Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Brattleboro Retreat

Name of Innovative Program: 
Four Innovative Leadership Processes
Sponsoring Organization
Brattleboro Retreat
Name of Innovative Program Lead: 
Dr. Robert Simpson
E-mail Address of Innovative Program Lead:
Project Description: 
 In 2007 the Brattleboro Retreat hired a new CEO and the organization began to implement Four Innovative Leadership Processes to turn around the hospital’s operations. Each innovation was a key to the next innovation process forming the basis for driving innovative thinking continuously throughout the organization: FAST CAR (Financial And Strategic Thinking Can Achieve Results) is a performance improvement process that brings together the hospital management team to brainstorm ideas that can achieve new financial and strategic results to the existing budget cycle.Leadership Development refers to a Nine Core Leadership Trainings offered by Senior Executives to the Management Team and Physicians to drive operational excellence.The Uniform Service Program (USP) is for police, emergency service workers, firemen and veterans came out of FAST CAR.The Management Service Organization is a joint venture with Blue Cross to integrate mental and physical health to perform in the new Accountable Care legislative environment.
Creativity and Innovation: 
 Hospitals are conservative in their innovative processes due to the demand to have protocols designed to protect human life. Innovations tend to be sustaining (incremental) and tested with small innovative steps that target mainstream results improving performance along traditional dimensions. Disruptive innovations that involve new benefits that customers, employees or patients may value more such as a unique patient care focus target new outcome dimensions and are more complex to implement. This is the fundamental reason that the Retreat began with FAST CAR as it is a unique “no idea is a bad idea” process asking managers to brainstorm new processes along a spectrum from patient care improvements, new programs or operational innovations aimed at efficiencies or dollar improvements. Each idea is implemented with a formal performance improvement team and the dollar and quality improvements are tracked against expected outcomes. The other Three Innovative Processes grew out of FAST CAR.
 All FAST CAR initiatives require process improvements in business and clinical practices to reach expected outcomes. Integration with the Quality Improvement department assures regulatory compliance assuring that leaders work to sustain “disruptive” innovations. The unique disruptive niche innovation Uniform Service Program for police, emergency service workers, firemen and veterans came out of FAST CAR. It combines new treatments for trauma with a partial hospital program supported by the purchase of an Inn for lodging circumventing the lack of billing support for residential treatment. The Leadership Development innovation combined the unique resources of Linkage, a worldwide best in class leadership trainer with the required team teaching of Executive Team leaders of nine core leadership skills. Other hospitals have asked for consultation on how to administer FAST CAR and the Leadership Development program. The Blue Cross joint venture will play a major leadership role in the Vermont Accountable Care legislation.
 The FAST CAR program created an additional substantial stream of unbudgeted revenue opportunities. The finance department and the CEO have the responsibility to track the process of idea generation through partnering with leaders throughout the organization. Innovations include partnerships with other entities; community mental health centers (emergency room diversion program), hospitals (psychiatrist employment joint ventures) and the creation of Vermont Care Collaborative, the venture with Blue Cross. Market research supported the expected outcome that niche programs developed including the USP and the unique LGBT inpatient program expand overall market share for other existing hospital programs (detox, partial hospital, inpatient programs). The Leadership Development program demonstrates the premise that excellent “leaders are made not born” through our partnership with Linkage that includes a cost effective innovative consulting, coaching and transfer of teaching responsibilities to executive leaders that make the program sustainable and develop physician, manager, SW Supervisor unit and other teams.
 All Four Innovative Leadership Processes have the potential to be replicated in other organizations. FAST CAR is a method with processes, metrics and rules that are easily adapted to any business. The fact that the finance department is instrumentally involved assures that off budget opportunities will be paid attention to with the attention to detail that is notable in finance. The finding that niche generates additional mainstream business has promise for any organization intending to grow its overall business. The Leadership Development program assures that all leaders have the necessary abilities to lead in an increasingly complex healthcare environment. The Linkage assessment tools allow benchmarking against global leaders in multiple industries. The lessons from the joint venture to control total healthcare costs through the integration of the management of behavioral and physical health are applicable to all behavioral healthcare organizations as the Affordable Healthcare Act is implemented nationwide.
 All Four Innovative Leadership Processes have outcome measures that derive from the focus on leadership and accountability inherent in the Leadership development program with Linkage. FAST CAR has a structured process that measures expected financial opportunities against actual returns for innovative ideas on a monthly basis. The specialty program, USP, measures outcomes based on the TOPS scale assessing symptom and functional domains: work functioning, sexual functioning, depression, life quality, panic, mania, substance abuse, sleep, suicidal ideation, and violence. The Leadership Program assesses each leader using the Leadership Assessment Inventory, given by Linkage to over 80,000 leaders globally and measures their expected improvement on 81 leadership skill areas over the course of each year through a performance evaluation tool. The MSO project measures the expected reduction in total health care costs by integrating mental health and physical medicine preserving scarce medical resources that can be deployed more wisely elsewhere.