff work, and provide training on the effects of staff fatigue on patient care.
While efforts were made to implement an electronic health records system, parts of the system are still incomplete, adversely affecting efficiency and potentially the quality and cost of patient care. Auditors recommend the hospital complete the electronic health record system implementation, prioritizing automating processes that significantly affect patient care and converting critical patient information to electronic format.
Read the full audit on the Secretary of State website or an executive summary on the Audits Division Blog
