Government Readiness for Process Improvement

1
Government Readiness for Process Improvement
Alexandra M. Bruehl, M.A. Los Angeles County
Department of Public Health Alcohol and Drug
Program Administration Cynthia Diaz, Deputy
Director MELA Counseling Services Center Inc.
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What is Process Improvement?

• A systematic problem-solving approach
• Client/Customer-based
• Evaluate internal processes
• Maximize use of available resources

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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

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Step 1 Plan

• What is NIATx?
• What is Process Improvement (PI)?
• Who are the experts?

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Who is NIATx?

• A partnership between
• RWJFs Paths to Recovery program
• CSATs Strengthening Treatment Access and
  Retention (STAR) program, and
• Single state authorities
• Independent addiction treatment organizations.

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What is NIATx?

• Shares PI strategies that help
• Maximize use of existing resources and improve
  services at a treatment center
• Learn innovative strategies through peer
  networking, and
• Model organizational improvements in addiction
  treatment

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4 Aims of NIATx
Increase Admissions
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Summary of PI Model

• Step 1 Apply Rapid Cycle Testing
• Step 2 Use the Quick Start Roadmap
• Step 3 Measure the impact of the change
• Step 4 Depending on results
• Sustain the change make additional changes
• Abandon the change begin a new change

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Do Rapid Cycle Testing

• Start by asking 3 questions
• What are we trying to accomplish? (AIM)
• How will we know the change is an improvement?
  (MEASURE)
• What changes can we test that will result in an
  improvement? (CHANGE)
• Langley, Nolan, Nolan, Norman, Provost. The
  Improvement Guide, San Francisco, Jossey-Bass
  Publishers, 1996

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Who are the Experts?

• Steve Gallon NIATx
• The PI Guru and Expert.
• Really difficult questions go to Steve.

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Who are the Experts?

• Beth Rutkowski UCLA/PSATTC
• Major role in Phase I
• Responsible for facilitating most meetings and
  trainings
• Desiree Crevecoeur-MacPhail UCLA/LACES
• Los Angeles County Evaluation System (LACES)
  Project Director
• Responsible for assisting in conducting trainings

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Who are the Experts?

• Wayne Sugita LA County, ADPA
• ADPA Leader
• Responsible for ADPA activities
• Alexandra Bruehl LA County, ADPA
• Primary contact person at ADPA
• Responsible for communicating with internal staff
  and external partners

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Step 2 Do

• Conduct pilot projects to find out
• Will agencies be willing to implement it?
• What kinds of problems and challenges will we
  face during implementation?
• Are we ready?

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PIPP- Phase I

• 6 outpatient and 1 residential program
• Some of the Objectives
• Find out whether agencies can integrate PI
  methods with no financial assistance
• Identify what contributed to successful business
  and service improvements.
• Assess agency commitment to PI

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PIPP- Phase I (Key Activities)

• One-Day Workshop
• Site walk-through by the executive sponsor or
  executive director
• Monthly conference calls and submission of data
  collection and change report
• Site visits by experts

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Step 3 Study

• Evaluation of PIPP Phase I
• Modest to marked improvements in
• Assessment no-show rates
• 30- and 60-day continuation rates
• Met or exceeded their goals

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No-show Rate for Scheduled Assessments/Intakes
(OP/IOP)
80 Improvement in No-Show Rate
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30-day Continuation RatesAcross OP/IOP Agencies
6 Improvement in Continuation
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Problems Challenges?

• Indirect costs
• Strong agency leadership and support
• Data collection
• Decrease in client turnover leads to reduced
  availability of services longer waiting lists
• Culture Change

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Successes?

• Increase in profits/reduction in costs
• Improved staff morale
• Eye-opening to conduct walk-through

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Step 4 Act

• Looked at Internal Readiness
• Organizational Development
• Workforce Development
• Looked at External Differentials
• Out Patient
• Intensive Out Patient
• Residential
• Methadone

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Step 5 Plan

• Plan for internal readiness
• Rowers Management Staff
• Are we in synch?

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Are We In Synch?

• Strength and confidence
• Coordination and trust to boldly go where no one
  has gone before
• Endurance to follow through and normalize

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Engaging Staff

• Increase Self-Efficacy
• Gatekeeper for integration into agencies
• Crucial in sustaining new culture
• Technical Experts for agencies

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Boat Infrastructure

• Labor Union issues?
• Policy changes?
• Procedural changes?
• Contract language changes?
• Database changes?
• Funding changes?
• Training needs?

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Step 5 Do
Grants
Finance
Contracts
Policy
IS/IT
HR
Engage ADPA Leadership
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Engaged Frontline Staff

• E-mail information
• In-Service
• Updates on Pilot Projects
• Representation in Pilot Projects

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PIPP- Phase II

• 8 agencies and 13 sites
• 9 outpatient (2 youth)
• 4 residential sites

MELA Counseling Services Center, Inc.
Antelope Valley Rehabilitation Center
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Agency Objectives

• Reduce Wait Time
• CHCADA (1 of 2 Sites)
• House of Hope (1 of 1 Site)
• BHS (1 of 2 Sites)
• SHIELDS (1 of 1 Site)
• Reduce No-Shows
• Tarzana Treatment Center (1 of 2 Sites)
• BHS (1 of 2 Sites)

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Agency Objectives contd.

• Increase Admissions
• MELA Counseling Center (1 of 1 Site)
• Increase Continuation
• CHCADA (1 of 2 Sites)
• Antelope Valley Rehabilitation Center (2
  Sites)
• Tarzana Treatment Center (1 of 2 Sites)
• Didi Hirsch (2 Sites)

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Process Improvement Pilot Project Phase II
ADP Conference
In-Service
Manager Meeting
Jun 08
Nov 07 Feb 08 Pre Work
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MELA A Case Study

• Change Management
• Management Realizing the Need For Change
• Embracing Change
• IMPROVEMENT! IMPROVEMENT!
• Identify Area of Deficiency
• Productivity
• Consumer Satisfaction
• Group Numbers/Amount of No-Shows
• Revenue Trend

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TEAM WORK

• The Right Team The Change Team
• Data Collector
• Visionaries
• Multi-Taskers
• The Challenge-
• Motivating Staff Capturing Change by Defining
  Service Excellence

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Initial Steps

• PROBLEM AREA IDENTIFIED
• The Program with the Lowest Admissions
• Benchmark 1-2 admissions per month
• Goal 8 admissions per month.
• RAPID CYCLE TESTING
• Increased Admissions
• Apply the PDSA

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The Change

• Developed a Process Improvement Change or Change
  Strategy
• Achievable Targets equates to Successful Hits!
• The Change SAME DAY SERVICE
• Implement Change Enforced by All Points of Client
  Contact
• The Enforcers Every Staff Member served as
  frontline change members

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Small Changes, Big Results

• RAPID CYCLE CHANGES RAPID RESULTS
• First Month of Implementation
• From a baseline of 2 admissions to 10! A 400
  increase!
• Over the course of the project (through July), we
  have increased average admissions to almost 6 per
  month. This represents an increase of 188!
• 188 increase equates to billable services!

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MELA Admissions
This represents an increase in admissions of 188
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Phase II Midway Data
30-Day Continuation
No-Shows
15 Avg. Increase 5 agencies
47 Avg. Decrease 3 agencies
Wait Time
Admissions
100 Avg. Increase1 agency
62 Avg. Decrease 2 agencies
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Where do we go from here?

• Step 7Study
• How to implement in contract

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Group Discussions

• What do you plan to accomplish?
• Implementation of the PI tool?
• Implementation of 4 Aims?

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Group Discussions

• Will implementation be mandatory?
• Will it be in contracts?
• Will it be part of policy?

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Group Discussions

• What kinds of financial commitments are you
  willing to make?
• Do you have plans for indirect costs?

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Group Discussions

• Who will be the PI Coach?
• How will you spread the PI knowledge?

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Group Discussions

• How will you evaluate the programs?
• Will this evaluation be part of the contract?
• Will you develop an evaluation tool?
• Will you train agencies on use of the evaluation
  tool?

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Thank you!

• Alexandra M. Bruehl
• [phone]
• abruehl_at_ph.lacounty.gov
• Cynthia Diaz
• [phone]
• Cynthia-melacenter_at_sbcglobal.net