Sustaining Change May 2009 Follow-up Calls (Call #6)

Based on the fall 2008 CATES Training Series Contra Costa County, San Bernardino County, & Sutter County October 24, November 7, and November 14, 2008 Call Facilitators: Beth Rutkowski, MPH, and Sherry Larkins, Ph.D.

UCLA Integrated Substance Abuse Programs/ Pacific Southwest Addiction Technology Transfer Center

Agenda

• • • • • Making the business case for sustainability Principles of sustainability Q-A period Survey of next steps Resources for continued learning 2

Review of Previous Conference Call Tutorials

1. Conducting a Walk-Through 2. Gathering Baseline Data 3. Setting a Change Objective 4. Using the Quick Start Road Map 5. Conducting PDSA Change Cycles 3

Key to Sustainability: Making the Business Case

   Economics drive an agency’s ability to provide services A positive economic impact is an important leverage point for change Services that drain resources are rarely continued 4

What do we mean by the “Business Case” ?

Process improvements can impact your: a. Financial bottom line b. Organizational climate c. Efficiency and productivity d. Relationship with referral sources e. Staff retention f. Client satisfaction g. Treatment outcome 5

Example 1 Increase in Admissions/Month Community Resource Center

50 40 30 20

Target 19.4

Baseline 17.6

10 0 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 6

Example 2 Reduced No-Shows Franklin-Williamson Human Services

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Example 3 Monthly Revenue Increase Franklin Williamson Human Services

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Sustainability

• Sustainability of change is not easy. • Up to 70% of improvements are not sustained.

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Definition

Sustainability

exists when a newly implemented process: • continues to improve over time, • becomes “the way things are done around here” and • does not return to the ‘old’ process that existed before the improvement project began.

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Sustainability Model

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Process

1. Does the change improve efficiency?

2. Are the benefits obvious, supported by evidence and believed by stakeholders?

3. Can the change be adapted or spread to the whole organization?

4. Is there a system for monitoring and continually improving the process?

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Staff

1. Has the staff been informed of the change and trained to sustain the process?

2. Do staff feel empowered as part of the change process and believe the improvement will be sustained?

3. Do agency leaders take responsibility for efforts to sustain the change process and communicate regularly with staff?

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Organization

1. Is the improvement consistent with the agency’s strategic aims?

2. Are staff, facilities and equipment, job descriptions, policies, procedures and communication systems appropriate for sustaining the improved process?

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One Secret to Sustaining Change

Make it as easy as possible for people to use the new methods and very difficult for them to revert to old ways of doing business.

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Who do you need?

A “Sustain Leader” who understands the change and can monitor performance to make sure the change is sustained.

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In Summary What Needs to be Done

1. Update all documents and operating procedures 2. Train all staff in the new procedures 3. Hold an official launch of the new protocol 4. Have a clear method for monitoring the new process 5. Verify maintenance of the change periodically 17

Learning Resources: #1

Join the ACTION Campaign:

“Adopting Changes to Improve Outcomes Now”

www.actioncampaign.org

Download

Action Kits

for improving access, engagement, and transition between levels of care 18

Learning Resources: #2

NIATx:

“Network for the Improvement of Addiction Treatment”

www.niatx.net

• NIATx Workbook • Videos on Process Improvement • Tools to help with improvement projects • Case studies • Promising practices and strategies 19

Thank you for joining us!

Best wishes to all of you as you experiment with improving access, engagement and retention. Your clients will appreciate it! - The CATES staff at UCLA and the Pacific Southwest ATTC 20