Ed Coffey, MD

25 Ed CoffeyAs a model, in 1996, the Henry Ford Health Service (HFHS) had developed a very strong quality improvement system that consistently made incremental improvements in target areas (e.g., inpatient falls, medication errors). They were committed to improving care for depression using these tools, and in 2001 CEO Dr. Ed Coffey and the HFHS team applied for Robert Wood Johnson Foundation’s Pursuing Perfect Care initiative, which aimed to realize the Institute of Medicine’s principles for a “21st-century health system.”

Don Berwick was the President and CEO of the Institute of Health Improvement at the time and the primary author of the Chasm Report. He challenged the HFHS leadership that their goals for this pursuing perfection effort (e.g., measuring improved clinical status) were insufficient. In this context, a staff member suggested that perfect depression care should result in zero suicide deaths. Over the next six months, staff wrestled with this radical concept and, in the end, this commitment became the cornerstone of their future approach and success.

Within four years, the suicide rate at HFHS Behavioral Health Services HMO had decreased by 75 percent. More recently, the program has generated considerable excitement and attention as it has not reported a suicide death for those enrolled in its care for ten consecutive quarters.

According to Ed Coffey, MD, the keys to the program success included the following elements:

  • Partnership with patients through advisory council for design of the program and increased partnership throughout treatment planning and care process;
  • Planned care model, including stratification of risk into three levels with accompanying interventions, including emphasis on means restriction;
  • Established and maintained all clinician competency and training in Cognitive Behavioral Therapy (CBT);
  • Robust performance improvement techniques; and
  • Improved access to immediate care for patients, including drop-in group medication appointments, advanced same day access to care and e-mail “visits.”