Hi all, As we in VISN 22 become ever more data driven ... One thing we're noticing is that our leadership may not understand our Model of Care very well. Often by default, they try to impose models more familiar to them (such as Primary Care's "panel size," "physician extenders," "teamlets," etc.). Those models don't always fit very well, and lead to further confusion and frustration for everyone. In our various Psychology and Mental Health Data and Discipline groups, we're struggling with how to develop ways to explain ourselves in ways that Leadership can better understand. We believe an emphasis on data will help. Among things we're generally considering/using to varying degrees are the following. This email is a request for any input on OTHER things you may be using or trying out, in hopes of brainstorming ideas that may lead to a more understood Psychology (and MH) Service generally. Then we'll work on World Peace. Here's what we've been using/considering so far: 1. Uniques and Encounters: the most readily available information, but with all the pitfalls everyone knows. Our VISN leadership asked us to develop some minimum/maximum "trigger points" for an average clinician's unique and encounters. The idea is that, with many exceptions for good reasons, an average clinician's workload should be looked at if it's below or above the range of triggers. For example, psychologists were pegged at 250-400 uniques and 1300-1900 encounters. The data, of course, is all over the map for all those reasons alluded to, and can be seriously misused. But at least our Leadership has something as a reference standard. 2. RVU and DSS: some of us are further along than others on this, but we hope the variable weighting of encounters overcomes some of the above pitfalls. It's not clear how available data is on individuals. We have a LOT to learn here, and are plugging away. 3. Hybrid data: I understand there's an existing system (which I believe Russ Lemle and others use) which is kind of middle ground between 1 and 2 , where group encounters are separated from individual encounters, offering some level of refinement. 4. "Carve outs:" Of course, in some programs there are mandated maximum caseloads (MHICM, VASH, Day Programs, Home Based Care, etc.). And in others there may be similar rationale for measuring by a different standard, which would obviously need to be explained and supported. 5. "Extras:" We're also starting to try to identify and measure "special extras" we are bringing, such as: a. Comp and Pen exams b. Employee Assistance c. ED backup coverage d. Police Evals e. Boards of Investigation f. Other tasks for which "Psychology is so good," and so seems to get a disproportionate share of the load, without full appreciation of the cost in other workload. 6. Guidance: In all of this we've referred to and quoted from the two very helpful reports from Bob Gresen's groups (the 2003 revised MH Provider Workload document and the 2009 PowerPoint about FY08 Productivity and Staffing), which we believe is the closest material to official guidance. 7. Teaming up: And of course we all lack sufficient resources to make a serious effort in any of these areas. So by working together in the VISN we're hoping to support each other in our collective efforts and get further than any of us could on our own. We'll also be able to help our VISN Leadership understand us better. We hope. 8. Bribery, sweet talking, threats. Any other ideas you all have been using or are considering will be very welcome. I'll recommend NOT using "reply all" to reduce email blizzard, but be happy to share a summary of what I learn from your replies. We're betting some of you are further along this trail than are we, and will very much appreciate any specific concepts you find helpful. THANKS! Peter Graves, Ph.D., J.D. Associate Chair of Psychology for WLA Outpatient Programs, U.S. Dept. of Veterans Affairs 11301 Wilshire Blvd. Building 257, Room 12B Los Angeles, CA 90073 (310)268-3771 cel (best) (213) 305-1444