building momentum for process improvement: the california
TRANSCRIPT
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
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
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
Recipe for Success
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
Important Utensils
Agency Walk-Through Change Team Agency Site Visits Quick Start Road Map Administrative Data Change Project Report Storyboarding Airplane Exercise
“Where it all started…”
Los Angeles County, California
Phase I Los Angeles County Process Improvement Pilot Project
November 2005-September 2006
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
Phase I Pilot Project Timeline
Nov ‘05
Orientation
Jan ‘06
Kick-Off
Workshop
Pre-Work
Nov ‘05-Jan ‘06
Feb ‘06
Site Visits
Mar ‘06
Monthly
Conference
Calls
Jun ‘06
Mid-Way
Change
Leader
Meeting
Sept ‘06
Completion
Conference
Phase I Aggregate Results
83% reduction in assessment/intake no-shows (2 agencies reporting)
39% increase in 30-day continuation (3 agencies reporting).
California Addiction Training and Education Series
November 2007-May 2009
**1,430 participants
***50 counties
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)
Sample Agenda
Case study - from an agency’s perspective Process Improvement 101 How to get started Measuring impact of change Promising practices
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
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)
Target Areas of Call Participation
= 10+ callers
= 5-9 callers
Phase II Los Angeles County Process Improvement Pilot Project
November 2007-October 2008
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)
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
6
2.6 2.5
44.3
1.9
4.6
3.5
1.2
6.9
0
1
2
3
4
5
6
7
Basel
ine
Mar
chApril
May
June
July
AugSep Oct
Avg
Day
sWait Time from First Contact to Admission
42% Average Improvement in Wait Time
43.5
2521.2
26.628.4
36.4
28.2
12.7
24.618.6
05
101520253035404550
Basel
ine
Mar
chApril
May
June
July
AugSep Oct
Avg
%
43% Average Improvement in No-Shows
No-Shows
70.677.4
84.8 86.680.5 84.3 87.5 84.6 87
84.1
0102030405060708090
100
Basel
ine
AprilM
ayJu
neJu
lyAug
Sept
Oct
NovAvg
% 19% Average Increase in Session-by-Session Attendance
Session-by-Session Attendance
68.5
73.9
68.9
73.975.1
72.9
70.7
75.172.9
64
66
68
70
72
74
76
Basel
ine
AprilM
ayJu
neJu
lyAug
Sept
Oct
Avg
%
30-Day Continuation
6% Average Improvement in 30-Day Continuation
California NIATx Coach Pilot Project
July 2008-April 2009
Infrastructure Development
Coach Academy Change Leader Academy Building local coaching and change leader
expertise within California – essential for spread to occur
Local Learning Collaboratives
July 2008-Present
“Local” Learning Collaboratives
Regional Learning Collaboratives – California Endowment
April 2009-Present
Target Areas of Call Participation
= 10+ callers
= 5-9 callers
Regional Learning Collaboratives – Like-Size County Structure
6
1 1
5
1
3
2
4
1
3
5
1
2
14
1
8
0%
20%
40%
60%
80%
100%
So Cal(n=8)
CentralValley (n-8)
CapitolRegion(n=12)
Bay Area(n=11)
Nor Cal(n=10)
Large Medium Small MBA*
*MBA = Minimum-Based Allocation (under 90K population)
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
“Nine Lessons Learned” Phase I and Phase II Pilot Projects
Strategies for Successful Change Project Implementation
Communicate
Brainstorm Multiple Ideas for Change
Be Creative
Work as a Team
Review Data Regularly!
Celebrate Early Successes
Keys Ingredients for Change Project Success
1. Choose the right Change Leader
2. Establish a clear objective
3. Implement only 1 new change at a time
4. Make sure everyone implements change project as planned
5. Start small
6. Study the results before making modifications
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
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?
Small Changes, Big Impacts
Small changes make a big difference for both clients and staff
Effective changes do not have to be costly
Sustainability is Possible…
What Does the Future Hold?
• Beth Rutkowski, MPH
• (310) 388-7647; [email protected]
• Steve Gallon, PhD
• (503) 378-3537; [email protected]
• Alex Bruehl, MA
• (626) 299-4502; [email protected]
Thank you for your time!