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Adam Swanson

Policy Associate

Behavioral Health Center of Excellence: How to Go All In

October 23, 2014 | Community Impact | Comments
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Taking the steps necessary to become a behavioral health center of excellence does not come with a certificate or accreditation – it is simply a model of excellence that improves the care we provide to individuals with behavioral health conditions, and prepares organizations to take advantage of opportunities ahead. 

The National Council recently sat down with Dr. Camis Milam, Executive Vice President for Medical Services at The Center for Health Care Services (CHCS) in San Antonio, Texas (and a member of the 2014 Executive Leadership Program) to discuss her organization’s experience implementing the five elements of a behavioral health center of excellence.

In 2012, CHCS began integrating behavioral and primary health care with a large federally qualified health center (FQHC). However, the ensuing volume-dependent business model did not adequately take into account the characteristics of a complex population with serious mental illnesses and physical conditions. The FQHC exited the partnership after the first year. Since then, the CHCS team has continued work to integrate their own primary care providers within its behavioral health settings. In the process of improving care coordination, the CHCS team has spent the past several months diligently working to implement the standards of a behavioral health center of excellence.

For further background, read the white paper describing the key elements of a behavioral health center of excellence released earlier this year.


Camis MilamNational Council: What inspired you to implement the five elements of a behavioral health center of excellence within your organization?

Dr. Milam: We started to integrate primary care into our services because we weren’t able to find accessible healthcare for our clients. In the process, our Vice President for Adult Behavioral Health came across information on behavioral health centers of excellence and the concept dovetailed so perfectly with other efforts we were already pursuing. We were already talking about excellent outcomescomprehensive careaccess when you need it — so it was simple to go on and think about how to incorporate world class customer service, engagement, wellness, and value. Aiming to become a behavioral health center of excellence ended up being a no brainer.

National Council: How did you go about building buy-in to the elements of a behavioral health center of excellence with staff and leadership?

Dr. Milam: Several things came together at once. First of all, our CEO was very invested in creating a quality culture. We looked at the information on behavioral health centers of excellence that was being put out there and listened to Dale Jarvis’ presentations, and thought, “This makes amazing sense. We need to do this.” We thought we were already doing everything that encompasses a behavioral health center of excellence, but the truth was, we were not systematically sitting down and making sure everything we did fit within a process of excellence. Today, we think about each of the center of excellence elements and we believe in them. Part of the challenge we ran into was: how do we draw people’s attention towards the elements of excellence and how do we incorporate them into absolutely everything we do? And the answer was: consciously, thoughtfully, and with an eye toward what each individual person does and we can help them to be excellent.

National Council: What was the implementation process like and how long did it take you to begin executing the elements of a behavioral health center of excellence?

Dr. Milam: It is very much still a work in process – it is certainly not “done” by any means. We had reached a critical mass of employing physicians who were interested in being leaders of their own teams. We started there. Putting physicians in charge of a team was a big change for our organization; we literally restructured the way folks work within the clinic to allow them to function as small teams of excellence.

My particular focus was a stretch, but we wanted to do something we had never done before, so I tackled the clinical policies and procedures. In the process of reviewing them, I engaged everybody in the clinic from case managers, to nurses, to physicians and asked, “What needs to change? What’s the purpose of having this particular policy and/or procedure, and how does it support the elements of a behavioral health center of excellence?  What is missing that we need to have?”

This process now extends even further. We lead conversations with team leaders around two questions: “What does it take to achieve excellence?” and “Instead of complaining about something, what can we do to make your team better?” We encourage people to look at their own actions and ask them to consider what they can adjust. Staff are invested in building up their teams, and they work with case managers, therapists and clinical administrators to gain buy-in. One thing about physicians — we are competitive. Implementing center of excellence standards gives people motivation to think about, “What can I do to make my team better? What else can we do to get ahead?”

National Council: How did you establish organizational goals for each of the behavioral health center of excellence elements?

Dr. Milam: We are still in the takeoff phase, but once a culture is established in the belief of being a behavioral health center of excellence, everything else comes easily. Several employees brought up issues they had mentioned in the past, but in a new, more engaged way. Our initiative gained a lot of momentum as people began thinking in the context of behavioral health centers of excellence.  Some of the actual pieces that need to happen are not there yet, but the difference now is that when something happens that isn’t the way it should be, instead of the issue flying under the radar, somebody pops up and says, “We can do this better next time, and here is an idea.” It is about changing the way people think and the culture that surrounds our work to have it focused around excellence in every aspect.

National CouncilWhich of the five behavioral health centers of excellence elements have you found to be the most challenging?

Dr. Milam: Customer service, but we’re definitely making progress. To take on the challenge of becoming a center of excellence, we realized that staff needed to be highly engaged with one another, and clients working with a case managers or physicians should feel that whatever services they’re receiving are useful and readily accessible. By increasing staff engagement through team-based coordinated care, the takeaway for clients is now, “Here is your care team and they will provide all these services collectively.” This approach has allowed for a dramatic increase in client engagement, and has allowed each member of the team to really consider the unique care services they provide that no one else can.

National CouncilHave you experienced any obstacles in the process of implementing the center of excellence elements?

Dr. Milam: Of course! I wouldn’t know what to do with a day at work without an obstacle. One example would be the tremendous IT challenges we have run into in creating an integrated medical record. But under new direction our IT department has taken on the center of excellence mentality, and views everyone in the clinic as a customer. So when I have an issue, they address it immediately and treat me like a valued customer. They have exemplified the belief that excellence is something to strive for in every aspect. When you treat everyone and everything with value, you are forced to constantly think about improvement and how you can make things better.

National Council: What is one piece of advice you would give to an organization considering the adoption of behavioral health centers of excellence?

Dr. Milam: The main thing I would want people to know is that you have to go all in. Transitioning work flows to become a behavioral health center of excellence is not going to work the way you think it is going to work; it is going to take longer than you had planned, but your organization will be different on the other side. You have to be prepared for change. We are reinventing ourselves and it is a huge process. There are going be pockets of resistance, but if you approach it from the perspective that we’re all in this together – we are a behavioral health center of excellence – people will get on board. It has really changed the way we approach the services we provide. We’re not on the other side yet, but we’re already a different organization. And it is not just our external face, this is who we are – we are a center of excellence, and we do all of the things that a behavioral health center of excellence should do.


Is your organization in the process of setting new standards of excellence? Share your story in the comments section of this blog. Or perhaps your organization is interested in implementing the elements of a behavioral health center of excellence? Is a center of excellence a concept you think you can achieve? Contact the National Council to inquire about how we can help.