Introduction to Wisconsin’s ADRC Quality Improvement Program

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Methods of Quality 4

Reactive

Quality by Design

Quality by Process Improvement

Quality by Compliance

Quality by Inspection

Active

Aiming for Excellence

Focus

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Process Improvement Offers:

• Innovative solutions to serve customers better

• Improvements in service delivery • Serve more people/customers • Reduce costs • Improve staff morale • Increase or maintain resources/revenue by

saving time and/or money while using existing resources

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W. Edwards Deming October 14, 1900 – December 20, 1993

85/15 rule: 85 percent of worker’s effectiveness is determined by the system he works within, only 15% by his own skill. This means that 85% customer problems are caused by processes (not people). All processes have inputs, steps, and outcomes, for which data can be collected, measurements can be made, and changes can be developed and tested to lead to improvement.

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Why Process Improvement?

• Customers are served by processes.

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

• You must improve your processes to better serve your customers.

The focus is on the process, not people.

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Why Process Improvement?

Process improvement will help you deal with what’s coming.

• Small changes do increase customer satisfaction. • Satisfied customers are more likely to show up and

engage in your services. • More customers served helps to make your work

more rewarding.

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Small Changes, Big Impacts

• Small changes create a big difference for both customers and staff

• Effective changes don’t have to be expensive

• “Look for the purple door”

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Aiming for Excellence

Model

• Used AoA ADRC grant funds to contract with the University of Wisconsin/NIATx

• The NIATx model is being used in more than 2000 agencies and organizations nationwide.

• The principles of the NIATx

model for process improvement are transferable to most organizations and agencies.

• ADRC Aiming for Excellence modeled after NIATx approach.

Five Key Principles of the

NIATx Model

1. Understand and involve the customer.

2. Fix key problems that keep the CEO awake at night.

3. Pick a powerful change leader.

4. Get ideas from outside the organization or field.

5. Use rapid-cycle testing to establish effective changes.

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NIATx on a Napkin

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ADRC Aims (The BIG A’s)

1. Reduce Customer Wait Time

2. Increase New ADRC Customers

3. Increase Utility of Referrals

4. Increase Customer’s Ability to be Healthy at Home

Decrease Customer Wait Time

Project

AGING & DISABILITY RESOURCE CENTER of JEFFERSON COUNTY

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Results

The ADRC reduced customer wait time between an initial call and a home visit from an average of 21 days to 4.5 days.

Increase New ADRC Customers Example

The ADRC of Central WI Marketing

Project

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Results

The ADRC’s goal was to decrease average customer wait time between the initial contact and a home visit from an average of 21

days to 14 days (or less) over a two month period.

Over the course of the project, the average number of new customers increased from 112 per week to 138.

This is a 20% increase in customers!

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112 Contacts 138 Contacts

# of Contacts

112 Contacts

138 Contacts

By the ADRC of Trempealeau

County

An “Increase Utility of Referrals” Example

The Follow-Up Works Project

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Results The ADRC discovered that it is not only follow-up that matters, but

who does it matters too.

The ADRC’s goal was to decrease average customer wait time between the initial contact and a home visit from an average of 21

days to 14 days (or less) over a two month period.

Over the course of the project, customer reports of “exceeded expectations” increased from 23.5% to an average of 41%

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Baseline

% ExceededExpectations

% Met Expectations

Rolling Out the Initiative

1. Group Training

• 2-day training held in four regions of the state

• 142 attendees

• Voluntary; 94% of ADRCs attended

2. Monthly Conference Calls • Held in the 4 regions with attendees from trainings

• Discuss progress on change projects

• Learn what others are doing

• Keep people on track

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Rolling Out the Initiative

3. On-Site Coaching Visits

• Initially, 6 ADRCs received on-site coaching support

• Assist local change team with the process

• Help to facilitate team and support change leader

4. 5x5 Displays

• Display hall at the 2011 ADRC conference

• Each ADRC displayed the results of their change project(s)

• Created some ‘good’ pressure to complete a project.

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Rolling Out the Initiative

5. One on One Consultation

• ADRC staff could contact NIATx staff at any time to discuss a project, barriers, challenges, etc.

6. NIATx Written Materials and Website

• Reference materials available on each step in the process.

• Create a statewide website

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Aiming for Excellence Process Evaluation

Overview • Primary research questions:

– What worked well with the implementation process and what could be improved?

– What factors lead agencies to adopt process improvement into their organization? How ‘easy to adopt’ is the NIATx approach to process improvement?

• 3rd party evaluator

– Wilberg Community Planning, LLC

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Aiming for Excellence Process Evaluation

Methodology

• Pre and Post-Surveys

• Document review (change project forms)

• Telephone Interviews (19 ADRCs)

• Site visits (3 ADRCs)

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• Group Training

• 100% of respondents found the training to be very or somewhat helpful (with 74% indicating very helpful).

• On-site Coaching Visit

• 100% of the ADRCs that had an on-site coaching visit found the visit to be very or somewhat helpful (with 83% indicating very helpful).

What We Learned About the

Implementation Process

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• Monthly Conference Calls

• 58% found the monthly calls to be ‘NOT helpful’. • Although, ADRCs are interested in learning about

other projects.

• 5x5 Display Session (at the conference)

• 79% of respondents found the 5X5 display session at the conference to be helpful.

• Opportunity to see other ADRC’s projects. • “Push” provided by the expectation that each

ADRC have a project. 24

What We Learned About the

Implementation Process

• One on One Consultation with NIATx Staff

• 67% of respondents had phone consultation and had generally positive reactions to experience.

• Several ADRCs expressed a desire for more one-on- one support after training, i.e. “someone we could call and talk to”.

• Written Materials and Website

• All respondents found NIATx reference materials to be very/somewhat helpful.

• Website was used by 53% of respondents, those who used it felt it was somewhat helpful.

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What We Learned About the

Implementation Process

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Factors Supporting Adoption

• Openness of staff to try new things • Very cohesive, committed staff, very motivated • Great leadership • Capacity to do business in a data-driven manner • Seeing the value in quality improvement • Previous experience with NIATx in a different

environment • Choosing the right project! • The process itself! It makes sense!

Factors Influencing Adoption of

Quality Improvement Methodology

Factors Supporting Adoption

• Being able to devote dedicated staff time • Having QI already part of the ADRC philosophy • Quality of the training • Use by other/related units of government • ADRC with additional training and/or ability to

access local TA in the on the model and method

Factors Influencing Adoption of

Quality Improvement Methodology

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Factors Influencing Adoption of

Quality Improvement Methodology

Barriers to Adoption

• Having a poor attitude toward quality improvement • Commitment of management and staff; getting buy-in • Some ADRC’s are struggling to meet minimum

standards for an ADRC and do not have their procedures standardized enough to do QI

• ADRC’s are “treading water” – the time commitment is a big thing

• Having difficulty with the process working in our context

Factors Influencing Adoption of

Quality Improvement Methodology

Barriers to Adoption

• The changes are too small to help us justify the use in our ADRC

• Outcomes won’t be sufficient to warrant the investment

• The time involved is a barrier • Don’t have enough knowledge; we weren’t able to

get our project going • Lot of steps, documentation that is not needed • Difficulty in identifying what needs to be improved

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• Interviews supported the conclusion that adoption of the Niatx methodology was not an easy process.

• ADRCs felt pressure to implement the process.

• Appreciated the training and the need for new

methods for QI, but expressed feeling inadequate to the challenge.

• Even still, ADRC directors generally viewed the

NIATX methodology as helpful and QI as an essential component of their operation.

What We Learned About the Factors That

Influence Adoption of Quality Improvement

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• Training. Opportunities to expand and deepen the training. Need more staff trained.

• Coaching. Need for on-going support and coaching at

the ADRC level.

• Choosing the right project. Need help zeroing in on the right-size project.

• Data Collection. Need increased knowledge and skill

around the data requirements of the NIATx process.

• Expectations. Concern re: ORCD’s high expectations re: QI.

ADRC Recommendations for

Improvement

What ORCD Is Doing with The

Results

• Change Leader Academy (CLA)

– Training revised and improved. Better clarity around aims, data, sustainability…ADRC examples.

– Offer Regular Training Opportunities. CLAs will be offered annually (as needed) and/or in response to ADRC requests.

– 2012 CLAs offered in April, August (GWAAR), and October

– Level 202 CLA training in development.

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What ORCD Is Doing with The

Results

• Trained Coaches

– ORCD Quality Staff, 3 GWAAR staff, and 3 ADRC staff trained coaches (train-the-trainer program)

– RQS’ shadow NIATx staff on site visits, then NIATx staff shadow RQS staff, and phase out

– On-going coaching/skill development provided to coaches

– Plans to train more ADRC staff to be coaches

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What ORCD Is Doing with The

Results • Coaching Support Available to ADRCs (from RQS’)

– Bi-monthly Check-in calls. Simply a check-in on how things are going and whether the ADRC is working on a QI project.

– Coaching calls. Scheduled calls designed to assist the ADRC with the progression of a project.

– Coaching Site Visit. Assist the ADRC with the progression of a change project. Visit occurs with change team.

– Change Leader Mentoring Calls or Visits. Designed to provide one-one-one support to the Change Leader.

– Document Review. Review change project forms and 5x5s to help refine aims, data collection, results, etc.

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After Only 1 Year…(through 1/2012)

• 142 ADRC Employees Trained

• 47 projects completed

– Increase new customers (9 projects)

– Increased Efficiency/Reduce Wait Time (10)

– Increased Effectiveness/Utility of Referrals (26)

– Increased impact/Healthy at Home (2)

• Not bad!!!

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Contact Information

Presenter: Carrie Molke Phone: 608-267-5267 Email: Carrie.Molke@wi.gov

Presenter: Christine See Phone: 608-575-6480 Email: Christine.See@wi.gov

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