Prairie Ridge: Better tomorrow than we are today

Prairie Ridge Addiction Treatment Services in Mason City, Iowa, was among the first treatment agencies to test the NIATx model as a grantee in the Robert Wood Johnson Foundation-funded Paths to Recovery Program (2003-2005).

Paths to Recovery provided 26 treatment centers in 18 states with expert coaching, peer learning, support groups, and process improvement techniques using the NIATx rapid-cycle change model. This first group made dramatic improvements in reducing no-shows and wait times and increasing admissions and continuation in treatment. The success of the original projects helped expand use of the NIATx model throughout the behavioral health field.

“We were very excited about being chosen as one of the few agencies in the country to work on process improvement,” says Jay Hansen, who has served as Executive Director since 1984. “Working with the NIATx team, RWJF, and the other grantees was a wonderful experience for our agency.”

Over the past ten years Prairie Ridge has grown to include two residential treatment programs, along with out-patient programs that include the evidence- based approaches of Dialectical Behavior Therapy, Motivational Interviewing, Multi-Dimensional Family Therapy, and Feedback Informed Treatment, as developed by Dr. Scott Miller. Prairie Ridge has also expanded from three to five full-time out reach offices and doubled its staff to 70 employees, in addition to developing a gender-specific residential programming. While a lot has changed, NIATx continues to be an important part of the way this organization delivers services and does business. Hansen thinks the business case of creating a client-centered culture of care has contributed to the strong financial performance Prairie Ridge has experienced since implementing NIATx practices.

“For example, we continue to provide walk-in, same day service as the easy access point to our services,” says Hansen. A hospital administrator touring the Prairie Ridge facility recently asked why the waiting room was so crowded. “When I told him that it was because we offer same-day service, he seemed surprised,” explains Hansen. “One of the enduring lessons from NIATx is the importance of providing immediate service.”

Same-day service has helped make Prairie Ridge a preferred provider for many local hospitals and other referral sources from across the state. “Clients and referral sources often say the reason they chose our residential services is because we were the first to get back to them,” says Hansen. Staff taking referrals are required to return calls on the same day. “It’s just one example of the NIATx idea that little things can make a big difference,” adds Hansen.

Another lasting lesson from NIATx? Using data to measure and monitor improvements. “Quality improvement efforts that rely on data are ingrained in the Prairie Ridge culture today,” says Hansen.  “A group of managers called “The Change Machine” meets regularly to collect and analyze data on different benchmarks such as wait times, length of stay, leaving against advice, and time to first treatment episode.

Rapid-cycle testing with PDSA Cycles

Hansen adds that the PDSA Cycle recommended by NIATx remains an easy way to test and implement change at Prairie Ridge.

“There’s nothing complex about PDSA – it’s a process that everybody can learn quickly and understand,” he comments. Prairie Ridge staff meet weekly to conduct their own on-the-spot “mini-PDSA” cycles focused on different areas of direct services. He cites a recent NIATx change project on paperwork.

“For many years we have had constant problems with staff not staying current with paper work. We tried numerous things and nothing seemed to stick,” says Hansen.

A change team set a goal that clinical staff would complete all paperwork by the end of each workday. “Then we collected data on how much time was actually required to get the paperwork done and scheduled time to complete it as part of a completed process, says Hansen. “Within a week, completion improved from 70% to 100%, and now people are going home every night with their paperwork done. It was all a matter of looking at the data and clarifying expectations.”

For Hansen, this project also embodies the NIATx concept of small changes in a short time frame. “It didn’t take us more than a day to figure it out, and then we just implemented it.”  

Understand and Involve the Customer

The NIATx principle #1: Understand and Involve the Customer continues to inform Prairie Ridge improvement efforts as the organization adapts to the changing health care environment. Hansen conducts regular focus groups with staff and clients at the two residential programs. “The focus groups are not just about finding problems and making improvements. They’re also a way to find successes and congratulating staff on work well done.”

For Hansen and his team at Prairie Ridge, the NIATx model continues to offer an easy way make changes, work as a team, and see results quickly. It also provides a new way of looking at problems. “With NIATx you begin to see problems as opportunities for improvement, “ says Hansen. “It gives you a way to seek feedback and use data to uncover strengths and celebrate improvements.”

At Prairie Ridge, NIATx helped create the culture that begins with the idea that we can be better tomorrow than we are today.”