One in five U.S. adults experiences a mental illness within a given year. With more than 550,000 people working to support this underserved community, the mental healthcare system has grappled with inadequacies and shortcomings in safety, quality, and care delivery. There is a wide range of problems, from access-to-care issues and errors, to complications stemming from poor care. Our country is also on an unsustainable path as our healthcare expenditure keeps growing. To add to all of this, we are facing a rampant epidemic of burnout among healthcare workers. Modern advancements introduced with many promises-such as electronic medical records, newer medications, or advanced treatments-have created unique challenges when ushered into a highly regulated healthcare system.

What does it take to provide patients with everything they need-the right quality of care, at the right time, and at the right cost-to keep them healthy? Which process steps add value? Which steps are wasteful? A widely accepted fact is that a conservative 30-50% of every step in the mental healthcare process does not help patients feel better or stay better. When considering delays in care, workarounds, excessive documentation, and an overuse of auditing, the care system has moved highly skilled clinicians away from providing value, as administrative tasks continue to encroach on their time. There is a clear need to rethink and redesign the system of care.

This book is a primer for understanding the current state of the mental health system and the performance improvement skills and leadership acumen needed to address existing challenges. Sheppard Pratt, the award-winning, leading institution for mental healthcare in America, provided the focus on mental healthcare and became the laboratory for this body of work over the course of eight years. It hired a seasoned systems thinker with improvement expertise to work with mental health professionals and solve some of their most complex and chronic problems.

The book is a result of the collaboration between a practicing psychiatrist in a leadership role and the systems engineer. Working together, they demonstrate how to think about redesigning care and redefining the nature of work to enhance value for both the people served and the healthcare workforce. They crafted a multi-pronged approach towards culture change at Sheppard Pratt, including implementing a course on "Learning to Improve," which introduced staff to a performance improvement methodology. There are several vignettes interwoven throughout the book that describe the complexities and constraints of the system. Solving some of these challenges creates a new paradigm of work while minimizing waste and enhancing value.