I very much agree with Ruth, the only additional thing I might add is remember that building leadership skills takes time. (unless you import it). That means early identification of potentials, ensuring the necessary skills training and allowing exposure to greater and greater leadership roles.
However, there needs to be some aspect of customisation of what Ruth has mentioned. Including emphasis of the unit goals, visions and objectives. Unit values and culture. Also, mentoring is important.
We are also in the midst of “vertical integration” of our mental health services with the herculean task of engaging a very heterogenous primary care and volunteer welfare organisations (VWOs). Whilst things are in a state of flux and it is tempting to wait for things to settle down, I would suggest that a dynamic state of flux is the natural state of any healthcare organisation.
I would suggest a multi-prong approach to laydown some groundwork. We have looked into upskilling our primary care physicians and VWOs via training programs as well as a support network. Structurely, as things are being re-organised, we have to advocate that there should be no financial gradient for the patient between seeing a hospital and private primary care provider. Similarly, the provision of medications and services should not be that different.
We have assigned teams to geographical regions to build up relationships with the community partners, adopting a 70/30 approach.
This groundwork hopefully will allow us to adapt to systemic changes in the future.
We face similar situations. Some HODs step-down with a huge sigh of relief as they recognise that administration isn’t their forte and are happy to return to clinical and education. However, there are some who are unable to let go. In these cases, I would agree with SN and Ulli and find someway to arrange a “lateral” promotion for such individuals. Ultimately, a healthcare facility is subject to certain goals and KPIs. Including a responsiblity to ensure a healthy team to provide best care for patients.
1. Well trained nurses are always a premium. What we did was to look at what nurses are required to do and see if the tasks can be done by non-nurses such as nursing aids and volunteers. Investment in training and upskilling of these helps us stretch the capabilities of each nurse further.
2. Its a struggle to expand long term facilities. Probaly the greatest effect is intervention at primary care level.
I think most Emergency services would face similar problems. Whilst it would be ideal to have close mental health support and services, the reality is that it is not cost effective. I would suggest more data is required. What are the common behavioural health presentations. Are there variations throughout the day/month/year.
Can the presentations be risk stratified? Minor cases can be handled by a counsellor, referral to an external provider or even the emergency staff. We found that emergency staff still need some basic trainings in mental health first aid and risk assessments.
For moderate to severe cases, if there are commonalities, some form of treatment algorithms/pathways may be possible. Thereby hopefully lessening the reliance on manpower.