Center for Drug Free Living The Four Aims Stepping to it… From your Walk-through to PDSA Angie Maldonado Center for Drug Free Living This product is supported by the Florida Department of Children & Families Substance Abuse Program Office funding.

What is Process Improvement? Find a better way to do things that makes a positive impact on customers.

Process has a Beginning and an End Start End

Individual Steps = Process Start End

At the End is an Outcome Start End/ Outcome

Why Focus on Process Organizations exists to serve customers Customers are served by people following processes 85% of customer related problems due to process To better serve your customer, improve processes

NIATx Aims Decrease wait time (from any service) Increase continuation (engagement) Increase # of Admissions (Customers) Reduce no shows (Stakeholders)

Five Key Principles

Fix key problems Get ideas outside the organization Understand & Involve customer Choose powerful change leader Test changes quickly (PDSA)

NIATx Approach Do a Walk Through to… What areas can be improved? What concerns were identified? Brainstorm solutions Choose one solution to test Test the idea by Monday Adapt, test again, abandon or adopt

Why a Walk-through? The walk-through…Can be done for any process Helps understand the customer and organizational processes Provides a new perspective Allows you to feel what it’s like Lets you see the process for what it is Seeks out and identifies real problems Generates ideas for improvement Keeps you asking why?…and why? again

Challenge Assumptions Clear deck of old ideas Consider everything you “know” to be true about a current service or process Examine each assumption in turn (no matter how logical) and ask yourself – “What if it’s not necessarily the case?” Share your walkthrough with your team C a Walk Through

What Are We Trying to Accomplish? Review results of the walk-through Examine baseline data How do these compare with the agency mission and goals?

How to Conduct a Change Cycle

Start with a Creative Attitude Treat Problem Solving as a game – have fun! “The supreme accomplishment is to blur the line between work and play” – Arnold Toynbee Be Daring “If at first an idea is not absurd, then there is no hope for it.” – Albert Einstein Be optimistic and persistent “Whether you think you can or think you can’t, you are absolutely right.” – Henry Ford

Encourage Creative Thinking!

Encourage Creative Thinking!

PDSA Cycle for Improvement Act Plan Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when) What changes are to be made in next cycle? Abandon Adapt Adopt Study Do Complete the analysis of the data Compare data to predictions Summarize what was learned Carry out the plan Document problems and unexpected observations Begin analysis of the data Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide

Change/Adapt – Don’t Throw Out Netflix Step 1: rent DVDs over Internet Added Step 2: subscription service Added Step 3: download DVDs directly off Internet

Accomplishing one aim contributes to accomplishing the next Where to Begin? Accomplishing one aim contributes to accomplishing the next Decrease wait time Reduce no-shows Increase continuation (engagement) Increase admissions/customers

Increase continuation (engagement) Identify a aim Decrease wait time Increase continuation (engagement) Increase # of admissions (customers) Reduce no shows What to accomplish? Is change an improvement? How can you measure changes?

PLAN the Change

DO the Plan/Change

STUDY the Results –What Worked and What Didn’t

The role of data (and graphs) in decision-making Chg 1 Chg 2 Chg 3 Month

ACT on the new knowledge Decide your next steps

How To Conduct a Change Cycle

Coalition, Consultant, or Provider Walk Through Summary

Building your TEAM for Performance Improvement

Keys to Successful Change Planning Management defines and sets change objectives Objectives achievable but challenging All participants in change experiments are clear on roles and responsibilities Progress is charted and reviewed frequently

The Change Process Includes… Management looking at processes from the customers perspective Change Team identifying and prioritizing potential improvements Turning responsibility for experimenting with change over to a small group of employees Successes and failures...and investment by both management and staff

Work closely together and communicate often

Establish a Change Team Diverse talents Outside perspectives Staff affected by or knowledgeable of the change process Keep it small – no more than 7 people

Change Team Responsibilities Meet regularly Ensure accountability Record and distribute minutes Assign tasks and responsibilities Identify potential solutions Quickly test one idea Measure the impact of the change

Qualities of Good Change Team Members Enthusiastic Willing to try new things Able to think creatively Not afraid to admit failure and move on Open in dealings with others

Avoiding Common Pitfalls of Change Leader and Team Understand your customer’s needs – ask them! Communicate constantly – update others Gather data quickly (weekly), by hand if necessary Break projects into manageable chunks Look for early successes Stick with one aim and do several cycles Be bold – this is an experiment, not a permanent change

Remember Process Barriers for the TEAM Excessive Paperwork Initial and Ongoing Customer Interaction and Engagement Length of time Antiquated Systems Redundancy Tailored Responses

Business Case is Key to Sustainability Economics drive an organization’s ability to offer services A positive economic position is a better leverage point for organizational change Programs that drain resources from the organization are rarely expanded – they also have more difficulty attracting staff

Create a sense of direction and project importance People love to win. If you’re not totally clear about the purpose of what you are doing, you have no chance of winning. David Allen

For more information www.NIATx.net Forms Business case examples Tool box