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Overview

Spectrum Health Systems Lincoln St OTP Reducing administrative discharges. Overview. Lisa Blanchard, MA, LMHC, Program Director.

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Overview

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  1. Spectrum Health Systems Lincoln St OTP Reducing administrative discharges Overview Lisa Blanchard, MA, LMHC, Program Director

  2. NIATx team identified that a high number of clients are being administratively discharged per month and look at this as a missed opportunity to engage with some clients. Primary aim to reduce the number of administrative discharges and thereby increase retention Gathered the entire clinical staff for a focused change team meeting and completed Nominal Group Technique to gather new ideas and retention specific strategies to help clients avoid administrative discharge. Top ideas were put in an online Survey Monkey to gather consensus for the first potential change project. Small goal was to decrease the number of termination notices given. The clinical team felt that by intervening at the point of the termination warning, clients would be less likely to receive a termination notice, resulting in less administrative discharges. AIM (Plan)

  3. Most termination warnings resulted in clients receiving termination notices in the future. We gave out 60 warnings within a two week timeframe representing a significant number of potential administrative discharges. Rapid Cycle 1: Currently clients receive termination warnings through medical staff when receiving their medication with no opportunity to discuss or to engage the client Piloted new process to present the warning in person during a treatment meeting with clinical staff. Included in the meeting is a discussion of the client’s treatment and any barriers to success and other ways the program can meet their needs. A set schedule two days per week (Tues/Fri) was created with a staff member available throughout the entire day during dispensing hours to meet with clients. A template for these meetings was created in the EHR to ensure consistent process between staff and prompt discussion of barriers CHANGE (Do)

  4. Table below indicates # termination notices pre and post change RESULTS (Study)

  5. Adopted change to present warnings and contracts in person in the format of a treatment meeting Adjusted the schedule to be more sustainable Tues/Wed instead of Tues/Fri. Primarily using masters level clinical staff so that any meetings that are 20 minutes and longer can be billed as a counseling session to increase revenue to offset cost Continue to monitor # of term notices and the rate of administrative discharges and impact on retention and census overall NEXT STEPS (Act)

  6. Rapid Cycle 2: Utilize the treatment meeting process for delivering termination notices. This will ensure the client understands the hearing process as well as schedule a hearing with the hearings officer at this time. Many clients are d/c due to not following hearing procedure Created a hearings schedule to allow clinicians to both issue termination notices, explain the process and directly schedule the hearings in the treatment meeting Expected that the number of clients who do not follow through with the hearings process will decrease and because of this the number of administrative detoxes will decrease. CHANGE (Do)

  7. Table below displays reduction in termination notices and administrative detoxes Even when warnings increase, termination notices and administrative detoxes decrease RESULTS (Study)

  8. Overall the change project has resulted in a reduction in administrative detoxes from an average of 3 detoxes beginning a month to an average of 2 The overall clinic census has increased from 871 to 956 in part due to these efforts, a 10% increase 1 less clients discharged per month, at an average of $4700 per client in annual revenue equals $56,400 a year This has also reduced the administrative burden of the hearings process The culture at the clinic has also changed, and staff and clients are viewing the warning and termination process differently IMPACT (Business Case, Lessons Learned)

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