Overview of NIATx & Process Improvement

1. Overview of NIATx & Process Improvement Process Improvement Overview and Basic Training 2008

2. Overview of the Presentation • What is NIATx? • Four Aims • Why Process Improvement (PI)? • Summary of Process Improvement Model

3. What is NIATx? • A partnership between: • RWJF’s Paths to Recovery program • CSAT’s Strengthening Treatment Access and Retention (STAR) program, and • A number of single state authorities and independent addiction treatment organizations. • NIATx works with addiction treatment providers to make more efficient use of their capacity and shares strategies for improving treatment access and retention.

4. What is NIATx?, continued • NIATx members create a culture of process improvement in which treatment center staff: • Use existing resources to improve services • Learn innovative strategies through peer networking, and • Model organizational improvements in addiction treatment

5. Reduce Waiting Times Reduce No-Shows Increase Continuation Rates The Four Aims Increase Admissions

6. More on the Four Aims • Four aims developed by NIATx • Goal to improve treatment in these specific areas • These areas are usually areas where programs would like to improve • Areas were examined by providers in the LA County pilot project

7. Why Process Improvement? • Process Improvement (PI) • Systematic way to address specific areas of concern • Shown to be effective in other areas • Medical care • Automotive industry • Straightforward and relatively simple to implement

8. What is Process Improvement? • An evidence-based framework that when applied to client access and retention processes can get clients in the door quickly and keep them there long enough to make a difference • A systematic problem-solving approach that can be used to understand client needs, restructure processes, and make the most efficient use of available resources

9. Three Fundamental Questions • What are we trying to accomplish? (AIM) • How will we know that a change is an improvement? (MEASURE) • What changes can we test that may result in an improvement? (CHANGE)

10. Summary of Process Improvement Model • Apply “Rapid Cycle Testing” • Use the “Quick Start Roadmap” • Measure the impact of the change • Depending on results • Sustain the change and make additional changes • Abandon the change and implement a new change

11. 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

12. Using a Quick Start Road Map To Plan Change Projects • Identify problem important to management • Target objective (measurable/specific) • How will you measure the change? • Who will be on the change team? • Instructions for change team

13. Using a Quick Start Road Map To Plan Change Projects, continued • What contributes to the problem? • What possible changes might help? • What is the implementation process? • What data will be gathered? • How will progress be studied? • What is the next step?

14. Specific Steps • Walk Through • Determine area of improvement • Gather “Change Team” • Collect baseline data • Implement change and measure the impact of that change • Sustain the improvement and continue to collect data

15. Walk Through • Conduct an agency walk-through • Identify potential improvements to existing procedures • Usually conducted by the director • Allows the director to see the process through the eyes of the treatment participant • Provides examples of how programs can easily make impressive changes (usually for FREE)

16. Area for Improvement • Many programs come up with multiple changes to make • It is important that the program focuses on one change at a time. • If more than one change is implemented, it is impossible to determine which change resulted in the effect • Some changes can be made immediately (e.g., cleaning up graffiti)

17. Change Team • Responsible for the changes that are made and should include the following: • Executive Sponsor • Someone who “has the ear” of the director • Has the power to implement changes • Change Leader • Provides daily leadership • Keeps the project organized • Change team • Implements the changes • Collects data to measure impact of the change.

18. Baseline Data • Collect at least two months of data in the following areas • Total number of admissions • Waiting time from first contact to intake/assessment • No-show rates for • Intake/assessment appointments • Treatment sessions • 30 and 60 day client continuation rates (retention)

19. How Do You Measure the Impact of Change? • Define your measures • Collect baseline data • Establish a clear aim • Consistently collect data • Chart your progress • Ask questions

20. Sustain the Change? • When determining whether to sustain a change, ask these questions: • Is the change feasible (e.g., financially, personnel-wise, etc.)? • Did the change result in the desired levels of improvement? • Can someone be assigned the task to ensure the change is sustained?

21. How to Sustain an Improvement Another key: Have a sustainability leader to… • Clarify staff duties and responsibilities • Communicate progress data with staff • Plan with staff how to restore gains if data falls below an agreed level • Implement actions to restore gains • Advise management about infrastructure changes needed to sustain the improvement

22. And then… • Once the change has been implemented and it is determined that the change can be sustained, it is time to select the next area for improvement. • At that point, the program may choose a new change team or keep the existing one. • Then the process begins again…

23. For more information, see the NIATx Website www.niatx.net