Reduce Waiting & No-Shows  Increase Admissions & Continuation Overview CO HIV-STIC NIATx Kick-off Training November 8, 2011 Colorado Springs, CO

Reduce Waiting & No-Shows  Increase Admissions & Continuation Good Morning! Linda Frazier RN, MCHES NIATx Coach

Reduce Waiting & No-Shows  Increase Admissions & Continuation Why Process Improvement? Between clients and clinicians lies a canyon of poor business processes that interfere with care Customers, (clients, family, staff, payers, referrers), are served by organizational processes 85% of customer related problems are caused by organizational processes, not people To better serve customers, organizations must improve processes, not improve the staff’s use of existing processes

Reduce Waiting & No-Shows  Increase Admissions & Continuation NIATx: Growing and Making a Difference NIATx started in 2003 with 13 substance abuse treatment provider organizations Today, NIATx works with more than 2000 payer and provider organizations across multiple initiatives in 50 states

Reduce Waiting & No-Shows  Increase Admissions & Continuation NIATx Provider Results Reduce Waiting Times: 23.6% reduction (82 change projects in 34 agencies) Reduce No-Shows: 32% reduction (51 change projects in 29 agencies) Increase Admissions: 25.3% increase (52 change projects in 25 agencies) Increase Continuation: 13.5% increase (102 change projects in 34 agencies)

Reduce Waiting & No-Shows  Increase Admissions & Continuation 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 2-3 weeks

Reduce Waiting & No-Shows  Increase Admissions & Continuation Common Goals Increasing the number of people served Eliminating waiting lists Implementing evidenced based practice Reducing recidivism Increasing retention NIATx Can Help!

Reduce Waiting & No-Shows  Increase Admissions & Continuation The NIATx Offer Simple and innovative solutions to: Get people into treatment faster get more people into treatment keep them there longer reduce costs improve staff morale increase revenue using existing resources

Reduce Waiting & No-Shows  Increase Admissions & Continuation Box for DC orders in Clerk’s Office & Spreadsheet of new client information for Arkansas DC Team RESULTS: March & April 2010: Days from Call to Assessment decreased BUT total days from Call to Admission increased by 7 days

Reduce Waiting & No-Shows  Increase Admissions & Continuation MidCoast ARC: Snapshot of calls requesting MAT (15-20/mo); Feb. 2007, 25% of those with opiate addiction with LOC Asses retained past initial eval & all retained able to access suboxone; all who did not engage in treatment (75%) unable to access MAT.

Reduce Waiting & No-Shows  Increase Admissions & Continuation ME STAR SI Retention project NIATx aims: Reduce no shows Increase continuation rates Change Made: Agency level changes

Reduce Waiting & No-Shows  Increase Admissions & Continuation Alabama RESULTS (STUDY) Change #1: Admission Appts. to Open Scheduling Baseline: Average number of days between orientation and admission = 12.4 Post Change: Average number of days between orientation and admission = % decrease in time

Reduce Waiting & No-Shows  Increase Admissions & Continuation Impact In addition to favorable results directly related to the change, we had an unintended positive side effect: Increased client return rate by nine percentage points (from 76% to 85%), saving counselor time and increasing billing Business Case: $17,000 per year

Reduce Waiting & No-Shows  Increase Admissions & Continuation Missouri Screen –Admission Days

Reduce Waiting & No-Shows  Increase Admissions & Continuation Missouri Cost Savings- Impact $48, Month # Confined Admits # Days Saved $ Saved July18322$17,066. August7175$9,275. Sept564$3,392. Oct11166$8,798. Nov11140$7,430. Dec656$2,968.

Reduce Waiting & No-Shows  Increase Admissions & Continuation Began AIMS 3/1/11 Avg 8.5/mo Avg 3.4/mo RESULTS (study)

Reduce Waiting & No-Shows  Increase Admissions & Continuation WI CHANGE CYCLE #1 Aim: Reduce the time for the response from Defense Attorneys indicating their interest in DTC Change: Client Services Specialist from State Public Defender’s Office will also contact Defense Attorneys to obtain response Result: Pre-change = 10 days ( N=28) Post-change = 1.6 days ( N=12) Act: Adopt the change

Reduce Waiting & No-Shows  Increase Admissions & Continuation SAMSHA TCE/HIV Program 17 Sites working on admissions, HIV testing, follow-up/continuation. 30 to 90% increase in clients attending next four sessions after intake in LA % increase in clients agreeing to HIV testing in urban site % increase in completed intake/assessments

Reduce Waiting & No-Shows  Increase Admissions & Continuation What DC Change Teams Say Small changes can make revenue impact Clinicians more aware of productivity [Data] - Analyze your data—it can tell you what the problem is—it’s continuous - look at your data -Turn to Data to Indicate Need for Change & Problem Solving Rapid cycle testing has given us the opportunity to see that even small changes can have a large impact Successful collaboration leads to better client outcomes In addition to favorable results directly related to the change, we had an unintended positive side effect: ---- Increased client return rate by nine percentage points (from 76% to 85%), saving counselor time and increasing billing Taking time to study the results and process how each member of the team felt about the results or helped to support the decision Used “WALK THROUGH” for other processes

Reduce Waiting & No-Shows  Increase Admissions & Continuation Ball Pass PDSA Stand in a circle Change Leader pass ball to someone not next to them. After all have touched ball it goes back to the change leader. Time from beginning to end of cycle 1 Change at a time Document results