07/16/12 — Welsh named CEO at Cherry

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Welsh named CEO at Cherry

By Matthew Whittle
Published in News on July 16, 2012 1:46 PM

After nearly a year at the helm as interim director at Cherry Hospital, Luckey Welsh took the reins on a more permanent basis Wednesday as state Department of Health and Human Services named him chief executive officer of the state psychiatric facility.

And while, for Welsh, the move means stepping down as the director of DHHS State Operated Healthcare Facilities -- a position he will hold on an interim basis until the end of the year -- he said he is excited to help lead Cherry as it prepares to move into a new facility and to expand its staff by a third.

"Moving a hospital is a big deal, and it's going to take a lot of time and effort to find and recruit all the new people we'll need," Welsh said.

And as somebody who has worked closely with the state mental health system for more than three years, and who has spent the last 11 months intimately involved in the operation of Cherry Hospital, he more than knows the challenges facing him.

"Anytime you bring in a new CEO from outside the system, they have their own way of doing things," Welsh said. "I've gotten to know the people here and they know me. Cherry has really made some positive strides, and we don't want to interrupt that."

But, he said, he feels he can say with confidence that the hospital will continue to improve -- thanks to the facility's staff and leadership team and a continuing effort, funded by the General Assembly, to continue to implement a certain standard of care.

And one part of that is to reduce the use of restraints.

"We want to continue to reduce the use of restraints. Even though we can't completely eliminate it, we don't want that to be the first course of action," Welsh said.

The first course of action, he explained, needs to be de-escalating situations in which patients could become upset and then a danger to themselves or others.

But, he said, making the necessary improvements is not just a matter of talking about it, it's also a matter of continuing to train and educate employees -- something he commended Clinical Director Dr. Jim Mayo for focusing on, and something he said will continue to be a priority.

"It's a continual thing," he said.

He also explained that not every nurse or health care technician comes from a background in mental health, and so making sure they learn about and understand the mental illnesses behind the patients and their actions also is a critical component.

Additionally, Welsh said, they are working to train supervisors, and teach them how manage their people better. After all, he said, "Supervising is something you have to learn how to do, and we need to give them the tools to do it well."

But more than that, Welsh said, he and his leadership team are focused on continuing to change the overall culture at Cherry with the help of a program used in hospitals across the nation called Just Culture - an effort being paid for by a three-year grant from the Duke Endowment. The program, he explained, is intended to help create "an environment that is fair and just."

"Every day the employees in our system and at Cherry Hospital come in and go to work," Welsh said. "They don't come in intending to make a mistake."

The program therefore looks at mistakes on three levels, he explained -- those that occur even though the employee followed proper procedure, those that occur because the employee was operating just outside the normal guidelines, and those that occur because the employee is being reckless, and then deals with each of those appropriately. The program also, he continued, forces administrators to examine the systems in which the employees are operating to ensure there is consistency from hospital to hospital and department to department.

The goal, Welsh said, is improve communication and trust between line employees, their supervisors and the administration, creating a culture in which people aren't afraid to make mistakes, and even more important, to report when mistakes are made.

"If people make a human error, if they don't feel they're going to be treated fairly, they don't report it," he said. "So you have to change the culture to say, 'It's OK to make a mistake. We're going help you.'

"This program is going to put us all in the room together. Anytime employees feel they're being treated fairly, they'll be better employees.

"I tell people, you've got to help me help you. I'm on a learning curve and I'm open to learning. To have quality patient care, you've got to take care of your employees. I've never seen an unhappy employee who's cared for a patient very well for long."

But not only is Welsh faced with continuing to improve the culture of a hospital where he says incidents of both patient and staff injuries are on the decline -- while acknowledging that those numbers "are not where we want them to be yet" -- he's also faced with the prospect of moving into a brand-new, "state-of-the-art" facility by spring, and then hiring 387 new people on top of the 900 already in place to care for the nearly 300 beds he expects Cherry's 38 eastern North Carolina counties will have no trouble filling.

With the facility about 30 days behind, he said he's been told he will have the keys by the end of January, and then that they will be able to move in by April or May. And while the section closest to West Ash Street may not look like much, he said, the building is being completed back to front and is beginning to really take shape and look like a hospital, which is starting to create a lot of excitement.

"Any time there's change, people get worried. People have been in these buildings (on the current campus) a long time. But our people getting anxious to get in there," he said. "And I see this as a chance for a new beginning here.

"We're accountable for the people who come here. This is not just a job that people come to. This is a real mission we're on."

He estimates that about 3 percent of people with mental illnesses who require a clinical intervention wind up at Cherry Hospital, and those who do often average about a 25-day stay, longer than in recent years.

"The patients we get are the one nobody else can help. We're the safety net," Welsh said. "The state hospitals really fulfill a great need."

And, he added, the Legislature and the governor have begun to notice.

"I told my people, the governor and this Legislature have put a lot of faith in you, and a lot of expense in you that we're now accountable for. Given this opportunity, we can't blow it."

He is aware, though, of Cherry's reputation as a place that can be tough on its directors, having had little continuity in its leadership over the last 10 years. And, Welsh acknowledged, he will likely only be in the position for two to three years -- long enough to see Cherry through its upcoming transitionatory phase and leave it in a stable place for the next in line.

"I came to the decision I would see Cherry through these two major transitions, which will likely take two or three years." Welsh said. "The average hospital director tenure is five years. I want to take Cherry at this critical time and get it on sound footing. I'll leave it better than I found it -- that's my goal."