Using the Quality Improvement Process

1
Using the Quality Improvement Process

• Todd Molfenter MHA
• Consultant for Paths to Recovery
• A Robert Wood Johnson Foundation National Program
  Office
• University of Wisconsin-Madison

2
Paths to Recovery RWJF NPO

• Improve Access to and Retention (Early
  Engagement) in Addiction Treatment Services

3
Paths to Recovery RWJF NPO

• Programs and supports to advance organizational
  change effectiveness in the addiction treatment
  field

4
What is Quality Improvement?
5
Dave

• Presented for treatment with heroin addiction
• Told to call back weekly
• Reached answering machine when called
• 3 weeks later was admitted

6
Organization X

• Was perceived to be hard to access
• - Lengthy waits for treatment
• Clinical staff was frustrated with administrative
  tasks
• Overtime costs were problematic

7
Quality Studies in Healthcare

• Institute of Medicines Quality
• Chasm Report

8
Quality Studies in Healthcare

• Institute of Medicines Quality
• Chasm Report
• Rand

9
What is Quality Improvement?

• Organizational processes can be a significant
  cause of poor quality

10
Change isnt easy.

• 1497 - Vasco de Gama 100 of 140 dead. citrus?
• 1601- James Lancaster 4 ships 3 tsp lemon
• 40 vs. 0
• 1747 Randomized trial citrus again
• 1795 British Navy citrus all ships
• 1865 British Board of Trade adopts.

Thanks to Everett Rogers Laura Adams and Don
Berwick
11
Organizational Change - Evidence

• 80 factors
• 640 companies
• 13 different industries

12
Research on successful change

13
Research on successful change

14
It all starts with the customer (Especially when
they are reluctant!)

• Assume we dont understand their needs
• Find out by
• Asking them (Whats it like Critical incident)
• Walking in their shoes.
• Design improvements to meet key needs

15
Learn from others.

• Reach outside the
• industry.
• organization.

16
Quality Solutions
Improvement Approach
Improved Services
External Examples
17
Quality Solutions
Improvement Approach
Improved Services
User Acceptance
External Examples
18
Quality Solutions
Aims
Improvement Approach
Improved Services
User Acceptance
Pilot Tests
External Examples
19
Quality Solutions
Aims
Improvement Approach
Improved Services
User Acceptance
Pilot Tests
External Examples
Change Package
20
St. Johns - Marshfield WI

• Aim Reduce Overtime/Improve Access
• General Change Idea Match Staff Availability to
  Client Need
• Pilot Tests
• - Evening Hours
• - Reduced Paperwork

21
CAB - Salem, MA

• Redesigned intake process
• Change staffing patterns
• Increased admissions
• Reduced wait times for treatment
• Improved profitability

22
Paths to Recovery

• Process Improvement Can...
• Meet Client Needs
• Enhance Staff Satisfaction
• Decrease Costs

23
How Can States Become Involved?

• Participate in RWJF Resources to Recovery
  Policy Institute
• 20 States
• Grant or technical support
• To adopt purchasing strategies that can expand
  services

24
How Can States Become Involved?

• RWJF Paths to Recovery
• Educational Sessions
• - January 24 (Chicago, IL)
• - January 31 (Portland, OR)
• Grant Support

25

• Knowing is not enough we must apply.
• Willing is not enough we must do.
• Gothe