1. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Improving Client Engagement & Retention Lynn M Madden, MPA Reduce Waiting & No-Shows  Increase Admissions & Continuation

2. www.NIATx.net 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

3. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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

4. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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%

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

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

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

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

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

10. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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.

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

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

13. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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.

14. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Four Project Aims Reduce Waiting Times Reduce No-Shows Increase Admissions Increase Continuation Rates

15. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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)

16. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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

17. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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

18. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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?

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

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

21. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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

22. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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

23. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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

24. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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

25. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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

26. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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

27. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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

28. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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

29. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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.

30. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net 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