• Embracing new challenges
    December 05,2013
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    The recent notification to the Brattleboro Retreat that we have fully and successfully met all conditions of participation for our recent Centers for Medicare and Medicaid (CMS) survey provides a moment in time to reflect on how far we have come as an organization and as a state.

    Mental illness and addiction can threaten human life just as heart disease and cancer do. Those of us at the Retreat who have chosen this work have done so out of a belief that people who have the courage to seek care deserve our ongoing commitment to always challenge ourselves to be better and continuously improve our practice.

    When Tropical Storm Irene forced the closing of the state hospital in Waterbury more than two years ago, it set in motion a chain of events that changed the way mental health and addiction care is delivered in Vermont. The time to act had arrived, and complicated decisions had to be made. Gov. Peter Shumlin moved quickly.

    When asked for our help by the governor, our decision at the Retreat was not a difficult one. We agreed to assume the care of some of the most vulnerable patients in Vermont. That decision started us on a journey that has demanded that we continually seek innovative ways to improve our work.

    Many of the post-Irene changes to Vermont’s mental health system were already on various drawing boards across the state as the Vermont State Hospital had been decertified by CMS for the majority of the previous eight years. What wasn’t on anyone’s drawing board was that literally overnight, a natural disaster would displace a significant number of individuals who were suffering from complex psychiatric disorders.

    It has not always been easy or smooth, but the results have been significant. At the Retreat we have made important changes to our clinical care and security arrangements. We have strengthened our positive partnership with the Department of Mental Health and with our Consumer Advisory Council. We built a new state-of-the art 14-bed unit to provide the most acute patients with individual rooms, group rooms for leisure activities, a dining area, a family visiting room, and a study area equipped with computers and Internet service.

    Our clinical staff members have received extensive training on processes to keep our patients and themselves safe should a patient, due to his or her illness, become verbally or physically challenging and engage in life-threatening behaviors. We have incorporated approaches to care that are informed by an understanding of the interplay of trauma, psychiatric illness, addiction and violence. All of our clinical protocols are designed to meet and/or exceed state, federal, and local regulatory requirements.

    During this time the Retreat has committed significant resources to implement an electronic health record that improves patient care. We have redesigned our safety training to meet our own standards for internal safety management in conformance to CMS guidelines that limit police involvement in hospitals.

    The recently ratified union contract with Retreat employees who are members of the United Nurses and Allied Professionals contains additional examples of our efforts, not just to meet, but to exceed regulatory requirements. We have instituted a hospital Collaborative Solutions Committee with representatives from union and management who together are tasked with monitoring incidents, safety concerns, and patient and staff satisfaction while providing recommendations for corrective action that flow to our ongoing performance improvement quality committees.

    These are just a few of the many changes and initiatives we have put into action over the past 24 months. The work required to succeed in this transformation has demanded extraordinary levels of focus and determination. It is important to underscore that the level of changes implemented at the Retreat are only in part a reflection of the context of the crisis created by the precipitous closure of Vermont State Hospital. We had already embarked upon a massive change effort beginning in 2007 to respond to the heightened demand for our services. We have grown from a hospital of approximately 50 inpatient beds to one of 120 beds providing specialized services on our LGBT, Emerging Adult, Dual Diagnosis Addiction, General Adult, Acute Adult Intensive, and Children and Adolescent units. We successfully recruited 266 new employees including physicians, nurses, mental health workers, social workers, and support staff and presently provide jobs for 775 individuals.

    At the same time, we were engaged in the process of renovating inpatient units while also instituting complex facility improvements including new roofs, deferred maintenance projects, re-designed adolescent residential homes and new programs in ambulatory services for veterans, police, fire and first responders. Because instituting major and immediate changes requires reinforcing leadership skills, we created a partnership with an outside organization, Linkage Inc., to assure our constant focus on managing change successfully.

    Our journey is not complete. On the contrary, we embrace a culture of continuous improvement. Not only are we called to do this to meet the complex needs of our patients and existing regulatory requirements, but we know that more will be asked of us —and hospitals everywhere — as our nation enters the era of health care reform.

    I am confident that the employees of the Brattleboro Retreat possess the spirit of innovation that will be required to meet this challenge. They have already proven it. I am tremendously proud of what our employees have accomplished, and I know that we have the talent, determination and, most importantly, the heart to continue on this journey.



    Dr. Robert E. Simpson Jr. is president and CEO of the Brattleboro Retreat.
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