Date of Award


Document Type

Open Access Dissertation


College of Nursing


Nursing Practice

First Advisor

Ronda Hughes


Background: The United States (U.S.) has an ever-growing incarcerated population. The sheer volume of this population coupled with inefficient patient flow through the judicial and health care systems, create a large imbalance between the high demand for services and the capacity to deliver them. The delay in criminal defendants accessing mental health services is impacted by the lack of patient flow, which creates barriers to entering and exiting the forensic hospital system. The increasing demand for inpatient forensic services, coupled with a static supply of resources, warrants further intervention by treatment and service providers. Identifying and removing barriers to patient flow can reduce the imbalance between capacity and demand and result in lower wait times to access inpatient treatment and care.

Purpose: The purpose of this evidence-based quality improvement project was to identify barriers to the patient flow process that lead to inefficient treatment for forensic psychiatric patients and to implement a plan for removing those barriers.

Methods: A nonexperimental evidence-based quality improvement study was conducted at a forensic psychiatric hospital in the Southeastern region of the U.S. utilizing Lean Methodology and Plan-Do-Study-Act (PDSA) to identify barriers (communication, legal, active treatment, discharge process) to patient flow and improve timely treatment by reducing wait time and length of stay for forensic psychiatric patients.

Results: Statistically significant reductions in the forensic waitlist (51%) and wait time (50%) were achieved. During the study period, the average length of stay was reduced, and the number of admissions and discharges were increased.

Conclusions: Maximization of efficiencies within the forensic psychiatric hospital patient flow process, through the minimization and elimination of non-value-added waste (waiting, over-processing, defects and skills) resulted in a reduction in the waitlist and wait times due to improved patient flow. Such improvements increased the state’s treatment capacity for defendants awaiting inpatient services at the forensic psychiatric hospital.


© 2018, Versie J. Bellamy