Sustaining change with NIATx: Community Mental Health Center of Lawrenceburg, Indiana

Based in Lawrenceburg, Indiana, Community Mental Health Center (CMHC) operates 20 facilities, including five outpatient sites, in five counties (covering 1400 square miles) in southeastern Indiana. Its comprehensive range of services for adults, children, and adolescents includes a psychiatric inpatient unit and residential and outpatient mental health and substance abuse disorder treatment. CMHC also provides services for compulsive gambling.

Since 2009, CMHC has been a grantee of a NIATx project funded by The Health Foundation of Greater Cincinnati.

“We received a “pay for performance” award every quarter, with the amount based on meeting specific access and retention outcomes using the NIATx model,” explains Nancy Janszen, program director for the three southern counties in the CMCH service area. Over the five years of the project, CMHC has received a total of $70,000.

One of CMHC’s first projects to reduce waiting time won the storyboard competition at the 2011 NIATx Summit and SAAS National Conference. The project, “Assisting Consumers in Taking the First Step: Rapid Access Project” tested an open access model for outpatient admission. Before the change project, the average wait time was 28 days. Today, there is no wait time for clients who choose walk-in appointments, and CMHC offers walk-in services at three of its five outpatient sites.

 “Switching to an open access model has been one of the most dramatic changes we’ve made,” says Nancy.

Like many other organizations that use the NIATx model, CMHC discovered that one change leads to another. “NIATx opened our eyes to other process issues,” says Nancy. Changing from scheduled to walk-in appointments brought attention to paperwork, and changes to streamline intake paperwork cut paperwork processing time from an average of 63 minutes per client to just over 20 minutes. “We really examined the documents associated with intake and identified ways to eliminate redundancy among intake secretaries, billing staff, and clinical staff,” explains Nancy.

The change team also took a look at better ways to use office space to accommodate walk-in traffic. One outpatient site had only one intake station, but was staffed by three intake secretaries. “We’d sometimes have a single line out the door waiting to check in at the single station. With our grant funds, we were able to renovate the space so that it now has three intake stations and shorter lines,” she explains.  

To train as many staff as possible in the NIATx model, CMHC scheduled a NIATx Change Leader Academy early in the project. Newly-trained staff were eager to try rapid-cycle change.  As Nancy explains, “CMHC began in 1967, and like a lot of organizations we had a tendency to schedule committees that met endlessly without accomplishing much. Even simple changes used to require multiple levels of approval. Giving teams team authority to make changes without manager approval was really exciting.”

Along with learning to use data to measure the effectiveness of changes, CMHC learned the value of the first and most important NIATx principle, “Understand and involve the customer.”

“Having a consumer involved in every change team and an entirely different perspective to the whole process,” says Nancy. “It also really helped staff shift their thinking from “How will this affect me?” to “How will this affect clients coming in our doors?”

An ongoing project at CMCH is focused on improving transitions from inpatient treatment to continuing care. “We’re making reminder calls to these patients, and we’ve also developed an information folder that aims to answer any questions they or their family members have about continuing care,” explains Nancy. “Through this change project we’ve recognized the need to track these patients accurately,” she adds. Currently, the CHMC electronic system doesn’t flag patients stepping down from inpatient care. “In spite of that, program directors and intake staff know that we are now reporting on this outcome, and that increased awareness is helping in our tracking efforts.”

Sustaining NIATx

“Our Executive Director Tom Talbot is committed to maintaining a focus on NIATx and to ensuring that the agency always has a NIATx czar,” says Nancy. “He provides an orientation module to all new hires that includes a description of our history values, and mission. He also introduces NIATx as a model of change embraced by CMHC in this module.”

Plans for the immediate future include spreading NIATx to additional CMHC locations, in addition to the outpatient sites that have been the main focus for the grant-funded NIATx activities.

Nancy summarizes the benefits that CMCH has gained from adopting the NIATx model. “In many organizations and also in some teams, leaders struggle to feel comfortable with delegation. The NIATx model provides a structure with regular feedback to executive sponsor in a concise format for describing data, changes and results. Having defined start and end dates, a clear team membership, and a designated leader with ultimate responsibility has made NIATx an ideal model for managing change at CMCH.”