Southern California Learning Collaborative Kick-Off Workshop

1. Southern California Learning Collaborative Kick-Off Workshop Presented by: Beth Rutkowski, MPH, and Kimberly Johnson, MSEd, MBA April 2, 2009 – Rialto, California

2. Adopting Changes in Addiction Treatment • One year project funded by the California Endowment • A partnership of the Pacific Southwest Addiction Technology Transfer Center, the NIATx National Program Office, and CADPAAC • Development of five regional learning collaboratives

3. Regional Learning Collaboratives: Key Activities One-day kick-off workshop in April/May 2009 Series of monthly conference calls commencing one month following kick-off workshop Ongoing data collection and periodic submission – to measure progress made with change projects

4. What do we plan to cover today? Key components of the ACTION Campaign and NIATx model of process improvement How to identify key problem areas within your agency Strategies to plan for change and implement rapid cycle improvement projects

5. How to measuring the impact of change How to brainstorm possible solutions and motivate a change team Next steps and networking opportunities What do we plan to cover today?

6. Learning Collaboratives

7. What is a Learning Collaborative? A data driven network of change teams that works collectively to enhance performance. Data Network Change Teams Collective Performance Process Improvement

8. The Culture of Learning Collaboratives Data Driven Dialogue and Discussion Celebrations

9. Data-Driven Baseline Data Keep it simple/manageable Sustainability Use existing sources of data Real-time data

10. Dialogue and Discussion Evidence is that this is how adults learn best Provides for sharing experience and celebrating success Provides for group problem-solving Allows participants to choose what they want to learn and address

11. Celebrate!

12. Motivate the Collaborative Members Record and celebrate success (need data) Acknowledge performance of team members, and whole change teams Provide support and share experiences

13. 23 million Americans need treatment 25% are able to access treatment 50% of those in treatment do not complete The way services are delivered is a barrier to both access and retention The Reality SOURCE: Nat’l Survey on Drug Use & Health, SAMHSA, 2006.

14. At any one time… • 110,000 individuals waiting for assessment • 42,000 waiting for treatment • 32 days from first contact to treatment • No-show rates about 50% SOURCE: Survey conducted by Survey Research Laboratory University of Illinois – Chicago, March 2007.

15. When we add them together… • 170,000 don’t connect to next LOC in 14 days • 250,000 not transferred from Detox to next LOC • 770,000 leave treatment before goals met • 1,190,000 opportunities for improvement?

16. Luckily, we know a few things about process improvement!

17. NIATx: Network for the Improvement of Addiction Treatment NIATx teaches behavioral health providers to use a simple process improvement model, developed under the leadership of Dr. Dave Gustafson, to improve access to and retention in treatment for all clients.

18. NIATx Mission • To improve care delivery in order to help people live better lives • To become the premier resource for systems and process improvement for behavioral health services

19. Why Process Improvement? • Customers are served by processes. • 85 percent of customer-related problemsare caused by processes. • You must improve your processes to better serve customers. CUSTOMERS = CLIENTS

20. Why Organizational Change? • Small changes do increase client satisfaction. • Satisfied clients are more likely to show up and continue their treatment. • More clients in treatment make your work more rewarding. • More admissions and fewer drop-outs improve the bottom line.

21. Small Changes, Big Impacts • Small changes make a big difference for both clients and staff • Effective changes do not have to be expensive

22. The NIATx Model: An Introduction

23. Four NIATx Project Aims Reduce Waiting Times Reduce No-Shows Increase Admissions Increase Continuation Rates

24. NIATx Results Reduce Waiting Times: 51% reduction(37 agencies reporting) Reduce No-Shows: 41% reduction (28 agencies reporting) Increase Admissions: 56% increase(23 agencies reporting) Increase Continuation: 39% increase(39 agencies reporting)

25. Five Key Principles • Understand and involve the customer • Fix key problems • Pick a powerful Change Leader • Get ideas from outside the organization • Use rapid-cycle testing

26. The Business Case: The Sixth Principle Commitment to improving processes can help solve key problems fundamental to organizational performance • The ability to operate at a positive margin • The ability to attract funding • The ability to attract & retain staff members

27. 1. Understand & Involve the Customer • Most important of the Five Principles • What is it like to be a customer? • Your staff can be considered customers, too. • Conduct walk-throughs • Hold focus groups and do surveys

28. 2. Focus on Key Problems • What keeps the CEO awake at night? • What processes do staff and customers identify as barriersto excellent service?

29. 3. Powerful Change Leader The Change Leader must have… • Influence, respect, and authority across levels of the organization • A direct line to the CEO • Empathy for all staff members • Time devoted to leading Change Projects

30. 4. Ideas from Outside Organization • Real creative problem-solving comes from looking beyond the familiar • Provides a new way to look at the problem • Access • Walk-in clinics in Wal-Mart • Client Engagement • Hair Dressers • Coffee Shops • Client Handoffs • National Rental Car • Hyatt Hotels

31. 5. Rapid Cycle Changes • Pilot tests or experiments • Two-four week cycles • Many small changes can quickly add up to make a big impact

32. Role of the Executive Sponsor Senior leader in the agency Must see change/improvement as a priority Identifies the problem and articulates the vision Demonstrates commitment to the process (time, resources) Empowers the change leader

33. Selecting a Change Leader Person has sufficient power and respect to influence others at all levels of the organization. Person has the ability to: instill optimism, has big-picture thinking, is focused and goal-oriented, and has a good sense of humor.

34. Change Leader Responsibilities Serves as a catalyst to develop ideas Successful communicator: facilitates change team meetings, is consistent, concise (data), creative, engaging (incentives), and a skilled listener. Minimizes resistance to change Keeps the Executive Sponsor updated on change team activities

35. The ACTION Campaign: An Introduction

36. What is the ACTION Campaign? The ACTION Campaign provides easily adoptable practices that NIATx members have tested in the field

37. Why this Campaign? • The field is ready for a transformation • The ACTION Campaign promotes a set of changes that many organizations in the addiction treatment field are ready to make

38. An Unprecedented Partnership • Leading organizations join to reach the widest possible audience • No single organization has ties to all the addiction treatment providers across the country

39. Our Growing List of Partners • American Association for the Treatment of Opioid Dependence • Addiction Technology Transfer Centers • Faces and Voices of Recovery • Join Together • Legal Action Center • National Association of Addiction Treatment Providers • National Association of Alcohol and Drug Abuse Counselors

40. Our Growing List of Partners • National Association of State Alcohol and Drug Abuse Directors • National Council for Community Behavioral Healthcare • Robert Wood Johnson Foundation • State Associations of Addiction Services • Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment • Treatment Research Institute

41. The Formula 500 treatment agencies implementing oneintervention to increase access, engagement or level of care transition over 18 months will impact 55,000lives affected by addiction

42. Three ACTIONs that Make a Difference • Provide rapid access to services • Improve client engagement • Create a seamless transition between levels of care

43. The ACTION Campaign www.actioncampaign.org Join Today!

46. Why a Walk-through? The walk-through… Helps understand the customer and organizational processes Provides a new perspective Allows you to feel what it’s like Lets you see the process for what it is Seeks out and identifies real problems Generates ideas for improvement Keeps you asking why?…and why? again

47. How to Do a Walk-Through • Agency director or executive sponsor plays the role of client and or family member • Inform staff and clients if needed, in advance that you will be doing the walk through • Encourage staff to treat you as they would a client; no special treatment • Think, feel, observe • Record observations and feelings • Involve staff, get their feedback

48. The Walk-Through Write-Up • First contact • First Appointment • The Intake Process • Transition between level of service - “The Handoff.” • What surprised you? • What two things would you like to change most?

49. “E.T. Phone Home” Here is your mission: Call your agency to request an assessment appointment

50. “E.T. Phone Home” • What did you learn? • How easy was it to reach a live person? • How were you greeted? • What information was requested? • How long was the wait for the next available appointment? • What would you change?