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Newly-appointed New Hampshire Hospital CEO touts integration



Monitor staff
Saturday, September 23, 2017

Lori Shibinette harbors no illusions about New Hampshire’s mental health crisis. The newly-appointed CEO of the state-run psychiatric hospital says the facility’s patient backlog, which has strained emergency rooms statewide and disrupted timely care, is not about to turn around on a dime.

But stepping into the top role at one of the primary providers for mental health care in the state, Shibinette said she’s putting her faith into a time-tested strategy: relationship building. Key to improve patient access to care, Shibinette said, is making sure that providers at each step of the treatment process communicate closely.

That means keeping tabs on patients as they move from treatment at public and private hospitals, community providers, outpatient facilities and sometimes nursing homes – and catering services provided to each patient’s needs.

“(We’re) talking about breaking down barriers so that the patient’s treatment doesn’t ... begin and then end in one area,” said Shibinette, who begins the role Oct. 20. “We really need to be integrated so that we’re part of each other’s teams.”

It’s a realm in which Shibinette, who presently serves as the deputy commissioner of the Department of Health and Human Services, has some experience. Prior to her appointment to her present post in October 2016, Shibinette served as CEO and administrator of the 290-bed Merrimack County Nursing Home. And at DHHS, she worked to collaborate between New Hampshire Hospital and Glencliff Home, a long-term care facility run by the state.

But the challenges are vast. For years, the waitlist to get treatment at the 168-bed hospital has taken a toll on care. Staff shortages, shuttering regional facilities and sparse community organizations are dragging on New Hampshire health providers’ ability to place patients effectively. The backlog has turned emergency rooms at traditional hospitals into long-term boarding facilities for suicidal and at-risk people waiting for specialized care. And that, in turn, has backlogged emergency room admissions for those needing other treatments.

Addressing the bed shortage will require a multi-front approach, Shibinette said. Among her plans is to review the facility’s in-patient capacity, find improving efficiencies in patient discharges, and collaborate with other providers.

That latter effort will soon be getting a boost: New Hampshire’s latest biennial budget includes funding to create 20 designated receiving facility beds in hospitals for mental health patients. Beyond funding, Shibinette pointed to a recent “nurse-to-nurse” initiative – which increased communication between New Hampshire Hospital staff and local community centers in areas such as collaboration – as evidence of a successful approach.

But in dealing with the crisis, Shibinette has another challenge on her hands: addressing the hospital’s rocky recent history. In May, Shibinette’s predecessor, Bob MacLeod, was asked to resign by Gov. Chris Sununu, following revelations that Dartmouth-Hitchcock Medical Center had failed to provide 10 of 12 physicians promised under contract.

And civil rights activists have long railed against the hospital’s practice of relocating some patients – more than 90 percent of whom are involuntarily committed – to the Secure Psychiatric Unit at the state prison.

Shibinette called that process necessary to ensure the safety of physicians and staff members at the hospital, adding that whether the process continues is a decision to be made by DHHS. As for Dartmouth-Hitchcock, which agreed last month to credit the state $75,000 for a loss of services and will continue to staff the hospital, Shibinette said she is “very confident” that the private organization will meet the hospital’s staffing needs moving forward.

Officials in the private and public sector say Shibinette is well-equipped to handle the challenges.

DHHS Commissioner Jeffrey Meyers, lauded Shibinette’s experience in hospital administration as an asset for the state hospital as it seeks to reorganize itself. The same background that had made her the top candidate for the deputy commissioner post qualified Shibinette for her new hands-on role, Meyers said.

“I felt that she knows the hospital, she’s been interacting with everybody there, she’s well respected, and she can do this job in an exceptional way,” Meyers said at a Monitor editorial board meeting Wednesday.

Susan Stearns, deputy director at the New Hampshire office of the National Alliance on Mental Illness, agreed, saying the organization was “pleased” with the choice.

“She is very much aware of the issues that individuals and families affected by mental illness are facing,” Stearns said. She added that Shibinette’s focus on community provider partnerships is key to solving the patient backlog.

“Those relationships are critical in order to facilitate someone’s discharge,” she said. “... It is very tied together.”

Shibinette agreed.

“We don’t want a wall separating treatment decisions,” she said. “We want to make sure that there is flow, and no fragmentation of care, between the hospital and the community.”

(Ethan DeWitt can be reached at edewitt@cmonitor.com, or on Twitter at @edewittNH.)