SWOT Analysis 1

SWOT Analysis: Sutter Center for Psychiatry Outpatient Program

Thuy Lindsay Dao

Saint Mary's University of Minnesota

Schools of Graduate & Professional Programs

HS720 Strategic Health and Human Service Leadership

Becky Brodin, RN, MA, CNOR(e)

March 1, 2018
SWOT Analysis 2

S W
- The only Outpatient Program that is part of a - Limited Per Diem pool to address
not-for-profit integrated health care system in staffing shortages therefore impacting
Northern California delivery of services.
- An extension of Sutter Center for Psychiatry - Does not have designated Outpatient
which offers step down program that
psychiatrists- shares same
transitions from Inpatient to Outpatient
(inpatient referrals)
psychiatrists as inpatient
- Offers an Intensive Outpatient Program (IOP) - Poor succession planning
for 5 days/week treatment for 6 hours/day - Not on same campus as Inpatient
- Offers a Partial Hospitalization Program hospital: isolation (employee)
(PHP) for 3 days/week treatment for 3 - Does not offer transportation services
hours/day - 7 years ago, stopped contract with
- Offers an Adult program and an Adolescent Sacramento County. No longer
Program (days and evenings) accepting Medicare
- Interdisciplinary Care that includes - Does not have own Outreach
Psychologist, Psychiatrist, Licensed Clinical Coordinator, depends on Inpatient
Social Workers, Registered Nurses, Music
Outreach Coordinator for marketing
Therapy, Recreational Therapy, Chaplain
- Individual therapy session with Psychologist;
and promoting referrals
Family Therapy - Heavily relies on referrals or step-down
- Follows Recovery Philosophy and specialize patients from inpatient hospital.
in Dialectical Behavioral Therapy, CBT - Does not offer competitive pay
- Offers tracks for individualized treatment: comparative to for-profit organizations
Depression, Substance Abuse, Bi-Polar,
O T
- Provide a Child Outpatient program (4-12 - Sierra Vista Hospital opened an
years) to capture opportunity for growth. Outpatient program for Adolescents
Sutter Center for Psychiatry is the only and Adults. Located 15 miles away
hospital that provides inpatient program - Changes in Healthcare on a national
for children, in Northern California. and federal level
- Develop a Social Work Fellowship - Does not accept County Insurance,
program and Psychology Post-Doctoral relies heavily on referrals and private
program - California State University,
- Employ Outreach Coordinator specifically Sacramento, received grant and offers
designated to Outpatient Program campus mental health for 1:1 therapy.
Located 2 miles away
- Stigma of mental health: decrease
census
- Specialized outpatient clinics are
expanding in Sacramento (Anxiety
center, Addiction center, Eating d/o)
- Changes in health insurance market
- Nearby Medical Hospitals are starting
to offer outpatient programs
SWOT Analysis 3

Sutter Center for Psychiatry is a private, not-for-profit behavioral health care entity,

which provides services to the Sacramento, California region. It is part of the Sutter Medical

Centers group of hospitals in the Sutter Health network. Sutter Center for Psychiatry (SCP)

hospital is a 73-bed freestanding acute psychiatric facility. In addition, SCP operates an off-site

Partial Hospitalization Program (PhP) and Intensive Outpatient Program (IOP) under its

umbrella of care. The Partial Hospitalization Program, offered 5 days a week, provides a full

range of psychiatric, mental health and co-occurring substance abuse services. It is the only

comprehensive mental health system in the Sacramento region, which operates as part of a

nonprofit, integrated health care system. Outpatient services is a voluntary program that follows

the recovery approach model of care and provides both Dialectical Behavior Therapy (DBT) and

Cognitive Behavior Therapy (CBT). Kidd, Kenny & McKinstry (2014) states, “organizational

commitment to recovery-oriented care requires consumer leadership, a recovery vision, work-

place support structures, quality improvement though evaluation, workforce planning, resources

and programs supporting peer support” (p. 45). Services can assist with symptom reduction in

patients with anxiety disorders, bi polar disorders, major depressive disorder, posttraumatic stress

disorder and co-occurring disorders. The Intensive Outpatient Program is designed to treat

mental health needs just as the Partial Hospitalization Program, but it’s offered at fewer hours a

week and includes an evening program (About Php, n.d.).

Strength lies in their outpatient center being in connection with the main hospital, Sutter

Center for Psychiatry. Admission to the outpatient programs can be directly from the community

or as a step-down service from an inpatient hospitalization stay, therefore improving continuity

of care. Another strength is their cohesive unit is formed with organizational administrative

leaders, medical and psychiatric staff, nursing staff, social workers, recreational therapists, and
SWOT Analysis 4

other licensed mental health professionals functioning collaboratively as an interdisciplinary

team to achieve positive patient outcomes. In 2016, Sutter Partial Hospitalization Program

recently expanded to a new $1.1 million outpatient psychiatry center and increased capacity for

serving more clients with individualized program tracks. In addition, Sutter Health is known as

one of the leading organizational for mental and behavioral health programs in the Greater

Sacramento area, and is actively promoted by the Sacramento Mayor Steinberg.

With the strengths of the Outpatient Center, there are some weaknesses as well.

Organizations, as part of society, have a responsibility to behave ethically. In this view,

responsible health care leaders have an ethical duty to care about multiple stakeholders because it

is simply the right thing to do. Social responsibility becomes as integral to the business as is

economic performance. It is argued that positive ethical duty exists whether or not an economic

payoff is likely to result (Trevino and Nelson, 2014, p. 321). The Partial Hospitalization Program

has expanded significantly in census after opening the new $1.1 million outpatient psychiatry

center. Despite this growth in client census, the Partial program “shares” the same psychiatrists

as the inpatient program. This results in a delay in patient care, lack of inconsistencies and

workflow as the inpatient services may impeded on the Psychiatrist’s ability to meet with their

clients in the outpatient program. In addition, the Partial program has not expanded their staffing

structure in relations to the expansion in their client population. According to Baker, Baker and

Dworkin (2018), the organizational plan should describe the management team. But it should

also describe how the proposed service fits into the organization (p. 310). This leaves their day-

to-day operations unpredictable and demanding.

As part of the Sutter Health network, there are significant opportunities for the

Partial program, in which the most significant and impactful would be to expand their program to
SWOT Analysis 5

include a Children’s Intensive Outpatient program. There are less than 60 beds exclusively for

children aged 11 and under requiring inpatient psychiatric services, compared to more than 500

beds for adolescents 12 and up. While new adult and adolescent only are being added to the

California market, no one is adding child services. The reason is risk and cost. Child units

require more staffing, teachers and specialists than other psych units. These units treat children

that are severely mentally ill and have no other options for treatment. Some argue that children

should not be treated in an inpatient unit, but the inpatient setting allows for proper observation

of behaviors, responses to medications, sleep patterns, family dynamics, peer and social skills on

a 24/7 basis. Most families in California do not understand that, insured or not, wealthy or

indigent, access to services for California children are extremely limited and in many cases

simply unavailable (www.calhospital.org).

With the severely lack of inpatient psychiatric beds of children, there are even less

intensive partial hospitalization programs. Expanding Sutter Center for Psychiatry’s Intensive

Outpatient Program to include a Children’s Partial Hospitalization Program will meet the current

demands of pediatric mental health services in California. Expanding the Intensive Outpatient

Program will increase revenue for Sutter Center for Psychiatry as the accepted funding would be

in the form of private payers. Overall, it is expected that there is a strong marketing niche for the

expanded program due to the existing relationships with referral sources, in addition to expecting

the majority of participants will have managed care networks as their funding source.

The Affordable Care Act of 2010 aims to make broad changes to the structure of the U.S.

health care system and includes a host of provisions to improve access to insurance, restructure

care delivery, and improve quality of care (Garfield & Druss, 2012, p. 675). Included in the ten -

essential health benefits category of the ACA 2010 is the inclusion of mental health and
SWOT Analysis 6

substance use disorder services. With changes in the health care climate, the ambiguity of the

health insurance market poses as a threat to the Partial Hospitalization program in terms of their

financial sustainability. In addition, the diversity and abundance of health organizations,

programs and clinics poses as a threat to the growth of Sutter’s Outpatient program as it creates a

competitive environment that is further exacerbated due to the Outpatient program not having

their own designated Outreach division.

Recommendations

It is recommended to ensure the success of Sutter’s Outpatient program, is to develop a 5-

year action plan that focuses on developing the expanded program of creating an Outpatient

Children’s program. Sustaining the expanded Outpatient Children’s program would be based on

three strategic components to the financial plan: 1) Securing contracts current vendors and

county programs to establish consistent referral sources, 2) Strategically manage staffing matrix

and structure to control labor costs, and work aggressively with stakeholders (inpatient services,

Director of Access and Outreach, etc) to drive the goal of meeting the maximum serviced

participants of and 3) Deliver billing claims within 24 hours from when service was rendered to

obtain receivables within 30-day period

REFERECES:

Baker, J. J., Baker, R. W., & Dworkin, N. R. (2018). Health care finance: Basic tools for

nonfinancial managers (5thed.). Burlington, MA: Jones & Bartlett Learning.

Child and adolescent inpatient psychiatric beds in California [Pdf]. (2015, August 6). California:

www.calhospital.org.

Garfield, R. L., & Druss, B. G. (2012). Health Reform, Health Insurance, and Mental Health

Care. American Journal of Psychiatry,169(7), 675-677.

doi:10.1176/appi.ajp.2012.12040506

Kidd, S., Kenny, A., & Mckinstry, C. (2014). Exploring the meaning of recovery-oriented care:

An action-research study. International Journal of Mental Health, 24(1), 38-48.

doi:10.1111/inm.12095.