Reduce Waiting & No-Shows Increase Admissions & Continuation www.NIATx.net Making Changes Last- Sustainability for the OTP Project Thomas R Zastowny, PhD NIATx Coach & Healthcare Consultant & all OTP coaches Reduce Waiting & No-Shows Increase Admissions & Continuation All authors share equally in this presentation
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Making Changes Last- Sustainability for the OTP Project Thomas R Zastowny, PhD
Making Changes Last- Sustainability for the OTP Project Thomas R Zastowny, PhD NIATx Coach & Healthcare Consultant & all OTP coaches. Reduce Waiting & No-Shows Increase Admissions & Continuation All authors share equally in this presentation. PRESENTATION. Background & Theory - PowerPoint PPT Presentation
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• As we have witnessed the significant and powerful performance improvement changes associated with NIATx, our attention has turned to sustainability of improvements. Webster has defined sustainability in many ways but including these two succinct and clear elements: “A characteristic of a process or state that can be maintained indefinitely; to keep in existence, to maintain or prolong” What family of strategies then can help us maintain the important changes we have made?
Not everything thatNot everything that can be counted counts, can be counted counts,and not everything thatand not everything thatcounts can be counted.counts can be counted.
• Roadblocks and barriers:– Staffing turnover - 25 agencies“Change team meetings have been suspended due to staffing difficulties
and the PDSA cycles are not being used.”
– Staff resistance – 18 agencies“They abandoned the attempt to integrate the Session Rating Scale and the Outcomes Rating Scale into clinical sessions. Counselors never were very supportive. But, they have used the experience to make their treatment planning process more client centered.”
– Unforeseen consequences – 11 agencies– Too many changes at one time – 2 agencies
Monitoring prevents negative spirals:“Participants noted that it is important to continue to monitor
changes after implementation. Otherwise, staff will tend to revert to old practices. Participants provided examples of previous changes undertaken in the outpatient programs that had not been sustained.”
Regular meetings allow important data review:“The agency was reminded of the importance of looking at data every
single month and having good indicators in place to flag problems.”
• Implementation of policies and procedures; another mechanism to change and sustain culture:
“Staffing changes give challenges to sustainability. One good thing is that those changes that were working became standard so new staff didn’t know anything but the changed practices. It’s not extra; it’s just what we do!”
oversight processes that assure continuation? (e.g., stability, integration into the organization culture, allowance of fluctuations within statistical control, sustain plans and staff ownership)
Sustainability Plan (only complete if you are sustaining the changes) A. Who is the SUSTAIN LEADER?B. What CHANGES do you want TO SUSTAIN?C. What SUSTAIN STEPS are being taken to ensure that the changes stay
in place and that it is not possible to revert back to the old way of doing things?
D. What is the TARGET SUSTAIN MEASURE, i.e. the point at which the Change Team would intervene to get the project back on track?
E. What system is in place to effectively MONITOR the SUSTAIN MEASURE?
outcomes we continue to want to see to know sustainability is working? (e.g., definitions-, i.e. same day service, continuation & client participation, and intervals of measurement to gauge stability, increases in access and retention).
One Story ▲One organization’s plan for sustainability for access
included the following…(a) two policy changes to ensure same day treatment, (b) a mandate to revisit the process if same day treatment was unsuccessful for 2 contiguous days, (c) continuous measurement in the first year after the improvement using a step down approach (e.g., measure weekly, then monthly, then quarterly ,then yearly). A well crafted plan for sustainability is a must for longevity. Inclusion of these dimensions can help improve the precision of the sustainability plan and cover a wide reaching set of strategies to “hold the gain” across the organization. This strategy works equally as well within single and complex organizations, and state wide collaboratives.
British National Health Services Sustainability Model
The NHS Sustainability Model is a diagnostic scoring model designed to be used by each member of the core project team. The information collected provides the whole team with a really good understanding of areas that need improving in order to maximize the potential of sustainability within the project. An accompanying Sustainability Guide provides a range of practical ideas about how to actually make those improvements.
WORKSHEET(1) What organizational and operational structures (e.g.,
policies, procedures, work guidelines for providing service, ownership of the process?) are in place to hold the gain?
(2) What are the clinical, business and oversight processes that assure continuation? (e.g., stability, integration into the organization culture, allowance of fluctuations within statistical control, sustain plans and staff ownership)
(3) What are the outputs, impacts and outcomes we continue to want to see to know sustainability is working? (e.g., definitions-, i.e. same day service, continuation & client participation, and intervals of measurement to gauge stability, increases in access and retention).
(4) What is the Business Case for the Improvement and Sustainability? ( e.g. cost benefit, dollars and sense, new revenue)
What are the organizational structures that can be put in place to help preserve the process changes you have made?
What are the ongoing data needs that will help the organization know if the desired change is being sustained? Who will gather this data? Who will review it and when? Is there a standard meeting that could own this responsibility?
What is the business case for the improvement you want to sustain?
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