Overview NIATx Model

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

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

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.

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?

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

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!

5. Rapid-cycle Testing The PDSA model 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

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

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)

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

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 1.What are we trying to accomplish? ` Establish a clear aim 2.How will we know a change is an improvement? Collect baseline data 3.What changes can we test? Change Leader & Change Team and conduct rapid cycle tests

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

Questions