MULTI-STATE LEARNING COLLABORATIVE:

SMALL CHANGES—DRAMATIC RESULTS

Tom MosgallerDirector of Change ManagementCHESS/NIATx – University of Wisconsin

All work is a process.

W. Edwards Deming

Poor processes account for 85% of the problems in serving customers.

Health – To Be Whole

• A system is a whole consisting of interdependent parts

• You cannot understand the whole by understanding each part

• You cannot improve the whole by improving each part

• The net output of the whole—for better or for worse—is the result of the interactions

Health – To Be Whole

• THE FIVE DETERMINANTS OF HEALTH1. Personal awareness2. Community and connections3. Safety and sense of security4. The opportunity to use our gifts

and talents in a meaningful way5. Access to therapy/medical care

The Geometry Lesson

InstitutionCommunit

y

The Role of Quality in the New Economy

• QUALITY is what makes it possible for our customers to have a long-term love affair with our products and services

The Methods of Quality4

Reactive

Quality by Design

Quality by Process Improvement

Quality by Compliance

Quality by Inspection

Active

NIATx focusNIATx focus

Four Approaches to Quality

• When you think about your work, what percentage of your time and energy is spent on each of these four aspects of quality? INSPECTION (%) ASSURANCE/COMPLIANCE (%) QUALITY IMPROVEMENT (%) DESIGN AND INNOVATION (%)

The NIATx Approach to Quality

• CORE PRINCIPLES: Understand and involve the

customer Focus on key problems Select the right change agent Seek ideas from outside the field Do rapid cycle testing

The NIATx Approach to Quality

• CORE PRACTICES: Simple model of improvement Use of aims Collaborative approach Empower those closest to the

work Develop the business case

The NIATx Approach to Quality: PDSA Cycle of Improvement

ACT PLAN

STUDY DO

Adopt, Adapt, or Abandon

Study dataWhat steps are you making to test the idea/change? Who is responsible?

What is the idea/change to be

tested?

Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide

What is a 5x5?

• 5 minutes to present 5 Power Point slides which tell your story of your change project:

Title Slide

1. Aim(PLAN)

2. Change

(DO)

3. Results(STUDY)

4. Next Steps (ACT)

5. Impact(lessons learned,

etc.)

Decrease wait time between 1st contact and 1st treatment for IOP* clients from 16 days to 5 days.

This is a 69% improvement goal. Location is the Oakdale IOP office. Length of the change project is May-July, 2010.

Project

Aim

*IOP = Intensive Outpatient

AIM

1) Eliminated old procedure of scheduling intakes with clinicians weeks in advance.

2) Established daily walk-in orientation group between 9am – 10am.

Changes we made:

• Contact with clinician.• Program orientation.• Intake appointment

IOP clients can now have same day:

These changes had a positive impact on customers.

These changes had a positive impact on customers.

Clients enter the IOP program NOW, when they are motivated!

CHANGE

Wait time decreased from 16 to 3.5 days.

Wait time between 1st contact and 1st treatment

Days

MonthsMAY JUNE JULY

5

10

15

20

Baseline 16 days

ChangeProject

WaitTime78%

RESULTS

Adopt daily walk-in orientation as standard procedure at the Oakdale office.

Create a sustainability plan to maintain the improvement.

Expand the walk-in orientation pilot test to our Smithville office.

NEXT STEPS

84 more clients seen per year

$29,016 in added revenue per year

Reputation for same day service

IMPACT(business case, efficiency, lessons learned etc.)

NIATx 200

• 5-year grant funded by NIDA• State-based collaborative• Identify the “active ingredients”• What parts of our approach to

quality produce the greatest improvement? Which parts are the most cost effective?

Preliminary Lessons & Outcomes

• Largest randomized trial ever done in healthcare: 200 organizations 5 states 9000 hours of training 80,000 client records analyzed 4000 staff surveys reported

• Successfully reduced waiting time and continuation of care among participant organizations with different rates of improvement between groups in the trial

Simple Changes Dramatic Results

• What struck you?

Quality in Daily Work

• “Thus in all ways I will leave my community greater and more beautiful than it was transmitted to me.”–Pericles Athenian Oath