2018 Wisconsin Mental Health Readmission Collaborative Welcome! 2018 Wisconsin Mental Health Readmission Collaborative Overview

NIATx Model Overview

NIATx History RWJF and SAMHSA Supported and Field Testing Development driven by proven methods and tools Customer-focused Use data to measure effectiveness Field testing resulted in evidence based practices Funders sought experts in the field of org change, QI improvement and behavioral health care to lead the initiative. Selected Dr. David Gustafson, a prf of I E at UW-Madsion and has earned an international reputation for excelleence in heathcare improve,emt. Dr. Gustafson continues to do so… These experts used the best of prover methods in their disciples---and understanding of health care delivery to design a model that could be easily used by people who don’t necessaryily guided by basic critia to be easy to use, customer focused and driven by data. Fielding testing began within a yea, 2002… and met with early success. took place after about a year of designing. Since spread to several other arenas including:

What is a process? The steps we take in order to do something.

Why Process Improvement? Everything we do is part of some process Each of us serves others, or is served by processes of work. 85 percent of problems are caused by processes – not people.

Why Process Improvement? “Your processes of work are perfect. They are perfectly designed to give you the results you are getting.” - W. Edwards Deming, process improvement pioneer

Readmissions (& Process Improvement) 9-48% of Readmissions are Preventable Some preventable reasons are poor: medication adherence, patient education, and follow-up care.

Evidence based predictors of successful change Five Key Principles Evidence based predictors of successful change Understand & Involve the Customer Focus on Key Problems Select the Right Change Leader Seek Ideas from Outside the Field and Organization Do Rapid Cycle Testing

1. Understand & Involve the Customer Most important of the Five Principles What is it like to be a customer? Your staff are customers, too. Conduct walk-throughs. Hold focus groups. Standard slide – please do not modify. This is the most important factor of the Five Principles. Organizations that involve the customer are 14 times more liked to be successful than those that do not. The collective importance of the 79 other factors in Gustafson’s research is outweighed by the importance of this principle alone. 9

2. Focus on Key Problems What keeps the CEO awake at night? What processes do staff and customers identify as barriers to excellent service? How to chose a change project? Standard slide – please do not modify. Engage the audience: This is a good time to ask whether there are any CEOs in the audience. If so, ask them what issues keep them awake at night. 10

3. Powerful Change Leader The Change Leader must have… Influence and respect across levels of the organization A direct line to the Executive Sponsor Empathy for all staff members Time devoted to leading Change Projects Standard slide – please do not modify. There are two aspects of the Change Leader that are particularly important: the ability to make connections with both the CEO and the rest of the staff and the ability to devote time to the Change Project. 11

4. Ideas from Outside Organization Real creative problem solving comes from looking beyond the familiar. Provides a new way to look at the problem Client Engagement Northwest Airlines Ford Motor Company Reduce no-shows through reminders Dentist Office Public Libraries Client Handoffs Football! Standard slide – please do not modify. Importance of looking outside for ideas for solving problems. Engage the audience by asking for ideas from outside the field—though beware that the audience may not respond. Specific examples: Northwest Airlines: automatic notification of cancellations and delays via telephone (confirmation calls). Ford: Their sales approach varies depending on the model that they are selling (individualized services). Dentist and Library: confirmation calls with automated voice processing. National Rental Car: seamless transitions from the airport to checkout of the car to return the car to airport. Hyatt Place Hotels: automated check-in and checkout by credit card to get key without personal interaction. 12

5. Rapid-cycle Testing The PDSA model Rapid-cycle changes Plan the change Do the plan Study the results Act on the new knowledge Rapid-cycle changes Changes should be do-able in two weeks Adapt, adopt, abandon The NIATx change model relies on the Plan-Do-Study-Act (PDSA) Cycle to turn a change idea into action. The PDSA Cycle uses a series of short rapid cycles, with each cycle from planning through implementation taking only a couple of weeks. The results of each change cycle are compared to pre-test measurements to ensure that the change is actually an improvement. Only when the change cycle results in a significant improvement in the existing process is the change fully implemented. By testing changes this way, organizations: 1) minimize risks and expenditures of time and money, 2) make changes in a way that is less disruptive to clients and staff, 3) reduce resistance to change by starting on a small scale, and 4) learn from the ideas that work, as well as from those that do not. By starting with small changes to test ideas quickly and easily, and using simple measurements to monitor the effect of changes over time, the PDSA model can lead to larger improvements through successive quick cycles of change.

PDSA Cycle for Improvement Act Plan Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when) What improvement will we make next? Do we need to: Abandon? Adapt? Adopt? Sustain the gain 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

Key Roles: Change Team

Executive Sponsor Senior leader in the agency Must see change/improvement as a priority Identifies the problem; articulates the vision Demonstrates commitment to the process Removes barriers to change Is engaged Allocates time and resources Empowers and supports the change leader Provides a clear link to a strategic plan Sets a clear aim for the Change Project

Change Leader Person has sufficient power and respect in the organization Able to influence others at all levels of the organization Ability to instill optimism; sees the big-picture; focused and goal-oriented A good sense of humor

Change Leader Responsibilities Serves as a catalyst to develop ideas Successful communicator: plans & facilitates team meetings, is consistent, concise (data), creative, engaging (incentives), and a skilled listener Minimizes resistance to change Keeps the Executive Sponsor updated on change team activities

A Change Team Front line workers and supervisors Key community stakeholders Others impacted by the change: Staff from other county, healthcare or community organizations Members of the community (clients) 3-5 staff members

Change Team Responsibilities Meet regularly Ensure accountability Record and distribute minutes Assign tasks and responsibilities Identify potential solutions Measure the impact of the change Standard slide – please do not modify.

Change Team Responsibilities Meet regularly Identify possible changes that could meet the goal Decide how to implement the change Quickly test one change at a time Measure the impact of the change Decide if the change should be adopted, adapted or abandoned

Ask 3 Questions What are we trying to accomplish?` Establish a clear aim How will we know a change is an improvement? Collect baseline data What changes can we test? Change Leader & Change Team and conduct rapid cycle tests Standard slide – please do not modify. Specific Examples: The dates of the first request for service, the first appointment, the assessment appointment, and the first therapeutic session. Adolescents in treatment at a particular clinic. Reduce the number of days between first request for service to the first treatment session to less than 7 days. A Change Leader and a Change Team constructed to focus on the selected aim.

What makes this approach to improvement different? Change is a big experiment No mistakes, no right or wrong Data tells you if the change was an improvement Customer perspective guides change ideas Use existing resources

NIATx on a Napkin https://www.youtube.com/watch?v=Te3FV1YoE-4

Questions