Q&A WITH JACQUELINE HOBBS M.D., PH.D.
Over the past three years, a hardworking group of doctors, nurses and operations leaders have led a process-improvement initiative to enhance care for emergency patients with behavioral health conditions. Their approach aims to preserve the dignity of this vulnerable patient population in the acute care setting. A specific priority has been to improve E.R. patient transport and hand-off to other units, emphasizing a safe and respectful experience for each customer.
The Behavioral Health Work Group, or BHWG, has expanded to include representatives not only from emergency medicine, psychiatry, nursing and patient services and operations, but also from facilities, legal services, pharmacy, quality and safety, security, social work and transportation. The group now addresses issues such as patient elopement prevention, suicide screening and assessment, involuntary hospitalization (Baker Act and Marchman Act) training and tracking, hand-off communication, safety concerns for patients and staff, privacy concerns and patient education. The BHWG’s evolution has provided a very active hospital wide, multidisciplinary forum for faculty and staff discussion, problem-solving and strategic development as advocates for patients with behavioral health challenges. One major outcome has been a complete overhaul of our inpatient suicide risk screening and assessment, based on new requirements from The Joint Commission.
Guiding the work group for two years has been its chair, Jacqueline Hobbs, M.D., Ph.D., a UF College of Medicine associate professor of psychiatry. She also serves as the psychiatry department vice chair for education, residency training director and a physician director of quality, or PDQ.
What does quality in behavioral health care mean to you?
To me, quality means that every patient, no matter where they enter our system, will have their behavioral health concerns recognized and addressed in a dignified and compassionate manner. It also means standardizing our processes to offer the best possible outcomes. In July, we updated our suicide screening process. Without these standard questions, quality outcomes may be adversely impacted. Health care providers may not ask about risk factors in the same way, and serious indicators could be overlooked.
How does a person’s mental health affect other aspects of their health?
It is difficult to have good physical health without good mental health and vice versa. In the worst-case scenario, someone could end their life, but there is also a full spectrum of harmful effects that impact achieving one’s full potential in life, including poor performance in school and work, troubled social function or isolation. Additionally, even if a health care team formulated the best treatment plan for a patient’s physical needs, if mental health is not addressed, the patient may never carry out that perfect plan, and their overall health will continue to suffer.
How does the Behavioral Health Work Group address stigma in mental health?
The BHWG provides a forum for a multidisciplinary group to evaluate and work on improving our current practices. I think talking about mental illness in the BHWG — educating each other on how to treat mentally ill patients both personally and medically — helps overcome the stigma.
Why do a patient’s psychiatrist and psychologist notes remain private and inaccessible to other health care providers? How does that create a barrier to providing the best patient care?
Our patients frequently move between non-behavioral and behavioral health care arenas. Providers in each need to know certain facts to provide the best care. Psychiatrists and psychologists are held to high standards of confidentiality, both ethically and by law, and their notes are kept under lock and key. Part of our notes contains the intimate details our patients share with us, which aren’t necessary for other health care staff to know. We also document medications patients are taking, side effects they’ve experienced and their health histories — that’s what other providers need to know. The plan is to keep the intimate details in a separate, private note — and make the other, relevant information in the patient’s medical record available to other physicians and staff.
How is UF Health preparing the next generation of medical professionals to care for patients with behavioral health concerns?
Our medical students spend six weeks on a rotation focused on psychiatry and addiction medicine. That’s a significant rotation in medical school. This time is crucial to helping future doctors understand these disorders and their impacts on overall health. In addition, our psychiatrists visit other departments to educate physicians and staff on these issues. We also have Handle with Care courses that demonstrate how to engage with these patients.
What research has sparked your interest lately?
Part of my background is in research, so I’m very interested in gene therapy for mental illness— finding genes that impact mental health and learning how to replace them. On the other hand, I’m an educator, so I have been engrossed in psychiatry curriculum redesign. We are constantly discovering different and better teaching methods, and neuroscience is continuously evolving, so we have to keep up.
