Transcript Eliminating Excessive Paperwork: A Step-by-Step Guide www.NIATx.net Reduce Waiting & No-Shows  Increase Admissions & Continuation.

Eliminating Excessive Paperwork:
A Step-by-Step Guide
www.NIATx.net
Reduce Waiting & No-Shows  Increase Admissions & Continuation
The Problem
• Time consuming for staff and consumers
• Barrier to treatment access
• Barrier for client engagement
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
What are we trying to accomplish?
• Streamline paperwork
– Decrease time to treatment
– Increase consumer engagement
• Capture the right information
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How will we know a change is an
improvement?
• The number of questions will decrease.
• The number of pages of paperwork will
decrease.
• The time required for consumers to
complete paperwork will decrease.
• The time required for staff to complete
paperwork will decrease.
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Paperwork Reduction Project
Project Aim: Reduce waiting time from first contact to admission
Measures:
 Number of pieces of paper in the process
 Number of hours/minutes to complete the intake process
 Days from first contact to assessment (use ICIS data)
 Days from assessment to admission (use ICIS data)
Agency Name: ______________________________________
Tools for tracking your improvement:
Instructions:
1. Count the number of pieces of paper in intake/assessment process before you make any reductions in paperwork.
2. Measure how many hours/minutes it takes to complete intake/assessment process on at least ten clients before you make any
reductions in paperwork. Then measure the hours/minutes it takes once you have reduced your paperwork. Try & use the same
sample size before and after.
Client #1: _____________
Client #11: ______________
Client #2: _____________
Client #12: ______________
Client #3: _____________
Client #13: ______________
Client #4: _____________
Client #14: ______________
Client #5: _____________
Client #15: ______________
Client #6: _____________
Client #16: ______________
Client #7: _____________
Client #17: ______________
Client #8: _____________
Client #18: ______________
Client #9: _____________
Client #19: ______________
Client #10: _____________
Client #20: ______________
3. Calculate the total hours/minutes for all clients:
____________________
4. Divide the total hours/minutes by total # of clients to get the average length of time for intake process. ________________
Average intake process time = Total hours/minutes
Total # of clients
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Steps to take
1. Appoint a paperwork Czar or Czarina (not a
committee) within the agency, who is
–
Knowledgeable about required forms
–
In a position to communicate with state
representatives/payers
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Steps to take
2. Apply “Just-in-Time” paperwork principle –
Delay paperwork until needed.
–
Before assessment
–
During assessment
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After assessment/during treatment
–
Post-discharge
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Steps to take
3. Identify existing paperwork
– Flowchart the process from the perspective
of the customer.
– Collect forms during a walk-through.
– Check for paperwork in client’s charts.
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Steps to take
4. Redesign paperwork
–
Question why all existing forms are being used.
–
Eliminate forms that are not required.
–
Eliminate duplication.
–
Combine forms wherever possible.
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Steps to take
5. Assure compliance with state, payer, and
accreditation agency requirements.
–
State Administrative Code
–
Medicaid
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JCAHO
–
CARF
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Steps to take
6. Pilot test changes in the paperwork
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Review new packet of forms with staff.
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Test revised forms for 2 weeks (use a sample
group)
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Get feedback from staff & customers.
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Adopt, adapt or abandon forms as needed.
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Steps to take
7. Redesign the paperwork process to
minimize counselor time required and
delays in engagement.
Consider:
• Who needs to complete what forms
• Creating templates on Word
• Remember the “Just-in-Time” paperwork
principle: Delay paperwork until needed.
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Steps to take
8. Pilot test changes in the process
– Review the new process with staff.
– Test the revised process for 2 weeks and
get feedback from staff & consumers.
– Adopt, adapt or abandon changes as
needed.
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Steps to take
9. Sustain paperwork management
– Assign someone within the agency the
responsibility to check records periodically
– Watch out for “Paper Creep”
– Beware of “It’s the Easiest Way” vs. what is
most convenient for the customer
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Reduce Waiting & No-Shows  Increase Admissions & Continuation
Remember to…..
Once PDSA cycles begin
• Clearly document change cycles,
including start and end dates
• Track results, relative to baseline
• Expand changes that were tested on a
small pilot scale
• Develop & Implement Sustain Plan
• Have fun!
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Reduce Waiting & No-Shows  Increase Admissions & Continuation