Overview

What Is NIATx

Mark Zehner, NIATx

Milwaukee County

November 20th 2013

Nobody should have to suffer twice.

Dave Gustafson

Original Aims

Reduce Waiting Times

Reduce No-Shows

Increase Admissions

Increase Continuation

Every system is perfectly designed to achieve exactly the results it gets.

Paul Batalden

Why Process Improvement?

• Customers are served by processes.

• 85 percent of customer-related problems are caused by processes.

• You must improve your processes to better serve customers.

Small Changes, Big Impacts

• Small changes create a big difference for both clients and staff.

• Effective changes don’t have to be expensive

Devoting an hour a day of a receptionist’s time to confirm next-day appointments cost one agency $4,000 per year. The resulting reduction in no-shows increased their revenues by over $400,000 per year.

Change is Hard

• As I say, it shall be done– “Yeah, right”

• Just hope things are better tomorrow– Chances are they’ll be worse

• If we only had more money we would be so much better at doing this– Please, share with us just where that money

tree is

What makes this approach to change different?

• Change is a big experiment

• No mistakes, no right or wrong

• Data tells you if the change was an improvement

• Customer guides change ideas

(Title)

Name(s) of presenter(s)Organizational Affiliation

“For all its macho rhetoric and technological

content, reengineering in the end is like any other effort to change the way people work:

Culture counts big. Change won’t occur merely because management wills it.”

Stewart, T.A. (1993). Reengineering: The hot new managing tool. Fortune, August 23, 41-48.

Why Organizational Change?

• Small changes do increase client satisfaction.

• Satisfied clients are more likely to show up and continue their treatment.

• More clients in treatment make your work more rewarding.

• More admissions and fewer drop-outs improve the bottom line.

So, how do you do it?

NIATx Model Tab 2

Executive Executive

SponsorSponsor

Change Change

LeaderLeader

Change Change

TeamTeam

People

Walk-throughWalk-through

FlowchartingFlowcharting

Nominal Group Nominal Group

TechniqueTechnique

PDSA CyclePDSA Cycle

ToolsTools

RulesRulesUse existing Use existing

resourcesresourcesMeasure Measure

changechange

ImproveImprove

mentment

ProcessProcessModelModel

ChangeChange

ProjectProject

aimaim

Sustain the gainsSustain the gains

The NIATx Change Process

• Complete a Walk-through

• Choose an Aim and set a Goal

• Measure the Effectiveness of Change

• Select and Test Changes

• Sustain the Gains

People

• Three Key Roles• Executive Sponsor• Change Leader• Change Team

Tab 3

Executive Sponsor

• Has the authority to allocate the resources for this particular project

• Sees the change/improvement as a priority

• Identifies the problem and articulates the vision

Executive Sponsor Responsibilities

• Chooses the change leader

• Works with Change Leader to identify who will be on the change team

• Invites staff to be on the team

• Removes barriers and allocates resources

• Allows/Empowers the team to make changes

Change Leader

• Person who feels passionately about the change

• Able to influence others at all levels of the organization

• Ability to instill optimism; sees the big-picture; focused and goal-oriented

• A good sense of humor

Change Leader Responsibilities

• Serves as a catalyst to develop ideas

• Successful communicator: facilitates change team meetings, is consistent, concise (data), creative, engaging (incentives), and a skilled listener

• Minimizes resistance to change

• Keeps the Executive Sponsor updated on change team activities

What do Change Team Members look like?

• Front line workers and supervisors in unit where changes will be implemented

• Other employees impacted by the change

• People with special knowledge about the change such as

customers, family members, experts from outside the organization, IT staff…..

Change Team Responsibilities

• Identify possible changes that could meet the objective

• Decide how to implement the change• Create and conduct rapid-cycle pilot tests until

goal is achieved• Study results to see if the change should be

adopted, adapted or abandoned

Five Principles

• Fix key problems

• Pick a powerful Change Leader

• Get ideas from outside the organization

• Use rapid-cycle testing

• Understand and involve the customer

Why a Walk-through?

The walk-through…– Helps understand the customer and organizational

processes– Provides a new perspective

• Allows you to feel what it’s like• Lets you see the process for what it is

– Seeks out and identifies real problems – Generates ideas for improvement– Keeps you asking why?…and why? again

How to Do a Walk-Through

1. Agency director or executive sponsor plays the role of client and or family member

2. Inform staff in advance that you will be doing the walk through

3. Encourage staff to treat you as they would a client; no special treatment

4. Think, feel, observe5. Record observations and feelings6. Involve staff, get their feedback

Walk-through Results

Strengths • No waiting• Efficient intake

process• Positive group

experience• Friendly staff

Opportunities• Long intake process• Cumbersome

paperwork• No privacy• No family services

How to begin? Ask 3 Questions:

3. What change can we make that will result in improvement? (CHANGE)

1. What are we trying to accomplish? (AIM)

2. How will we know that a change is an improvement? (MEASURE)

Act Plan

Study DoReference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide

Measuring the Impact of Change:How will we know that a change

is an improvement?1. Define measures

2. Collect baseline data

3. Establish a clear aim

4. Collect data consistently

5. Chart and document progress, including date you implemented a change

6. Ask questions

Making Changes

• PDSA Cycles – Plan the change– Do the plan– Study the results– Act on the new knowledge

• Adapt• Adopt• Abandon

Process Improvement

Hunches Theories

Ideas

Changes that Result in

Improvement

A PS D

APS

D

A PS D

D SP A

DATA

Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide

Technical Assistance and Tools

• NIATx Web site: www.niatx.net• Tutorial Conference Calls• Promising Practices• Electronic Newsletter• Case studies• Learning Collaboratives

For More Information

www.niatx.net

Mark Zehner, M.S., Associate Researcher | NIATxCenter for Health Enhancement Systems Studies (CHESS) University of Wisconsin-Madison (UW)Ph: 608-265-6322Mark.Zehner@chess.wisc.edu