u of md ssw org change

8/14/2019 U of MD SSW Org Change

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Organizational Change Case

Analysis:EAP Crisis-Management and

On-Call SystemMichael Heitt, PsyD

Associate Director

Faculty and Staff Assistance Program& Student Assistance Program

Johns Hopkins University & Hospital

www.fasap.org


2/21

FASAP Organization

Internal EAP for JHU, JHH, etc

SAP for BSPH & SOM

WORKlife Programs

33,000+ Faculty, Staff, Students and their

families

Confidential and free services

Client and Organizationally oriented


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FASAP Staffing & Funding

Director (0.5 FTE) Associate Director (1.0 FTE) Medical Director (0.2 FTE)

Research Assistant (0.8 FTE) Six clinicians (4.8/1.2 FTE) Five support/administrative staff (2.45/2.45 FTE)

Separate budgets for FASAP, SAP and WL FASAP budget is funded by Human Resources and JAA

funds FASAP budget totals just under $800,000


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Statement of Problem:

Crisis-Management Appointment-basis office structure

Customer-service oriented program

Triage all walk-ins and take all calls

33K employees (and families): 6 clinicians

1-2 week wait for scheduled appointment Manager feels comfortable in crises


8/21

MichaelHeitt


9/21

Current On-Call System

On-call and back-up on-call schedule

Crises go to first person available

If no one is available on-call clinician is

interrupted

After-hours coverage provided by external

contractor


10/21

Problems with Current System

Always on-call

No protected time

Urgent displaces emergent

Unfair distribution of crisis coverage?


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Baseline Data(February & March, 2005)

Emergent Contact Urgent Contact Walk-In

Front Desk Direct Font Desk Direct Emergent Urgent

Total 17.2 19.8 28.8 117.2 19.6 14.8

Mean/Wk 2.2 2.5 3.6 14.7 2.5 1.9

Mean/Dy 0.4 0.5 0.7 2.9 0.5 0.4


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Data Discussion

1 walk-in per day (5 min 4 hrs ea)

2-3 emergent calls & 3-4 urgent calls forwarded

from admin staff per week (2 - 60 min ea) >17 phone calls (2-3 emergent) received directly

per week, (2 - 60 min ea)

Emergent Contact Urgent Contact Walk-In Total

Mean/Day 0.5 hours 3.5 hours 1.5 hours 5.5 hours


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Contributing Factors Hybrid program structured upon traditional EAP core technology yet

staffed by licensed clinicians and supervised by psychiatric faculty Affects the identity of the program and its staff

Dictates the clinical evaluation, intervention and documentation expectations

More time intensive than a non-clinical problem assessment

Institutional culture of crisis response Lots of VIPs at Hopkins

Budgetary constraints

Significant staffing change/turnover Retirements, promotions, new hires

Loss of Institutional Wisdom and career/life experience

Professional inflexibility

Admin staff change project


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Objectives

Appropriate, timely and efficient crisis triaging

and intervening with minimal disruption

Empowering the clinical and administrative staff,raising their expertise level and reducing their

anxiety when dealing with crises

Protecting clinicians non-clinical time so they

feel a greater sense of control over their workdays


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Strategies

Urgency: Baseline data

Change-management education and exercises:

Piggyback on Admin Staff Change Skill-building: Fundamentals of EAP, Crisis Call

Handling, Suicide Assessment, WPV Risk Assessment

Technology: Call center implementation

Engagement: Brainstorming ideas/options


18/21

How may I direct your call? Doctor-assisted or Regular?


19/21

Action Steps

1. Strengthen the protective buffer of the administrative staff

2. FASAP leadership will reinforce a generalist approach to EAPwork

3. Administrative staff will be encouraged to utilize a warm-line

transfer from FASAP to a ProtoCall counselor4. FASAP clinical and administrative staff will continue to discuss

the differences between emergent and urgent situations

5. A new on-call schedule will be implemented on a pilot basis Administrative staff will direct crises to the on-call clinician first, then

the back-up clinician.

The on-call clinician will enjoy a limited or light day of scheduledactivity of no more than two new scheduled evaluations (typicallyscheduled for two hours each)

On-call clinician will be devoted to handling all crisis situations thatarise, and spare time can be spent on administrative duties such aspaperwork, event planning and writing.


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Outcome Measures

Repeated assessment of frequency data and

comparison to baseline data

Assess negative impact on wait time forscheduled appointment

Subjective rating of stress, control, sense of

overwhelm and overall satisfaction


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u of md ssw org change

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