Growing and changing with NIATx: Kentucky River Community Care

Kentucky River Community Care (KRCC) is a non-profit Community Mental Health Center that serves eight counties in eastern Kentucky. When Mike Kadish joined the organization in 1980, KRCC had about 80 staff across all eight counties; only four of the counties had full-time offices. Today, the KRCC team includes more than 500 staff in 58 operating sites across those eight counties. That phenomenal growth, says Kadish, is due to KRCC’s use of NIATx tools and techniques, along with the visionary leadership of Dr. Louise Howell, who came on as Executive Director in 1991. Mary Meade-McKenzie joined KRCC as Executive Director in April 2014 and carries on legacy of top-level support support for NIATx as KRCC’s organizational change model.

“KRCC was very fortunate to be selected as a grantee in the original NIATx demonstration project back in 2003,” says Mike. “Our main motivation for applying for the grant was to find a tried and true method to address systems problems and make lasting changes. There’s no question that our growth is due to using NIATx and improving our new programs as they grew.” 

As Clinical Director of programs for adults with serious mental illness, Mike oversees case management, community support, supported employment and peer support services, in addition to providing board supervision for social work staff. He also chairs a weekly meeting of the Executive Change team and is considered the KRCC historian. “Anyone who wants to know anything about KRCC’s recent or past history calls me.” 

For NIATx questions, Mike can refer to a record of every KRCC change project conducted, county by county, over the past decade.

“If a problem comes up I can quickly check to see how we’ve addressed it in the past,” he says. “With that historical perspective, I can say that NIATx is just as important to our organizational culture now as it was with our first successful change project back in 2003,” says Mike.

Along the way, KRCC has been recognized for its success, receiving innovation awards at the NIATx/SAAS national summits. See related stories:

Kentucky River Community Care: Taking NIATx to the Next Level

Technology, work of change teams enhance access at Kentucky Center

NIATx is so firmly embedded in the KRCC culture that it’s written into job descriptions.

“Our change teams cut across all departments—billing, medical records, IT, as well as direct services,” says Mike. “A new employee who joined us recently was participating on a change team by her second week.”

Mike describes current change project launched earlier that’s now approaching sustain mode.

“This project involves getting patients connect to case management as soon as possible after discharge from the psychiatric hospital in Perry County,” says Mike. Baseline data showed that only 20 percent of people leaving the hospital who wanted case management services were actually getting connected with those services after discharge.

Mike convened a change team with the aim to increase engagement in case management services.

“Within three months, we increased that connection with case management services to 83%,” says Mike. 

The key to this successful change involved the NIATx most important principle: understanding and involving the customer.

“Our psychiatric patients can be hard to find,” Mike explains. “They don’t always have a permanent residence or a working phone. The change we tested was to obtain contact information at the hospital pre-discharge and actually try it with the patient present to make sure it was in working order. If it wasn’t, the team requested the contact information for a trusted friend or family member who we could contact for follow-up.”

This change has also proven that once patients make an initial connection with case management, they’re likely to continue with the services and avoid psychiatric readmission.

In addition to the historical record of KRCC change projects, Mike cites the “Dashboard Report” as an essential tool for the organization’s NIATx culture.

“The Dashboard Report is spreadsheet tool that our data management department runs monthly to track the sustainability of each change project,” explains Mike. “Running graphs show monthly progress toward making or sustaining an improvement goal.”

Each KRCC change team includes someone from the KRCC data management department. “We learned the importance of using data to measure our changes very early on with NIATx,” comments Mike.

KRCC change teams refer to a variety of NIATx tools to train new staff, get ideas for change projects, or just refresh their NIATx knowledge.

“We always turn to the website, and the NIATx workbook has also been critical for new staff.” Mike uses the NIATx PI 101 modules as part of the training he provides to new staff.

“PI 101 is especially helpful because the quizzes at the end of each short module make it interactive,” he adds.

Support and consultation from NIATx expert coaches over the past decade has also been vital in making NIATx part of KRCC’s organizational culture. “Don Holloway was one of our first coaches, and we continue to work with Betta Owens on change projects today.”

KRCC also has trained staff to conduct NIATx Change Leader Academies on site.

“We work hard to make sure that we offer high-level change leader training, and we’re always looking for new staff that have the ability to lead change teams.”

NIATx tools and techniques are especially critical now, says Mike, as the behavioral health system in Kentucky is switching from fee-for-service to a managed care model.

“Our goal is to grow our change teams based on the new systems and processes being developed for behavioral health. I see us doing more and more change projects with more change teams and new processes, and NIATx will be with as we move forward.”