1. 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.

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

3. Process has a Beginning and an End
Start
End

4. Individual Steps = Process
Start
End

5. At the End is an Outcome
Start
End/
Outcome

6. 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

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

8. Five Key Principles

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

10. 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

11. 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

12. 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

13. 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?

14. How to Conduct a Change Cycle

15. 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

16. Encourage Creative Thinking!

17. Encourage Creative Thinking!

18. 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

19. 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

20. 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

21. 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?

22. PLAN the Change

23. DO the Plan/Change

24. STUDY the Results –What Worked and What Didn’t

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

26. ACT on the new knowledge
Decide your next steps

27. How To Conduct a Change Cycle

28. Coalition, Consultant, or Provider Walk Through Summary

29. Building your TEAM for Performance Improvement

30. 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

31. 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

32. Work closely together and communicate often

33. 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

34. 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

35. 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

36. 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

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

38. 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

39. 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

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