1. 2018 Wisconsin Mental Health Readmission Collaborative
Welcome!
2018 Wisconsin Mental Health Readmission Collaborative
Overview

2. NIATx Model
Overview

3. 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:

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

5. 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.

6. 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

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

8. 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

9. 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.
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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

10. 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?
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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

11. 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
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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

12. 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!
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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

13. 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.

14. 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

15. Key Roles: Change Team

16. 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

17. 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

18. 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

19. 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

20. Change Team Responsibilities
Meet regularly
Ensure accountability
Record and distribute minutes
Assign tasks and responsibilities
Identify potential solutions
Measure the impact of the change
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21. 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

22. 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
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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.

23. 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

24. NIATx on a Napkin

25. Questions