overview niatx overview. niatx mission to improve care delivery to help people live better lives to...
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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
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
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
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
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.
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.
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.
Focus on Four Aims
• Reduce waiting times
• Reduce no-shows
• Increase admissions
• Increase continuation
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
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
2. Focus on Key Problems
• What keeps the CEO • awake at night?
• What processes do staff and customers identify as barriers to excellent service?
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
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
5. Rapid Cycle Changes
• Pilot tests or experiments
• Two-four week cycles
• Many small changes
can quickly add up to make a big impact
PDSA Cycle for Improvement
Act Plan
Study Do
• 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
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
NIATx opportunities for tomorrow
NIATx opportunities for tomorrow
Over 13,000 Over 13,000 substance abuse substance abuse
treatment providers treatment providers nationwide.nationwide.Break!!!
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
Why Walk-through?
• Seeks out and identifies real problems
• Generates ideas for improvement
• Keeps you asking why?...and why?
again
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
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
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.
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
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
Collaborate on making changes to address theProblem
• 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
Making Changes
• PDSA Cycles – Plan the change– Do the plan– Study the results– Act on the new knowledge
• Adapt• Adopt• Abandon
Process Improvement
Hunches Theories
Ideas
Changes that Result in
Improvement
A PS D
APS
D
A PS D
D SP A
DATA
SOURCE: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide, San Francisco, Jossey-Bass Publishers, 1996
Keys to Change Project Success1. 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
Frequent start-up issuesFrequent start-up issues1. 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
NIATx opportunities for tomorrow
NIATx opportunities for tomorrow
Over 13,000 Over 13,000 substance abuse substance abuse
treatment providers treatment providers nationwide.nationwide.
Reduce Waiting & No-Shows Increase Admissions & Continuation
Lunch!!!!!
NIATx opportunities for tomorrow
NIATx opportunities for tomorrow
Over 13,000 Over 13,000 substance abuse substance abuse
treatment providers treatment providers nationwide.nationwide.
Reduce Waiting & No-Shows Increase Admissions & Continuation
PDSA Airplane Exercise
Model for ImprovementModel 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?
Act Plan
Study Do
Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide
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.
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
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).
NIATx opportunities for tomorrow
NIATx opportunities for tomorrow
Over 13,000 Over 13,000 substance abuse substance abuse
treatment providers treatment providers nationwide.nationwide.
Measuring Progress for Project Aims Change Leader Academy
Learning Objectives
Participants will:
• Learn to define clear measures (data collection)
• Learn to assess progress toward an aim (data analysis)
Action Phases of Change
– Understand customer needs– Decide what you want to accomplish– Identify when an aim is an improvement– Select and test changes
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
Six Simple Rules of the Road
• Define measures
• Collect baseline data
• Establish a clear aim
• Consistent collection
• Chart progress
• Ask questions
Define Measures
• Establish clear definitions
• Clarify project aim
• Agreed upon by key stakeholders
Establish a Baseline
• Never start a project without it
• Define a clear starting point
• Use agreed-upon definition
Start Finish
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
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?
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?
NIATx opportunities for tomorrow
NIATx opportunities for tomorrow
Over 13,000 Over 13,000 substance abuse substance abuse
treatment providers treatment providers nationwide.nationwide.
Making Decisions: Nominal Group
Technique
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)
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!!
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
NIATx opportunities for tomorrow
NIATx opportunities for tomorrow
Over 13,000 Over 13,000 substance abuse substance abuse
treatment providers treatment providers nationwide.nationwide.Break!!!