1. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Eliminating Excessive Paperwork: A Step-by-Step Guide

2. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net The Problem Time consuming for staff and consumers Barrier to treatment access Barrier for client engagement

3. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net What are we trying to accomplish? Streamline paperwork –Decrease time to treatment –Increase consumer engagement Capture the right information

4. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net How will we know a change is an improvement? The number of questions will decrease. The number of pages of paperwork will decrease. The time required for consumers to complete paperwork will decrease. The time required for staff to complete paperwork will decrease.

5. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net

6. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Steps to take 1.Appoint a paperwork Czar or Czarina (not a committee) within the agency, who is –Knowledgeable about required forms –In a position to communicate with state representatives/payers

7. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Steps to take 2.Apply “Just-in-Time” paperwork principle – Delay paperwork until needed. –Before assessment –During assessment –After assessment/during treatment –Post-discharge

8. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Steps to take 3. Identify existing paperwork –Flowchart the process from the perspective of the customer. –Collect forms during a walk-through. –Check for paperwork in client’s charts.

9. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Steps to take 4. Redesign paperwork –Question why all existing forms are being used. –Eliminate forms that are not required. –Eliminate duplication. –Combine forms wherever possible.

10. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Steps to take 5.Assure compliance with state, payer, and accreditation agency requirements. –State Administrative Code –Medicaid –JCAHO –CARF

11. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Steps to take 6. Pilot test changes in the paperwork –Review new packet of forms with staff. –Test revised forms for 2 weeks (use a sample group) –Get feedback from staff & customers. –Adopt, adapt or abandon forms as needed.

12. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Steps to take 7. Redesign the paperwork process to minimize counselor time required and delays in engagement. Consider: Who needs to complete what forms Creating templates on Word Remember the “Just-in-Time” paperwork principle: Delay paperwork until needed.

13. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Steps to take 8. Pilot test changes in the process –Review the new process with staff. –Test the revised process for 2 weeks and get feedback from staff & consumers. –Adopt, adapt or abandon changes as needed.

14. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Steps to take 9.Sustain paperwork management –Assign someone within the agency the responsibility to check records periodically –Watch out for “Paper Creep” –Beware of “It’s the Easiest Way” vs. what is most convenient for the customer

15. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Remember to….. Once PDSA cycles begin Clearly document change cycles, including start and end dates Track results, relative to baseline Expand changes that were tested on a small pilot scale Develop & Implement Sustain Plan Have fun!