1. Overview Spectrum Health Systems Lincoln St OTP Reducing administrative discharges

2. AIM (Plan) NIATx team identified that a high number of clients are being administratively discharged per month and look at this as a missed opportunity to engage with some clients. Primary aim to reduce the number of administrative discharges and thereby increase retention Gathered the entire clinical staff for a focused change team meeting and completed Nominal Group Technique to gather new ideas and retention specific strategies to help clients avoid administrative discharge. Top ideas were put in an online Survey Monkey to gather consensus for the first potential change project. Small goal was to decrease the number of termination notices given. The clinical team felt that by intervening at the point of the termination warning, clients would be less likely to receive a termination notice, resulting in less administrative discharges.

3. CHANGE (Do) Most termination warnings resulted in clients receiving termination notices in the future. We gave out 60 warnings within a two week timeframe representing a significant number of potential administrative discharges. Rapid Cycle 1: Currently clients receive termination warnings through medical staff when receiving their medication with no opportunity to discuss or to engage the client Piloted new process to present the warning in person during a treatment meeting with clinical staff. Included in the meeting is a discussion of the client’s treatment and any barriers to success and other ways the program can meet their needs. A set schedule two days per week (Tues/Fri) was created with a staff member available throughout the entire day during dispensing hours to meet with clients. A template for these meetings was created in the EHR to ensure consistent process between staff and prompt discussion of barriers

4. RESULTS (Study) Table below indicates # termination notices pre and post change Week# Termination Notices 11/14-11/2043 11/21-11/2711 11/28-12/4 * cycle 1 change project begins27 12/5- 12/1127 12/12-12/188 12/19/-12/2522 12/26/2011-1/1/124 1/2/12-1/8/1214

5. NEXT STEPS (Act) Adopted change to present warnings and contracts in person in the format of a treatment meeting Adjusted the schedule to be more sustainable Tues/Wed instead of Tues/Fri. Primarily using masters level clinical staff so that any meetings that are 20 minutes and longer can be billed as a counseling session to increase revenue to offset cost Continue to monitor # of term notices and the rate of administrative discharges and impact on retention and census overall Next Change: Utilize the treatment meeting process for delivering termination notices. This will ensure the client understands the hearing process as well as schedule a hearing with the hearings officer at this time. Many clients are d/c due to not following hearing procedure

6. IMPACT (Business Case, Lessons Learned) Engaging clients during the treatment meeting has given clinical staff the opportunity to intervene and provide clinical support to help identify treatment barriers. Clients voiced the meeting gave them an opportunity to be heard, and report feeling much more supported by the program. Staff have also identified instances where termination warnings were not being used effectively resulting in training and discussion with the clinical team Decreasing the warnings has resulted in clients remaining in treatment improving the agency census resulting in an increase in revenue.