Breakout F – October 13, 2011

What can a Toyota car teach us about implementation of an evidence based group psychotherapy program?
Presentation Slides

Brad Steinfeld, Nicole Shiraev, Gavin Vilander, Julie Lindberg, and Jennifer Scott, Group Health

Discussant: Kelly Koerner 

Abstract:    How do you in implement an evidence based practice (EBP) group psychotherapy program that is integrated into a large scale care delivery system, is aligned with the objectives of the organization, engages staff and most importantly meets the needs of patients (or members) presenting with mental health concerns? This symposium will detail how a mental health department within a large integrated health care setting applied Lean management principles in the development of a group psychotherapy program for the treatment of depression and anxiety. Lean is a continuous improvement approach that originated in manufacturing settings during the early 20th century and came to prominence with the rise of the Toyota Production System. Presenters will offer perspectives from the customers (i.e. patients), the stakeholders (i.e. therapist), and management (both local and executive) groups. Data on patient clinical outcomes, as well as strategies for both maximizing staff engagement while at the same time maintaining fidelity to evidence based model will be presented. The presenters will highlight what we have learned about applying Lean to a mental health care delivery model and will discuss potential implications for future research in dissemination and implementation of EBP.


1. Developing and Implementing a Group Psychotherapy Program: What Do the Patients Think?

Brad Steinfeld, PhD Group Health

Abstract:    Foundational to Lean management principles is making sure that the improvement process being developed is based upon what is most important to the customer or in the case of behavioral health the individual (often referred to as client or patient) who presents with some type of mental health difficulty. The intent with this presentation is to have the customer requirements to be shared by an actual patient who has participated in the Group Health group psychotherapy program. Topics to be addressed include: 

  • Key customer requirements in terms of service, quality, and cost for the group psychotherapy program 
  • Patients’ experience with the Group Health group psychotherapy program. Did it meet their requirements? What are their future program improvement recommendations? 


2. Engaging the Mental Health Clinician in Developing and Implementing a Group Psychotherapy Program

Nicole Shiraev, LICSW, Group Health

Abstract:  One of the frequent challenges in implementation of an EBP is making an evidence based program practical, meaningful, and relevant to the front line clinician. Lean improvement process principles emphasize that the person doing the work is most knowledgeable about the process (in this case, group psychotherapy) and in the best position to determine the way to improve the process. This presentation will involve having a front line mental health clinician Discuss the following topics: 

  • Clinician requirements and concerns related to doing a group psychotherapy program 
  • Clinician role in the development of the group psychotherapy program. 
  • Clinician experiences with implementation particularly focusing on adherence to treatment fidelity or what is referred to in a Lean management system as standard work. 

3.  Integrating Implementation of Evidence Based Group Psychotherapy Program into Ongoing Service Delivery

Gavin Vilander, Group Health

Abstract:    Implementing a program improvement such as an evidence based group psychotherapy program in a clinical setting involves many administrative and clinical challenges. How do you develop the administrative infrastructure necessary to support the program? How do you insure that clinicians actively participate in the program both in terms of making the referrals necessary for the program as well as adhering to the agreed upon structure of the group’s process and clinical content? This presentation will describe how a clinic manager uses Lean principles of daily management, standard work, job breakdowns, and visual systems to both promote and insure this work. A particular focus will be on how to best address the challenges that often go with doing program innovation while at the same time needing to provide ongoing clinical care in a busy multidisciplinary outpatient mental health clinic.
4. The Role of Executive Leadership in Dissemination and Implementation of Evidence Based Practices

Julie Lindberg, MSW, Group Health

Abstract:     Organizational leadership is critical to insuring that there is the sponsorship, resources, and commitment necessary to sustain clinical innovation. How does a leader develop and sustain the vision of change? How does one utilize Lean management principles of rounding, huddles, and tiered checking to help promote and insure program development and improvement? This presentation by a leader within the Group Heath Behavioral Health services will describe her experience in leading the group psychotherapy improvement process. Key areas of focus will include how to establish targets, obtain resources, and develop the organizational structure necessary to both plan, develop, and implement this change effort.

Evaluating the Effectiveness of a Group Psychotherapy Program

Jennifer Scott, BA, Group Health

Abstract:  What difference does group psychotherapy make for patients? How has this program met its intended goals of improving clinical and service outcomes while at the same time being cost effective? This presentation will focus on the clinical, services, and cost outcomes of the group psychotherapy program. Information related to utilization of the program, patient satisfaction, cost effectiveness, and clinical outcomes will be presented. Particular focus will be on how a Lean management system can help promote integration of outcomes into ongoing administrative and clinical care processes.