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The University of Virginia Health System is a large academic medical center with approximately 7,500 faculty and staff. The system includes a Center for Appreciative Practice, which facilitates and spreads the use of appreciative inquiry (AI) methodology throughout the organization. AI was successfully applied within the health system to improve the transition from inpatient psychiatric care to outpatient mental health services.
Leaders of the inpatient psychiatric unit recognized the need for better communication and collaboration with community services for outpatients. Too often, patients discharged from inpatient care did not successfully transition to care in the outpatient facility or community service site to which they were referred. Frequently, these patients would experience a psychiatric deterioration and require readmission. Leaders believed that better communication and improved relationships among inpatient and outpatient care providers and community service providers would help prevent these transition issues.
Faculty of the Center for Appreciative Practice facilitated a two-day event focused on application of AI towards this goal. A total of 50 attendees gathered for three hours each day; attendees included physicians, nurses, representatives of community services groups, members of a mental health advocacy group, and individuals who had used inpatient services at the health system in the past.
On the first day, the facilitators walked the group through a discovery process in which participants reflected on the positive aspects of the current state of mental health care in the community and the present care transition process. Participants told stories of their experiences that illustrated commitment, collaboration, empowerment, empathy and perseverance. Next, participants described the ideal state of how they hoped care transitions could be. They listed improved access to substance abuse treatment services, additional face-to-face and electronic networks for providers, and the development of a transition clinic staffed jointly by inpatient and outpatient care providers. An especially moving moment occurred when one of the patient participants reflected on his experience of the day: “I can't believe how much you all care about us.” On the second day of the event, facilitators helped the group create a revised transition process and begin plans for future implementation. As part of the new process, the group agreed upon a common format for care plans that would travel between sites and a common form for shared documentation.
As a result of the AI event, the connection and communication between inpatient care providers and outpatient community groups has improved. During the event, attendees learned about the services available from the other groups and about the roles of various members of those groups. Colleagues in outpatient settings, many of whom had worked together virtually for years, met in person for the first time, fostering improved professional relationships. After the event, connections continued to grow. An inpatient nurse joined the board of a mental health advocacy group. Clinicians from the inpatient unit began volunteering at a homeless shelter that was frequented by patients. Individuals from community mental health groups hosted three educational sessions for inpatient staff and created a handout listing available community resources. Throughout the two-day event and during the subsequent action steps, AI facilitated improved connections between inpatient, outpatient, and community services and a produced a new transition process. Ultimately, patients benefit from smoother transitions and patient satisfaction scores have improved for psychiatric services.
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