Overview

Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net

Overview

CO HIV-STIC NIATx Kick-off Training

November 8, 2011Colorado Springs, CO


Good Morning!

Linda Frazier RN, MCHES

NIATx Coach


Why Process Improvement?

• Between clients and clinicians lies a canyon of poor business processes that interfere with care

• Customers, (clients, family, staff, payers, referrers), are served by organizational processes

• 85% of customer related problems are caused by organizational processes, not people

• To better serve customers, organizations must improve processes, not improve the staff’s use of existing processes


NIATx: Growing and Making a Difference

• NIATx started in 2003 with 13 substance abuse treatment provider organizations

• Today, NIATx works with more than 2000 payer and provider organizations across multiple initiatives in 50 states


NIATx Provider Results

Reduce Waiting Times: 23.6% reduction (82 change projects in 34 agencies)

Reduce No-Shows: 32% reduction (51 change projects in 29 agencies)

Increase Admissions: 25.3% increase

(52 change projects in 25 agencies)

Increase Continuation: 13.5% increase (102 change projects in 34 agencies)


Conducting a Change Exercise

PDSA cycles Plan the changeDo the planStudy the resultsAct on the new

knowledge

Rapid cycle changes Changes should be

doable in 2-3 weeks


Common Goals• Increasing the number of people served

• Eliminating waiting lists

• Implementing evidenced based practice

• Reducing recidivism

• Increasing retention

NIATx Can Help!


The NIATx Offer

Simple and innovative solutions to:

• Get people into treatment faster

• get more people into treatment

• keep them there longer

• reduce costs

• improve staff morale

• increase revenue

using existing resources


Box for DC orders in Clerk’s Office & Spreadsheet of new client information for Arkansas DC Team

RESULTS: March & April 2010: Days from Call to Assessment decreased BUT total days from Call to Admission increased by 7 days


MidCoast ARC: Snapshot of calls requesting MAT (15-20/mo); Feb. 2007, 25% of those

with opiate addiction with LOC Asses retained past initial eval & all retained able to access suboxone; all who did not engage in treatment

(75%) unable to access MAT.

2642 47

115

0

20

40

60

80

100

120

Lincoln Sagadahoc N.Cumberland

Total

Opioid Admits outside ARC Service Area from w/in ARC Service Area- 2005

20

34

5

29

0

10

20

30

40

# admitted # attending 1'sttx. session

Number attending 1'st treatent session following Opioid MAT Implementation

Baseline

Post Implementation


ME STAR SI Retention projectNIATx aims: Reduce no shows

Increase continuation rates

Change Made: Agency level changes

# of requests

# assessed # 1st session

# 2nd session

# 3rd session

# 4th session

Pre-Change: October – November 2007

439 302 305 76.07%

232 76.72%

178 79.78%

142 46.56%

Post-Change dates: April 7 – April 25, 2008

408

285

300 83.33%

250 79.60%

199 90.45%

180 60.00%

% point change

7.27% 2.88% 10.68% 13.44%


Alabama RESULTS (STUDY)• Change #1: Admission Appts. to Open Scheduling• Baseline: Average number of days between orientation and

admission = 12.4• Post Change: Average number of days between orientation

and admission = 2.0

84% decrease in time

0

5

10

15

Before Change After Change

# of Days


Impact

In addition to favorable results directly related to the change, we had an unintended positive side effect:

• Increased client return rate by nine percentage points (from 76% to 85%), saving counselor time and increasing billing

• Business Case: $17,000 per year


Missouri Screen –Admission Days

0

5

10

15

20

25

30

35

40

45

Pre-Plea 41 11 18 10 13 14 17

Post 41 24 20 23 26 40 24

June July Aug Sept Oct Nov Dec


Missouri Cost Savings- Impact

$48,929.00

Month # Confined Admits

# Days Saved $ Saved

July 18 322 $17,066.

August 7 175 $9,275.

Sept 5 64 $3,392.

Oct 11 166 $8,798.

Nov 11 140 $7,430.

Dec 6 56 $2,968.


21 1 11 1

23

1

1

21

2

3

1 3

1

1

10

5

7

1

1

1

2

1

1

2

2

0

5

10

15

Jul-

10

Au

g-10

Sep

-10

Oct

-10

Nov

-10

Dec

-10

Jan

-11

Feb

-11

Ma

r-11

Ap

r-1

1

Ma

y-11

Jun

-11

Other

SentencingServicesPrivate Atty

DCC

PD

DA

Judge

Began AIMS 3/1/11

Avg 8.5/mo

Avg 3.4/mo

RESULTS (study)


WI CHANGE CYCLE #1• Aim: Reduce the time for the response from Defense

Attorneys indicating their interest in DTC

• Change: Client Services Specialist from State Public Defender’s Office will also contact Defense Attorneys to obtain response

• Result: Pre-change = 10 days ( N=28) Post-change = 1.6 days ( N=12)

• Act: Adopt the change


SAMSHA TCE/HIV Program

• 17 Sites working on admissions, HIV testing, follow-up/continuation.

• 30 to 90% increase in clients attending next four sessions after intake in LA.

• 10-80% increase in clients agreeing to HIV testing in urban site.

• 44-100% increase in completed intake/assessments


What DC Change Teams Say• Small changes can make revenue impact

• Clinicians more aware of productivity

• [Data] - Analyze your data—it can tell you what the problem is—it’s continuous - look at your data -Turn to Data to Indicate Need for Change & Problem Solving

• Rapid cycle testing has given us the opportunity to see that even small changes can have a large impact

• Successful collaboration leads to better client outcomes

• In addition to favorable results directly related to the change, we had an unintended positive side effect: ---- Increased client return rate by nine percentage points (from 76% to 85%), saving counselor time and increasing billing

• Taking time to study the results and process how each member of the team felt about the results or helped to support the decision

• Used “WALK THROUGH” for other processes


Ball Pass PDSA

• Stand in a circle

• Change Leader pass ball to someone not next to them.

• After all have touched ball it goes back to the change leader.

• Time from beginning to end of cycle

• 1 Change at a time

• Document results

Overview

Documents

Transcript of Overview