1. Overview What Is NIATx Mark Zehner, NIATx Milwaukee County
November 20th 2013

2. Nobody should have to suffer twice. Dave Gustafson

3. Original Aims Reduce Waiting Times Reduce No-Shows Increase Admissions
Increase Continuation

5. Every system is perfectly designed to achieve exactly the results it gets. Paul Batalden

6. Why Process Improvement?
Customers are served by processes.
85 percent of customer-related problems are caused by processes.
You must improve your processes to better serve customers.

7. Small Changes, Big Impacts
Small changes create a big difference for both clients and staff.
Effective changes don’t have to be expensive
Devoting an hour a day of a receptionist’s time to confirm next-day appointments cost one agency $4,000 per year. The resulting reduction in no-shows increased their revenues by over $400,000 per year.
Standard slide – please do not modify.
This slide shows a standard example of a small change with a larger impact—a 100:1 return on investment. This is usually a response to the objections (lots of work, lots of expense) tacitly raised by the previous slide.

8. Change is Hard As I say, it shall be done
“Yeah, right”
Just hope things are better tomorrow
Chances are they’ll be worse
If we only had more money we would be so much better at doing this
Please, share with us just where that money tree is

9. What makes this approach to change different?
Change is a big experiment
No mistakes, no right or wrong
Data tells you if the change was an improvement
Customer guides change ideas

10. “For all its macho rhetoric and technological content, reengineering in the end is like any other effort to change the way people work: Culture counts big.
Change won’t occur merely because management wills it.”
(Title)
Accounting, Management and Information Technologies Volume 5, Issue 1, January-March 1995, Pages 23-39
Name(s) of presenter(s)
Organizational Affiliation
Stewart, T.A. (1993). Reengineering: The hot new managing tool. Fortune, August 23,

11. Why Organizational Change?
Small changes do increase client satisfaction.
Satisfied clients are more likely to show up and continue their treatment.
More clients in treatment make your work more rewarding.
More admissions and fewer drop-outs improve the bottom line.
Standard slide – please do not modify.
Tie the four bullet points together in a logical sequence in the order given: client satisfaction leads to increased continuation which leads to more rewarding work and a better bottom line.

12. So, how do you do it?

13. NIATx Model Tab 2
If you can not upload the video by double clicking on the picture use the next slide instead

15. Nominal Group Technique
Process
Improvement
Model
People
Change
Executive Sponsor
Change Leader
Change Team
Tools
aim
SCRIPT – written by Scott Gatzke use this slide only if you are unable to access the video.
NIATx on a Napkin (2-min homepage version)
At NIATx, one of the main things we do is to teach process improvement to human service professionals. We’ve been known to explain our entire process improvement model to folks over lunch using only a napkin and a marker. It’s that simple. Here’s how it works…
Whenever you want to make a change or improve something, you start a change project. Every change project has one aim. Think of the aim as the “target.” It’s the specific, measureable goal you’re trying to achieve.
Now, to carry out a change project, you need people and some tools.
On the people side, we emphasize three key roles. The executive sponsor, the change leader, and the change team.
The executive sponsor is often a senior leader in the organization.
The change leader is the project owner.
And the change team is a group of staff members selected to work on the change project.
When it comes to process improvement tools, the NIATx model focuses on four that we have found to be easy to learn and effective for most change projects. These tools are the walk-through; flowcharting; the nominal group technique; and the PDSA Cycle.
The walk-through is a tool to help you experience a process just as your customer would.
Flowcharting is a tool which creates an actual picture of a process from beginning to end.
The nominal group technique is a tool the change team uses to brainstorm ideas that will help achieve the aim of the change project.
And the PDSA Cycle, which is an acronym for plan, do, study, act, is an efficient way to test changes and learn what will work in your organization.
Finally, the NIATx model has three rules for change leaders and their teams to follow when conducting a change project:
Number one is to use existing resources. The goal is to achieve your change project aim using currently available staff and materials.
Two, is to measure change. Simple measures are the life blood of successful change projects. Collect only the information you need to achieve your project aim.
Walk-through
Flowcharting
Nominal Group Technique
PDSA Cycle
Project
Rules
Use existing resources
Measure change
Sustain the gains

16. The NIATx Change Process
Complete a Walk-through
Choose an Aim and set a Goal
Measure the Effectiveness of Change
Select and Test Changes
Sustain the Gains

17. Three Key Roles Executive Sponsor Change Leader Change Team
Tab 3
People
Three Key Roles
Executive Sponsor
Change Leader
Change Team

18. Executive Sponsor
Has the authority to allocate the resources for this particular project
Sees the change/improvement as a priority
Identifies the problem and articulates the vision

19. Executive Sponsor Responsibilities
Chooses the change leader
Works with Change Leader to identify who will be on the change team
Invites staff to be on the team
Removes barriers and allocates resources
Allows/Empowers the team to make changes

20. Change Leader Person who feels passionately about the change
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

21. Change Leader Responsibilities
Serves as a catalyst to develop ideas
Successful communicator: facilitates change 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

22. What do Change Team Members look like?
Front line workers and supervisors in unit where changes will be implemented
Other employees impacted by the change
People with special knowledge about the change such as
customers, family members, experts from outside the organization, IT staff…..

23. Change Team Responsibilities
Identify possible changes that could meet the objective
Decide how to implement the change
Create and conduct rapid-cycle pilot tests until goal is achieved
Study results to see if the change should be adopted, adapted or abandoned

24. Five Principles Fix key problems Pick a powerful Change Leader
Get ideas from outside the organization
Use rapid-cycle testing
Understand and involve the customer
These five principles are based on research by Dave Gustafson et al. that investigated which factors where characteristic of organizations that have successfully improved their processes. These principles represent the top five from a collection of eighty characteristics.

25. Why a Walk-through? The walk-through…
Helps understand the customer and organizational processes
Provides a new perspective
Allows you to feel what it’s like
Lets you see the process for what it is
Seeks out and identifies real problems
Generates ideas for improvement
Keeps you asking why?…and why? again
Engage the audience: This is a good time to ask of anyone has done a walk-through before—and if so, what their experiences were.
If not, provide an example of your own from a recent walk-through experience.
Go over the walk-through exercise here 25

26. How to Do a Walk-Through
1. Agency director or executive sponsor plays the role of client and or family member
2. Inform staff in advance that you will be doing the walk through
3. Encourage staff to treat you as they would a client; no special treatment
4. Think, feel, observe
5. Record observations and feelings
6. Involve staff, get their feedback

27. Walk-through Results Strengths Opportunities No waiting
Efficient intake process
Positive group experience
Friendly staff
Opportunities
Long intake process
Cumbersome paperwork
No privacy
No family services
Standard slide – please do not modify.
Each agency starts out in a different place—each with their own strengths and opportunities for improvement. The purpose of the walk-through is to find both, keep what works, and improve what doesn’t.

28. How to begin? Ask 3 Questions:
What are we trying to accomplish? (AIM)
2. How will we know that a change is an improvement? (MEASURE)
3. What change can we make that will result in improvement? (CHANGE)
Nolan’s model--three questions and PDSA, but not just one PDSA. Difference between this and Juran is the emphasis on repeated PDSA cycles
Act
Plan
Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide
Study Do

29. Measuring the Impact of Change:. How will we know that a change
Measuring the Impact of Change: How will we know that a change is an improvement?
1. Define measures
2. Collect baseline data
3. Establish a clear aim
4. Collect data consistently
5. Chart and document progress, including date you implemented a change
6. Ask questions

30. Making Changes PDSA Cycles Plan the change Do the plan
Study the results
Act on the new knowledge
Adapt
Adopt
Abandon
Standard slide – please do not modify.
Pick a concrete example of a PDSA cycle and walk the audience through the story.
Example:
Plan: An agency decides to offer walk-in service on Wednesday afternoons
Do: The agency offers the walk-in hours on Wednesday afternoon for two weeks.
Study: No clients showed up for service during the walk-in hours—because the agency forget to notify their community that they were open for walk-ins.
Act: Adapt by continuing to offer walk-ins and by advertising the walk-in hours to their community.
Emphasis on short cycles—two or three weeks at the most. 30

31. Changes that Result in Improvement Hunches Theories Ideas
Process Improvement
Changes that Result in Improvement A P S D
DATA D S P A
Standard slide – please do not modify. A P S D A P S D
Hunches Theories Ideas
Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide 31

32. Technical Assistance and Tools
NIATx Web site:
Tutorial Conference Calls
Promising Practices
Electronic Newsletter
Case studies
Learning Collaboratives
These tools will help agencies make specific changes that have been proven to work at hundreds of treatment programs across the country. Clear instructions, data collection tools and a social support network as well as access to experts who can answer questions and help trouble shoot problems are all available to agencies who sign up to participate in the campaign.

33. For More Information www.niatx.net Mark Zehner, M.S.,
Associate Researcher | NIATx
Center for Health Enhancement Systems Studies (CHESS)
University of Wisconsin-Madison (UW)
Ph: