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MULTI-STATE LEARNING COLLABORATIVE: SMALL CHANGES—DRAMATIC RESULTS

MULTI-STATE LEARNING COLLABORATIVE: SMALL CHANGES—DRAMATIC RESULTS. Tom Mosgaller Director of Change Management CHESS/NIATx – University of Wisconsin. All work is a process. W. Edwards Deming. Poor processes account for 85% of the problems in serving customers. Health – To Be Whole.

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MULTI-STATE LEARNING COLLABORATIVE: SMALL CHANGES—DRAMATIC RESULTS

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  1. MULTI-STATE LEARNING COLLABORATIVE:SMALL CHANGES—DRAMATIC RESULTS Tom Mosgaller Director of Change Management CHESS/NIATx – University of Wisconsin

  2. All work is a process. W. Edwards Deming Poor processes account for 85% of the problems in serving customers.

  3. Health – To Be Whole • A system is a whole consisting of interdependent parts • You cannot understand the whole by understanding each part • You cannot improve the whole by improving each part • The net output of the whole—for better or for worse—is the result of the interactions

  4. Health – To Be Whole • THE FIVE DETERMINANTS OF HEALTH • Personal awareness • Community and connections • Safety and sense of security • The opportunity to use our gifts and talents in a meaningful way • Access to therapy/medical care

  5. The Geometry Lesson Institution Community

  6. The Role of Quality in the New Economy • QUALITY is what makes it possible for our customers to have a long-term love affair with our products and services

  7. 4 The Methods of Quality NIATx focus Quality by Design Quality by Process Improvement Quality by Compliance Active Quality by Inspection Reactive

  8. Four Approaches to Quality • When you think about your work, what percentage of your time and energy is spent on each of these four aspects of quality? • INSPECTION (%) • ASSURANCE/COMPLIANCE (%) • QUALITY IMPROVEMENT (%) • DESIGN AND INNOVATION (%)

  9. The NIATx Approach to Quality • CORE PRINCIPLES: • Understand and involve the customer • Focus on key problems • Select the right change agent • Seek ideas from outside the field • Do rapid cycle testing

  10. The NIATx Approach to Quality • CORE PRACTICES: • Simple model of improvement • Use of aims • Collaborative approach • Empower those closest to the work • Develop the business case

  11. The NIATx Approach to Quality: PDSA Cycle of Improvement ACT PLAN What is the idea/change to be tested? Adopt, Adapt, or Abandon STUDY DO What steps are you making to test the idea/change? Who is responsible? Study data Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide

  12. What is a 5x5? • 5 minutes to present 5 Power Point slides which tell your story of your change project: Title Slide 1. Aim (PLAN) 2. Change (DO) 3. Results (STUDY) 4. Next Steps (ACT) 5. Impact (lessons learned, etc.)

  13. AIM • Decrease wait time between 1st contact and 1st treatment for IOP* clients from 16 days to 5 days. • This is a 69% improvement goal. • Location is the Oakdale IOP office. • Length of the change project is May-July, 2010. Project Aim *IOP = Intensive Outpatient

  14. CHANGE Changes we made: 1) Eliminated old procedure of scheduling intakes with clinicians weeks in advance. 2) Established daily walk-in orientation group between 9am – 10am. These changes had a positive impact on customers. IOP clients can now have same day: • Contact with clinician. • Program orientation. • Intake appointment Clients enter the IOP program NOW, when they are motivated!

  15. Wait time between 1st contact and 1st treatment RESULTS Change Project 20 Baseline 16 days 15 Days 10 5 JUNE JULY MAY Months Wait Time 78% Wait time decreased from 16 to 3.5 days.

  16. NEXT STEPS • Adoptdaily walk-in orientation as standard procedure at the Oakdale office. • Createa sustainability plan to maintain the improvement. • Expand the walk-in orientation pilot test to our Smithville office.

  17. IMPACT(business case, efficiency, lessons learned etc.) • 84more clients seen per year • $29,016 in added revenue per year • Reputation for same day service

  18. NIATx 200 • 5-year grant funded by NIDA • State-based collaborative • Identify the “active ingredients” • What parts of our approach to quality produce the greatest improvement? Which parts are the most cost effective?

  19. Preliminary Lessons & Outcomes • Largest randomized trial ever done in healthcare: • 200 organizations • 5 states • 9000 hours of training • 80,000 client records analyzed • 4000 staff surveys reported • Successfully reduced waiting time and continuation of care among participant organizations with different rates of improvement between groups in the trial

  20. Simple Changes Dramatic Results • What struck you?

  21. Quality in Daily Work • “Thus in all ways I will leave my community greater and more beautiful than it was transmitted to me.” –Pericles Athenian Oath

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