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![Page 1: HIV-STIC November 8, 2011 NIATx Tools for Effective Change Reduce Waiting & No-Shows Increase Admissions & Continuation.](https://reader035.fdocuments.us/reader035/viewer/2022062719/56649ec85503460f94bd4a07/html5/thumbnails/1.jpg)
HIV-STICNovember 8, 2011
NIATx Tools for Effective Change
Reduce Waiting & No-Shows Increase Admissions & Continuation
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NIATx opportunities for tomorrow
NIATx opportunities for tomorrow
Over 13,000 Over 13,000 substance abuse substance abuse
treatment providers treatment providers nationwide.nationwide.
Reduce Waiting & No-Shows Increase Admissions & Continuation
Conducting a Walk Through
How does the client experience services?
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The walk-through is a cornerstone of NIATx process. A walk-through is an exercise that allows you to experience your services exactly as your customers do.
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Why do a walk-through?
• Value in seeing your services from a new perspective.
• We make assumptions about how services are being delivered that may not reflect what actually happens.
• The walk-through can identify low-cost opportunities for improvement that can make a big difference in engaging and retaining clients
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How to do a walk-through
• Plan – let staff know, client and recorder
• Do – try to think and act as client would
• Do – ask staff what changes @ each step, record your own ideas (no cost improvements)
• Study – make a list of changes to discuss with team, share results with Executive Sponsor
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Act on the Results
• Discuss how to incorporate relevant change ideas into your project
• Have the ES decide how to handle ideas not directly related to your project
• Use PDSA to implement any change that the ES wants to implement immediately
• Share your lessons learned about doing walk-throughs in your organization
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Results of Walkthrough: “low hanging fruit” – Update magazines in waiting room– Inexpensive radio for “tasteful” music– On sale “décor” within budget– Refill cups for water bubbler– “low maintenance” flowers– Bulletin board with program information– Seating for paperwork– Local Commuter Rail & community – How do we give directions to our office?– Get clients involved
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Ayer MA DC Process Problems with Admissions
• Identified “front door problems” = calls for intakes going to voicemail leading to a delay in services:– phone system needed upgrade– Vacant admin staff position– Under-utilization of centralized scheduling system– Clinicians with low productivity– Missed opportunity to increase business which could
help sustain grant funded drug court
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NIATx opportunities for tomorrow
NIATx opportunities for tomorrow
Over 13,000 Over 13,000 substance abuse substance abuse
treatment providers treatment providers nationwide.nationwide.
Reduce Waiting & No-Shows Increase Admissions & Continuation
Flowcharting
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Why Flowchart?
Flowcharting is useful for:– Providing a starting point/baseline view– Understanding the process – Identifying key problems/bottlenecks– Showing where to test ideas for most impact– Stimulating thinking - results in brilliant ideas– Adding interactivity & fun - gets the team together– Creating a simple & succinct visual process overview
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Key Questions for Flowcharts
• Is the name of process clear?
• Where does the process begin?
• Where does the process stop?
• What does the process include/not include?
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Process Change
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Process Change
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Identify Processes to Change
Nominal Group Technique
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Nominal Group Technique
• Designed to promote group participation in the decision making process
• Used by small groups to – Reach consensus on the identification of key
problems (NIATx Key Principle 2) or
– Develop solutions that can be tested using rapid- change cycles (NIATx Key Principle 5).
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Generating Solutions
• We have done a walk-through
• We have created a flowchart
• We have started to identify bottlenecks
• NOW we need to identify PROBLEMS & SOLUTIONS– NGT can help!!
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Seven Steps
• Preparation (e.g., room and question)
• Silent idea generation
• Recording of ideas
• Idea discussion
• Preliminary voting
• Discussion of preliminary voting
• Final voting on ideas
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HIV-STICNovember 8, 2011
NIATx Progress TrackingBaseline Data & Measuring Results
Reduce Waiting & No-Shows Increase Admissions & Continuation
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Before Making Changes
• Collect baseline data
• Determine the target population and location
• Establish a clear aim
• Select a Change Leader and the Change Team
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Model for Improvement
Start by asking three questions:
1. What are we trying to accomplish?
2. How will we know a change is an improvement?
3. What changes can we test? (next Tuesday!)
• Model for ImprovementLangley, Nolan, Nolan, Norman, & Provost. The Improvement Guide, San Francisco, Jossey-Bass Publishers, 1996
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Executive Sponsor
• Articulates vision, linking PI efforts to grant goals, strategic plan and the bottom line
• Engages and empowers Change Leader and Change Team
• Removes barriers to change
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Change Leader
• Motivates and leads Change Team• Catalyst for developing ideas for rapid cycles• Sets agenda and facilitates change team
meetings• Oversees changes and helps team with
implementation issues• Supervises measurement, compilation and
interpretation of data• Keeps Executive Sponsor aware of change
team activities
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Change Team
• Focuses on one Change Project (1 aim, 1 LOC, 1 location, 1 population)
• Meets at least every other week
• Generates ideas for rapid cycle changes
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Change Team cont’d
• Prioritizes, plans and carries-out change cycles until the goal is achieved
• Collects simple, timely data related to the cycle
• Decides if the change should be adopted, adapted or abandoned
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What do Change Team Members look like?
• A small group of (~ 5-7) people invited by the Executive Sponsor
• Court administrators, front line workers, clinicians, judges, supervisors whose work “touches” the process
• People with special knowledge about the change, e.g. alumni, family members, IT staff, attorneys, police
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• METHODS OF COLLECTING DATA FOR DECIDING WHAT CHANGE YOU WANT TO MAKE
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Model for Improvement
Start by asking three questions:
1. What are we trying to accomplish?
2. How will we know a change is an improvement?
3. What changes can we test? (next Tuesday!)
• Model for ImprovementLangley, Nolan, Nolan, Norman, & Provost. The Improvement Guide, San Francisco, Jossey-Bass Publishers, 1996
![Page 29: HIV-STIC November 8, 2011 NIATx Tools for Effective Change Reduce Waiting & No-Shows Increase Admissions & Continuation.](https://reader035.fdocuments.us/reader035/viewer/2022062719/56649ec85503460f94bd4a07/html5/thumbnails/29.jpg)
Measuring Change7 Simple Rules of the Road
• Define measures
• Collect baseline data
• Establish a clear goal
• Consistent collection
• Avoid common pitfalls
• Report and Chart progress
• Ask questions
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Rule 1: Define Measures
• Establish clear definitions– Continuation or
admissions may mean many things
• Clarify project aim &
goal• Agreed upon by key
stakeholders
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Rule 2: Establish a Baseline
• Never start a project without it
• Define a clear starting point
• Use agreed-upon definition
Start Finish
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Rule 3: Establish a Goal
– A realistic goal still challenges the agency to improve
– Set a goal that stretches the agency’s capacity to improve
– If information suggests changing the goal, change it
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Rule 4: Consistently Collect Data
• Devise ways to collect information but remember KEEP IT SIMPLE
• Collect small samples over short time periods– Next 10 clients– Next 15 Phone Calls– Measure impact in days not weeks or months– Cycles rarely last more than a month
• The length of time necessary to test a change will vary depending on an agency’s size.
• Once change is successful, continue data collection to verify progress– Track clients admitted next week– Examine data for one month
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Rule 5: Avoid Common Pitfalls
• Collect only the data you NEED
• Focus only on measures that relate to your aim
• Keep collection process as simple as possible
• Check that everyone understands the collection process --- early and often
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Rule 6: Report and Chart Progress
• A Simple Axiom: One chart, one message
• Charts can be used to: – Highlight the baseline (pre-change) data– Identify when a change was introduced– Visually represent the impact of individual changes
over time, and – Inform your agency about sustaining change over
time.
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Example Chart
Time from First Contact to First Treatment
0.00
2.00
4.00
6.00
8.00
10.00
12.00
Jun-03
Jul-03
Aug-03
Sep-03
Oct-03
Nov-03
Dec-03
Jan-04
Feb-04
Mar-04
Apr-04
May-04
Jun-04
Jul-04
Aug-04
Sep-04
Oct-04
Nov-04
Changes Implemented ChangesSustained
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Rule 7: Ask Questions• Do not accept results at face
value
• Do the results look right?
• What is the data telling us?
• Unsuccessful changes afford the opportunity to ask Why?
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Track Change Cycle Data• Baseline Data
• Describe the Change
• Chart the Results – Post change
• Study Results
• Plan next change
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Conducting a Change Exercise
PDSA cycles Plan the changeDo the planStudy the resultsAct on the new
knowledge
Rapid cycle changes Changes should be
doable in 2-3 weeks
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Aim: Access for incarcerated referrals – is difficult and time consuming.
Change: Judge worked with jail personnel to arrange that clients referred to drug court be brought to the courthouse on the day of drug court. Jail staff always have prisoners to transport. Intake & screening done before and/or after drug court at the courthouse.
Results: Client seen sooner, intake person didn’t have to wait at the jail, and the drug court intake process faster.
Cooperation between jail, judge, and treatment improve process and client flow
Counseling Services, Inc. & York County Adult Drug Court, Maine
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Ottumwa Iowa Family Drug Court
Aim: improve transfer of clients from Child Welfare to Family Drug Court
Change: Add dates to paperwork to track flow, provide training to case workers and identify one person to receives referral forms
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Ottumwa Drug Court Results:
Total Number of
Client Referral Sheets
Number of Clients
starting Drug Court
Cases started prior
to adjudication
hearingBaseline Data 6 2 1
Change Data 17 5 3
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MAINE STAR-SI: Learning Collaborative ID of the key focus areas using nominal group technique (NGT)
#1 Look at the practice of “giving appointments” to assess clients# 2 Paperwork issues – many – subset of concerns around time to DEEP treatment (OUI programming)
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PROJECT DESCRIPTION # OF AGENCIES
REPORTING
# OF REQEUSTS
FOR SERVICE
# OF ASSESSMENTS
AVG TIME B/T 1ST PHONE CALL & ASSESSMENT
Pre-change:
12/19/06-1/15/07
Baseline 7 38 37
(Show rate=97%)
8.34 days
#1:
1/16/07-2/16/07
Faxing release forms & NEEDS or JASE vs. regular
8 77 66
(Show rate=86%)
5.84 days
#2:
3/5/07-3/30/07
DEEP office notify providers of
process (vs. OSA notification)
8 64 52
(Show rate=81%)
7.08 days
#3:
8/6/07-8/24/07
Use multi-party release form,
signed by client at 1st face to face
session
8
(2 agencies had 0 clients)
45 40
(Unable to calculate show
rate)
4.91 days
Maine DEEP Change Cycle Data
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ME Driver Education & Evaluation Program (DEEP) for OUI offenders
Aim: Increase AccessChange: OSA Fax paperwork (not mail)Results: • Time to treatment dropped 7+ days to 5• No show rates dropped 15%• Revenue rose by $24,146 or $313,898/year!
OSA began work to diffuse/spread project statewide for all OUI DEEP Program agencies