Overview Process Improvement

History Founded in 2003, NIATx works with behavioral health care organizations across the country to improve access to and retention in treatment for the millions of Americans with substance abuse and/or mental health issues. NIATx was formerly the acronym for the Network for the Improvement of Addiction Treatment. Now, we're known simply as NIATx.

Overview NIATx –History –AIMS –Principles –Promising Practices –Tools –Missouri Change Projects

NIATx Aims Reduce waiting time Reduce no-shows Increase admissions Increase continuation Aims

NIATx Aims

NIATx Principles

Five Principles Understand and Involve the Customer Focus on the Key Problems Pick a Powerful Change Leader Get Ideas from Outside the Organization Do Rapid-Cycle Testing

1. Understand & Involve the Customer Most important of the Five Principles What is it like to be a customer? Walk-through, focus groups… Five Principles

Why Walk-through? The walk-through is useful for: –Understanding the customer and organizational processes –Providing a new perspective Allowing us to ‘feel’ what it’s like Letting us see the process for what it is –Seeking out and identifying real problems –Generating ideas for improvement –Asking why?…and why? again Five Principles

2. Focus on Key Problems What keeps the CEO awake at night? What processes have been identified by staff and customers as barriers to excellent service? Five Principles

Examples of Key Problems Excessive paperwork Initial and ongoing client no- shows for services Length of the intake process Creating successful handoffs across levels of care Improving financial solvency Staff turnover Tailored treatment Five Principles

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 devoted to leading change projects Five Principles

4. Seek Ideas Outside the Organization and the Field Provides a new way to look at the problem Real creativity in problem solving comes from looking beyond the familiar Five Principles

5. Do Rapid Cycle Testing Start by asking three questions: 1.What are we trying to accomplish? 2.How will we know the change is an improvement? 3.What changes can we test that will result in an improvement? Model for Improvement Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide, San Francisco, Jossey-Bass Publishers, 1996 Five Principles

Before Starting the Change Collect baseline data Determine the target population and location Establish a clear aim Five Principles

Make Changes PDSA Cycles –Plan the change –Do the plan –Study the results –Act on the new knowledge Adapt Adopt Abandon Rapid-cycle changes should be doable in two weeks Five Principles

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 Five Principles

Promising Practices Promising Practices are changes which were tested and shown to be actual improvements by various behavioral health organizations.

Process Improvement Tools Nominal Group Technique –The Nominal Group Technique (NGT) is designed to promote group participation in the decision-making process –The Nominal Group Technique can be used by small groups to reach consensus on the identification of key problems or in the development of solutions that can be tested using rapid-change cycles. Flow Chart –Flowcharts force an organizational focus on process. –Flowcharting is useful for: –Providing a starting point/baseline view –Understanding the process –Identifying key problems/bottlenecks –Showing where to test ideas for most impact Walk Through PDSA

Change Leader Calls Facilitated by ADA staff Calls One hour, each month Participants share change projects Ask for comments, questions, feedback after each report Participants working on change projects utilizing the same process and working on familiar AIMS.

Mark Shields, M.Ed, LPC Director Access to Recovery (573)