Reduce Waiting & No-Shows  Increase Admissions & Continuation Improving Client Engagement & Retention Lynn M Madden, MPA Reduce Waiting & No-Shows  Increase Admissions & Continuation

A Systems Thinking Orientation Starting Assumptions Everyone is acting as they should, given the system they are in Your current system is perfectly designed to produce the results it is currently producing –To produce different results you must change the system We all contribute to the system that we are a part of, both positively and negatively W. Edwards Deming

Reduce Waiting & No-Shows  Increase Admissions & Continuation At any one time: 110,000 waiting for assessment*. 42,000 waiting for treatment* 32 days from first contact to treatment No show rates about 50% * Based on survey conducted by Survey Research Laboratory University of Illinois - Chicago March 2007

Reduce Waiting & No-Shows  Increase Admissions & Continuation Detox Retention Rate Finish Detox No Transfer: 61% Don’t finish: 23% Don’t Connect: 12% Based on 2004 TEDS admission & discharge reports Successful transfer 4%

Reduce Waiting & No-Shows  Increase Admissions & Continuation Finish Treatment No Transfer: 51% Residential Retention Rate Transfer; No connect: 10% Don’t finish: 34% 4% successful transfer

Reduce Waiting & No-Shows  Increase Admissions & Continuation Finish Treatment, No transfer: 36% Don’t finish: 51% Successful transfer: 7% Transfer but no connection: 7% OP/IOP Retention Rate

Reduce Waiting & No-Shows  Increase Admissions & Continuation “It is not necessary to change. Survival is not mandatory” W. Edwards Deming

Reduce Waiting & No-Shows  Increase Admissions & Continuation 85 percent of the problems that organizations have in serving customers are caused by their processes

Reduce Waiting & No-Shows  Increase Admissions & Continuation A process is a collection of interrelated tasks, which accomplish a particular goal. Three types: management operational supporting

Reduce Waiting & No-Shows  Increase Admissions & Continuation All processes have inputs, steps, and outcomes, for which data can be collected, measurements can be made, and changes can be developed and tested to lead to improvement.

Reduce Waiting & No-Shows  Increase Admissions & Continuation Some methodologies for process improvement that you may have heard of: –TQM –Six Sigma –ISO 9000 –NIATx

Reduce Waiting & No-Shows  Increase Admissions & Continuation Process improvement is one way of making change. It uses an incremental improvement process that leads to gradual improvement over time.

Reduce Waiting & No-Shows  Increase Admissions & Continuation We are looking for opportunities to improve processes – not for bad people. Most people are doing their jobs the way they believe they have been asked to do them.

Reduce Waiting & No-Shows  Increase Admissions & Continuation Four Project Aims Reduce Waiting Times Reduce No-Shows Increase Admissions Increase Continuation Rates

Reduce Waiting & No-Shows  Increase Admissions & Continuation NIATx Results Reduce Waiting Times: 51% reduction (37 agencies reporting) Reduce No-Shows: 41% reduction (28 agencies reporting) Increase Admissions: 56% increase (23 agencies reporting) Increase Continuation: 39% increase (39 agencies reporting)

Reduce Waiting & No-Shows  Increase Admissions & Continuation Five Key Principles Evidence-based predictors of change  Focus on Key Problems  Select the Right Change Agent  Understand & Involve the Customer  Seek Ideas from Outside the Field and Organization  Do Rapid-Cycle Testing

Reduce Waiting & No-Shows  Increase Admissions & Continuation Most important of all the Principles What is it like to be a customer? Staff are customers, too! Walk-through, focus groups… 1. Understand and Involve the Customer

Reduce Waiting & No-Shows  Increase Admissions & Continuation 2. Focus on Key Problems What is keeping senior management awake at night? What processes have staff and customers identified as barriers to excellent service?

Reduce Waiting & No-Shows  Increase Admissions & Continuation What Problems Are You Having with your MTP program?

Reduce Waiting & No-Shows  Increase Admissions & Continuation How do you know these are the problems? Or, how are we going to measure improvement?

Reduce Waiting & No-Shows  Increase Admissions & Continuation Conducting a Change Exercise PDSA cycles  Plan the change  Do the plan  Study the results  Act on the new knowledge Rapid cycle changes  Changes should be doable in 3 weeks

Reduce Waiting & No-Shows  Increase Admissions & Continuation Change Cycles Hunches Theories Ideas Changes that Result in Improvement AP SD A P S D AP SD D S P A DATA Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide

Reduce Waiting & No-Shows  Increase Admissions & Continuation NIATx Process Improvement Project 1.Conduct a walk-through 2.Using the walk through and existing data select an aim 3.Select a change leader 4.Send the change leader and other change team members to training

Reduce Waiting & No-Shows  Increase Admissions & Continuation NIATx Process Improvement Project 5.Change team meets weekly to design and assess change projects 6.New change cycles monthly 7.Monthly learning collaborative calls 8.Coach calls with change leader (and executive sponsor) 9.Final face to face wrap up session

Reduce Waiting & No-Shows  Increase Admissions & Continuation Role of the Executive Sponsor Senior leader in the organization Must see change/improvement as a priority Identifies the problem and articulates the vision Demonstrates commitment to the process (time, resources) Empowers the change leader

Reduce Waiting & No-Shows  Increase Admissions & Continuation Leadership responsibilities: 1.Do a needs assessment and identify a problem important to management Walk-Through Focus Groups Existing Data 2.Establish a target objective Achievable Specific Measurable

Reduce Waiting & No-Shows  Increase Admissions & Continuation Leadership responsibilities: 3. Developing a Change Team Change Leader 3-5 Members Work together until success is achieved Clear statement of problem with data Priority for improvement Clear objective Promise of support and commitment

Reduce Waiting & No-Shows  Increase Admissions & Continuation 3. Select a Powerful Change Leader Who has: –influence, respect and authority across levels of the organization –a direct line to the CEO –empathy for the staff –time available to lead change projects –no fear of data

Reduce Waiting & No-Shows  Increase Admissions & Continuation Change Leader Responsibilities Serves as a catalyst to develop ideas Successful communicator: facilitates change team meetings, consistent, concise (data), creative and engaging (incentives), skilled listener. Minimizes resistance to change Keeps the executive sponsor updated on change leader activities.

Reduce Waiting & No-Shows  Increase Admissions & Continuation Next Steps Put together a change team Using information from the walk through or other data, identify some problems that need to be solved Support the staff that attended the kick off