Driving Incremental Change to Achieve Organizational Change. Practice Transformation Academy Webinar #3

Transcription

1 Driving Incremental Change to Achieve Organizational Change Practice Transformation Academy Webinar #3

2 Presenters National Council for Behavioral Health Mental Heath Association of Greater Lowell Kate Davidson Assistant Vice President, Practice Improvement Samantha Holcombe Project Director, Practice Improvement Marcia Reni Manager for Client Quality and Information Systems Daniel Nakamoto Executive Director & CEO

3 Action Step Develop an Algorithm Algorithm What parts of the algorithm have you developed? Does the algorithm help drive progress toward outcomes? How have you been able to implement change?

4 In March Identify common indicators Activity Wk1 Wk2 Wk3 Wk4 Wk5 Wk6 Wk7 Wk8 Wk9 Wk10 Wk11 Wk12 Design and implement data registry Align organizational policies and procedures Staff training Data collection

5 From Planning to Implementation Planning Implementation Monitoring and Evaluation

6 Where are we now? Steering committee and leadership buy-in Clearly defined, measurable outcome Identified set of data to measure outcomes Evolving work plan Consistently review what actions/services/admin/costs needed to achieve outcomes

7 How Often Do You Revisit/Update Your Workplan? Biweekly Monthly

8 Leadership Response Fully supportive Actively involved/steering committee participation Leadership Buy-In Weighing in on design, metrics and outcomes Presented to Executive Leadership Have Not Presented to EL

9 Steering Committee 100% have a steering committee in place! Meets Monthly Meets Biweekly

10 Metrics Clearly Defined, Measureable Outcome Identified Data and Metrics to Measure Your Outcome Yes No Yes No

11 Common Barriers Other 3 IT challenges 2 Identifying metrics 1 0 Provider Buy-In Collecting and Using Data Lack of Resources Confusing Strategy and Goal Organizational Culture Other Client enrollment

12 Mental Health Association of Greater Lowell Stretch Project

13 Community and Family Counseling Services Outpatient clinic in the heart of downtown Lowell Serve clients annually Publicly funded population: o 71% Masshealth (Medicaid) o 22% Dual Medicare/Medicaid o 1% Medicare o 6% Private Insurance Mix of full-time salaried and part-time fee-for-service clinicians Mix of credentials among clinicians

14 Evidence Based Assessment and Treatment Goal: Demonstrate Improved Client Outcomes by adopting evidencebased tools to assess and treat clients at the start of, over the course of, and at the conclusion of treatment. With the assistance of our coach; we chose two initial assessment tools to administer to our adult clients: PHQ-9 GAD-7

15 PHQ-9 and GAD-7 for Depression and Anxiety Among the most validated tools in mental health o o o o Screening Assist with diagnosis Measure severity of symptoms Monitor response to treatment Translated, reliable across multiple languages and cultures, including those we see in our clinic Brief, can be administered multiple ways Easy to score Public Domain

16 Steps so far Chose initial tools Chose initial population: o New adult intakes o Existing adult clients

17 Built into EHR: o Clinical access o Reporting o Reminder triggers Collected translations o Spanish o Portuguese Trained front desk staff Oriented clinical staff to tool Steps so far

18 Status July 3 rd - all new adult intakes are screened at first appointment July 17 th - staggered administration to current clients began By Sept all adult clients will have completed at least once Assessments to be readministered at least every three months and at discharge Clinical option to re-administer whenever clinically appropriate Results are tracked in our EHR Clinicians can see at a glance how their client is responding to various interventions

19 Next: Care Paths and Additional Assessments Convene clinical committee Research evidence based practices related to assessments Develop Care Paths to guide clinical staff with clinical interventions Add additional adult assessment tools to our toolbox (substance use disorders and trauma related issues likely first) Add additional assessment tools for use with children and adolescents Develop Care Paths for each additional assessment Continuous quality improvement cycle: implement, analyze, adjust, repeat

20 Steering Committee Comprised of Executive Director, Clinical Director, Clinic Office Manager, PTA Lead Standing weekly meeting Touch base, look back, look ahead Senior Staff Meetings Comprised of Executive Director, Program Directors, CFO, PTA Lead Meet 2x/month Standing Agenda Item: Update on Stretch Project Discussion of implications for other agency programs

21 Work Planning Occurs Formally - during steering committee meetings o Status o Issues and Questions o Next Steps Occurs Informally ongoing; daily contact between PTA Lead, Clinic Office Manager, Clinical Director o Staff questions o EHR issues

22 Data Collection/Evaluation Electronic Health Record: Evolv from Netsmart Process Analysis - Underway e.g. July 3-20: 37 GADs and PHQs administered Average 17 intakes/month; 625 active adult clients as of July 1, 2017 Outcome Analysis In development e.g. July: o GAD Average: Range: 1-21 o PHQ Average: Range: 1-27 Overall Project Analysis At completion e.g. clinical and support staff response, client attitude

23 Potential Barriers Competing demands - all staff Staff turnover - Front desk Client reaction Clinician buy-in and adherence; are clinicians actually using in clinical practice? o Clinical Practice Change Barriers* - MHA response: Awareness and Knowledge - introduced at clinical meeting; follow-up s Motivation - described potential benefits; dropped unpopular previous assessment tool Acceptance and Beliefs disseminate, discuss professional literature Skills - discuss in Team meetings, supervision Practicalities - ensure EHR is functioning; sufficient forms; front desk training *How to change practice National Institute for Health and Clinical Excellence, London, 2007

24 Re-evaluate Progress Use the Practice Assessment Tool (PAT) Re-evaluate where you are Determine which milestones are progressing o What are the factors supporting your progress? Identify areas for improvement o What technical assistance or support will you need? Example: Specialty PAT 2.0 Tab

25 Bringing it All Together Improved Health Ability stratify populations based on risk and assign clinical pathways based on population needs The Triple Aim Lower Costs Better Care Rapid cycle change and using data to drive clinical practice Creating operational efficiencies and ability to benchmark progress and articulate value

26 Next Steps Practice Assessment Tool Reassessment o To Coaches by August 8 August Coaching Calls CEO Call September 5, 12-1pm Mid-Year Meeting September 12 (National); September 19 (CTN) o Prep report out: Description of stretch project Progress to date Foreseen challenges Reassessed Practice Assessment Tool

27 Thank you! Presenter Contact Information Kate Davidson Samantha Holcombe Marcia Reni Daniel Nakamoto