Perfect Care Initiative

Henry Ford Health System has adopted something that they call the Perfect Depression Care initiative that establishes the goal of eliminating suicide.

Here are the tactics they’ve identified:

The Perfect Depression Care initiative includes six major tactics:

  1. commit to “perfection” (zero suicides) as a goal;
  2. develop a clear vision of how each patient’s care will change;
  3. listen to patients regarding their care redesign;
  4. conceptualize, design and test strategies for improving patient partnership, clinical practice, access to care and information systems;
  5. implement relevant measures of care quality, assess progress and adjust as needed; and
  6. communicate the results.

Here’s some discussion about how they’ve operationalized these tactics:

“There’s nothing unique about the strategies,” Coffey said. “Everyone would say they’re doing the same thing. We assess the risk and do everything we can do to lessen that risk,” he adds. “I do think we have developed some unique tactics that have helped,” he says, adding that staff members do not spend much time making distinctions between levels of risk because they accept that any patient will be at risk.

For example, Coffey explains, there is a difference between a patient who needs “emergent” intervention — which describes a scenario in which a patient does not leave the office until a plan is established — and one who requires “urgent” intervention, which is for someone who could be seen the next day. “Even that — making that fine a distinction — is difficult to do as well,” Coffey said, adding that the real issue is that everyone is at risk, and often assigning “low risk” can lead to a false sense of security.

With that in mind, staff members try several things at one time to address the problem, which often makes it hard to know which “change” is working.

One intervention the team uses relates to the availability of weapons. Because the majority of suicides results from impulsive acts, it is important to make it harder for patients to act on those impulses, Coffey says. For this, patients are asked about the types of weapons they have access to at home and are asked to check again and then call a staff member. If a staff member from the department does not hear back, he or she will follow up. “It’s unbelievable what people find that they didn’t report,” Coffey said. “Sometimes, they really didn’t know.”

As Coffey explains, the department leaves the definition of weapon to the patient and family. So, while guns would be included for sure, if there are other potential weapons in the home, patients are encouraged to remove those also.

What might this look like for addiction treatment? It’s important to note that they report that this has not taken more time. It seems to emphasize different mindsets and processes. I’d love to hear how Dawn Farm folk and others would operationalize something like this to manage addiction.