Transcript Overview of NIATx & Process Improvement

Overview of NIATx &
Process Improvement
Process Improvement Overview and
Basic Training
2008
Overview of the Presentation
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What is NIATx?
Four Aims
Why Process Improvement (PI)?
Summary of Process Improvement
Model
What is NIATx?
• A partnership between:
– RWJF’s Paths to Recovery program
– CSAT’s Strengthening Treatment Access and
Retention (STAR) program, and
– A number of single state authorities and
independent addiction treatment organizations.
• NIATx works with addiction treatment
providers to make more efficient use of their
capacity and shares strategies for improving
treatment access and retention.
What is NIATx?, continued
• NIATx members create a culture of
process improvement in which treatment
center staff:
– Use existing resources to improve
services
– Learn innovative strategies through peer
networking, and
– Model organizational improvements in
addiction treatment
The Four Aims
Reduce Waiting Times
Reduce No-Shows
Increase Admissions
Increase Continuation Rates
More on the Four Aims
• Four aims developed by NIATx
• Goal to improve treatment in these
specific areas
• These areas are usually areas where
programs would like to improve
• Areas were examined by providers in
the LA County pilot project
Why Process Improvement?
• Process Improvement (PI)
– Systematic way to address specific areas
of concern
– Shown to be effective in other areas
• Medical care
• Automotive industry
– Straightforward and relatively simple to
implement
What is Process Improvement?
• An evidence-based framework that when
applied to client access and retention
processes can get clients in the door quickly
and keep them there long enough to make a
difference
• A systematic problem-solving approach that
can be used to understand client needs,
restructure processes, and make the most
efficient use of available resources
Three Fundamental Questions
1. What are we trying to accomplish?
(AIM)
2. How will we know that a change is an
improvement? (MEASURE)
3. What changes can we test that may
result in an improvement? (CHANGE)
Summary of Process
Improvement Model
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Apply “Rapid Cycle Testing”
Use the “Quick Start Roadmap”
Measure the impact of the change
Depending on results
– Sustain the change and make additional
changes
– Abandon the change and implement a new
change
Rapid-Cycle Testing
Rapid-Cycle changes
 Are quick; do-able in 2
weeks
PDSA cycles
 Plan the change
 Do the plan
 Study the results
 Act on the new
knowledge
Using a Quick Start Road Map To
Plan Change Projects
1. Identify problem important to
management
2. Target objective (measurable/specific)
3. How will you measure the change?
4. Who will be on the change team?
5. Instructions for change team
Using a Quick Start Road Map To
Plan Change Projects, continued
6. What contributes to the problem?
7. What possible changes might help?
8. What is the implementation process?
9. What data will be gathered?
10. How will progress be studied?
11. What is the next step?
Specific Steps
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Walk Through
Determine area of improvement
Gather “Change Team”
Collect baseline data
Implement change and measure the
impact of that change
• Sustain the improvement and continue
to collect data
Walk Through
• Conduct an agency walk-through
– Identify potential improvements to existing
procedures
– Usually conducted by the director
– Allows the director to see the process through the
eyes of the treatment participant
• Provides examples of how programs can
easily make impressive changes (usually for
FREE)
Area for Improvement
• Many programs come up with multiple
changes to make
– It is important that the program focuses on
one change at a time.
– If more than one change is implemented, it
is impossible to determine which change
resulted in the effect
• Some changes can be made
immediately (e.g., cleaning up graffiti)
Change Team
• Responsible for the changes that are made
and should include the following:
– Executive Sponsor
• Someone who “has the ear” of the director
• Has the power to implement changes
– Change Leader
• Provides daily leadership
• Keeps the project organized
– Change team
• Implements the changes
• Collects data to measure impact of the change.
Baseline Data
• Collect at least two months of data in
the following areas
– Total number of admissions
– Waiting time from first contact to
intake/assessment
– No-show rates for
• Intake/assessment appointments
• Treatment sessions
– 30 and 60 day client continuation rates
(retention)
How Do You Measure the
Impact of Change?
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Define your measures
Collect baseline data
Establish a clear aim
Consistently collect data
Chart your progress
Ask questions
Sustain the Change?
• When determining whether to sustain a
change, ask these questions:
– Is the change feasible (e.g., financially,
personnel-wise, etc.)?
– Did the change result in the desired levels
of improvement?
– Can someone be assigned the task to
ensure the change is sustained?
How to Sustain an Improvement
Another key: Have a sustainability
leader to…
1. Clarify staff duties and responsibilities
2. Communicate progress data with staff
3. Plan with staff how to restore gains if data
falls below an agreed level
4. Implement actions to restore gains
5. Advise management about infrastructure
changes needed to sustain the
improvement
And then…
• Once the change has been
implemented and it is determined that
the change can be sustained, it is time
to select the next area for improvement.
• At that point, the program may choose a
new change team or keep the existing
one.
• Then the process begins again…
For more information, see
the NIATx Website
www.niatx.net