Transforming the culture inside Minnesota Security Hospital is a complex and difficult mission, but I believe we are moving in the right direction.
Our goal is to create a culture of empathetic, constructive engagement between staff and our patients.
We are working to make Minnesota Security Hospital more effective in treating approximately 380 patients — those committed as mentally ill and dangerous, those not competent to face criminal charges and those being treated at the Forensic Nursing Home.
We learned recently that the hospital’s conditional license will be extended for another year, until December 2014. While that might not sound like good news, I for one welcome the continued oversight as we work on the tough challenge of changing Minnesota’s only secure treatment facility for people committed by the courts as mentally ill and dangerous.
When I started as the hospital’s medical director in January 2012, I found an atmosphere of fear among both employees and patients. Our license had just been put on conditional status, and there was turmoil about the way things were being done and the changes that would be required.
We have addressed many of the problems originally cited by licensing officials. Our license was made conditional in 2011 because patients were being put in restraints and seclusion too often. This was at the root of the licensing officials’ finding of abuse of vulnerable adults. The focus of the hospital’s management had shifted away from treatment to enforcement of rules and consequences.
None of our current licensing issues have to do with overusing restraints or seclusion. We have significantly reduced use of these tactics since last July, and our goal is to eliminate the need for these interventions by training staff and effectively engaging our patients in treatment. We are also making progress in reducing staff injuries, patient injuries and the use of our emergency response system.
While we made great efforts to back away from overly aggressive interventions, we have since had to make a course correction and better understand when we do need to intervene. I believe we have made significant progress and are now much closer to the appropriate balance.
My focus has been on transforming the environment at the Security Hospital for patients and staff. We must shift from enforcing rules and meting out consequences to empathetically engaging with the people we serve and building positive alliances to support their success in treatment. I believe this change begins with how we treat our own staff. The mantra I repeat to people at all levels of the organization is that we cannot treat employees differently from how we want them to treat our patients.
In the past, employees feared discipline for making mistakes. They were afraid of taking any action and running the risk of getting in trouble. This type of fear often leads to system failure, and the punishment for the mistakes then continues the cycle of fear.
Instead of perpetuating that cycle, we are shifting our approach to looking at problems as systemic issues. When we have poor outcomes, our first response should to be ask, “How can we build safeguards into the system to ensure that the problem doesn’t happen again?”
Sometimes we still find problems with individual employees, but overall we have a workforce that is committed to patient care. Working with people who are seriously and persistently mentally ill, and who have been committed for treatment against their will, is difficult and challenging. There will be times when we aren’t as good as we would like to be. Instead of finding fault with hardworking, dedicated employees, we invite those who care about our hospital to help us craft systems-level solutions.
We are undertaking a significant effort to improve quality and train staff in methods to engage constructively and sensitively with our patients. We are also overhauling our staffing schedule to allow more frequent on-the-job training and to increase staffing when patients’ needs are at their highest levels during the day.
Quality improvement is a never-ending effort for a secure mental health treatment facility. On this journey to better care, we must not return to reflexively punishing mistakes instead of using them as an opportunity to improve our performance. The efforts we are making to change the culture at Minnesota Security Hospital are so important for both our employees and our patients.
Steven Pratt is medical director at the Minnesota Security Hospital in St. Peter.