multi-state learning collaborative: small changes—dramatic results tom mosgaller director of...
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MULTI-STATE LEARNING COLLABORATIVE:
SMALL CHANGES—DRAMATIC RESULTS
Tom MosgallerDirector of Change ManagementCHESS/NIATx – University of Wisconsin
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All work is a process.
W. Edwards Deming
Poor processes account for 85% of the problems in serving customers.
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Health – To Be Whole
• A system is a whole consisting of interdependent parts
• You cannot understand the whole by understanding each part
• You cannot improve the whole by improving each part
• The net output of the whole—for better or for worse—is the result of the interactions
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Health – To Be Whole
• THE FIVE DETERMINANTS OF HEALTH1. Personal awareness2. Community and connections3. Safety and sense of security4. The opportunity to use our gifts
and talents in a meaningful way5. Access to therapy/medical care
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The Geometry Lesson
InstitutionCommunit
y
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The Role of Quality in the New Economy
• QUALITY is what makes it possible for our customers to have a long-term love affair with our products and services
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The Methods of Quality4
Reactive
Quality by Design
Quality by Process Improvement
Quality by Compliance
Quality by Inspection
Active
NIATx focusNIATx focus
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Four Approaches to Quality
• When you think about your work, what percentage of your time and energy is spent on each of these four aspects of quality? INSPECTION (%) ASSURANCE/COMPLIANCE (%) QUALITY IMPROVEMENT (%) DESIGN AND INNOVATION (%)
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The NIATx Approach to Quality
• CORE PRINCIPLES: Understand and involve the
customer Focus on key problems Select the right change agent Seek ideas from outside the field Do rapid cycle testing
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The NIATx Approach to Quality
• CORE PRACTICES: Simple model of improvement Use of aims Collaborative approach Empower those closest to the
work Develop the business case
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The NIATx Approach to Quality: PDSA Cycle of Improvement
ACT PLAN
STUDY DO
Adopt, Adapt, or Abandon
Study dataWhat steps are you making to test the idea/change? Who is responsible?
What is the idea/change to be
tested?
Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide
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What is a 5x5?
• 5 minutes to present 5 Power Point slides which tell your story of your change project:
Title Slide
1. Aim(PLAN)
2. Change
(DO)
3. Results(STUDY)
4. Next Steps (ACT)
5. Impact(lessons learned,
etc.)
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Decrease wait time between 1st contact and 1st treatment for IOP* clients from 16 days to 5 days.
This is a 69% improvement goal. Location is the Oakdale IOP office. Length of the change project is May-July, 2010.
Project
Aim
*IOP = Intensive Outpatient
AIM
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1) Eliminated old procedure of scheduling intakes with clinicians weeks in advance.
2) Established daily walk-in orientation group between 9am – 10am.
Changes we made:
• Contact with clinician.• Program orientation.• Intake appointment
IOP clients can now have same day:
These changes had a positive impact on customers.
These changes had a positive impact on customers.
Clients enter the IOP program NOW, when they are motivated!
CHANGE
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Wait time decreased from 16 to 3.5 days.
Wait time between 1st contact and 1st treatment
Days
MonthsMAY JUNE JULY
5
10
15
20
Baseline 16 days
ChangeProject
WaitTime78%
RESULTS
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Adopt daily walk-in orientation as standard procedure at the Oakdale office.
Create a sustainability plan to maintain the improvement.
Expand the walk-in orientation pilot test to our Smithville office.
NEXT STEPS
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84 more clients seen per year
$29,016 in added revenue per year
Reputation for same day service
IMPACT(business case, efficiency, lessons learned etc.)
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NIATx 200
• 5-year grant funded by NIDA• State-based collaborative• Identify the “active ingredients”• What parts of our approach to
quality produce the greatest improvement? Which parts are the most cost effective?
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Preliminary Lessons & Outcomes
• Largest randomized trial ever done in healthcare: 200 organizations 5 states 9000 hours of training 80,000 client records analyzed 4000 staff surveys reported
• Successfully reduced waiting time and continuation of care among participant organizations with different rates of improvement between groups in the trial
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Simple Changes Dramatic Results
• What struck you?
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Quality in Daily Work
• “Thus in all ways I will leave my community greater and more beautiful than it was transmitted to me.”–Pericles Athenian Oath