getting staff buy-in for sustaining improvements in difficult times: the south carolina experience...

Getting Staff Buy-in for Sustaining Improvements in Difficult Times:

The South Carolina Experience

Harry PrimManagement/Prevention Consultant

South Carolina Department of Alcohol and Other Drug Abuse Services

“ We must improve access and, through increased retention,

produce better outcomes, including clients whose quality

of life has improved, making them more productive at school

or at work.”

SSA Director W. Lee Catoe

ContextMature substance abuse prevention,

intervention and treatment public systemSSA in business for 50+ years33 county authorities that serve all 46

countiesThe SSA had been drastically downsized

Treatment, prevention and QA/planning staff consolidated into a small, cohesive team

STAR-SI planned and implemented by the treatment and planning parts of this lean and mean team, in collaboration with key plank-holders

Building BlocksSSA commitment

Director, principal deputies, data, finance, logistics, program administration

Federal commitmentCollaboration of provider associationChange Leader & Coach AcademiesCommunities of CommitmentPeer Mentors

STAR-SI Aims

Access and Retention Aim

Number of Providers

2007 2008 2009

Increase admissions 6 10 20

Reduce time 1st contact to 1st service 8 23 31

Increase services within 30 days of admission 5 7 25

Progress on Common AimMeasure: Average days 1st contact to 1st

service (Reduce wait times)

Baseline: Jan – Dec 2006

Cohort 1: Jan 2007 – Sep 2009 (33 months)

Cohort 2: Oct 2007 – Sep 2009 (24 months)

Cohort 3: Aug 2008 – Sep 2009 (14 months)

State ResultsAll Three Cohorts

Aim BaselinePost-

Change% Change

Increase number of outpatient admissions (monthly average)

47.96 53.59 +11.73%

Decrease average number of days from 1st contact to 1st treatment service

25.26 19.55 -22.58%

Increase average number of services within 30 days of admission

3.12 3.24 +3.83%

Baseline: Jan-Dec 2006

STAR-SI Implementation: Jan 2007- Jun 2009 (30 months)

Cohort BaselinePost-

Change%

Change

Cohort I: 8 providersImplementation: 30 months

21.50 15.21 -29.27%

Cohort II: 15 providersImplementation: 21 months

29.53 25.61 -13.28%

Cohort III: 10 providers

Implementation: 11 months21.73 13.58 -37.53%

Provider ImprovementsAim: Decrease average number of days from 1st contact to 1st treatment service

Performance Results Year 1 Cohort

STAR-SI Implementation: 1 Jan 2007- 30 Sep 2009 (33 months)

Aim

Long Term

From Jan 07 through

Last 3 Months ending

Jun 09 Sep 09 Jun 09 Sep 09

Increase number of outpatient admissions from 73.7 monthly average/per agency

72.1 adms

-2.14%

72.4 adms

-1.66%

68.0 adms

-7.61%

72.9 adms

-0.99%

Decrease average number of days from 1st contact to 1st treatment service from 21.8 days

15.2 days

-29.27%

15.6 days

-28.38%

8.9 days

-58.82%

11.8 days

-46.11%

Increase average number of services within 30 days of admission from 3.28 services

3.36 svs

7.48%

3.48 svs

6.11%

3.79 svs

20.91%

3.61 svs

9.91%


STAR-SI Implementation: 1 Oct 2007- 30 Sep 2009 (24 months)

Aim

Long Term

From Jan 07 through

Last 3 Months ending



49.4 adms

0.04%

49.4 adms

0.08%

48.1 adms

-2.45%

48.2 adms

-2.26%


25.61days

-12.76%

25.34 days

-15.73%

22.8 days

-22.51%

21.7 days

-27.98%


3.36 svs

2.44%

3.18 svs

-3.05%

3.79 svs

15.55%

3.22 svs

-1.85%


STAR-SI Implementation: 1 Aug 2008 - 30 Sep 2009 (14 months)

Aim

Long Term

From Jan 07 throughLast 3 Months ending



27.5 adms

-0.13%

27.1 adms

-1.40%

28.0 adms

1.84%

25.6 adms

-6.85%


14.2 days

-38.24%

15.6 days

-31.80%

14.4 days

-37.54%

14.6 days

-36.17%


3.16 svs

0.64%

2.95 svs

-6.02%

3.43 svs

9.24%

3.00 svs

-4.45%

Access: Statewide ResultsAverage number of days from 1st contact

to 1st treatment service

Retention: Statewide ResultsAverage number of services within

30 days of admission

Provider Achievements: AdmissionsProvider

Executive Director

Change Leader Percent change

Admissions - Rate of Change in monthly average, long term (10% or better)

Shoreline John Coffin Charles Bell 164%

Colleton Ron Rickenbacker Kathleen Padgett 46%

Charleston Center Mark Cowell Chanda Brown 26%

Dorchester Samuel Miller Sarah Larrabee 18%

Phoenix Center Adam Brickner Mary Irby 12%

Admissions - Rate of Change in monthly average, last 3 months (Top Five)



Cornerstone David Matthews Joyce Dilleshaw 29%

Circle Park Randy Cole Jeannie James 25%


Reduce Wait Time - Rate of Change in monthly average , long term (Top Ten)

Provider Executive Director Change Leader Percent change


Cherokee Beth Powell Robert Strait 61%


Clarendon Ann Kirven Robin Murphy 47%

Spartanburg David Forrester Kathy Murphy 47%

Sumter Glenn PeaglerDarren Wilson& Patricia Colclough

47%

Keystone Janet Martini Janet Bush 42%

Union Jackie Dawkins Amanda Prince 41%

Kennedy Center Linda Bailey Michelle Crawford 38%

Axis I Center Cheryl Long Amy Coto, Pam Rush 33%

Provider Achievements: Access

Provider Achievements: Access 2Reduce Wait Time - Rate of Change in monthly average, last 3 months (Top Ten)

Provider Executive Director Change Leader Percent change

Union Jackie Dawkins Amanda Prince 95%


LRADAC Debbie Francis Gayle Aycock 74%


Cherokee Beth Powell Robert Strait 68%

Sumter Glenn PeaglerDarren Wilson& Patricia Colclough

67%



Keystone Janet Martini Janet Bush 55%

Pickens Robert Hiott Faye Nichols 50%


Colleton Ron Rickenbacker Kathleen Padgett 43%

Provider Achievements: Retention

Provider Executive Sponsor Change Leader Percent change

Increase No. of Services - Rate of change in monthly average, long term (Top Five)

Keystone Janet Martini Janet Bunch 32%


Hazel Pittman Center David Seward Tommicha Walker 23%


Williamsburg Jackie Scott Graham Jannie Snow 17%


Increase No. of Services - Rate of change in monthly average, last 3 months (Top Five)


Keystone Janet Martini Janet Bunch 32%

Kennedy Center Linda Bailey Michelle Crawford 38%



Process Improvement CapacityChange Teams 40 provider level

3 state level

Peer Mentors 4 (plus 4 coaches)

Peer Networking Meetings

3 per year

70+ attendees/meeting

Change Leader & Coach Academy Training

1 per year

59 trained overall

Peer networking calls Monthly

Change Projects 143 in 27 months of STAR-SI

Process Improvement Capacity

Change Teams 40 provider level, 3 state level

Change: Fewer active change teams

Peer Mentors 4 (plus 4 coaches)

Change: One active coach

Peer Networking Meetings 3 per year; 70+ attendees/meeting

Change: Reduced numbers

Change Leader & Coach Academies, Communities of Commitment

1 per year, 64 trained overall

None trained since early 2009

Peer networking calls Monthly

Change: Through ACTION Campaign calls only

Change Projects 208 in 33 months of STAR-SI

Change: Fewer projects since July 2009

STAR FORCE InitiativeNew initiative developed

through the NIATx Whole Systems Change CommunityVoluntaryUltimate goal: agencies’

management culture is based on the NIATx model

Working collaboratively with Provider association leadership.

Our Customers and StakeholdersCustomers Stakeholders33 ProvidersProviders’ Clients

W. Lee Catoe, Single State Authority

DAODAS Executive Management Team

Behavioral Health System Association (BHSA) Leadership

Provider Agency Executive Directors

Provider Agency Staff

STAR FORCE Proposed Plan ComponentsUse existing joint committee structures and

state & regional meeting venues

Plan to use existing professional development and technical assistance resources, such as NIATx, Southeastern ATTC, and the S.C. School of Alcohol and Other Drug Studies

Working toward implementing a management institute that will include the NIATx process improvement and whole systems change models

Continue to hold learning collaboratives and deploy national and state mentors and coaches

Seek state and federal funding

Action StepsObtained Commitment from Key

Stakeholders through Briefings.Following Whole Systems Change ModelMimic Experience of Whole Systems

Change Workout held December 3-5, 2008 in Madison, Wisconsin.

Held Two State-Wide Meetings focused on Information Gathering and Solidifying Customer Buy-in.

South Carolina WorkoutInvitation issued to local providers for

voluntary participation in workout and subsequent project.

Volunteering providers participated in four one hour pre-workout conference calls facilitating conversations around relevant topics associated with whole systems change.

Workout held on May 20, 2009 facilitated by whole systems change project coach.

Core Concepts ExaminedPre-workout conference call topics:1. Transformational Leadership2. Whole Systems Change Model3. Managing Change4. Whole Systems Change Charter

May 20, 2009 STAR FORCE Workout TopicsIndentify Opportunities as a SystemUnderstanding Our Customers and

StakeholdersBegin Discussion on Our VisionGenerating IdeasLooking at MeasurementsSustainability

Benefits from May 20, 2009 WorkoutBegan process for identifying a framework

for looking at whole systems change.Re-affirmation from local provider network

leadership to continue and expand dialogue around whole systems change.

Foundation for planning and holding a learning collaborative in conjunction with one-day STAR FORCE meeting in Fall 2009.

Building on WorkoutHeld a Learning Collaborative on September

16, 2009 in conjunction with a one-day voluntary STAR FORCE meeting.Began transition from STAR-SI to STAR FORCEClarified STAR FORCE visionIdentified possible areas that need to be

addressedDeveloped proposed action steps that can

address identified needsGathered information will be synthesized into

an action plan that will facilitate the vision.

Continued Building on WorkoutDeveloped and held another Learning Collaborative

on March 9, 2010 that included a breakout session devoted to STAR FORCE Initiative.Highlighted the successes identified from STAR-SITwo providers presented on local successes and

how rapid cycle change has been institutionalized in their agency.

Continued the transition to STAR FORCE Initiative by looking at sustainability and organizational structure.

Among agencies that are voluntarily participating in STAR FORCE, presented a draft document that outlined the STAR FORCE project with shared goals and implementation steps.

TakeawaysCollaborative relationships between the SSA

and the providers are essential

Performance management capability is a must

To face future challenges, start using the NIATx model now; don’t just copy successful projects

Contact InformationHarry S. Prim III, M.P.H. , M.Div.

Management/Prevention ConsultantSouth Carolina Department of Alcohol and Other

Drug Abuse Services101 Executive Center Drive, Suite 215

Columbia, SC [email protected]

(803) 896-1199

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