Getting Staff Buy-in for Sustaining Improvements in Difficult Times: The South Carolina Experience...
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Transcript of Getting Staff Buy-in for Sustaining Improvements in Difficult Times: The South Carolina Experience...
Getting Staff Buy-in for Sustaining Improvements in Difficult Times:
The South Carolina Experience
Harry PrimManagement/Prevention Consultant
South Carolina Department of Alcohol and Other Drug Abuse Services
“ We must improve access and, through increased retention,
produce better outcomes, including clients whose quality
of life has improved, making them more productive at school
or at work.”
SSA Director W. Lee Catoe
ContextMature substance abuse prevention,
intervention and treatment public systemSSA in business for 50+ years33 county authorities that serve all 46
countiesThe SSA had been drastically downsized
Treatment, prevention and QA/planning staff consolidated into a small, cohesive team
STAR-SI planned and implemented by the treatment and planning parts of this lean and mean team, in collaboration with key plank-holders
Building BlocksSSA commitment
Director, principal deputies, data, finance, logistics, program administration
Federal commitmentCollaboration of provider associationChange Leader & Coach AcademiesCommunities of CommitmentPeer Mentors
STAR-SI Aims
Access and Retention Aim
Number of Providers
2007 2008 2009
Increase admissions 6 10 20
Reduce time 1st contact to 1st service 8 23 31
Increase services within 30 days of admission 5 7 25
Progress on Common AimMeasure: Average days 1st contact to 1st
service (Reduce wait times)
Baseline: Jan – Dec 2006
Cohort 1: Jan 2007 – Sep 2009 (33 months)
Cohort 2: Oct 2007 – Sep 2009 (24 months)
Cohort 3: Aug 2008 – Sep 2009 (14 months)
State ResultsAll Three Cohorts
Aim BaselinePost-
Change% Change
Increase number of outpatient admissions (monthly average)
47.96 53.59 +11.73%
Decrease average number of days from 1st contact to 1st treatment service
25.26 19.55 -22.58%
Increase average number of services within 30 days of admission
3.12 3.24 +3.83%
Baseline: Jan-Dec 2006
STAR-SI Implementation: Jan 2007- Jun 2009 (30 months)
Cohort BaselinePost-
Change%
Change
Cohort I: 8 providersImplementation: 30 months
21.50 15.21 -29.27%
Cohort II: 15 providersImplementation: 21 months
29.53 25.61 -13.28%
Cohort III: 10 providers
Implementation: 11 months21.73 13.58 -37.53%
Provider ImprovementsAim: Decrease average number of days from 1st contact to 1st treatment service
Performance Results Year 1 Cohort
STAR-SI Implementation: 1 Jan 2007- 30 Sep 2009 (33 months)
Aim
Long Term
From Jan 07 through
Last 3 Months ending
Jun 09 Sep 09 Jun 09 Sep 09
Increase number of outpatient admissions from 73.7 monthly average/per agency
72.1 adms
-2.14%
72.4 adms
-1.66%
68.0 adms
-7.61%
72.9 adms
-0.99%
Decrease average number of days from 1st contact to 1st treatment service from 21.8 days
15.2 days
-29.27%
15.6 days
-28.38%
8.9 days
-58.82%
11.8 days
-46.11%
Increase average number of services within 30 days of admission from 3.28 services
3.36 svs
7.48%
3.48 svs
6.11%
3.79 svs
20.91%
3.61 svs
9.91%
Performance Results Year 2 Cohort
STAR-SI Implementation: 1 Oct 2007- 30 Sep 2009 (24 months)
Aim
Long Term
From Jan 07 through
Last 3 Months ending
Jun 09 Sep 09 Jun 09 Sep 09
Increase number of outpatient admissions from 49.35 monthly average/per agency
49.4 adms
0.04%
49.4 adms
0.08%
48.1 adms
-2.45%
48.2 adms
-2.26%
Decrease average number of days from 1st contact to 1st treatment service from 30.1 days
25.61days
-12.76%
25.34 days
-15.73%
22.8 days
-22.51%
21.7 days
-27.98%
Increase average number of services within 30 days of admission from 3.28 services
3.36 svs
2.44%
3.18 svs
-3.05%
3.79 svs
15.55%
3.22 svs
-1.85%
Performance Results Year 3 Cohort
STAR-SI Implementation: 1 Aug 2008 - 30 Sep 2009 (14 months)
Aim
Long Term
From Jan 07 throughLast 3 Months ending
Jun 09 Sep 09 Jun 09 Sep 09
Increase number of outpatient admissions from 27.52 monthly average/per agency
27.5 adms
-0.13%
27.1 adms
-1.40%
28.0 adms
1.84%
25.6 adms
-6.85%
Decrease average number of days from 1st contact to 1st treatment service from 22.8 days
14.2 days
-38.24%
15.6 days
-31.80%
14.4 days
-37.54%
14.6 days
-36.17%
Increase average number of services within 30 days of admission from 3.14 services
3.16 svs
0.64%
2.95 svs
-6.02%
3.43 svs
9.24%
3.00 svs
-4.45%
Access: Statewide ResultsAverage number of days from 1st contact
to 1st treatment service
Retention: Statewide ResultsAverage number of services within
30 days of admission
Provider Achievements: AdmissionsProvider
Executive Director
Change Leader Percent change
Admissions - Rate of Change in monthly average, long term (10% or better)
Shoreline John Coffin Charles Bell 164%
Colleton Ron Rickenbacker Kathleen Padgett 46%
Charleston Center Mark Cowell Chanda Brown 26%
Dorchester Samuel Miller Sarah Larrabee 18%
Phoenix Center Adam Brickner Mary Irby 12%
Admissions - Rate of Change in monthly average, last 3 months (Top Five)
Shoreline John Coffin Charles Bell 128%
Dorchester Samuel Miller Sarah Larrabee 34%
Cornerstone David Matthews Joyce Dilleshaw 29%
Circle Park Randy Cole Jeannie James 25%
Phoenix Center Adam Brickner Mary Irby 22%
Reduce Wait Time - Rate of Change in monthly average , long term (Top Ten)
Provider Executive Director Change Leader Percent change
Dorchester Samuel Miller Sarah Larrabee 89%
Cherokee Beth Powell Robert Strait 61%
Phoenix Center Adam Brickner Mary Irby 57%
Clarendon Ann Kirven Robin Murphy 47%
Spartanburg David Forrester Kathy Murphy 47%
Sumter Glenn PeaglerDarren Wilson& Patricia Colclough
47%
Keystone Janet Martini Janet Bush 42%
Union Jackie Dawkins Amanda Prince 41%
Kennedy Center Linda Bailey Michelle Crawford 38%
Axis I Center Cheryl Long Amy Coto, Pam Rush 33%
Provider Achievements: Access
Provider Achievements: Access 2Reduce Wait Time - Rate of Change in monthly average, last 3 months (Top Ten)
Provider Executive Director Change Leader Percent change
Union Jackie Dawkins Amanda Prince 95%
Phoenix Center Adam Brickner Mary Irby 77%
LRADAC Debbie Francis Gayle Aycock 74%
Spartanburg David Forrester Kathy Murphy 71%
Cherokee Beth Powell Robert Strait 68%
Sumter Glenn PeaglerDarren Wilson& Patricia Colclough
67%
Circle Park Randy Cole Jeannie James 65%
Dorchester Samuel Miller Sarah Larrabee 55%
Keystone Janet Martini Janet Bush 55%
Pickens Robert Hiott Faye Nichols 50%
Shoreline John Coffin Charles Bell 47%
Colleton Ron Rickenbacker Kathleen Padgett 43%
Provider Achievements: Retention
Provider Executive Sponsor Change Leader Percent change
Increase No. of Services - Rate of change in monthly average, long term (Top Five)
Keystone Janet Martini Janet Bunch 32%
Spartanburg David Forrester Kathy Murphy 45%
Hazel Pittman Center David Seward Tommicha Walker 23%
Circle Park Randy Cole Jeannie James 21%
Williamsburg Jackie Scott Graham Jannie Snow 17%
Cornerstone David Matthews Joyce Dilleshaw 16%
Increase No. of Services - Rate of change in monthly average, last 3 months (Top Five)
Spartanburg David Forrester Kathy Murphy 45%
Keystone Janet Martini Janet Bunch 32%
Kennedy Center Linda Bailey Michelle Crawford 38%
Cornerstone David Matthews Joyce Dilleshaw 31%
Circle Park Randy Cole Jeannie James 30%
Process Improvement CapacityChange Teams 40 provider level
3 state level
Peer Mentors 4 (plus 4 coaches)
Peer Networking Meetings
3 per year
70+ attendees/meeting
Change Leader & Coach Academy Training
1 per year
59 trained overall
Peer networking calls Monthly
Change Projects 143 in 27 months of STAR-SI
Process Improvement Capacity
Change Teams 40 provider level, 3 state level
Change: Fewer active change teams
Peer Mentors 4 (plus 4 coaches)
Change: One active coach
Peer Networking Meetings 3 per year; 70+ attendees/meeting
Change: Reduced numbers
Change Leader & Coach Academies, Communities of Commitment
1 per year, 64 trained overall
None trained since early 2009
Peer networking calls Monthly
Change: Through ACTION Campaign calls only
Change Projects 208 in 33 months of STAR-SI
Change: Fewer projects since July 2009
STAR FORCE InitiativeNew initiative developed
through the NIATx Whole Systems Change CommunityVoluntaryUltimate goal: agencies’
management culture is based on the NIATx model
Working collaboratively with Provider association leadership.
Our Customers and StakeholdersCustomers Stakeholders33 ProvidersProviders’ Clients
W. Lee Catoe, Single State Authority
DAODAS Executive Management Team
Behavioral Health System Association (BHSA) Leadership
Provider Agency Executive Directors
Provider Agency Staff
STAR FORCE Proposed Plan ComponentsUse existing joint committee structures and
state & regional meeting venues
Plan to use existing professional development and technical assistance resources, such as NIATx, Southeastern ATTC, and the S.C. School of Alcohol and Other Drug Studies
Working toward implementing a management institute that will include the NIATx process improvement and whole systems change models
Continue to hold learning collaboratives and deploy national and state mentors and coaches
Seek state and federal funding
Action StepsObtained Commitment from Key
Stakeholders through Briefings.Following Whole Systems Change ModelMimic Experience of Whole Systems
Change Workout held December 3-5, 2008 in Madison, Wisconsin.
Held Two State-Wide Meetings focused on Information Gathering and Solidifying Customer Buy-in.
South Carolina WorkoutInvitation issued to local providers for
voluntary participation in workout and subsequent project.
Volunteering providers participated in four one hour pre-workout conference calls facilitating conversations around relevant topics associated with whole systems change.
Workout held on May 20, 2009 facilitated by whole systems change project coach.
Core Concepts ExaminedPre-workout conference call topics:1. Transformational Leadership2. Whole Systems Change Model3. Managing Change4. Whole Systems Change Charter
May 20, 2009 STAR FORCE Workout TopicsIndentify Opportunities as a SystemUnderstanding Our Customers and
StakeholdersBegin Discussion on Our VisionGenerating IdeasLooking at MeasurementsSustainability
Benefits from May 20, 2009 WorkoutBegan process for identifying a framework
for looking at whole systems change.Re-affirmation from local provider network
leadership to continue and expand dialogue around whole systems change.
Foundation for planning and holding a learning collaborative in conjunction with one-day STAR FORCE meeting in Fall 2009.
Building on WorkoutHeld a Learning Collaborative on September
16, 2009 in conjunction with a one-day voluntary STAR FORCE meeting.Began transition from STAR-SI to STAR FORCEClarified STAR FORCE visionIdentified possible areas that need to be
addressedDeveloped proposed action steps that can
address identified needsGathered information will be synthesized into
an action plan that will facilitate the vision.
Continued Building on WorkoutDeveloped and held another Learning Collaborative
on March 9, 2010 that included a breakout session devoted to STAR FORCE Initiative.Highlighted the successes identified from STAR-SITwo providers presented on local successes and
how rapid cycle change has been institutionalized in their agency.
Continued the transition to STAR FORCE Initiative by looking at sustainability and organizational structure.
Among agencies that are voluntarily participating in STAR FORCE, presented a draft document that outlined the STAR FORCE project with shared goals and implementation steps.
TakeawaysCollaborative relationships between the SSA
and the providers are essential
Performance management capability is a must
To face future challenges, start using the NIATx model now; don’t just copy successful projects
Contact InformationHarry S. Prim III, M.P.H. , M.Div.
Management/Prevention ConsultantSouth Carolina Department of Alcohol and Other
Drug Abuse Services101 Executive Center Drive, Suite 215
Columbia, SC [email protected]
(803) 896-1199
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