Transcript WA HIV-STIC Kick-off February, 2012 Elizabeth Strauss, NIATx PI Coach

WA HIV-STIC
Kick-off
February, 2012
Elizabeth Strauss, NIATx PI Coach
Reduce Waiting & No-Shows  Increase Admissions & Continuation
Current
State
The Change Process
Desired
Future
1. Your Name/Organization/Role
2. If the bike represents your organization’s current
“change process”, what part of the bike are you?
AGENDA
•
•
•
•
Implementing SHIELD for HIV Prevention
Introduction to Process Improvement
Experience Rapid Cycle Testing
How can the NIATx Way help with the
implementation of SHIELD?
• NIATx Tools:
–
–
–
–
Nominal Group Process
Aim Measures and Cycle Measures
Change Project Form
Flowcharting
• What’s next?
• Closing
The Network for the Improvement
of Addiction Treatment (NIATx)
• Started in 2003 with 13 substance abuse
treatment provider organizations, funded by
RWJF and SAMHSA/CSAT
• Today, nearly 1000 payers and providers
participating in initiatives in 50 states
NIATx Provider Results
(As of November 2006)
Reduce Waiting Times: 23.6% reduction
(82 change projects in 34 agencies)
Reduce No-Shows: 32% reduction
(51 change projects in 29 agencies)
Increase Admissions: 25.3% increase
(52 change projects in 25 agencies)
Increase Continuation: 13.5% increase
(102 change projects in 34 agencies)
SAMSHA Targeted Capacity
Expansion/HIV Program
AIM:
• Increase admissions, HIV testing, followup/continuation in HIV programs. (17 sites)
RESULTS:
• Increase from 30% to 90% of clients attending
next 4 sessions after intake (LA, CA).
• Increase from 10% to 80% of clients agreeing
to HIV testing (Newark, NJ).
• Increase from 44% to 100% of clients
completing intake/assessment (Detroit, MI).
Denver Public Health Infectious
Disease Clinic Referral Process
• Increased the number of HIV+
patients referred to OP Behavioral
Health Services from 1/month to 12/week
Denver Public Health Infectious
Disease Clinic Referral Process
• CHANGES:
– Offered weekly groups for HIV+ patients,
publicizing with flyers, posters, and tickets at
the ID Clinic and Primary Care Clinic.
– Did outreach to individuals.
– Scheduled appointments rather than having
walk-ins.
– Social Workers from the ID Clinic held
monthly meetings with ID Clinic, PCC, and
OBHS staff to provide education about
services available for HIV+ patients.
The Network for the Improvement
of Addiction Treatment (NIATx)
• Applied the access and retention aims to
Corrections
• Used the NIATx Way for Prevention
• Implemented Evidence-Based Practices using
the NIATx model
HIV Services and Treatment
Implementation in Corrections
(HIV-STIC)
• NEW - Apply the NIATx Way to:
– HIV Services in Corrections
– HIV Prevention
– Implementing an Evidence Based Practice -SHIELD
Overall Research Goals
1.
Conduct implementation research on how to more
effectively implement and sustain improvements in
the HIV Services Continuum for offenders under
correctional supervision
2.
Evaluate relative effectiveness of a local change
team process improvement approach for improving
HIV service implementation in criminal justice
settings
1
•
Randomized design (matched pairs of facilities) will
compare HIV implementation and service outcomes in
facilities using a local change team/process improvement
approach to control sites receiving baseline training only
•
4 facilities/sites per Research Center; 36 facilities total
•
Each agency (through Executive Sponsor) selects an
area of HIV services continuum and instructs facilities to
improve these services
•
Control sites receive training and access to resources,
and staff is charged with improving HIV services
• Experimental sites receive same training and resources
as Controls PLUS local change team process
improvement approach with a Coach
1
Why Process Improvement?
• Customers are served by processes
• 85% of customer related problems are
caused by organizational processes
• To better serve customers,
organizations must improve processes
What is Process Improvement?
• An experiment in change…
using a structured process,
guided by the customer,
driven by data
Based on the Model For Improvement in The Improvement Guide,
by Langley, Nolan, Nolan, Norman, & Provost
Five Key Principles
Evidence-based predictors of change
Gustafson and Hundt, 1995
1. Understand & Involve the Customer
2. Focus on Key Problems
3. Appoint an Influential Change Leader
4. Seek Ideas from Outside the Organization
5. Do Rapid-Cycle Testing (PDSA cycles)
1. Understand and Involve the Customer
• Most important of the Five Principles
1. Understand and Involve the Customer
• What is it like to be our customer
(inmate, patient, client, peer educator)?
 Do a walk-through
 Flowchart the process
 Hold focus groups
 Ask the customer
Walk-through
Complete a walk-through of the area you
are trying to improve
1. Select 2 people to play the roles of inmate and
friend.
2. Let staff know in advance.
3. Act as if you were a typical inmate.
4. Observe and record your experiences and feelings.
• What barriers, discomfort, information gaps,
positive experiences are there?
• Ask staff what changes would make their job
easier or make it better for inmates.
5. Make a list of the areas that need improvement
and specific changes you would want to make.
2. Focus on Key Problems
– What keeps the Executive Sponsor awake
at night?
– What processes have staff and customers
identified as barriers to prevention
education?
3. Appoint an Influential Change
Leader
Who has:
 Influence, respect and authority across
levels of the organization
 A direct line to the Executive Sponsor
 Empathy for staff and customers
 Time available to lead change projects
 No fear of data
 Enthusiasm
4. Seek Ideas from Outside the
Organization
• To provide new ways of looking at the
problem
• What can be learned from other
organizations and businesses?
5. Do Rapid-Cycle Testing
Rapid-Cycle changes
 Are quick, small,
do-able in 2 weeks
PDSA cycles
 Plan the change
 Do the plan
 Study the results
 Act on the new
knowledge (adapt,
adopt or abandon)
Act Plan
Study Do
The role of data (and graphs) in
decision-making
Chg
1
Chg
2
Chg
3
Month
Model for Improvement
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 make
that will result in an improvement?
Act Plan
Study Do
Reference:
Langley, Nolan,
Nolan, Norman,
& Provost. The
Improvement
Guide
4. How can we sustain the improvements?
What makes this approach to
change different?
•
•
•
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The customer is involved
Change is a big experiment
No mistakes, no right or wrong
Data tells you if the change was an
improvement
Who’s Who in
Process Improvement?
• The Executive Sponsor articulates the
vision and removes barriers to change.
• The Change Leader provides day-today leadership with energy and
enthusiasm to motivate and empower
the Change Team.
• The Change Team plans and
implements change cycles.
The Change Leader
• Facilitates change team meetings
• Supervises changes and helps team with
implementation issues
• Is empowered to overcome barriers to
implementation of change experiments
• Supervises measurement, compilation and
interpretation of data
• Keeps executive sponsor aware of change
team activities
The Change Team
• A small group of 5-7 people designated
by the Executive Sponsor to work on a
specific area for improvement (i.e. a
change project focused on 1 aim)
The Change Team
• Plans and implements change cycles
• Identifies possible changes that could
improve the aim
• Decides how to implement the change
• Creates and conducts rapid cycle pilot
tests until the goal is achieved
• Collects data
• Studies results to see if the change
should be adopted, adapted or
abandoned
What Change Teams Say
• Rapid cycle testing has given us the
opportunity to see that even small
changes can have a large impact.
• Analyze your data - it can tell you what the
problem is - it’s continuous - Turn to Data
to Indicate Need for Change & Problem
Solving.
• Successful collaboration leads to better
client outcomes.
What Change Teams Say
• In addition to favorable results directly related to
the change, we had an unintended positive side
effect: Increased client return rate… from 76%
to 85%, saving counselor time.
• Taking time to study the results and process
how each member of the team felt about results
helped to support decisions.
• “The walk-through opens your eyes to what a
client goes through—invaluable.”
• Used “WALK THROUGH” for other processes.
Experience
small scale, rapid PDSA cycles
The Ball Pass Exercise
Model for Improvement
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 make
that will result in an improvement?
Act Plan
Study Do
Reference:
Langley, Nolan,
Nolan, Norman,
& Provost. The
Improvement
Guide
The Ball Pass Exercise
• AIM: to pass the ball from person to person as
quickly as possible.
• RULES:
– Only one person may touch the ball at a time; each
person must touch the ball with both hands.
– The ball must be passed to a person who is not
right next to you.
– The cycle begins when the Change Leader passes
the ball the first time and ends when the Change
Leader has the ball at the end.
The Ball Pass Exercise
• Select a:
– Change Leader
– Data Recorder
• Cycle #1 (baseline):
– Stand in a circle.
– The Change Leader passes the ball to another
person in the circle who is not next to them.
– Each person passes the ball to another person who
is not right next to them; when everyone has
touched the ball, pass it back to the Change
Leader.
– The data recorder documents the time from the
beginning to the end of the cycle (baseline data).
The Ball Pass Exercise
• Conduct at least 3 PDSA cycles
– PLAN: What can we do to reduce the time required?
– DO: Implement the change and measure how long it
takes.
– STUDY: Did we get the results we expected? Was the
change implemented as planned?
– ACT: Adopt, adapt or abandon this change idea and
decide what the next cycle will be.
– Repeat another PDSA cycle.
The Ball Pass Exercise
• Tell your story:
Create a graph to show the data for each PDSA
cycle, noting the change that was made for each
cycle.
Ball Pass Time
420
360
Seconds
300
240
180
120
60
0
1
2
3
Cycle
4
The Ball Pass Exercise
Discussion Questions:
• How did you decide on a change?
• Were you able to implement one change
at a time?
• Did you decrease the amount of time
required?
• Why is it important to collect baseline
data?
• What changes were most effective?
How can the NIATx Way help
with the implementation of
SHIELD?
How can the NIATx Way help
with the implementation of
SHIELD?




Recruitment
Intervention sessions
Participant retention
Maintenance/Sustaining SHIELD
Model for Improvement
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 make
that will result in an improvement?
Act Plan
Study Do
Reference:
Langley, Nolan,
Nolan, Norman,
& Provost. The
Improvement
Guide
Nominal Group Process
to brainstorm change ideas and
assign priorities
STEP 1: Preparation (clarify objective,
prepare question, prepare meeting room)
STEP 2: Silent idea generation
STEP 3: Round-robin recording of ideas
STEP 4: Serial discussion of ideas
STEP 5: Preliminary voting
STEP 6: Discussion of preliminary voting
STEP 7: Final voting
Encourage creative thinking!
Nominal Group Process
to brainstorm change ideas and
assign priorities
STEP 1: Preparation
STEP 2: Silent idea generation
STEP 3: Round-robin recording of ideas
STEP 4: Serial discussion of ideas
STEP 5: Preliminary voting
STEP 6: Discussion of preliminary voting
STEP 7: Final voting
Model for Improvement
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 make
that will result in an improvement?
Act Plan
Study Do
Reference:
Langley, Nolan,
Nolan, Norman,
& Provost. The
Improvement
Guide
SHIELD AIM Measures
SHIELD Pre-Post Assessment Form
(Appendix 8) will measure:
• Communication
• Behaviors
• Knowledge
• Peer educator self-efficacy
• Social network
Aim Measures vs. Cycle Measures
How will you know if a change is an
improvement?
• Recruitment
• Participant retention
How to begin
The Change Project Form
Complete page 1, the Project Charter
Flowcharting
Flowcharts force an organizational
focus on process.
Why Flowchart?
Flowcharting is useful for:
1.
2.
3.
4.
5.
6.
7.
Providing a starting point/baseline view
Understanding the process
Identifying key problems/bottlenecks
Showing where to test ideas for most impact
Stimulating thinking - results in brilliant ideas
Adding interactivity & fun - gets the team together
Creating a simple & succinct visual process
overview
Key Questions for Flowcharts
• Is the name of process clear?
• Where does the process begin?
• Where does the process end?
• What does the process include/not include?
Key Symbols for Flowcharts
Post-It Notes are great for flowcharting.
Action
A square identifies a step in the process
Yes
?
No
A diamond is a decision point in the process
and asks a “yes or no” question or offers a
choice of direction in the process.
What’s next?
• Do a walk-through
• Collect baseline data
• Set up a regular time for the Change
Team to meet
For more information
www.NIATx.net
NIATx e-Learning Course:
Process Improvement 101