Inland Northwest Behavioral Health

Susan Giovanini

Patient Care Steward

Susan Giovanini serves as Chief Operating Officer at Inland Northwest Behavioral Health, where she provides executive oversight of Risk Management, Performance Improvement and Compliance. With a strong foundation in psychiatric care and clinical leadership, she is dedicated to advancing the integration of patient safety, quality outcomes and regulatory strategy into operationally sustainable practices across behavioral healthcare systems.

Behavioral healthcare leaders operate in a uniquely complex environment, where patient safety, quality outcomes and regulatory compliance must be balanced amid clinical unpredictability and ongoing resource constraints. In this setting, integrating operations, risk management, performance improvement and compliance is not optional; it is essential to organizational stability and long-term sustainability. Effective leadership goes beyond technical expertise. It requires a practical understanding of how decisions, policies and processes impact patients and staff in real terms.

Balancing Patient Safety, Quality and Regulatory Compliance

As Chief Operating Officer, my approach has been shaped primarily by early hands-on experience in psychiatric care and direct exposure to preventable harm and system failures.

Working closely with patients and frontline staff established a perspective that still guides my leadership: metrics are not abstract; they represent real people. This keeps the focus where it belongs and reinforces a principle I rely on consistently: the primary question must always be, what keeps the patient safest? Regulatory and financial priorities should align with that answer, not drive it.

Some of the most defining experiences in my career came from seeing harm occur when compliance became a check-the-box exercise. In many cases, warning signs were present—frontline concerns raised but not fully acted upon. Over time, these missed opportunities compound, turning small gaps into larger risks. These experiences reinforced that compliance alone is insufficient. What matters is how organizations engage, listen and respond in real time.

Equally important has been learning to bridge communication across disciplines. Pairing quantitative data with anonymized patient narratives helps align clinicians, operational leaders, and regulatory stakeholders. Data provides structure, while stories provide context. Together, they ensure decisions reflect not just performance metrics, but human impact, strengthening both accountability and shared ownership.

Navigating Risk Management and Compliance Challenges

One of the most pressing challenges healthcare organizations face is the normalization of deviance, the gradual acceptance of practices that deviate from established policy. Over time, behaviors that once raised concern become routine, increasing risk and eroding safety standards.

In behavioral healthcare, this is often amplified. High acuity environments can lead to desensitization, where repeated exposure to aggression, boundary issues or unsafe conditions makes them feel normal. When that happens, serious risks can go unrecognized.

Addressing this requires more than education. Leaders must clearly distinguish between being busy and being safe. Expectations must be defined, accountability applied consistently and follow-through made visible. Without these elements, standards erode quickly. Just as critical is fairness. Accountability must be applied consistently across all roles to maintain credibility.

How organizations handle near-misses is equally important. When near-misses are treated only as disciplinary issues, reporting declines. When they are approached as learning opportunities, transparency improves. Staff must see that speaking up leads to action.

Evolving Role of Performance Improvement in Behavioral Healthcare

Performance improvement in behavioral healthcare has evolved from a retrospective, compliance-based function into a continuous, operational process tied directly to outcomes. Historically, it relied on periodic reviews and documentation aimed at regulatory requirements. Today, it is embedded in daily operations and actively shapes care delivery.

Modern performance improvement takes a systems-based approach. Metrics like seclusion and restraint use, length of stay, readmissions and workplace safety are interconnected. Understanding those relationships allows organizations to address root causes and sustain meaningful improvements.

A key lesson in leading these efforts is that sustainability depends on relevance to frontline work. Initiatives that do not make daily tasks safer or more efficient rarely last. Effective solutions align with how work is performed, not how it is ideally designed.

Transparency is also critical. Sharing data regularly, recognizing progress and treating setbacks as learning opportunities helps build trust. When staff see improvement as something they contribute to rather than something imposed, they are more engaged, and outcomes improve.

Leadership Principles for Navigating Operational Complexity

Navigating complex operational and compliance-related situations requires a disciplined and consistent framework. I rely on a clear prioritization: patients first, staff second, systems third. This structure keeps decision-making grounded, particularly in high-pressure or uncertain environments.

Clarity and integrity in communication are equally important. Decisions must be transparent, precise and able to withstand scrutiny from regulators, leadership and families. This level of discipline strengthens accountability and builds trust.

Consistency and fairness are non-negotiable. Policies must be applied uniformly, regardless of role or position. When they are not, both culture and compliance begin to weaken.

Advice for Emerging Healthcare Leaders

Behavioral healthcare will continue to face increasing pressure. Patient acuity is rising while resources remain constrained and regulatory expectations continue to expand.

At the same time, data integration emerges as a critical differentiator. Organizations that can align safety, quality and financial data into clear, actionable insights will be better positioned to respond proactively, while those relying on anecdotal information will struggle to sustain improvement.

For emerging leaders, success will depend on the ability to work across clinical, regulatory and financial domains. Equally important is the willingness to make difficult decisions and avoid shortcuts that compromise safety. These decisions must be grounded in data, aligned with policy and supported by a clear rationale.

Ultimately, consistency, transparency and a commitment to patient-centered care remain the foundation of effective leadership. Integrating operations, risk management, performance improvement and compliance enables organizations to manage complexity while maintaining focus on what matters most: keeping patients safe.