Governor sees progress in effort to overhaul Western State Hospital
LAKEWOOD — Washington Gov. Jay Inslee is bullish about overhauling Western State Hospital, the state’s largest psychiatric facility.
Strained by deep cuts during the recession, the hospital has seen long-term impacts of significant staffing shortages that led to long wait times for patients, substandard care and concerns with safety and security. The hospital is under both a federal Systems Improvement Agreement to maintain its certification and court order to admit patients more quickly.
Inslee has worked with legislators to find resources to help the hospital recruit nurses and doctors, make security and safety improvements and get the hospital back on track. He replaced the hospital’s CEO last year and has since made a number of visits for updates about the health and safety of patients and staff. He returned Tuesday to talk with CEO Cheryl Strange and other hospital staff about how reforms are working out.
“Our leadership team is engaged — it’s alive, it’s awake, it’s alert, it’s enthusiastic — about the changes,” Strange said in a recent interview. “We’ve hired over 350 staff, which has been great. Now nurses can do nursing work instead of custodial work or food-service work. This last year has been about a restoration of those positions. It’s been getting on top of all that deferred maintenance that had occurred.”
During Strange’s tenure, the hospital has made major safety improvements and now has around-the-clock custodial services. More than 800 patient treatment plans have been reviewed and revised to more effectively meet the needs of each individual, and the hospital has improved its employee recruiting process, she explained.
It dramatically increased the amount of psychiatric treatment patients receive, complying with federal standards for the first time in years. The hospital also developed new strategies for interrupting the violent episodes that a small number of patients experienced, consumed a large amount of staff time and put both patients and staff at risk.
The overall strategy for managing Western State also has changed. Individual wards were given management staff to oversee the patient dynamics that differ from ward to ward.
Through these reforms, the hospital is changing outcomes for patients. Recently, the hospital was able to discharge a number of patients who had been there for more than 15 years, sending them back to their own communities.
In one case, a patient of 20 years who had no ability to see or hear following a traumatic brain injury was able to leave Western State when his care team found him an adult family home in his community, according to the Washington State Department of Social and Health Services.
The environment at Western State was challenging for the man, who had sensory issues. His sensory agitation often led to aggressive behavior, loud yelling and frequent assaults, and his care required four-to-one staffing to keep him safe.
But in February, he was able to leave. DSHS reports that his family and friends are happy to have the man living closer to home.
Though management issues, cultural problems and maintenance needs all stretched Western’s capacity to provide high-quality care, staffing challenges contributed the most to hospital problems. The facility had trouble hiring skilled staff because it couldn’t offer competitive pay. Western State requires a staff of more than 1,800 employees, and the hospital has more than 800 patient beds, according to DSHS.
“The inadequacy of staffing profoundly jeopardized patients at Western State and the primary reason for that is because we could not hire people at this institution,” Inslee said Tuesday. “There were 25 percent gaps between what this institution was paying and what people could make just working down the road, at other hospitals. We fixed that, and because we fixed that we are now providing great-quality care at Western State Hospital.”
Through the hospital’s staffing push, it saw a net increase of 162 direct-care workers from June to November of 2016. It attracted 1,500 qualified applicants, conducted 680 interviews, and 88 percent of its offers to job candidates were accepted, according to DSHS.
The agency also reports that before the hiring project, in June 2016, more than 20 percent of new hires quit before their 45th day of employment, but in March 17, that number was just 4.5 percent.
In the current budget, the state invested $80 million in improving the hospital. The governor’s proposed 2017–19 budget would backfill most of that investment, but Senate Republicans have proposed leaving that money out.
The governor said he hopes state lawmakers will support the reforms at Western State.
“Providing great care requires great people, and there is no way this hospital is going to maintain high-levels of care if we repeat the mistakes of the past and don’t invest in the people doing these very difficult jobs,” Inslee said. “That’s why we need to get Senate Republicans to listen to this issue.”
Despite ongoing improvements in the hospital, these reforms are only part of a larger vision to transform the state’s mental health care system. The governor has proposed creating a patient-centered system with sizable new resources for treating people in the community rather than in large psychiatric hospitals.
Budget proposals in both the House and the Senate include money to work toward that goal.
Under Inslee’s proposal, Western State would focus on serving forensic — or court-ordered — and hard-to-place civil commitment patients while many other civil commitment patients would be served in new, 16-bed regional hospitals run by the state and other community-based care facilities.
Strange expressed her support for that vision.
“I think there will always be a need for the state to take care of its most vulnerable citizens, especially for people with serious and persistent mental illness,” she said. “While we are working hard to get patients back to their home communities, which is where they belong, we cannot turn our backs on those that are seriously mentally ill who are not always able to go back home in a timely manner.”