NIATx Change Leader Academy: A catalyst to “become the organization we always thought we were!”

Robert Lathers, LMSW, is Chief Executive Officer of Ionia County Community Mental Health in Ionia, Michigan. Lathers has 30 years of experience as a non-profit administrator and also teaches a graduate level course in non-profit management at Grand Valley State University Graduate School of Social Work.

“There are lots of quality improvement models out there and we’ve tried to apply them in the non-profit world,” says Bob. “I teach flowcharting and we’ve done the nominal group process many times” he explains. “But I never saw all those components put together so well until I heard about NIATx.”

Dr. Tom Zastowny suggested NIATx when Ionia CMCH was seeking CARF accreditation. (Zastowny, a NIATx coach, is also a consultant for CARF and the Joint Commission on Accreditation of Healthcare Organizations.)

Ionia CMHC is a publicly funded organization, one of the state’s 46 community mental health centers. Ionia CMHC’s 90+ employees serve about 3,000 people each year, most of them with serious mental illness, a severe emotional disturbance, or a developmental disability. The organization is recognized as offering a premier program in jail diversion for people with mental illness, along with an intensive BCBA program for children with autism, and a program for patients with Alzheimers or dementia that allows them to remain in their homes.

When Zastowny suggested doing PDSA’s and embracing the NIATx model, Lathers said he thought it would just be a waste of time.

“Do NIATx. Go to the Change Leader Academy, and you will change your organization’s entire culture regarding quality improvement. Make it the organization you claim it to be,” said Zastowy.

“That got my attention,” says Lathers. He and his quality improvement director Susan Richards went to the NIATx website for more information. When they saw an announcement for a NIATx Change Leader for the summer of 2014, they signed up and went to Madison, Wisconsin for three days.  

As part of the pre-work for the NIATx Change Leader Academy, Lathers and Richards completed a walk-through. Each did a separate walk-through of their client intake process, and it was an eye-opening experience for both of them.

“Our agency has a very welcoming environment—soothing background music, plants, nice lighting,” says Lathers. “People tell us how nice it is all the time, that it’s like walking into a private practice office. And we have qualified and caring staff who knew we were doing a walk-though—this wasn’t a mystery shopper kind of thing. But the bureaucratic focus of the treatment staff at first contact totally contradicted the warm welcoming environment,” he explains.

“We didn’t ask people what brought them in that day,” says Lathers. “We just started immediately asking if they were eligible based on their insurance coverage. Susan and I asked each other “How can we treat people like this at the front door?”

Lathers and Richards arrived at the Change Leader Academy eager to share their walk-through experience with the other attendees and to get started on learning how to use the NIATx model to improve the customer experience.

The two-day hands-on training session “exceeded” their expectations, says Lathers.

“I am a very good, well-informed adult educator. I know that adults learn by doing,” he comments. “I’ve also attended a lot of trainings and workshops that simply do PowerPoint slides and videos and then provide a manual with instructions on how to apply what you’ve learned when you get home. But with the NIATx Change Leader Academy, we learned hands-on how to do the model during the two-day training so we were ready to hit the ground running when we got back.”

Lathers says instructors Amy McIlvaine and Betta Owens guided the group through the interactive activities so everyone left with practical experience on what to do back in the office.

And, says Lathers, he and Richards were so excited about NIATx that they took it to their board of directors, who in turn insisted that NIATx be written into the organization’s new strategic plan as the agency’s quality improvement model.

Lathers also called the lead Professor of Non-Profit Management Curriculum at Grand Valley School of social work, Dr. Steve Smith,  where he teaches a course on nonprofit management. “I told him that I didn’t think we really covered quality improvement very well in the course and suggested that we include a module on the NIATx model,” says Lathers, “It would be hands-on skill building for our graduate students.” Dr. Smith agreed, and he and Lathers taught the first group of graduate students in fall 2014.

“We had them do walk-throughs, flowcharting, and the nominal group process, and then PDSAs,” explains Lathers. “Some of the changes they were able to make in their field placements were outstanding.”

One student’s walk-through identified a simple change in an intake phone system that reduced waiting time on a crisis line for children’s protective services from an average of 20 minutes to less than 5 minutes.

“Student’s anonymous evaluations at the end of the course ranked learning the NIATx model as the best part of the course”, says Lathers. “I am hoping that NIATx  will be included as a standard part of the curriculum after another trail run in fall 2015.

Back at the Ionia CMHC, Lathers and Richards formed a change team focused on fixing their clients’ front door experience. “Improving client engagement at first contact meant working on changing some firmly entrenched processes and attitudes.”

With several months into the project, Lathers and Richards recognized that they weren’t making progress on their goal. The regular coaching calls that are part of the Change Leader Academy ongoing support helped Lathers and Richards realize that their aim was too big.

“We see now that PDSA only functions well when you take small steps. We were trying to change everything at once. With the next change project we’re redirecting our energy to making small changes in succession.”

To do that, the next change project will focus on first collecting baseline data from one Access clinician (rather than all 6) for 30 days.

“We’re just going to ask that access clinician to start each intake by asking “Tell me what brought you here today, before we start the paper work.” We want to see how that approach affects client continuation.”

Lathers’ goal is for everyone at Ionia CMCH to have an opportunity to experience success with the NIATx process.

“For me, key lessons from the NIATx Change Leader Academy have been learning how to assemble a change team, defining a concrete measureable goal, and figuring out how we’re going to measure success,” says Lathers. “Staying focused on one small change at a time has been essential when we have so many things to improve on, but we never practiced having a consistent baseline to measure from before.”

Using NIATx tools and principles has also helped Lathers and his team recognize the value of small improvements.

 “Accepting smaller improvements will ultimately lead to larger ones as the staff and Board embrace the NIATx model. Then I believe we will become the organization we always thought we were!”

The next NIATx Change Leader Academy is coming up in Madison, WI, March 24-25, 2015.  Register by March 6 and save $50.00