Project Management

1. Project Management Reduce Waiting & No-Shows  Increase Admissions & Continuation

2. What do we need to do? • Put your team together • Conduct change projects • Participate in the collaborative, depending on assignment • Collect and report data

3. Executive Sponsor Role • Visionary • Link to strategic plan • Set a clear aim • Engagement • Support the Change Leader • Periodically Attend Change Team Meetings • Personally invite change team participants • Leadership • Barrier removal • Connecting the dots • Communication

4. Change Leader Role Change Leader should have: • influence, respect and authority across levels of the organization • a direct line to the CEO • empathy for the staff • time devoted to leading change projects

5. Overall Perspective Leadership Characteristics • Change Leader Characteristic Survey • 29 Categories, 99 responses - Change leaders (n = 40)/Executive sponsors (n=20)/Change teams members (n=39)

6. Components of Leading Change Teams: • Establish direction through a clear aim • Create a sense of urgency • Provide accountability • Involve the Right Staff • Communicate, communicate, communicate • Engage Senior Leaders • Motivate and Inspire • Commitment to empowerment • Process for creating short term wins

7. Data Coordinator Role • Serve as point of contact for study • Provide Change Leader / Change Team with access to information

8. Change Team Responsibilities • Regular meetings • Ensure accountability • Take and distribute minutes • Assign tasks and responsibilities • Identify potential solutions • Quickly test one idea • Measure the impact of chang

9. Before Starting the Change • Collect baseline data • Determine the target population & location • Establish a clear aim • Select a change leader and change team

10. Services NIATx Includes • NIATx website • Interest Circle Calls • Coaching • Learning Sessions

11. Randomization • Why are we randomizing? • How does it work? • What do you need to do?

12. Combination of Services • Learning Session, Coaching, and Website • Learning Session, Interest Circle Calls, and Website • Coaching and Website • Interest Circle Calls and Website • Learning Session and Website

13. Reduce Waiting Times Reduce No-Shows Increase Continuation Increase Admissions NIATx 200 Website • Repository of Online Learning Kits with guides to promising practices designed to

14. Interest Circle Calls • Monthly group teleconferences with coaches focusing on: • collaborative sharing • guidance on implementing promising practices • utilization of online learning kits • Discuss progress and strategies to achieve the four NIATx aims

15. Coaching • Work with an expert in process improvement • Includes on-site visit Fall 2007 • Followed by phone consultation throughout the intervention • Be coached on how to make, sustain, and spread process improvement efforts

16. Learning Sessions • Multi-day meeting to learn from • Each other • Experts in the field • Experts outside the field • Three sessions within your state • Fall 2007 • Spring 2008 • Fall 2008

17. Data Collection • Primary outcomes • Admissions • Continuation • Waiting time • No-shows • Secondary outcomes • Contribution margin • Employee turnover • Treatment completion • Organizational propensity for change • Innovation status

19. Secondary outcomes • Staff survey • Who • What • How long will it take • How often • Executive sponsor survey • Who • What • How long will it take • How often

20. NIATx 200 Project Overview

21. Timeline for the summer • Data Collection- baseline data July – September (start now)! • Appointment requests from NIATx – starting in July • Executive Sponsor Survey – July/August • Staff surveys – August/September • Randomization – October 1 • Watch for email from NIATx

22. Michigan Client Data: TEDS and Encounters Reduce Waiting & No-Shows  Increase Admissions & Continuation

23. Part I: The Electronic Journey How Client Records Move From Provider Information Systems Through the CA to MDCH…

24. The Function Machine IN Out

25. The Production Process The DEG In Fail Production Processing Pass MDCH Data Repository

26. Data Exchange Gateway (DEG) • Electronic Mailbox that allows data exchanges between CAs and MDCH • File Transfer Protocol (FTP) • Works just like your mailbox at your place of residence

27. Examples of Flat Files DD17445470981022177777777700001399481478166720060515213204004140042400090000003120060516021500140098 DD17445470981022177777777700000948910170096120060603213422001010000098000000003120060607061500140098

28. Automated Edits 153 Admission Edits 132 Discharge Edits Examples A085: Primary Substance and Secondary Substance are the same - PSA cannot be same as SSA. A067: Admission Primary Age at First Use greater than current age

29. Error Correction Vs. Record Updating • Error Correction process involves all records that fail one or more of the automated validation edits • Record Updating involves making a change to a record that passed all the edits but is inaccurate

30. Data Processing Reminders • 100.00% of all records are never in either repository, but we get close (enough) • Delays in error correction have a snowballing effect • With occasional exceptions, the data reporting performance by the CAs is exemplary

31. Part II Definitions of Data Elements

32. Primary Outcomes: Admissions • Calendar Date of First Treatment Session or Date of First Service (DOFS) in TEDS Multiple Uses of the Term: • The DOFS (the when) • The Event (the what) • The Full Demographic/Use Client Record

33. Primary Outcomes: Continuation • % of Clients admitted who continue through 4 sessions (admission date + three more) • In Michigan, when a client is inactive for 45 calendar days, the date of discharge reverts back to last date of an encounter

34. Continuation Con’t Service Begin Date (837 P) associated with a Procedure Code • Assessment codes: H0001, 90801 There are instances where OP services begin without a submitted assessment code (H0001) • We Are Not Intending To Use H0002 or H0049 “Screenings”

35. Continuation: Outpatient Codes • Outpatient Codes: Any one of the following: H0004 (Individual) H0005 (Group) H2035 (Hour of SA Program) 90804-90815, 90826, 90847, 90853, 90857, 90862

36. Continuation: IOP Codes • H0015 IOP Chair Day • H2036 Substance Abuse Treatment Program per diem

37. Waiting Time #1: First Request to Assessment • The initial telephone or walk-in request for non-emergent services by the individual, parent of minor child, legal guardian, or referral source that results in the scheduling of a face-to-face assessment with a professional. • “Borrowed” from Medicaid PI Indicator #2 (% of assessments within 14-days of first contact) • Appointments management tab

38. Waiting Time #2: Assessment to Admission • NOTE: Current model puts most dates of assessment on or after admission date • The spirit of this measure more closely related to time from AAR screening to assessment

39. Primary Outcomes: No Show Rate • Number of persons admitted into a program divided by number “assessed and referred” (screened) • Current reporting does not allow for this to be fully collected

40. Secondary Outcomes: Treatment Completion • Admission Date (DOFS) • Discharge Date (DOLS) • Length of Stay ((DOLS+1) – DOFS) • Reason for Discharge

41. Discharge Reasons • 1 Completed • 2 Left Against Staff Advice • 3 In Jail • Staff Decision for Rules Violation • Death • Transfer /Continuing (Completed Current L o C) • Mutual Client/Staff Decision • Early Jail Release • Client Relocated, 10 Program Closed/Merged, 11 Other

42. Part III Snapshots of FY 07 Year-to-Date Reported Data

43. Age Demographics (Treatment Population vs. General Population)

44. Treatment Outcomes: Percentages of Clients Who Were: Source: FY 2006 Treatment Episode Data Set (TEDS) for Michigan “Recent” arrests are those within 30 days of admission or discharge