NIATx Webinar Maximizing Staff Productivity Tuesday, March 9, 2010

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Sinnissippi Centers Natalie Andrews: Director of Addictions

• Behavioral healthcare provider  Outpt: Substance Abuse, Mental Health, Family and Child Welfare, Crisis and Assessment • Service area: 4 rural counties in NW IL  Total population of service area: 165,587 • NIATx Founding Member 2003 2

Keep It Simple 1. Customer service/MI techniques at Admissions to increase admissions 2. Use of multiple group scheduling to reduce lost productivity of staff 3.Maximize your travel time

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#1. Customer service/MI techniques at Admissions

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AIM:

Increase Client Admissions • 18 intakes per month ( 7/05- 1/06 data) to 40 per month Promising Practices: walk through 4

Sinnissippi System

3 rd Party reporting system-Netsmart Opened admissions scheduling vs. intake slots only philosophy —Sept. of ‘04 Admissions is non-clinical staff- first point of contact for client scheduling appt.; training in motivational techniques – Dec. of ‘04 5

Change

• Admission staff will focus on customer service and engagement strategies • “Do you see anything that may prevent you from making your appointment?” • DATA  Track No Show Rates 6

Motivational Techniques Outline 1.

Discuss the situation/problem with the client. (For people who are in crisis or who do not want to discuss their problem, skip to #2).

a.

Ask open ended questions.

b.

c.

d.

e.

1.

2.

What can I do for you?

Can you tell me about you substance use history? Instead of What do you drink? How often? How much?

Focus on the clients reasons for coming to SCI.

Express Empathy 1.

Try to make the client feel like you understand them and what they are going through. Use Reflective Listening Summarize the situation for the client.

1.

For example, “Let me make sure I understood you right. After you drink a six pack or so you start to lose control of your temper. This has caused many legal and marital problems for you and you are wanting to possibly get help with your drinking and hopefully get into our anger management group.” 7

Compile all of the clients Demographic Information.

2.

3.

4.

Go back to Discussing the problem, if needed.

1.

Use the same M I techniques as above.

Ask the client when they would like to be seen.

1.

The clients answer may be today, in 2 weeks, any day but Thursday, or on Monday afternoon.

Look in central scheduling to see if we have an open time slot during the time that the client had requested.

1.

2.

If so, offer that time to them.

If not, find alternate times that are available. 1.

Apologize to the client and explain that we don’t have anyone 2.

available at that time.

Offer the client a couple of other appointment times 8

Set the appointment time.

a.

Write it on the face sheet.

b.

c.

Write it on the master schedule.

Put the appointment in the computer.

5.

Explain to the client what to expect when they come to their appointment.

1.

The first ½ hour is time to fill out paperwork.

1.

Remind them to bring in financial documentation and insurance/IDPA cards.

2.

The following hour will be time for you to meet with your counselor.

6.

Ask the client - Do you see anything that may prevent you from making your appointment.

1.

Use reflective listening and help problem solve.

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Ask the client - Do you see anything that may prevent you from making your appointment.

a.

Use reflective listening and help problem solve.

7.

8.

9.

Ask the client - Do you have reliable transportation?

1.

If not, offer a cab ride, paid for by SCI.

1.

Give the client the cab’s telephone number.

2.

3.

4.

Make sure the client understands it is their responsibility to call the cab atleast 3 hours in advance.

When the cab arrives, pay them with petty cash from either Natalie or Liz.

Make sure you document on our list the date, time, name of the client, and how much we were charged. Get a receipt if possible. (Continue this procedure until we hear otherwise from Natalie) Ask the client if they have any further questions.

Reconfirm the appointment.

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Admissions to Addictions

50 45 40 35 30 10 5 0 25 20 15 August Sept

Opened Admissions Scheduling

Oct Series1 Nov Linear (Series1) Dec

Engagement Strategies

Jan Feb 11

2. Multiple group scheduling

• AIM: Increase Client Admissions • Promising Practices: Intake groups and confirming appointments 12

Change Project Concern

• Low admissions  Increase admissions

keep rate

to 66% in two months) by 5% (63% High “no shows” and pattern of scheduled appointments that fail only to re-schedule and fail or cancel again 13

Baseline Data on Intakes

November/December 2007  Keep rate 63%  Cancel 19%  No Show 18% 14

Planning the Change

• Select one day a week that staff can provide a Group Intake in same timeframe:

Wednesday

• Change Team:

Reception, Financial, Admissions, Sec. and Treatment staff

• Communication & Teamwork • Identify time for client arrival:

8am - 9:15 a.m.

• Clients seen on a first come first serve basis • Admissions informed of capacity of 8 clients for 4 staff 15

What happened

• Client arrival ranged from 7am (to be first!) to 3 arriving right at the cut off time • Financial needed to shift a second business staff to accommodate clients • Addictions staff occasionally had 2 intakes back to back but had sufficient time to complete as 2 staff blocked time of 2.5 to 3 hours 16

Tracking data

11-10 - 11-14-08 Showed (qty/%) No Showed Cancelled Backfilled Unable to backfill Clients Scheduled Unable to Contact Intake Confirmed Cancelled 31 20 6 5 64.5% 19.4% 16.1% 0.0% 0.0% 3 1 2 33.3% 66.7% 0.0% 0.0% 0.0% 12 11 1 91.7% 8.3% 0.0% 0.0% 0.0% 5 0.0% 0.0% 0.0% 2 40.0% 3 60.0% Message Left 11 7 3 1 63.6% 27.3% 9.1% 0.0% 0.0% Backfilled 2 2 100.0% 0.0% 0.0% 0.0% 0.0% 17

Outcome

Nov/Dec 2007 2008 • Keep rate 63% 73.0% • Cancel 19% 8.0% • No Show 18% 18.0% 18

3.Maximize your travel time

Multiple office sites Staff between two sites Download NIATx or other webinars Productive travel time by learning 19

Key Lessons Learned

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Change cycles viewed as “pilots”

gets staff buy in since they understand that it is “not forever” if it does not work • •

Communication & teamwork Rapid cycle

are the key to success allows for immediate changes to tweak the system • As important as increasing admissions are the

efficiencies/cost savings

of lost productivity-Business case

Leaders and staff need to be flexible

to adjust to changing circumstance of the day-if inclement weather and few clients arriving hold a team meeting, assign UM 20

• • •

Key Lessons, cont.

Frequent communication

-face to face weekly meetings with start of change project

Weekly e-mails

on results of Group intake, sharing data, process snags, client feedback

Helpful to use Promising Practices-

talk with others, share ideas • •

Changes cut across

multiple processes and subsystems

Recognize, thank staff

and listen to their input 21

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Promising Practices from NIATx

Centralize Appointment Scheduling

Centralize appointment scheduling so that counselors can focus on seeing clients instead of scheduling, making phone calls, and other logistical tasks. Use this method for appointments made both when clients call and when they are present in person.

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Promising Practices from NIATx

Adjust Staff Schedules to Meet Client Demand

Adjust staff schedules to match client demand for service, including for assessments, groups, and individual sessions.

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Promising Practices from NIATx

Cross-train Counselors/Admissions staff and Assign Backups for Assessments

Cross-train to both assess and treat clients and assign backup counselors to see clients whenever the number of requests for service exceeds scheduled staffing levels 24

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Promising Practices from NIATx

No Show Tracking Sheet

NIATx example of tracking sheet found in promising practices.

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Double-book Time Slots

Schedule two clients for th same assessment time slot.

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Promising Practices from NIATx

Re-assign Non-clinical Tasks Performed by Clinicians

Reassign non-clinical tasks so that counselors, who are typically the most limited resource, do not perform them.

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Promising Practices from NIATx

Offer More Groups Instead of Individual Sessions

Offer groups in place of individual sessions so that counselors can see more clients during the same amount of time.

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Thank You

• “Step out of your comfort zone once more each week and create over 50 additional opportunities for excitement, challenge and possibility each year. This is what life’s about.”

Sam Parker

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