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Workshop Overview. LA County Phase I Process Improvement Pilot Project CATES Statewide Training EffortLA County Phase II Process Improvement Pilot ProjectCA NIATX Coach Pilot ProjectLocal Learning CollaborativesRegional Learning Collaboratives. Key Partners. UCLA Integrated Substance Abuse Prog
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1. Building Momentum for Process Improvement: The California Experience Presented by:
Beth Rutkowski, MPH, Steve Gallon, Ph.D., and Alex Bruehl, MA
2009 NIATx Summit and SAAS National Conference, August 1, 2009
2. Workshop Overview LA County Phase I Process Improvement Pilot Project
CATES Statewide Training Effort
LA County Phase II Process Improvement Pilot Project
CA NIATX Coach Pilot Project
Local Learning Collaboratives
Regional Learning Collaboratives Organic from the very beginning; the story begins before the phase I project overview of NIATx to a small group invited all county-contracted agency directors; from that determined interest; from there, the phase I pilot beganOrganic from the very beginning; the story begins before the phase I project overview of NIATx to a small group invited all county-contracted agency directors; from that determined interest; from there, the phase I pilot began
3. Key Partners UCLA Integrated Substance Abuse Programs
Pacific Southwest Addiction Technology Transfer Center
LA County Alcohol & Drug Program Administration
NIATx National Program Office
SAMHSA, Center for Substance Abuse Treatment
Robert Wood Johnson Foundation
County Alcohol and Drug Program Administrators Association of California
4. Recipe for Success It was about the people, not the money
BR glue to hold things together; catalytic, enthusiastic, vocal coordinator/leader for project
Interest from a variety of sectors
University-based training and technology transfer specialists, local government representatives, treatment agency personnel
Lets do a little experiment
Money
Expertise
Back-up support/project management
It was about the people, not the money
BR glue to hold things together; catalytic, enthusiastic, vocal coordinator/leader for project
Interest from a variety of sectors
University-based training and technology transfer specialists, local government representatives, treatment agency personnel
Lets do a little experiment
Money
Expertise
Back-up support/project management
5. Key Ingredients Start small and demonstrate success
Face-to-face learning sessions
Individualized technical assistance/coaching
Telephone-based technical assistance
Data collection, submission, and review
Availability of continuing education
Change Leader Academy
Coach Academy
6. Important Utensils Agency Walk-Through
Change Team
Agency Site Visits
Quick Start Road Map
Administrative Data
Change Project Report
Storyboarding
Airplane Exercise
7. Where it all started Los Angeles County, California
8. Phase I Los Angeles County Process Improvement Pilot Project November 2005-September 2006 Add logo; graphic newspaper headlineAdd logo; graphic newspaper headline
9. Participating Agencies Didi Hirsch CMHC, Via Avanta
LA Centers for Alcohol and Drug Abuse
Matrix Institute on Addictions (2)
Social Model Recovery Systems
Southern California Alcohol and Drug Programs
Tarzana Treatment Centers
10. Phase I Pilot Project Timeline
11. Phase I Aggregate Results 83% reduction in assessment/intake no-shows (2 agencies reporting)
39% increase in 30-day continuation (3 agencies reporting).
12. California Addiction Training and Education Series November 2007-May 2009 Add logo; graphic newspaper headlineAdd logo; graphic newspaper headline
14. Where Were the Trainings and How Many People Did We Train? Nov 2007
San Francisco 154 (18)
San Diego 137 (6)
Bakersfield - 129 (10)
May 2008
Redding 77 (17)
Santa Ana 145 (6)
Fresno 78 (12) July 2008
San Jose 341 (1)
Sept 2008
San Rafael - 51 (2)
Oct/Nov 2008
Concord 114 (12)
Rialto 97 (8)
Yuba City 107 (18)
15. Sample Agenda Case study - from an agencys perspective
Process Improvement 101
How to get started
Measuring impact of change
Promising practices
16. Monthly Coaching/Follow-Up Conference Call Topics Month 1: Conducting a Walk-Through
Month 2: Collecting Baseline Data
Month 3: Establishing a Change Objective
Month 4: Creating a Quick Start Road Map
Month 5: Conducting a PDSA Change Cycle
Month 6: Sustaining Change
17. Call Participation 60 hour-long conference calls held between Dec 2007 and May 2009
254 people from 35 counties
Callers joined an average of 2-3 calls (mean=2.6)
Targeted areas of participation (and implementation)
19. Phase II Los Angeles County Process Improvement Pilot Project November 2007-October 2008 Add logo; graphic newspaper headlineAdd logo; graphic newspaper headline
20. Participating Agencies Antelope Valley Rehabilitation Center (2)
Behavioral Health Services (2)
CA Hispanic Commission on Alcohol and Drug Abuse (2)
Didi Hirsch Community Mental Health Center (2)
House of Hope
MELA Counseling Services Center
SHIELDS for Families
Tarzana Treatment Centers (2)
21. Project Enhancements Formal application process
Greater focus on data
More comprehensive data review and feedback
5th Change Leader monthly conference call
2nd Executive Sponsor conference call
12 individualized data coaching calls
22. Wait Time from First Contact to Admission Wait time from first contact to assessment or admission:
Ranged from 3 to 9 days (based on data from 2 agencies)
Average wait time across sites = 6 daysWait time from first contact to assessment or admission:
Ranged from 3 to 9 days (based on data from 2 agencies)
Average wait time across sites = 6 days
23. No-Shows No-show rate for assessment/intake
Ranged from 24% to 65% (based on data from 4 agencies)
Average assessment/intake no-show rate across sites = 43.5%
No-show rate for assessment/intake
Ranged from 24% to 65% (based on data from 4 agencies)
Average assessment/intake no-show rate across sites = 43.5%
24. Session-by-Session Attendance Session-by-session attendance rates:
Ranged from 65% to 75% (based on data from 3 agencies)
Average treatment no-show rate across sites = 69.3%
Session-by-session attendance rates:
Ranged from 65% to 75% (based on data from 3 agencies)
Average treatment no-show rate across sites = 69.3%
25. 30-Day Continuation 30-Day Continuation rates:
Ranged from 67% to 70% (based on data from 2 agencies)
Average continuation rates across sites = 68.5%
30-Day Continuation rates:
Ranged from 67% to 70% (based on data from 2 agencies)
Average continuation rates across sites = 68.5%
26. California NIATx Coach Pilot Project July 2008-April 2009 Add logo; graphic newspaper headlineAdd logo; graphic newspaper headline
27. Infrastructure Development Coach Academy
Change Leader Academy
Building local coaching and change leader expertise within California essential for spread to occur
28. Local Learning Collaboratives July 2008-Present Add logo; graphic newspaper headlineAdd logo; graphic newspaper headline
30. Regional Learning Collaboratives California Endowment April 2009-Present
33. Regional Learning Collaboratives Like-Size County Structure
34. Regional ACTION Campaign/NIATx Learning Collaboratives CA-based ACTION Campaign membership more than doubled from 105 individuals in 82 agencies to 258 individuals from 204 agencies.
Five day-long kick-off workshops were held in April-May 2009
386 treatment providers/administrative staff
Staff from 156 agencies in 49 counties are now part of one of five collaboratives
35. Nine Lessons Learned Phase I and Phase II Pilot Projects
36. Seeing things from the clients perspective can be helpfulSeeing things from the clients perspective can be helpful
37. Multiple improvements can be made in a short period of timeMultiple improvements can be made in a short period of time
38. Process improvement can motivate staff and clients they get excited when good things happen
Process improvement can motivate staff and clients they get excited when good things happen
39. The results surpassed the initial objectives/expectationsThe results surpassed the initial objectives/expectations
40. Simple improvements yield big dividendsSimple improvements yield big dividends
41. Using data can actually be helpfulUsing data can actually be helpful
42. There is a huge value to sticking with it (sustaining effort and keeping communication flowing)
There is a huge value to sticking with it (sustaining effort and keeping communication flowing)
43. With any change comes resistanceWith any change comes resistance
44. One change may point to other changes that may improve servicesOne change may point to other changes that may improve services
45. Strategies for Successful Change Project Implementation
46. Communicate
49. Weekly or bi-weekly change team meetings
Troubleshoot initial start-up problems early
Provide management with updates on a frequent/as-needed basis
Regular meetings
Stay on Time
Take minutes
Keep roles clear
Maintain a parking lot list
Executive sponsor needs to show up (at least some of the time)
Celebrate and communicateWeekly or bi-weekly change team meetings
Troubleshoot initial start-up problems early
Provide management with updates on a frequent/as-needed basis
Regular meetings
Stay on Time
Take minutes
Keep roles clear
Maintain a parking lot list
Executive sponsor needs to show up (at least some of the time)
Celebrate and communicate
50. Establish a baseline
Create a data collection plan keep it simple!
Review and analyze data frequently
Provide feedback to change team
Use data to inform next steps
Establish a baseline
Create a data collection plan keep it simple!
Review and analyze data frequently
Provide feedback to change team
Use data to inform next steps
51. Choose an initial change project with a high likelihood of success
Discuss how management might formally acknowledge the success of the change team
Post the results in a common area for all staff to see
Choose an initial change project with a high likelihood of success
Discuss how management might formally acknowledge the success of the change team
Post the results in a common area for all staff to see
52. Keys Ingredients for Change Project Success Choose the right Change Leader
Establish a clear objective
Implement only 1 new change at a time
Make sure everyone implements change project as planned
Start small
Study the results before making modifications
53. Lack of commitment
Inexperience with process improvement tools
Failure to define problem and objective clearly
Difficulty creating simple measures
Lack of familiarity with data graphing
Failure to gather outside ideas Frequent Start-Up Issues Measuring the impact of change
What measures to use
Documenting the change process
Recording data daily; reviewing data weekly
Having the right people in key roles
Executive Champion or Sponsor
Change Leader with time to do the job
Small enough Team to be effective
Assuring key participants understand the service improvement model and process
Lack of customer involvement in establishing a change objective
Measuring the impact of change
What measures to use
Documenting the change process
Recording data daily; reviewing data weekly
Having the right people in key roles
Executive Champion or Sponsor
Change Leader with time to do the job
Small enough Team to be effective
Assuring key participants understand the service improvement model and process
Lack of customer involvement in establishing a change objective
54. Diagnosing Potential Problems Management commitment?
Agency walk-through?
Issues targeted for improvement?
Change Leader competency?
Appropriate measures?
Clear change project plan?
Business case?
Sustainability plan?
55. Small Changes, Big Impacts Small changes make a big difference for both clients and staff
56. Sustainability is Possible
58. What Does the Future Hold? Function of vision, leadership, and commitment
Built to last
Function of vision, leadership, and commitment
Built to last
59. (503) 378-3537(503) 378-3537