Transcript Building Momentum for Process Improvement

Building Momentum for
Process Improvement: The
California Experience
Presented by:
Beth Rutkowski, MPH
NIATx-SI Cohort 1 State Convening Meeting
January 27, 2010
Presentation Overview
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LA County Phase I Process Improvement
Pilot Project
CATES Statewide Training Effort
LA County Phase II Process Improvement
Pilot Project
CA NIATX Coach Pilot Project
Local Learning Collaboratives
Regional Learning Collaboratives
Key Partners
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UCLA Integrated Substance Abuse Programs
Pacific Southwest Addiction Technology Transfer Center
LA County Alcohol & Drug Program Administration
NIATx National Program Office
SAMHSA, Center for Substance Abuse Treatment
Robert Wood Johnson Foundation
County Alcohol and Drug Program Administrators
Association of California
Recipe for Success
Key Ingredients
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Start small and demonstrate success
Face-to-face learning sessions
Individualized technical assistance/coaching
Telephone-based technical assistance
Data collection, submission, and review
Availability of continuing education
Change Leader Academy
Coach Academy
“Where it all
started…”
Los Angeles
County, California
Phase I Los Angeles County
Process Improvement Pilot
Project
November 2005-September 2006
Participating Agencies
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Didi Hirsch CMHC, Via Avanta
LA Centers for Alcohol and Drug Abuse
Matrix Institute on Addictions (2)
Social Model Recovery Systems
Southern California Alcohol and Drug
Programs
Tarzana Treatment Centers
Phase I Pilot Project Timeline
Pre-Work
Nov ‘05-Jan ‘06
Nov ‘05
Orientation
Jan ‘06
Feb ‘06
Mar ‘06
Jun ‘06
Kick-Off
Site Visits
Monthly
Mid-Way
Completion
Conference
Change
Conference
Calls
Leader
Workshop
Meeting
Sept ‘06
Phase I Aggregate Results
83% reduction in assessment/intake
no-shows (2 agencies reporting)
 39% increase in 30-day
continuation (3 agencies reporting).
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California Addiction Training
and Education Series
November 2007-May 2009
**1,430 participants
***50 counties
Where Were the Trainings and
How Many People Did We Train?
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Nov 2007
 San Francisco – 154 (18)
 San Diego – 137 (6)
 Bakersfield - 129 (10)
May 2008
 Redding – 77 (17)
 Santa Ana – 145 (6)
 Fresno – 78 (12)
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July 2008
 San Jose – 341 (1)
Sept 2008
 San Rafael - 51 (2)
Oct/Nov 2008
 Concord – 114 (12)
 Rialto – 97 (8)
 Yuba City – 107 (18)
Sample Agenda
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Case study - from an agency’s perspective
Process Improvement 101
How to get started
Measuring impact of change
Promising practices
Monthly Coaching
Conference Call Topics
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Month 1: Conducting a Walk-Through
Month 2: Collecting Baseline Data
Month 3: Establishing a Change Objective
Month 4: Creating a Quick Start Road Map
Month 5: Conducting a PDSA Change Cycle
Month 6: Sustaining Change
Call Participation
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60 hour-long conference calls held between
Dec 2007 and May 2009
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254 people from 35 counties
Callers joined an average of 2-3 calls (mean=2.6)
Targeted areas of participation (and
implementation)
Phase II Los Angeles County
Process Improvement Pilot
Project
November 2007-October 2008
Participating Agencies
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Antelope Valley Rehabilitation Center (2)
Behavioral Health Services (2)
CA Hispanic Commission on Alcohol and Drug
Abuse (2)
Didi Hirsch Community Mental Health Center (2)
House of Hope
MELA Counseling Services Center
SHIELDS for Families
Tarzana Treatment Centers (2)
Project Enhancements
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Formal application process
Greater focus on data
More comprehensive data review and feedback
5th Change Leader monthly conference call
2nd Executive Sponsor conference call
12 individualized data coaching calls
Wait-Time from First Contact
to Admission
7
6
6.9
6
Days
5
4
4.6
4.3
4
3.5
3
2.6
2.5
2
42% average
reduction in
wait-time
1.9
1
1.2
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M
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0
43.5
36.4
28.4
28.2
21.2
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12.7
Se
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ug
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y
Ju
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Ju
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ay
43% average
reduction in
no-shows
pr
il
24.6
18.6
O
ct
26.6
25
A
as
el
in
e
M
ar
ch
50
45
40
35
30
25
20
15
10
5
0
B
%
No-Shows
70.6
86.6
77.4
80.5
84.3
87.5
84.6
87
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84.8
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ov
100
90
80
70
60
50
40
30
20
10
0
84.1
ct
O
Se
pt
A
ug
y
Ju
l
e
Ju
n
ay
M
A
pr
il
e
19% average
improvement
in session-bysession
attendance
B
as
el
in
%
Session-by-Session
Attendance
30-Day Continuation
76
75.1
74
73.9
72.9
72.9
72
70.7
70
68
6% average
improvement in
30-day
continuation
68.9
68.5
66
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64
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%
75.1
73.9
California NIATx Coach Pilot
Project (July 2008-April 2009)
Development of Local Learning
Collaboratives (August 2008Present)
Regional Learning
Collaboratives – California
Endowment
November 2008-October 2009
Regional ACTION Campaign/NIATx
Learning Collaboratives
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CA-based ACTION Campaign membership more than
doubled from 105 individuals in 82 agencies to 300
individuals from 221 agencies.
Five day-long kick-off workshops were held in AprilMay 2009
• 386 treatment providers/administrative staff
Staff from 173 agencies/programs in 49 counties are
now part of one of five collaboratives
28 agencies from 16 counties submitted a completed
change project report form for one or more change
projects
Adopting Changes in Addiction
Treatment – Promising Practices
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Strategies to decrease wait-time from initial contact
to intake/assessment/admission appointment
 Conduct group intakes 2 times per week
 Reduce repetitive paperwork
 Combine intake and assessment into one
appointment
 Offer walk-in intakes
Wait-Time from First Contact to
Assessment/Admission
35
32
89% average
reduction in
wait-time
Number of Days
30
25
20
15
10
4
5
0
Baseline
(2 agencies reporting)
Post-Change
Adopting Changes in Addiction
Treatment – Promising Practices
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Strategies to increase timeliness of admissions
 Assign intakes to 2 primary counselors
 Make immediate contact with client upon receipt
of referral and engage client
 Discuss the importance of enrolling on the report
date so that the client does not lose interest
and/or comes up with reasons not to enroll or
delay enrollment
 Improve therapeutic and clinical milieu of
Treatment Readiness Interview
Adopting Changes in Addiction
Treatment – Promising Practices
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Strategies to increase timeliness of admissions
 Offer staff training to improve empathy
 Call to schedule intake appointment for client at
the time of assessment
 Make reminder phone call 2-3 days prior to
scheduled intake appointment
Timeliness of Admissions (hybrid
of Wait-Time and Admissions)
100
64% average
improvement
in timely
admissions
80
60
40
54%
33%
20
0
Baseline
(4 agencies reporting)
Post-Change
Adopting Changes in Addiction
Treatment – Promising Practices
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Strategies to decrease no-shows to intake/ assessment
appointment
 Schedule group intakes
 Implement a series of paper-and-pencil screening tools
 Move full ASI assessment and treatment planning process
to subsequent counseling session
 Schedule clients to arrive 30 minutes prior to intake
appointment to allow time to complete screening
paperwork
 Streamline intake paperwork and create a single signature
page to acknowledge receipt of handbook
Adopting Changes in Addiction
Treatment – Promising Practices
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Strategies to decrease no-shows to intake/ assessment
appointment
 Place reminder calls for individual and group session
appointments
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Allow client to choose day/time of assessment appointment
Schedule first counseling appointment within 7 days of
intake
Introduce client to primary counselor at time of intake
Reschedule missed appointments
No-Shows
50%
45%
40%
43%
51% average
reduction in
no-shows
35%
30%
25%
21%
20%
15%
10%
5%
0%
Baseline
(15 agencies reporting)
Post-Change
Adopting Changes in Addiction
Treatment – Promising Practices
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Strategies to increase client retention
 Implement “contract for treatment success”
 Provide incentives for ongoing participation
 Greet and welcome new clients within the first 24
hours
 Provide incoming residential clients with a mentor
Client Retention – Length of Stay
160
Number of Days
140
146
134
120
100
80
9% average
improvement
in length of
stay
60
40
20
0
Baseline
(1 agency reporting)
Post-Change
Client Retention – 30-day
Continuation
100
93%
84%
80
60
11% average
improvement
in 30-day
continuation
40
20
0
Baseline
(2 agencies reporting)
Post-Change
Adopting Changes in Addiction
Treatment – Promising Practices
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Strategies to reduce early discharges
 Change scheduled chores for new clients by taking away
kitchen responsibility for the first two months of treatment
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Develop PowerPoint presentation to provide consistent
information at DUI program orientation
Discuss early termination policy with new clients
Schedule intakes in the morning to engage clients more
quickly
Client Retention – Reduction of
Early Discharges
100
80
66% average
reduction in
early
discharges
60
40
35%
20
12%
0
Baseline
(2 agencies reporting)
Post-Change
Keys Ingredients for
Change Project Success
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Choose the right Change Leader
Establish a clear objective
Implement only 1 new change at a time
Make sure everyone implements change
project as planned
Start small
Study the results before making
modifications
Frequent Start-Up
Issues
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Lack of executive or Change Team commitment
Inexperience with process improvement tools
Failure to define problem and objective clearly
Difficulty creating simple measures
Lack of familiarity with data graphing
Failure to gather outside ideas
Discussion Points
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How counties have incorporated NIATx into
regular meetings
Cost
Suggestions for involving the ATTC Network
in NIATx spread and sustainability
Thank you for your time!
• Beth Rutkowski, MPH
• (310) 388-7647; [email protected]