Florida STAR Peer Mentor Training November 15-16, 2012 Angie Maldonado Process Improvement Coach Reduce Waiting & No-Shows  Increase Admissions & Continuation This product was supported by the Florida Department of Children and Families Substance Abuse and Mental Health Program Office funding.

Peer Mentor Plays a critical role in the development of Florida’s performance improvement system

Criteria to Become a Peer Mentor Complete Specific Training Plan Do Study Act (PDSA) 101 How to Lead A Change Team Advanced Data collection and Analysis Making the Business Case Have Experience Leading a change team Implementing change cycles Failures/Challenging change cycles Characteristics Energetic Positive

Peer Mentors Key Roles Use their experience and expertise to provide in person, telephone and online technical assistance to STAR participants Identify promising process improvement strategies, tools, and products to be disseminated throughout the state Participate in and assist in expanding the peer learning network Provide training and share knowledge

Peer Mentor Role Reflections on Experiences as Peer Mentors What worked? What didn’t?

Peer Mentor Role Key Principle Listen

Is direction needed? Teach the process (PDSA) Provide Ideas (tools) Encourage brainstorming

Provider Project Set-up – Checklist for Peer Mentors Review walk-through results Create project charter Confirm that Change Leader is appropriate and has time to devote to PI Confirm that Change Team has been established Involve Executive Sponsor and get sign off on Project Charter

Provider Project Set-up – Checklist for Peer Mentors Review walk-through results Assist to identify at least two salient findings Assist to prioritize each one Introduce nominal group technique (if needed)

Provider Project Set-up – Checklist for Peer Mentors Create project charter (1st page of change project form) Aim statement Define measure and how data will be collected Baseline data Business case

Provider Project Set-up – Checklist for Peer Mentors Confirm that Change Leader is… Influential Experienced Knowledgeable Has freed up enough time to devote to PI activities

Provider Project Set-up – Checklist for Peer Mentors 4. Confirm that Change Team has been established No more than 7 people If Change Leader is not clinical person, make sure to include clinician on team Make sure to include someone who represents customer’s perspective Plan frequency of team meetings, e.g. 1.5 hrs. every other week

Provider Project Set-up – Checklist for Peer Mentors Involve Executive Sponsor Ensure ES engaged in PI Confirm that ES signed project charter Confirm ES support and commitment to sustain changes that result in improvement Establish communication flow with ES

PI Toolkit for Providers – Mentors offer, as needed Nominal Group Process Flowcharting How to measure change Next available appointment tracking/ graphing forms No-show tracking/graphing forms NIATx website - Promising Practices

PI Toolkit – Flowcharting GOLDEN RULE: Focus on fixing system, not individuals (no blame) Step 1 Define objective (e.g. see all clients within 24 hours of 1st contact, increase retention from 1st contact to admission) Step 2 Define process (e.g. admission process) Step 3 Define first and last steps Step 4 Quiet Time – Each person writes down current process steps (from customer’s perspective) Step 5 As a group, note steps in process on yellow Post-its Step 6 Review flowchart

PI Toolkit – Flowcharting Step 7 Quiet Time – Each person uses red Post- its to identify and record bottlenecks/drop out points and blue Post-its to describe suggestions for process improvements Step 8 Place blue and red Post-its on flowchart Step 9 Review suggested changes Step 10 Quiet time – Prioritize areas to focus on. Each participant picks three changes, based on ease of implementation and impact on objective. Use colored dots to mark on flowchart. Step 11 Select changes to pilot test Step 12 Discuss next steps

Peer Mentor Styles and Concepts 1. When to listen, when to tell When in doubt, listen Respect organizational lines of authority and roles

Peer Mentor Styles and Concepts 2. What to look for and listen for What kind of organization are you working with? Take the idea and run - Utopia Take the idea and run in the wrong direction – Ask questions to make sure you understand why Tell me what to do – Avoid this seduction/ dependence; find someone in the organization who can provide direction around improvement projects

Peer Mentor Styles and Concepts 3. When to add structure, when not to Feel the rhythm; watch what happens when they run a few cycles Great ideas, but trouble executing them – help develop a plan Great at implementation, but not at generating ideas – teach them idea generation techniques, e.g. Nominal Group Technique; direct them to the NIATx website

What to watch for – Common Pitfalls Too much, too quick Not holding people accountable Multiple changes made simultaneously Improvements aren’t affecting bottom line Waiting for aim measure results to see if there’s improvement “No authority/control” to change cause of problem Resistant staff

Project Monitoring/Reporting and Other Tasks Bi-Annual Peer Mentor Report Next Available Appointment Tracking No-show Tracking

Support for Peer Mentors: Role of Peer Mentor vs. Coach Total autonomy (the peer mentor acts as the coach and the coach reviews site activity without regular conversations); Supervisory (Coach talks to Peer Mentor on a regular basis); and/or Collaborative (Peer Mentor does provider awareness building and provides some phone call assistance and Coach does majority of technical assistance).

Support for Peer Mentors Monthly conference calls: Within state STAR-SI Peer Mentor Interest Circle Call

Support for Peer Mentors Resources Data Change Ideas NIATx website Interest Circle Calls State PI Coaches Sheila Barbee Rick Hankey Angie Maldonado

Next Steps Call provider to arrange site visit Learning Session (TBD) See Sample Initial Site Visit Agenda Learning Session (TBD)

Feedback What should we do differently in our next Peer Mentor training? What should stay the same?

Have fun!