1. Overview NIATx Overview

2. NIATx Mission To improve care delivery to help people live better lives To become the premier resource for systems and process improvement for behavioral health services

3. Based at the UW–Madison NIATx is part of the Center for Health Enhancement System Studies at the University of Wisconsin–Madison, directed by Dr. David Gustafson

4. NIATx Offers Simple and innovative solutions to serve families better: Get more people into treatment Keep them there longer Reduce costs Improve staff morale Improve communication between systems Using existing resources

5. Learning Objectives To develop an understanding of the foundation of NIATx Four Aims Five Key Principles The use of rapid-cycle change (PDSA) projects to transform your agency

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 your customers.

7. Why Organizational Change Small changes do increase client engagement. Engaged clients are more likely to show up and continue their treatment. More clients doing well in treatment make your work more rewarding. More admissions and fewer drop-outs improve the bottom line.

8. Small Changes, Big Impacts Small changes create a big difference for both clients and staff Effective changes don’t have to be expensive –Working to make sure clients made it to treatment through “live hand-offs” improved communication between case workers and treatment providers and led to better LOC decisions and a 22% reduction in no shows in one IA community.

9. Focus on Four Aims Reduce waiting times Reduce no-shows Increase admissions Increase continuation

10. NIATx Key Principles Understand and involve the customer Focus on key problems Pick a powerful Change Leader Get ideas from outside the organization Use rapid-cycle testing

11. 1. Understand & Involve the Customer Most important of the Five Principles What is it like to be a customer? Your staff can be considered customers, too. Conduct walk-throughs Hold focus groups and do surveys

12. 2. Focus on Key Problems What keeps the CEO awake at night? What processes do staff and customers identify as barriers to excellent service?

13. 3. Powerful Change Leader The Change Leader must have… –Influence, respect, and authority across levels of the organization –A direct line to the CEO –Empathy for all staff members –Time devoted to leading Change Projects

14. 4. Ideas from Outside Organization Real creative problem-solving comes from looking beyond the familiar Provides a new way to look at the problem –Access Walk-in clinics in Wal-Mart –Client Engagement Hair Dressers Coffee Shops –Client Handoffs Hertz Rental Car Hyatt Hotels

15. 5. Rapid Cycle Changes Pilot tests or experiments Two-four week cycles Many small changes can quickly add up to make a big impact

16. PDSA Cycle for Improvement ActPlan StudyDo What changes are to be made in next cycle? Abandon Adapt Adopt Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when) Complete the analysis of the data Compare data to predictions Summarize what was learned Carry out the plan Document problems and unexpected observations Begin analysis of the data

17. Action Phases of Change Understand customer needs Decide what you want to accomplish Identify when an aim is an improvement Select and test changes Sustain the gains

18. www.niatx.net

19. NIATx opportunities for tomorrow Over 13,000 substance abuse treatment providers nationwide. Break!!!

20. Why Walk-through? The walk-through: –Helps you 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

21. Why Walk-through? Seeks out and identifies real problems Generates ideas for improvement Keeps you asking why?...and why? again

22. Action Phases of Change Understand customer needs Decide what you want to accomplish Identify when an aim is an improvement Select and test changes Sustain the gains

23. Role of the Executive Sponsor Senior leader in the agency Must see change/improvement as a priority Identifies the problem and articulates the vision Demonstrates commitment to the process (time, resources) Empowers the change leader

24. Selecting a Change Leader Person has sufficient power and respect to influence others at all levels of the organization. Person has the ability to: instill optimism, has big-picture thinking, is focused and goal-oriented, and has a good sense of humor.

25. 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

26. Creating Change Teams Small group – no more than 7 people Include people who will be affected by the change or who could sabotage it if they don’t like it These are short term ad-hoc groups – when the project is done the group is disbanded

27. Collaborate on making changes to address the Problem Meet to identify potential solutions Meet regularly to review progress Adapt change project as necessary Review and interpret data Identify when change project is complete and idea is ready to spread Change Team Role

28. Making Changes PDSA Cycles –Plan the change –Do the plan –Study the results –Act on the new knowledge Adapt Adopt Abandon

29. Process Improvement Hunches Theories Ideas Changes that Result in Improvement AP SD A P S D AP SD D S P A DATA SOURCE: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide, San Francisco, Jossey-Bass Publishers, 1996

30. Keys to Change Project Success 1.Have a clear objective 2.Implement only 1 new thing at a time 3.Make sure everyone implements change as planned 4.Start small 5.Study the results before making modifications 6.Do not hesitate to start a new cycle

31. Frequent start-up issues 1.Measuring the impact of change What measures to use Documenting the change process Recording data daily; reviewing data weekly 2.Having the right people in key roles Executive Champion or Sponsor Change Leader with time to do the job Small enough Team to be effective 3.Assuring key participants understand the service improvement model and process 4.Lack of customer involvement in establishing a change objective

32. NIATx opportunities for tomorrow Over 13,000 substance abuse treatment providers nationwide. Reduce Waiting & No-Shows  Increase Admissions & Continuation Lunch!!!!!

33. NIATx opportunities for tomorrow Over 13,000 substance abuse treatment providers nationwide. Reduce Waiting & No-Shows  Increase Admissions & Continuation PDSA Airplane Exercise

34. Model for Improvement 3. What changes can we make that will result in an improvement? 1. What are we trying to accomplish? 2. How will we know that a change is an improvement? ActPlan Study Do Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide

35. PDSA Steps Plan: Set aim, design and develop a change Do: Test the change, measure/record results Study: Study data Act: Adopt, Adapt, Abandon Repeat PDSA Cycles until you reach your goal.

36. The Airplane Exercise Description: A small group activity to demonstrate use of the PDSA cycle Objective: Learn how to use the PDSA approach with a team in order to achieve a specific aim

37. The Aim: Get as Close to the End of the Runway as Possible 1. PLAN: Design a paper plane using the materials provided. Choose a change leader and a data coordinator 2.DO: Choose one person to be the flier. Have them make three flights. 3.STUDY: After each test flight, the data coordinator should measure the distance the plane traveled down the runway and record this on the change project form. Calculate the average distance from the end of the runway in either direction for the three flights. 4.ACT: Based on the measurements, review the design of your plane and look for improvements (what can we do that will result in an improvement). Make just ONE change to the design of the plane, and repeat steps 1-4 until you have collected data for 3 cycles (original design cycle + 2 change cycles).

38. NIATx opportunities for tomorrow Over 13,000 substance abuse treatment providers nationwide. Measuring Progress for Project Aims Change Leader Academy

39. Learning Objectives Participants will: Learn to define clear measures (data collection) Learn to assess progress toward an aim (data analysis)

40. Action Phases of Change –Understand customer needs –Decide what you want to accomplish –Identify when an aim is an improvement –Select and test changes

41. Why Measure Change? Measuring change enhances process improvement by –Identifying what happened in a Change Project and by how much –Giving insights to additional changes that may help achieve aim –Showing progress towards a given aim; shows sustainability

42. Six Simple Rules of the Road Define measures Collect baseline data Establish a clear aim Consistent collection Chart progress Ask questions

43. Define Measures Establish clear definitions Clarify project aim Agreed upon by key stakeholders

44. Establish a Baseline Never start a project without it Define a clear starting point Use agreed-upon definition Start Finish

45. Establish an Aim Be flexible –If information you gather suggests changing the aim: change it –If you find the aim too ambitious: revise it to be more realistic but still challenges the agency to improve –If aim is easily achieved: set a more ambitious aim that stretches the agency’s capacity to improve

46. Questions to Consider in Defining Data Collection Was the data defined to ensure exact collection of the information needed? How accurate is the data? Do the data collection procedures ensure that the measures will be collected consistently?

47. Questions to Consider in Defining Data Collection Do trade-offs exist? Is quality more important than the time required to collect data? What clients are targeted?

48. NIATx opportunities for tomorrow Over 13,000 substance abuse treatment providers nationwide. Making Decisions: Nominal Group Technique

49. Nominal Group Technique (NGT) Designed to promote group participation in the decision making process Uses priorities of each group member to discover the overall priorities of the group Used by small groups to –Reach consensus on the identification of key problems (NIATx Key Principle 2) or –Develop solutions that can be tested using rapid cycles (NIATx Key Principle 5)

50. Generating Solutions We have done a walk-through We have talked to some clients We have identified problems Now we need to identify Solutions –NGT can help!!

51. Seven Steps Preparation (e.g., room and question) Silent idea generation Recording of ideas Idea discussion Preliminary voting Discussion of preliminary voting Final voting on ideas

52. NIATx opportunities for tomorrow Over 13,000 substance abuse treatment providers nationwide. Break!!!

53. Design Your First Change Project

54. Next Steps 1.Do your first pilot change 2.Site Visits 3.First Learning Collaborative Call