Using QI to Decrease Client Drop-out Rates

Presented By: Val Di Gregorio, Carrie Duff, Kayla Pereira, Krista Vaughan, Meaghan Zwambag, & Heather Elliott

Learning Objectives

• You will be able to identify the benefit of utilizing a structured quality improvement process to address clinical issues

• You will be able to assess possible factors contributing to client drop-out rates

• You will be able to implement a quality improvement process to decrease client drop-out rates

Our TeamExecutive Sponsor: Linda Sibley

Team Lead: Heather Elliott/ Megan Neill

Process Owner: Valerie Di Gregorio

Improvement

Advisor:

Heather Elliott

Team Members: Carrie Duff

Kayla Pereira

Krista Vaughan

Meaghan Zwambag

Excellence through Quality Improvement Project (E-QIP)

• Provided data and quality improvement training and coaching supports throughout our project

• Website: http://ontario.cmha.ca/provincial-programs/e-qip-excellence-through-quality-improvement-project/

Exercise• Our project was concerned with reducing the number

of clients who were being closed as “drop-out” from our services.

To Do:

• At your tables, take a few minutes to brainstorm reasons why you believe a client would drop out of services. Write down as many reasons that you can think of.

• Once you have your hypothesized reasons, work together to choose one or two that you believe would account for the majority of client drop-outs.

• We will come together to discuss as a group

Why Focus on Client Drop-out?• Client feedback on the OPOC-MHA highlighted individuals did not

have enough information or support with discharge planning

• Analysis of data available to us showed that there has been a decrease in the number of individuals being discharged as treatment complete and that more individuals are dropping out of service

• We would like for the individuals attending our agency to receive the service they need for the length of time they need it and have successful discharges from the agency

• These understandings and realizations led us to the beginning of our quality improvement project to reduce the rate of client drop-out

Project Charter

Problem vs Aim: Two sides of the same coin…

Problem Statement:

Since 2016 approximately 60% of clients drop out of the Substance Use CT General Program in London for reasons that are not known, resulting in clients not receiving the appropriate services or having their needs met.

Aim Statement:

Reduce the number of clients with discharge reason “drop-out/no show” by 10% in the adult Substance Use Program in London by December 31, 2018.

The Diagnostic Journey

• Diagnostic Tools used:

oFishbone

o5 Whys

oPareto Chart

oExperience Based Design (Experience Survey)

Working Fishbone

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

1

2

3

4

5

6

Stage ofchange/ not

ready tochange

Completedgoals

Wait times (atintake, between

sessions)

Treatment notwhat expected

Turnover andtransfers

Lack ofinformation re:

dischargeplanning

Clear policy re: when to close and as what –catalyst input

No rapid re-engagement (in

intake again)

Client crisis/trauma

Found othersupports incommunity

Explainingtreatment

process, whatto expect,

options, etc.

Inconsistencyre: policy

GAIN Q3processes

Lack of follow-up – discharge

work

Cu

mu

lati

ve F

req

uen

cy

Fre

qu

en

cy C

ou

nt

Defect Type / Cause

Pareto Chart

EBD

DATENAME13

EBD Exercise

• At your tables, individually complete the emotion questionnaire based on how you think clients would respond

• As a group discuss what you think the biggest pain points clients would identify

• We will come back together as a large group to discuss

DATEPRESENTATION NAME14

EBD Results

DATEPRESENTATION NAME15

First Contact IntakePaperwork

Assessment Wait btwFirst Appt

FirstMeeting

Goal Setting Ongoingservices

ClinicianTransfer

Referrals

37

21 2120

39

30

43

7

19

810

87

2 20

7

3

Clients Currently Accessing Services- SU Program London

Positive Emotions Negative Emotions

Root Causes:

• Lack of Discharge Planning (in session conversations with clients)

• Lack of follow-up between intake and First Appointments

• Inconsistency regarding file closures and client contact (procedures).

Our Change Ideas

• Reminder Call for First Appointment

• Follow-up Contact after No-Show

• 60 Day Inactivity Contact

• A Discharge Quick Reference Guide

• File Closure Information Sheet

• Develop your team• Staff that are able to commit time and energy, varied

programs across the agency based on need of project

• Develop your project charter• Identifying a clear aim statement, living document that

will evolve as you continue the project

• Diagnostic Tools & Work• Identifying which diagnostic tools will give you the best

data, avoid predicting outcomes before you do the diagnostic work

Implementing Your Own QI Project

• Change Ideas, PDSA’s– Based on diagnostic outcomes, develop and

implement the change ideas that will help achieve the aim statement

• Identify Balancing measures– Weekly staff survey to measure the impact on

staff workload, gather information whether the changes were helping with caseload tracking

• Move to spread and sustainability – Involving feedback from other staff is essential

to get an accurate picture

Implementing Your Own QI Project

Key Overall Challenges

• Trusting the QI process… not rushing it

• Shifting focus to the key root causes identified that we can influence and implement changes to address

• Sustainability in the future… some of the change ideas implemented create increased workload for staff who are already concerned about balancing their existing workload

Lessons Learned• One project lead only… having two different project leads

had a negative impact on progress and team feeling supported overall throughout the entire project

• Implement change ideas on small scale

• Having dedicated and protected time each week to work on the EQIP project, not just having time protected for team meetings

• Implementing client feedback to measure impact of change idea – reminder calls

Benefits of QI Process

• Created clear picture of areas for improvement.

• Cohesive understanding of procedures amongst staff.

• Adapting root causes into change ideas – able to see results.

• Decrease in drop out rates, increase in Treatment Complete.

• Overall best practice, client centred approached by increasing communication and connection.

DATEPRESENTATION NAME22

Qualitative Results

Drop-out Treatment Complete

69

15

49

36

% o

f Fi

les

Clo

sed

Reason for File Closure

% OF FILES CLOSED DROP-OUT VS. TREATMENT COMPLETE

2017-18 2018-19

Questions, Comments, Concerns?