Front Matter

Professor of Psychiatry; Director, Center for Mental Health and Sport, Western University of Health Sciences, Pomona, California

Professor Emeritus, Department of Psychiatry and Behavioral Medicine, University of South Carolina School of Medicine, Greenville, South Carolina

Professor of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania

Professor Emeritus, Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington

Distinguished Service Professor and Chair Emeritus, SUNY Downstate Medical Center, Brooklyn, New York

Professor of Psychiatry, Harvard Medical School; and Clinical Supervisor, Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts

Clinical Professor of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York

Clinical Professor of Psychiatry and Behavioral Sciences, The George Washington School of Medicine and Health Sciences, Washington, D.C.

Contributors xi

Preface xvii

Introduction xix

PART 1

Basic Concepts

1 Psychiatric Leadership 3

2 Organizational Theory 17

The Advance of Scientific Management, Behavioral Science, and Social Science in the Workplace

3 Behavioral Health Care Landscape 33

Who Needs It? Who Buys It?

4 Inclusion: Voices of People in Recovery 59

PART 2

Program Development and Strategies for Dealing With Organizational Challenges

5 Organized Psychiatric Health Care Systems 77

Private Practices, Community-Based Clinics, Hospitals, and Health Systems

6 Planning 95

7 Business Development 111

Revenue Generation, Marketing, and Philanthropy

PART 3

Management

8 Implementation of Innovations in Routine Clinical Practice 131

Principles and Challenges

9 Training 153

What Do Psychiatrists Need to Learn About Administration?

10 Governance: Internal (Institutional) and External (Governmental Legislation and Regulation) 173

Who Runs and Navigates?

11 Introduction to Talent Management 187

Acquiring and Retaining the Talent Essential to Success

12 Fundamentals of Human Resource Management 209

13 No More Frostbite 227

Budgeting and Financial Management of Mental Health Programs

14 Financing of Health Care Services 245

15 Leading a Healthy Team 267

Addressing Staff Burnout and Cultivating Well-Being

16 Diversity and Leadership 291

PART 4

Law and Ethics

17 Legal and Regulatory Issues Affecting Psychiatric Practice 309

18 Psychiatric Malpractice 323

19 Ethics in Clinical Leadership 341

PART 5

Evaluation of Psychiatric Services

20 Institutional Accreditation and Licensure 361

21 Quality and Performance Improvement 375

22 Outcome Assessment and Measurement-Based Care 391

PART 6

Information Technology

23 Health Information Technology 415

24 Using Technology for Providing Care 435

25 Privacy and Security for Psychiatry Health Information Technology 459

PART 7

Conclusion

26 Leadership: A Personal Perspective 477

Index 483

Associate Professor of Psychiatry, Rutgers New Jersey Medical School, Newark, New Jersey

Medical Director, Health Home, Northwell Health, Manhasset, New York

Chief Medical Information Officer, South Carolina Department of Mental Health; and Clinical Assistant Professor, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina

Chief Medical Officer and Training and Research Director, CDC Office of Mental Health, Amsterdam, The Netherlands; and President, American Association for Psychiatric Administration and Leadership, Dallas, Texas

Clinical Assistant Professor (Affiliated), Stanford University School of Medicine, Palo Alto, California

Pediatric Therapist and Consultant, Private Practice, San Francisco, California

General and Forensic Psychiatrist, Central Regional Hospital, North Carolina Department of Health and Human Services, Butner, North Carolina

Vice Chair, Clinical Affairs; Director, Community Psychiatry Program; and Associate Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine and Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Assistant Professor, Director of Psychiatry Residency Training, and Director of Consultation-Liaison Psychiatry, Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Co-Founder, Bluestone Health, PLLC, and Chief Medical Officer, MindHealthy, New York, New York

Aerospace Psychiatrist, Human and Health and Performance Contract, Behavioral Health and Performance Operations Group, NASA Johnson Space Center, Houston, Texas

Vice President (Retired), Philanthropy, Hartford Hospital, Hartford, Connecticut

Clinical Professor, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California

Former Field Representative/Physician Surveyor, Division of Accreditation and Certification Operations, The Joint Commission, Oakbrook Terrace, Illinois

Executive Director, National Association of State Mental Health Program Directors, Alexandria, Virginia

Professor, School of Medicine, Department of Psychiatry, University of California, Davis, Sacramento, California

Associate Professor, University of California, Davis, Sacramento, California

Peer Support and Coordination, UPMC Western Behavioral Health, McKeesport, Pennsylvania

Vice President and Chief Medical Officer, ViTel Net, McLean, Virginia

Professor Emeritus of Psychiatry and Behavioral Medicine, Atrium Health Wake Forest Baptist Health Sciences; and Field Representative/Physician Surveyor, Division of Accreditation and Certification Operations, The Joint Commission, Oakbrook Terrace, Illinois

Professor, Department of Psychiatry and Behavioral Health; The Joyce D. Kales University Chair in Community Psychiatry, Pennsylvania State University College of Medicine; and Chief Medical Officer, Pennsylvania Psychiatric Institute, Department of Psychiatry and Behavioral Health, Hershey, Pennsylvania

Daniel Lieberman Professor and Chair, Department of Psychiatry and Human Behavior, Thomas Jefferson University–Sidney Kimmel Medical College; and Senior Vice President of Behavioral Health, Philadelphia, Pennsylvania

Assistant Research Scientist, University of California Los Angeles Center for Health Services and Society, Los Angeles, California

Chief of Psychiatry and Deputy Chief of Staff for Mental Health, Social Work, and Homeless Programs at VA Palo Alto Healthcare System; and Associate Professor, Stanford University School of Medicine, Palo Alto, California

Chief Medical Officer, Alliance Health; and Adjunct Assistant Professor, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina

Senior Director of Communications, Hartford HealthCare, Hartford, Connecticut

Associate Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland

Director, Forensic Psychiatry Fellowship, University Hospitals Cleveland Medical Center; Professor of Psychiatry, Case Western Reserve University School of Medicine; Adjunct Faculty, Case Western Reserve University School of Law; and Adjunct Faculty, University of Akron School of Law, Cleveland, Ohio

Attending Psychiatrist, Alameda Health System, San Leandro, California

Professor and Chairman, The Paul and Ruth Jonas Chair in Mental Health, and Chief of Psychiatry for OU Health, Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Faculty Researcher, School of Medicine, Department of Psychiatry, University of California, Davis, Sacramento, California

President & CEO, Services for the UnderServed, Inc., New York, New York

Chair and the Katharine Dexter McCormick and Stanley McCormick Memorial Professor, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California

Vice Chair, Clinical Business Development; and Professor (Clinical), Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland

Professor and Chair Emeritus, Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University (ECU), Greenville, North Carolina; Founding Director of the ECU Center for Telepsychiatry and e-Behavioral Health; and Founding Executive Director of the North Carolina Statewide Telepsychiatry Program (NC-STeP), Greenville, North Carolina

Senior Vice President, Hartford HealthCare; Physician-in-Chief, Behavioral Health Network; Assistant Clinical Professor of Psychiatry, Yale School of Medicine; and Assistant Professor of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut

Executive Director, Behavioral Health Services, Northwell Health; and Assistant Professor of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, New York

Gerald B. Shively and Robert Y. Tan Professor and Chair, Department of Psychiatry and Behavioral Health, Pennsylvania State College of Medicine, Pennsylvania State Health Milton S. Hershey Medical Center, Department of Psychiatry and Behavioral Health, Hershey, Pennsylvania

Clinical Assistant Professor, Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

Facilitator, NAMI Family-to-Family, Pittsburgh, Pennsylvania

President Emeritus, Sheppard Pratt Health System; Clinical Professor of Psychiatry, University of Maryland School of Medicine; and Adjunct Professor of Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland

Luke and Grace Kim Professor in Cultural Psychiatry, and Professor, University of California, Davis, Sacramento, California

Professor, Department of Psychiatry and Family Medicine; Director, Telemedicine Programming, Department of Psychiatry; and Director of Telemedicine, Helen and Arthur E. Johnson Depression Center, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado

Former Director, Mental Hygiene Administration, Department of Health and Mental Hygiene, State of Maryland, Baltimore, Maryland

Consultant Psychiatrist, Dovenlijn (Deaf Units), Trajectum Forensic Hospital, Boschoord, The Netherlands; Consultant Psychiatrist, Deaf Units Odion, Assisted Living for People With Intellectual Disabilities, Purmerend, The Netherlands; Honorary (Past) President, European Society for Mental Health and Deafness (ESMHD), Madrid, Spain; and Chair, Special Interest Group, Mental Health and Deafness Adults, ESMHD

Psychiatrist, VA Greater Los Angeles Health Care System, Los Angeles, California

Clinical Professor of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Senior Advisor, National Association of State Mental Health Program Directors, Alexandria, Virginia; and Former Deputy Secretary for Public Health Services for the Maryland Department of Health

Clinical Professor of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania

Professor of Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine and the Wilson Center for Science and Justice at the Duke Law School, Durham, North Carolina

Supervisor and Trainer, Peer Specialist Training Program, Peer Support and Advocacy Network, Pittsburgh, Pennsylvania

Clinical Director and Physician Advisor; and Assistant Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland

Director of Behavioral Health, Pacific Area, U.S. Coast Guard, Alameda, California

Assistant Professor of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio

Co-Chair, Holistic Health Initiative Professor and Chair Emeritus, Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

Chief Medical Officer, Whiting Forensic Hospital; and Assistant Professor of Psychiatry, Yale School of Medicine, Middletown, Connecticut

Chief of Staff, Brentwood Behavioral Healthcare, Jackson, Mississippi

Teaching Assistant Professor, Department of Management, College of Business, East Carolina University, Greenville, North Carolina

Professor of Psychiatry, Vice Chair for Faculty Development, Department of Psychiatry, University of California, Davis, Sacramento, California; and Past President, American Telemedicine Association, Arlington, Virginia

Today, it is often said that textbooks are a thing of the past—too long, too weighty, and too expensive. Information is at one’s fingertips online, and free. So why did we decide to write this textbook, which involved hours of planning, many solicitations to authors, and a significant collective effort by all the contributors? The answer is simple. Learning about administration and leadership and—even more important—becoming an effective administrator and leader require mentorship (i.e., acquiring the requisite knowledge) and practice (i.e., experience). This textbook brings together a curated, select group of authors to provide the framework for increasing the knowledge of both the aspiring and the established administrator and leader. As experienced department chairs and clinical administrators, we also learned a great deal in the creating and editing of this book. We found the experts and, along with our editorial board, challenged the authors to be both illustrative and supportive. Our goal is for the aspiring leaders to take on the roles of administrator and leader and for the more experienced administrators and leaders to improve their game.

This textbook is organized into several parts, starting with basic concepts about leadership and program development and moving on to specific chapters on topics such as malpractice and health information technology. We conclude with a personal perspective on leadership by Steven S. Sharfstein, M.D., M.P.A., a noted and venerated administrative leader in U.S. psychiatry. Throughout the book, we adhered to the following overarching principles:

Why does a book about psychiatry administration and leadership matter so much? The fact is that the current cadre of psychiatric administrators and leaders are aging out. This is true of many clinicians in our specialty, and it is even more acute when we include the current generation of leaders. Inspiring and training future administrators and leaders are critical to a healthy psychiatric care system. Ceding all leadership to nonclinicians risks having important decisions made by individuals with primarily financial backgrounds. The clinician needs to be involved, providing the perspective of provider and patient. This training has to start early, ideally in medical school but undoubtedly in residency. This textbook can provide the source documentation for such an administrative didactic curriculum.

Who should read this book? We believe everyone involved in psychiatric care should read this textbook. Administration and leadership have many layers. This book is not reserved for chairs or chief executives. Administration can start at chief residency and progress to the management of a clinic or a subspecialty division (e.g., inpatient chief, consult director). Opportunities are growing in the areas of quality or improvement and information technology, which also have administrative and leadership positions. Likewise, this book is not exclusive to psychiatrists. Psychiatry is now a big tent that includes psychologists, nurses, social workers, and advanced practitioners.

Finally, we are indebted to our editorial board. We realized early in the development of this book that the level of expertise of our chapter authors was impressive. We also realized that we would need assistance and expertise to review these manuscripts. Our editorial board brought a level of knowledge that was invaluable to our effort. In a few instances, the external reviewer questioned either the content or the focus of a particular chapter. We were able to facilitate a positive discussion between the author and the reviewer. The end product is a thoughtful and impactful effort.

Sy Atezaz Saeed, M.D., M.S., FACPsych

John Lauriello, M.D.

Laura Weiss Roberts, M.D., M.A.

Difficult decisions are common for psychiatrists; Hippocrates was not an administrator, but he would have made a good psychiatrist leader. Fortunately, we have Drs. Saeed, Lauriello, and Roberts and the Textbook of Psychiatric Administration and Leadership, Third Edition, to guide us.

I want to thank the editors of this important textbook for inviting me to write the introduction, because this is a subject close to my heart. Psychiatrists have the opportunity to take essential leadership positions in clinical care, academia, and research and at the conference tables of the C-suite (group of the highest-level executive positions within a corporation). I first worked with Dr. Saeed on a Group for the Advancement of Psychiatry (GAP) committee many years ago. Sy was (and is) a proficient committee chair, clear thinker, and preeminent leader. GAP has long been a group of brilliant psychiatrists and a hotbed of the latest thinking in the field of which I am proud to be a part.

I have been fortunate to have had a long career in administration and leadership in organized medicine and psychiatry. I led an anti-apartheid education trust in South Africa providing scholarships to South African Black students in health care, followed by a stint at Alcohol, Drug Abuse and Mental Health Services Administration/Substance Abuse and Mental Health Services Administration, where I led an initiative to integrate primary care, substance abuse, mental health, and HIV/AIDS response (also known as collaborative or integrative care). This provided me with the opportunity to see the importance of leadership and administration at all levels of care, especially when dealing with minority and unrepresented populations. At the American Medical Association, I oversaw programs related to evolving health care delivery systems and led efforts to improve the interface between clinical medicine and public health. I served briefly as senior deputy director of the U.S. Department of Health Addiction Prevention and Recovery Administration. This highlighted for me the necessity of the education of psychiatrists not only in clinical patient care but also in the running of practices and health care systems. And just before becoming chief executive officer and medical director of the American Psychiatric Association, I headed up the District of Columbia Department of Health. There, I was responsible for the health of the nation’s capital, from primary care for infants to seniors receiving Medicaid and Medicare; D.C.-funded health care; HIV/AIDS; addictions; health professional licensing; and regulation, policy, and planning, and sat on the Obama District of Columbia Health Exchange. This demonstrated the integral relationship between governmental entities and patient care. It made clear the importance of developing working and policy relationships at all levels of government to provide the best care with the help and support of the community at large. This book provides strategies and guidance on all the ways psychiatrists and physicians can increase their community participation and health administration and leadership.

Throughout my long career in organized medicine and psychiatry, I have seen much change in the delivery of health care in the United States. Such change calls out for leadership. Throughout the field, whether in academic centers, hospital systems, or research institutes, psychiatrists are well positioned to address this need. However, we will have to renew our focus on the education of psychiatrists about leadership and administration as a vital part of what they need to know. If not, leadership positions will be abdicated to nonphysician administrators and physicians other than psychiatrists. These leadership positions should be filled with psychiatrists, not delegated to others who do not have our wealth of understanding, empathy, and expertise.

The Textbook of Psychiatric Administration and Leadership provides a comprehensive understanding of psychiatrists’ roles in psychiatric administration and leadership. This definitive textbook provides practitioners and students of administration in behavioral health care with a framework for understanding leadership and guiding the evolution of behavioral health care during the next few years.

As psychiatrists, we have a unique ability to see how systems should work and how to improve them. We do this every day with our patients and with our medical and professional colleagues, but it is time for us to apply our skills in the C-suite, on boards, and in conference rooms where administrative problems are discussed and seminal decisions that affect patients, physicians, and the teams they manage are made. Psychiatrists today need to understand the importance of administration and take leadership seriously.

The leaders who have inspired me include Nelson Mandela, Bishop Desmond Tutu, John Talbott, Melvin Sabshin, Joseph Tupin, Mary Jane England, Ezra Griffith, members of the American Psychiatric Association’s Board of Trustees and Assembly, resident training directors, chairs of psychiatric departments, and many of my senior staff. They have the characteristics needed in our future psychiatrist leaders: transformative vision, commitment, collaboration, and the humility needed to surround themselves with other smart and committed experts. I believe that expert psychiatrist leaders and those aspiring to be leaders will find this textbook helpful. I look forward to referring to it regularly.

The art of medicine, attached to the exponentially evolving science of medicine and psychiatry, is indeed long and strong, and the decisions are difficult. I thank the editors and contributors to this volume for sharing their knowledge and helping to shape the psychiatrist leaders of the future.