The Zero Suicide Initiative: Applying a Systems Science and Stock & Flow Mapping Process to Suicide Prevention

The first known effort by a healthcare system to achieve the goal of zero suicides emerged from the 2001 Henry Ford Health System’s Perfect Depression Care program, with the realization that accepting this “worst outcome” could not be consistent with perfect or zero-defect care. This concept, known as the “Zero Suicide” (ZS) approach, became a healthcare quality goal with the 2011 report, Suicide Care in Systems Framework, and was adopted by the Magellan Health System of Arizona.

The ZS approach incorporates workforce readiness, leadership commitment and treatment best practices. Structured evaluation criteria and the demonstration of results are critical to increasing the numbers and scope of providers willing and capable of providing comprehensive and quality care.   This session will map and dynamically model Magellan’s ZS system and share preliminary results. The map traces the relative proportions and costs of patients from the system's point of entry through a bifurcated screening process, assessment and stratification of risk, safety planning and follow-up.  The session will show how a stock and flow model can be applied to evaluating care and improve processes by understanding the dynamic relationships as patients (stocks) process (flow) through the system. The stock and flow approach enables understanding of system components, feedback mechanisms and points of greatest impact. It provides a capability to objectively and quantitatively examine and test specific components of a system and anticipate potential impacts of system change – from both patient and cost perspectives.

Applying a stock and flow approach in conjunction with value stream mapping to the practice of behavior health business processes (such as the process used by the Magellan Health System of Arizona) assists the identification of required feedback metrics, value added processes and non-value added operations to improve the identification of suicidal patients, reduce suicide, and potentially reduce costs. It presents an economic model with a continuum ranging from highest financial burden level of care that could prevent significantly more suicides on the one end of the spectrum, to the highest social burden level of care that could only prevent suicide among those at highest risk. The economic data in the model can be customized and replicated by other healthcare settings.