MULTI-STATE LEARNING COLLABORATIVE: SMALL CHANGES—DRAMATIC RESULTS Tom Mosgaller Director of Change Management CHESS/NIATx – University of Wisconsin

All work is a process. W. Edwards Deming Poor processes account for 85% of the problems in serving customers.

Health – To Be Whole A system is a whole consisting of interdependent parts You cannot understand the whole by understanding each part You cannot improve the whole by improving each part The net output of the whole—for better or for worse—is the result of the interactions

Health – To Be Whole THE FIVE DETERMINANTS OF HEALTH 1. Personal awareness 2. Community and connections 3. Safety and sense of security 4. The opportunity to use our gifts and talents in a meaningful way 5. Access to therapy/medical care

The Geometry Lesson InstitutionCommunity

The Role of Quality in the New Economy QUALITY is what makes it possible for our customers to have a long-term love affair with our products and services

The Methods of Quality 4 Reactive Quality by Design Quality by Process Improvement Quality by Compliance Quality by Inspection Active NIATx focus

Four Approaches to Quality When you think about your work, what percentage of your time and energy is spent on each of these four aspects of quality?  INSPECTION (%)  ASSURANCE/COMPLIANCE (%)  QUALITY IMPROVEMENT (%)  DESIGN AND INNOVATION (%)

The NIATx Approach to Quality CORE PRINCIPLES:  Understand and involve the customer  Focus on key problems  Select the right change agent  Seek ideas from outside the field  Do rapid cycle testing

The NIATx Approach to Quality CORE PRACTICES:  Simple model of improvement  Use of aims  Collaborative approach  Empower those closest to the work  Develop the business case

The NIATx Approach to Quality: PDSA Cycle of Improvement ACTPLAN STUDY DO Adopt, Adapt, or Abandon Study data What steps are you making to test the idea/change? Who is responsible? What is the idea/change to be tested? Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide

What is a 5x5? 5 minutes to present 5 Power Point slides which tell your story of your change project: Title Slide 1. Aim (PLAN) 2. Change (DO) 3. Results (STUDY) 4. Next Steps (ACT) 5. Impact (lessons learned, etc.)

 Decrease wait time between 1 st contact and 1 st treatment for IOP* clients from 16 days to 5 days.  This is a 69% improvement goal.  Location is the Oakdale IOP office.  Length of the change project is May-July, Project Aim *IOP = Intensive Outpatient AIM

1) Eliminated old procedure of scheduling intakes with clinicians weeks in advance. 2) Established daily walk-in orientation group between 9am – 10am. Changes we made: Contact with clinician. Program orientation. Intake appointment IOP clients can now have same day: These changes had a positive impact on customers. Clients enter the IOP program NOW, when they are motivated! CHANGE

Wait time decreased from 16 to 3.5 days. Wait time between 1 st contact and 1 st treatment Days Months MAY JUNEJULY Baseline 16 days Change Project Wait Time 78% RESULTS

 Adopt daily walk-in orientation as standard procedure at the Oakdale office.  Create a sustainability plan to maintain the improvement.  Expand the walk-in orientation pilot test to our Smithville office. NEXT STEPS

84 more clients seen per year $29,016 in added revenue per year Reputation for same day service IMPACT (business case, efficiency, lessons learned etc.)

NIATx year grant funded by NIDA State-based collaborative Identify the “active ingredients” What parts of our approach to quality produce the greatest improvement? Which parts are the most cost effective?

Preliminary Lessons & Outcomes Largest randomized trial ever done in healthcare:  200 organizations  5 states  9000 hours of training  80,000 client records analyzed  4000 staff surveys reported Successfully reduced waiting time and continuation of care among participant organizations with different rates of improvement between groups in the trial

Simple Changes Dramatic Results What struck you?

Quality in Daily Work “Thus in all ways I will leave my community greater and more beautiful than it was transmitted to me.” – Pericles Athenian Oath