Riverview Psychiatric Center Action Plan

1. Riverview Psychiatric CenterAction Plan To Enhance Safety, Efficiency and Satisfaction

2. Employee Concerns • Survey by Dr. Daskivich and Ms. Fisher of April 2006. • Staff satisfaction survey completed by Union June 2006. • Consultation of Dr. Joe Bevilacquaof November 2006.

3. Staffing levels Staff Safety Staff Recognition Training Enhancements Communication Lack of care to Traumatized Staff Consequences for Clients Client Responsibility Supervision Common Themes

4. Staffing Levelsand Supervision • Assess staffing numbers compared to other psychiatric hospitals. • Defined new staffing plan to equalize staff distribution and make-up across 7 days a week and across shift (based on planned and assessed acuity). • Reorganize to primary discipline line model. • Re-engineer committee structure to reduce meetings. • Increase number of staff trained as a supervisor.

5. Staff Safety • Implement Forensic Administrative Segregation Policy. • Increase Security Officer Presence. • Implement Changes in the Physical Plant. • Enhance Staff Training Opportunities.

6. Staff Recognition • Weekly Updates • Luncheons with Superintendent • Quality Champions • Milieu Managers • Employee Relations Committee

7. Training Enhancements- Implemented as a result of staff feedback - • Forensic Training Program • Continuous Updating of Behavioral Response Training • Leadership Training – Principled Centered Decision Making. • Therapeutic Language • Boundary Training. • Psychiatric Rehabilitation Training.

8. Communications • Increase Town Hall Meetings. • Small Work Group Meetings. • “Red Alert” Process. • Implement Discipline Meetings on Units. • Milieu Managers Meetings. • Ensure Unit Based Performance Data is Available to All Staff.

9. Caring for Staff • Injury Review Process Implemented • New Staff Assault Debriefing Process • New Staff Wellness Coordinator Position

10. Client Consequences andClient responsibility • Boundaries Training with Staff • Psychiatric Rehabilitation Training • Treatment mall Training on Rights and Responsibilities for Clients • Orientation to Rights and Responsibilities at Admission. • Utilization of Milieu Managers to Facilitate Coaching.

11. Supervision- Developed through a Process Improvement Team of Discipine chiefs and Deputy Superintendents - Re-organization being implemented to; • Align Direct Supervision with Disciplines • Ensure all staff have minimum monthly supervision. • Development of staff development plans. • Focus on mentoring and coaching.

12. Joe Bevilacqua Recommendation One • Review and audit Recovery Model implementation at Riverview, particularly seclusion and restraint procedures, and compare Riverview experiences with other states with similar initiatives. NASMHPD could suggest several model states with which consultation and site visits could be arranged. • Riverview will send six staff to Pennsylvania State Hospital to review coercion reduction practices and experiences. • Increase Self Study Training Guides for Staff.

13. Joe Bevilacqua Recommendation Two • Audit the Staff Development and Training Office to determine appropriate training staff for full time responsibility and develop a training and evaluation plan. Consultative assistance and training protocols are available from the National Technical Assistance Office of NASMHPD. • Re assess NASMHPDraining protocols to ensure all protocols considered. • Riverview has filled an additional Staff development trainer to provide institute training. • Conduct a staff survey on training needs by mid February 2007. • Develop and distribute unit and discipline training plans considering staff survey information. • Adding a position to be defined as a “Staff Wellness Coordinator” position which (along with other training duties) will provide individual and group training on, maintenance of therapeutic perspective, emotional fitness or duty, ect..

14. Joe BevilacquaRecommendation Three • Review and analyze hospital committee structures with particular attention to direct care staff participation. This should include staffing levels, scheduling and duty requirements for all staff. One outcome should be the development of an Action Plan that has wide distribution throughout the hospital. • Enhance participation in process management committees. • Supervisor requirements to schedule participation (to ensure staff have ability to attend and participate). • Chair reports of participation to Superintendent. Process Management Committees include: • Behavioral Response Committee • Employee Relations Committee • Safety Committee • Milieu Managers Meeting • Efficiency Committee • 1/4ly advisory meeting of the Quality Champions group to the Superintendent.

15. Joe BevilacquaRecommendation Four • Examine the communications network at Riverview to determine its effectiveness in reaching all staff levels – clinical and administrative. Assure that direct care staff be engaged for this review on mechanisms of interactive communication with emphasis on vertical and horizontal linkages. • Re-engineer communication model at Riverview. Realign committee schedules (reducing total number). • Increase town hall meetings to 2 x month, (once per month at unit/department site – focus on staff recommendations/suggestions). • Establish executive leadership meetings on Wednesdays and department and program meetings on Thursdays. • Establish professional multidiscipline meetings on each unit to define treatment and rehabilitation activities/protocols/repertoire and resolve issues at unit level.