Shared Reflection to Maximize Resources and Minimize Costs: The Reflecting Team Applied to a Hospital Environment
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ORIGINAL PAPER
Shared Reflection to Maximize Resources and Minimize Costs: The Reflecting Team Applied to a Hospital Environment M. M. Balcells‑Oliveró1 · L. Nuño1 · N. Freixa1 · I. Domínguez3 · I. Pons2 · E. Alcover2 · T. Gual1 Received: 8 April 2020 / Accepted: 21 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Severe mental illness entails multiple hospital admissions and a large use of public resources. The Reflecting Team (RT), together with other dialogue strategies, place in a single therapeutic space, the patient, his family and a team of professionals to find together a solution to a situation of stagnation. The aim of this study was to evaluate feasibility and cost-effectiveness of a RT intervention in psychiatric inpatients in a public hospital. Six RT were performed, and clinical variables were collected retrospectively for six months pre-RT and post-RT. Both number of hospital admissions and total time spent in the psychiatric acute unit show a significant decrease. All computed cost showed statistically significant reduction. The results suggest RT might be a good strategy to introduce a positive change in the treatment of those psychiatric cases in which the patient and family find themselves caught in a system that seems to offer stale and ineffective help to problems that have become chronic. Keywords Reflecting team · Open dialogue · Severe mental illness · Mental health costs · Cost-effectivity
Introduction Psychiatric units in general hospitals provide care to patients with acute crises as well as patients with an exacerbation of a preexisting condition. Readmission rates are used as an indicator of efficiency (Kerkemeyer et al. 2018). Often patients with frequent hospital admissions are affected by multiple comorbidities that require resource-intensive treatment from a large range of professionals. In addition, these complex patients have an increased difficulty adhering to outpatient treatment plans and they eventually accumulate interventions and readmissions to the hospital in a “revolving door” manner (Hudson 2019), draining hospital resources at a high economic cost along with poor clinical outcome (Giacco et al. 2018). Moreover, all of this reflects
* L. Nuño [email protected] 1
Addictions Unit, Clinical Institute of Neuroscience (ICN), Hospital Clinic, Barcelona, Spain
2
Management Department, Clinical Institute of Neuroscience (ICN), Hospital Clinic, Barcelona, Spain
3
Fundació Sanitària Mollet, Barcelona, Spain
suffering of patients and their families (Schmidt-Kraepelin et al. 2019). In this context, there is a need for new intervention that may decrease re-admission rates and hospital costs, and, most relevant, diminish the suffering for patients, families and professionals involved.
The Reflecting Team Proposed by Tom Andersen During the 1990s, Tom Andersen, along with his team of professionals with systemic therapy backgrounds, developed a new way of working with families called Reflecting Team (RT) (Andersen 1987). A
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