1. Overview of NIATx & Process Improvement Process Improvement Overview and Basic Training 2008

2. Overview of the Presentation What is NIATx? Four Aims Why Process Improvement (PI)? Summary of Process Improvement Model

3. What is NIATx? A partnership between: –RWJF’s Paths to Recovery program –CSAT’s Strengthening Treatment Access and Retention (STAR) program, and –A number of single state authorities and independent addiction treatment organizations. NIATx works with addiction treatment providers to make more efficient use of their capacity and shares strategies for improving treatment access and retention.

4. What is NIATx?, continued NIATx members create a culture of process improvement in which treatment center staff: – Use existing resources to improve services –Learn innovative strategies through peer networking, and –Model organizational improvements in addiction treatment

5. The Four Aims Increase Admissions Reduce Waiting Times Increase Continuation Rates Reduce No-Shows

6. More on the Four Aims Four aims developed by NIATx Goal to improve treatment in these specific areas These areas are usually areas where programs would like to improve Areas were examined by providers in the LA County pilot project

7. Why Process Improvement? Process Improvement (PI) –Systematic way to address specific areas of concern –Shown to be effective in other areas Medical care Automotive industry –Straightforward and relatively simple to implement

8. What is Process Improvement? An evidence-based framework that when applied to client access and retention processes can get clients in the door quickly and keep them there long enough to make a difference A systematic problem-solving approach that can be used to understand client needs, restructure processes, and make the most efficient use of available resources

9. Three Fundamental Questions 1.What are we trying to accomplish? (AIM) 2.How will we know that a change is an improvement? (MEASURE) 3.What changes can we test that may result in an improvement? (CHANGE)

10. Summary of Process Improvement Model Apply “Rapid Cycle Testing” Use the “Quick Start Roadmap” Measure the impact of the change Depending on results –Sustain the change and make additional changes –Abandon the change and implement a new change

11. Do Rapid Cycle Testing Start by asking 3 questions: –What are we trying to accomplish? (AIM) –How will we know the change is an improvement? (MEASURE) –What changes can we test that will result in an improvement? (CHANGE) Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide, San Francisco, Jossey-Bass Publishers, 1996

12. Rapid-Cycle Testing Rapid-Cycle changes  Are quick; do-able in 2 weeks PDSA cycles  Plan the change  Do the plan  Study the results  Act on the new knowledge

13. Using a Quick Start Road Map To Plan Change Projects 1.Identify problem important to management 2.Target objective (measurable/specific) 3.How will you measure the change? 4.Who will be on the change team? 5.Instructions for change team

14. Using a Quick Start Road Map To Plan Change Projects, continued 6.What contributes to the problem? 7.What possible changes might help? 8.What is the implementation process? 9.What data will be gathered? 10.How will progress be studied? 11.What is the next step?

15. Specific Steps Walk Through Determine area of improvement Gather “Change Team” Collect baseline data Implement change and measure the impact of that change Sustain the improvement and continue to collect data

16. Walk Through Conduct an agency walk-through –Identify potential improvements to existing procedures –Usually conducted by the director –Allows the director to see the process through the eyes of the treatment participant Provides examples of how programs can easily make impressive changes (usually for FREE)

17. Area for Improvement Many programs come up with multiple changes to make –It is important that the program focuses on one change at a time. –If more than one change is implemented, it is impossible to determine which change resulted in the effect Some changes can be made immediately (e.g., cleaning up graffiti)

18. Change Team Responsible for the changes that are made and should include the following: –Executive Sponsor Someone who “has the ear” of the director Has the power to implement changes –Change Leader Provides daily leadership Keeps the project organized –Change team Implements the changes Collects data to measure impact of the change.

19. Baseline Data Collect at least two months of data in the following areas –Total number of admissions –Waiting time from first contact to intake/assessment –No-show rates for Intake/assessment appointments Treatment sessions –30 and 60 day client continuation rates (retention)

20. How Do You Measure the Impact of Change? Define your measures Collect baseline data Establish a clear aim Consistently collect data Chart your progress Ask questions

21. Sustain the Change? When determining whether to sustain a change, ask these questions: –Is the change feasible (e.g., financially, personnel-wise, etc.)? –Did the change result in the desired levels of improvement? –Can someone be assigned the task to ensure the change is sustained?

22. How to Sustain an Improvement Another key: Have a sustainability leader to… 1.Clarify staff duties and responsibilities 2.Communicate progress data with staff 3.Plan with staff how to restore gains if data falls below an agreed level 4.Implement actions to restore gains 5.Advise management about infrastructure changes needed to sustain the improvement

23. And then… Once the change has been implemented and it is determined that the change can be sustained, it is time to select the next area for improvement. At that point, the program may choose a new change team or keep the existing one. Then the process begins again…

24. For more information, see the NIATx Website www.niatx.net