sustaining change may 2009 follow-up calls (call #6) based on the fall 2008 cates training series...

Sustaining ChangeMay 2009 Follow-up Calls (Call #6)Based on the fall 2008 CATES Training SeriesContra Costa County, San Bernardino County, & Sutter County October 24, November 7, and November 14, 2008Call Facilitators:Beth Rutkowski, MPH, and Sherry Larkins, Ph.D.UCLA Integrated Substance Abuse Programs/ Pacific Southwest Addiction Technology Transfer Center

AgendaMaking the business case for sustainabilityPrinciples of sustainabilityQ-A periodSurvey of next stepsResources for continued learning

Review of Previous Conference Call TutorialsConducting a Walk-ThroughGathering Baseline DataSetting a Change ObjectiveUsing the Quick Start Road MapConducting PDSA Change Cycles

Key to Sustainability: Making the Business CaseEconomics drive an agencys ability to provide servicesA positive economic impact is an important leverage point for changeServices that drain resources are rarely continued

What do we mean by the Business Case ? Process improvements can impact your:Financial bottom lineOrganizational climateEfficiency and productivity Relationship with referral sourcesStaff retentionClient satisfactionTreatment outcome

Example 1Increase in Admissions/MonthCommunity Resource Center

STAR-SI A & R TABLE

STAR-SI ACCESS AND RETENTION MEASURES SUMMARY TABLE (A & R TABLE)

Illinois, Cohort 1 Providers - 03/21/2008

Primary Outcome Measure (Organization-wide)Provider OrganizationBaselineTargetJan-07Feb-07Mar-07Apr-07May-07Jun-07Jul-07Aug-07Sep-07Oct-07Nov-07Dec-07

AdmissionsCombined STAR-SI Providers669/month736/mo.804656774715776645742742729858728658

AdmissionsCombined Cohort 1 Providers144/month158/mo.186182195223236192202184173217160121

AdmissionsCombined Cohort 2 Providers525/month578/mo.618474579492540453540558556641568537

AdmissionsCommunity Resource Center17.6/month19.4/mo.232025244023432720331213

AdmissionsEgyptian Public and M.H. Dept.22.6/month25.2/mo.2415222725918926242222

AdmissionsFranklin/Williamson49.6/month54.6/mo.406160645864595545756243

AdmissionsSoutheastern54.0/month59.4mo.99868810811396829382856443

Primary Outcome Measure (Organization-wide)BaselineTargetJan-07Feb-07Mar-07Apr-07May-07Jun-07Jul-07Aug-07Sep-07Oct-07Nov-07Dec-07

Average Units of Service in first 30 daysCombined STAR-SI Providers2.12.32.22.22.12.12.02.12.22.02.32.11.91.8

Median Units of Service in first 30 days1.01.01.01.01.02.01.01.01.02.01.01.01.01.0

Average Units of Service in first 30 daysCombined Cohort 1 Providers2.22.42.22.22.12.11.91.81.92.02.32.21.71.9


Average Units of Service in first 30 daysCombined Cohort 2 Providers2.02.22.12.32.22.12.12.22.42.12.32.11.91.8


Average Units of Service in first 30 daysCommunity Resource Center2.52.72.32.52.42.62.62.52.42.33.53.02.13.5


Average Units of Service in first 30 daysEgyptian Public and M.H. Dept.3.33.63.72.93.33.72.92.63.03.03.43.52.42.0


Average Units of Service in first 30 daysFranklin/Williamson1.92.11.32.11.81.61.41.91.52.02.12.01.62.1


Average Units of Service in first 30 daysSoutheastern1.82.02.22.02.01.91.61.51.71.81.71.51.51.2




STAR-SI State-Specific Measure (Site-specific)Provider Reporting Unit #BaselineTargetJan-07Feb-07Mar-07Apr-07May-07Jun-07Jul-07Aug-07Sep-07Oct-07Nov-07Dec-07

Avg. Duration from Initial Contact to OpeningCombined STAR-SI Providers5.15.15.85.35.97.06.29.29.28.07.87.89.4

Number of Clients in Calculation8003800653770712776643741741728855727657

% Clients - No Wait75.9%79.0%76.2%77.9%72.7%69.5%71.8%61.2%57.3%60.4%64.0%64.1%58.4%

Avg. Duration from Initial Contact to OpeningCombined Cohort 1 Providers8.210.17.710.913.213.214.920.918.414.914.813.816.2


% Clients - No Wait68.4%69.4%62.6%59.0%51.6%44.9%53.1%46.5%38.6%43.4%52.5%56.3%51.2%

Avg. Duration from Initial Contact to OpeningCombined Cohort 2 Providers4.23.65.03.42.54.32.65.56.15.85.56.17.9


% Clients - No Wait77.9%81.9%81.4%84.3%82.3%80.2%80.1%66.7%63.4%65.6%67.9%66.4%60.0%

Avg. Duration from Initial Contact to OpeningCommunity Resource Center0.212.08.221.425.614.850.249.029.422.223.327.727.6


% Clients - No Wait98.1%60.9%75.0%24.0%16.7%12.5%4.3%7.0%3.7%15.0%12.1%8.3%7.7%

Avg. Duration from Initial Contact to OpeningEgyptian Public and M.H. Dept.12.10.00.00.00.00.80.09.911.011.913.739.628.9


% Clients - No Wait80.1%100.0%100.0%100.0%100.0%96.0%100.0%77.8%66.7%42.3%50.0%50.0%31.8%

Avg. Duration from Initial Contact to OpeningFranklin/Williamson0.00.00.00.00.00.00.00.00.00.00.00.00.0


% Clients - No Wait100.0%100.0%100.0%100.0%100.0%100.0%100.0%100.0%100.0%100.0%100.0%100.0%100.0%

Avg. Duration from Initial Contact to OpeningSoutheastern17.016.114.518.121.622.218.228.726.922.225.115.822.5


% Clients - No Wait24.7%51.5%26.7%30.7%18.5%16.8%29.2%22.0%9.7%19.5%27.1%25.0%25.6%




Days from Admission to 1st Treatment SessionCombined STAR-SI Providers21.119.020.821.924.018.724.320.916.518.114.315.214.211.3

Median Days from Admission to 1st Tx Session10.09.08.09.09.010.010.08.07.08.07.08.010.07.0


Days from Admission to 1st Treatment SessionCombined Cohort 1 Providers39.735.728.833.942.826.635.135.030.923.219.825.223.919.2



Days from Admission to 1st Treatment SessionCombined Cohort 2 Providers18.216.419.017.618.516.121.417.213.016.813.312.411.99.4



Days from Admission to 1st Treatment SessionCommunity Resource Center29.526.629.814.019.88.316.226.814.75.55.010.99.74.7

Median Days from Admission to 1st Tx SessionUnit 7328.025.028.014.012.07.010.022.016.07.05.07.010.06.0


Days from Admission to 1st Treatment SessionEgyptian Public and M.H. Dept.19.117.216.212.515.89.219.614.315.210.56.69.322.017.0



Days from Admission to 1st Treatment SessionFranklin/Williamson51.446.340.146.361.436.642.337.629.424.219.129.023.313.4



Days from Admission to 1st Treatment SessionSoutheastern23.020.724.523.427.523.541.737.440.229.942.232.532.333.3






Days from 1st to 2nd Treatment SessionCombined STAR-SI Providers15.113.618.515.117.217.218.218.915.813.914.415.09.47.1

Median Days from 1st to 2nd Treatment Session7.06.37.07.07.07.07.06.57.06.07.07.07.06.0


Days from 1st to 2nd Treatment SessionCombined Cohort 1 Providers17.615.818.515.818.114.418.822.116.416.614.317.213.110.8



Days from 1st to 2nd Treatment SessionCombined Cohort 2 Providers16.915.218.514.816.718.317.918.015.613.114.414.28.56.3



Days from 1st to 2nd Treatment SessionCommunity Resource Center25.723.112.513.023.518.719.538.36.713.23.511.315.0N.A.

Median Days from 1st to 2nd Treatment SessionUnit 7321.019.011.013.015.57.08.514.08.07.53.59.015.0N.A.


Days from 1st to 2nd Treatment SessionEgyptian Public and M.H. Dept.20.518.514.331.141.611.623.67.07.410.013.824.313.015.0

Median Days from 1st to 2nd Treatment SessionUnit 7418.016.07.022.014.07.014.07.07.07.012.512.57.012.0


Days from 1st to 2nd Treatment SessionFranklin/Williamson13.712.312.39.910.814.616.321.211.514.08.115.09.39.2



Days from 1st to 2nd Treatment SessionSoutheastern24.321.930.219.820.914.723.624.430.130.642.222.930.49.7





Primary Outcome Measure (Organization-wide)BaselineTargetJan-07Feb-07Mar-07Apr-07May-07Jun-07Jul-07Aug-07Sep-07Oct-07Nov-07Dec-07

% of Clients/At Least 4 Tx Sessions/First 30 DaysCombined STAR-SI Providers17.0%18.7%19.4%19.5%17.1%16.6%16.0%15.4%20.1%17.3%21.4%18.5%15.8%13.1%


% of Admitted Clients/At Least 4 TX Sessions39.6%42.5%43.1%41.0%38.0%39.2%34.9%41.8%38.0%41.0%37.5%27.7%21.3%

% of Clients/At Least 4 Tx Sessions/First 30 DaysCombined Cohort 1 Providers7.5%8.2%15.6%17.6%13.8%14.8%10.2%9.4%25.2%11.4%19.1%14.7%8.1%10.7%



% of Clients/At Least 4 Tx Sessions/First 30 DaysCombined Cohort 2 Providers19.6%21.6%20.2%20.3%18.1%17.5%18.5%18.1%23.0%19.2%22.1%19.8%18.0%13.6%



% of Clients/At Least 4 Tx Sessions/First 30 DaysCommunity Resource Center2.9%3.2%8.7%20.0%12.0%29.2%25.0%17.4%11.6%11.1%30.0%24.2%0.0%30.8%



% of Clients/At Least 4 Tx Sessions/First 30 DaysEgyptian Public and M.H. Dept.29.8%32.8%41.7%33.3%40.9%44.4%24.0%33.3%44.4%44.4%53.8%45.8%46.2%9.1%



% of Clients/At Least 4 Tx Sessions/First 30 DaysFranklin/Williamson4.1%4.5%0.0%18.0%10.0%7.8%5.2%10.9%10.2%14.5%20.0%16.0%8.1%16.3%



% of Clients/At Least 4 Tx Sessions/First 30 DaysSoutheastern1.8%2.0%17.2%14.0%10.2%8.3%4.4%4.2%7.3%6.5%4.9%1.2%3.1%0.0%



Note: Baseline data denoted by BOLD FONT

*Cohort 1 organization-wide baselines were developed on the basis of DARTS data submitted for clients opened from 07/01/05 through 06/30/06.

Cohort 1 site-specific baselines were developed on the basis of DARTS data submitted for clients opened from 10/01/06 through 12/31/06.

All Cohort 2 baselines were developed on the basis of DARTS data submitted for clients opened from 10/01/06 through 09/30/07.

**Baseline and monthly analyses of average duration from initial contact to opening involve deletion of outlier values greater than 300 days. These values account for less than 0.3% of the total observations

# of Adms. Per Month - Cohort 1

23

20

25

24

40

23

43

27

20

33

12

13

Target 158

Baseline 144

Community Resource Center

Number of Admissions

Number of Admissions/MonthTotal Cohort 1 and Individual Providers

# of Adms. Per Month-CRC

23

20

25

24

40

23

43

27

20

33

12

13

Target 19.4

Baseline 17.6



# of Adms. Per Month-EPMHC

24

15

22

27

25

9

18

9

26

24

22

22

Target 25.2

Baseline 22.6

Egyptian Public MHC


Number of Admissions/MonthEgyptian Public and Mental Health Center

# of Adms. Per Month-FWHS

40

61

60

64

58

64

59

55

45

75

62

43

Target 54.6

Baseline 49.6

Franklin Willamson


Number of Admissions/MonthFranklin/Williamson Human Services

# of Adms. Per Month-SECC

99

86

88

108

113

96

82

93

82

85

64

43

Target 59.4

Baseline 54.0

Southeastern


Number of Admissions/MonthSoutheastern Illinois Counseling Centers

Avg. Service Units-Cohort 1

2.22.33.71.32.2

2.22.52.92.12

2.12.43.31.82

2.12.63.71.61.9

1.92.62.91.41.6

1.82.52.61.91.5

1.92.431.51.7

22.3321.8

2.33.53.42.11.7

2.233.521.5

1.72.12.41.61.5

1.93.522.11.2

Target 2.4

Baseline 2.2

Combined Cohort 1


Egyptian Public MHC

Franklin Willamson

Southeastern

Average Number of Sessions

Average Units of Service/First 30 DaysTotal Cohort 1 and Individual Providers

Avg. Service Units-CRC

2.3

2.5

2.4

2.6

2.6

2.5

2.4

2.3

3.5

3

2.1

3.5

Target 2.7

Baseline 2.5



Average Units of Service/First 30 DaysCommunity Resource Center

Avg. Service Units-EPMHC

3.7

2.9

3.3

3.7

2.9

2.6

3

3

3.4

3.5

2.4

2

Target 3.6

Baseline 3.3

Egyptian Public MHC


Average Units of Service/First 30 DaysEgyptian Public and Mental Health Center

Avg. Service Units-FWHS

1.3

2.1

1.8

1.6

1.4

1.9

1.5

2

2.1

2

1.6

2.1

Target 2.1

Baseline 1.9

Franklin Willamson


Average Units of Service/First 30 daysFranklin/Williamson Human Services

Avg. Service Units-SECC

2.2

2

2

1.9

1.6

1.5

1.7

1.8

1.7

1.5

1.5

1.2

Target 2.0

Baseline 1.8

Southeastern


Average Units of Service/First 30 daysSoutheastern Illinois Counseling Centers

Avg. Time Adm.-1st Sess.-Coh.1

Avg. Time Adm.-1st Sess.-Coh.1

28.829.816.240.124.5

33.91412.546.323.4

42.819.815.861.427.5

26.68.39.236.623.5

35.116.219.642.341.7

3526.814.337.637.4

30.914.715.229.440.2

23.25.510.524.229.9

19.856.619.142.2

25.210.99.32932.5

23.99.72223.332.3

19.24.71713.433.3

Target 35.7

Baseline 39.7

Combined Cohort 1


Egyptian Public MHC

Franklin Willamson

Southeastern

Avg. Duration in Days from Admission to First Clinical Service

Average Duration (Days)/Admission to First ServiceTotal Cohort 1 and Individual Providers

Avg. Time Adm.-1st Sess.-CRC

Avg. Time Adm.-1st Sess.-CRC

29.8

14

19.8

8.3

16.2

26.8

14.7

5.5

5

10.9

9.7

4.7

Target 26.6

Baseline 29.5



Average Duration (Days)/Admission to First ServiceCommunity Resource Center

Avg. Time Adm.-1st Sess.-EPMHC

Avg. Time Adm.-1st Sess.-EPMHC

16.2

12.5

15.8

9.2

19.6

14.3

15.2

10.5

6.6

9.3

22

17

Target 17.2

Baseline 19.1

Egyptian Public MHC


Average Duration (Days)/Admission to First ServiceEgyptian Public and Mental Health Center

Avg. Time Adm.-1st Sess.-FWHS

Avg. Time Adm.-1st Sess.-FWHS

40.1

46.3

61.4

36.6

42.3

37.6

29.4

24.2

19.1

29

23.3

13.4

Target 46.3

Baseline 51.4

Franklin Willamson


Average Duration (Days)/Admission to First ServiceFranklin/Williamson Human Services

Avg. Time Adm.-1st Sess.-SECC

Avg. Time Adm.-1st Sess.-SECC

24.5

23.4

27.5

23.5

41.7

37.4

40.2

29.9

42.2

32.5

32.3

33.3

Target 20.7

Baseline 23.0

Southeastern


Average Duration (Days)/Admission to First ServiceSoutheastern Illinois Counseling Centers

Avg. Time 1st to 2nd Sess.- Co1

Avg. Time 1st to 2nd Sess.- Co1

18.512.514.312.330.2

15.81331.19.919.8

18.123.541.610.820.9

14.418.711.614.614.7

18.819.523.616.323.6

22.138.3721.224.4

16.46.77.411.530.1

16.613.2101430.6

14.33.513.88.142.2

17.211.324.31522.9

13.115139.330.4

10.80159.29.7

Target 15.8

Baseline 17.6

Combined Cohort 1


Egyptian Public MHC

Franklin Willamson

Southeastern


Average Duration (Days)/First to Second ServiceTotal Cohort 1 and Individual Providers

Avg. Time 1st to 2nd Sess.- CRC

Avg. Time 1st to 2nd Sess.- CRC

12.5

13

23.5

18.7

19.5

38.3

6.7

13.2

3.5

11.3

15

0

Target 23.1

Baseline 25.7



Average Duration (Days)/First to Second ServiceCommunity Resource Center

Avg. Time 1st to 2nd Sess.- EGY

Avg. Time 1st to 2nd Sess.- EGY

14.3

31.1

41.6

11.6

23.6

7

7.4

10

13.8

24.3

13

15

Target 18.5

Baseline 20.5

Egyptian Public MHC


Average Duration (Days)/First to Second ServiceEgyptian Public and Mental Health Center

Avg. Time 1st to 2nd Sess.- FW

Avg. Time 1st to 2nd Sess.- FW

12.3

9.9

10.8

14.6

16.3

21.2

11.5

14

8.1

15

9.3

9.2

Target 12.3

Baseline 13.7

Franklin Willamson


Average Duration (Days)/First to Second ServiceFranklin/Williamson Human Services

Avg. Time 1st to 2nd Sess.-SECC

Avg. Time 1st to 2nd Sess.-SECC

30.2

19.8

20.9

14.7

23.6

24.4

30.1

30.6

42.2

22.9

30.4

9.7

Target 21.9

Baseline 24.3

Southeastern


Average Duration (Days)/First to Second ServiceSoutheastern Illinois Counseling Centers

% Clients-4 Sessions-Cohort 1

% Clients-4 Sessions-Cohort 1

0.1560.0870.41700.172

0.1760.20.3330.180.14

0.1380.120.4090.10.102

0.1480.2920.4440.0780.083

0.1020.250.240.0520.044

0.0940.1740.3330.1090.042

0.2520.1160.4440.1020.073

0.1140.1110.4440.1450.065

0.1910.30.5380.20.049

0.1470.2420.4580.160.012

0.08100.4620.0810.031

0.1070.3080.0910.1630

Baseline 8.2%

Target 7.5%

Cohort 1 Providers


Egyptian Public and MH Dept

Franklin Williamson

Southeastern

% of Clients/At Least 4 Tx Sessions/First 30 DaysTotal Cohort 1 and Individual Providers

% Clients-4 Sessions-CRC

% Clients-4 Sessions-CRC

0.087

0.2

0.12

0.292

0.25

0.174

0.116

0.111

0.3

0.242

0

0.308

Baseline 2.9%

Target 3.2%


% of Clients/At Least 4 Tx Sessions/First 30 DaysCommunity Resource Center

% Clients-4 Sessions-EPMHD

% Clients-4 Sessions-EPMHD

0.417

0.333

0.409

0.444

0.24

0.333

0.444

0.444

0.538

0.458

0.462

0.091

Baseline 29.8%

Target 32.8%

Egyptian Public and MH Dept

% of Clients/At Least 4 Tx Sessions/First 30 DaysEgyptian Public and Mental Health Center

% Clients-4 Sessions-FWHS

% Clients-4 Sessions-FWHS

0

0.18

0.1

0.078

0.052

0.109

0.102

0.145

0.2

0.16

0.081

0.163

Baseline 4.1%

Target 4.5%

Franklin Williamson

% of Clients/At Least 4 Tx Sessions/First 30 DaysFranklin/Williamson Human Services

% Clients-4 Sessions-SECC

% Clients-4 Sessions-SECC

0.172

0.14

0.102

0.083

0.044

0.042

0.073

0.065

0.049

0.012

0.031

0

Baseline 1.8%

Target 2.0%

Southeastern

% of Clients/At Least 4 Tx Sessions/First 30 DaysSoutheastern Illinois Counseling Centers

Example 2 Reduced No-Shows Franklin-Williamson Human Services

Example 3 Monthly Revenue IncreaseFranklin Williamson Human Services

SustainabilitySustainability of change is not easy. Up to 70% of improvements are not sustained.

DefinitionSustainability exists when a newly implemented process: continues to improve over time,becomes the way things are done around here and does not return to the old process that existed before the improvement project began.

Sustainability Model

Process1. Does the change improve efficiency?2. Are the benefits obvious, supported by evidence and believed by stakeholders?3. Can the change be adapted or spread to the whole organization?4. Is there a system for monitoring and continually improving the process?

StaffHas the staff been informed of the change and trained to sustain the process?Do staff feel empowered as part of the change process and believe the improvement will be sustained?Do agency leaders take responsibility for efforts to sustain the change process and communicate regularly with staff?

OrganizationIs the improvement consistent with the agencys strategic aims?Are staff, facilities and equipment, job descriptions, policies, procedures and communication systems appropriate for sustaining the improved process?

One Secret to Sustaining Change Make it as easy as possible for people to use the new methods and very difficult for them to revert to old ways of doing business.

Who do you need? A Sustain Leader who understands the change and can monitor performance to make sure the change is sustained.

In SummaryWhat Needs to be DoneUpdate all documents and operating proceduresTrain all staff in the new proceduresHold an official launch of the new protocolHave a clear method for monitoring the new processVerify maintenance of the change periodically

Learning Resources: #1 Join the ACTION Campaign:Adopting Changes to Improve Outcomes Now

www.actioncampaign.org

Download Action Kits for improving access, engagement, and transition between levels of care

Learning Resources: #2NIATx:Network for the Improvement of Addiction Treatment

www.niatx.netNIATx WorkbookVideos on Process ImprovementTools to help with improvement projectsCase studiesPromising practices and strategies

Thank you for joining us! Best wishes to all of you as you experiment with improving access, engagement and retention. Your clients will appreciate it!

- The CATES staff at UCLA and the Pacific Southwest ATTC

*Please provide a couple of graphs, charts or tables highlighting at least 2 provider changes. Indicate the time frame on which the illustration is based.

sustaining change may 2009 follow-up calls (call #6) based on the fall 2008 cates training series...

Documents

median units of service

average units of service

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admis resource center17

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