Winning storyboard contest winners: Community Mental Health Center, Inc.

Nancy Pieper, LCSW, LCAC and Debbie Cohen of Community Mental Health Center, Inc. of Indiana submitted a winning storyboard at the 2011 NIATx Summit and SAAS National Conference in Boston. Their storyboard, titled “Assisting Consumers in Taking the First Step: Rapid Access Project,” was a winner in both categories—audience choice and judges’ choice.

Community Mental Health Center, Inc. (CMHC) serves five counties in SE Indiana, with seven outpatient offices. As North Outpatient Director, Nancy manages four outpatient offices that offer mental health and addiction treatment. The winning storyboard detailed her project to reduce waiting time to initial appointments at the outpatient office in Lawrenceburg. “We selected this site because it treats the largest number of clients for substance use disorders,” says Nancy. CMHC is also part of a NIATx learning community funded by The Health Foundation of Greater Cincinnati.

The storyboard contest judges noted that this change project, with its multiple PDSA Cycles, is an excellent example of rapid-cycle change—one of the five NIATx principles. Rapid-cycle change is a series of successive PDSA Cycles that test a change idea on a small scale for a short time period. PDSA Cycles continue until the change meets the targeted aim—only then does it become a permanent change.

The change team included Debbie Cohen, Director of Evaluation, as a data person, along with a finance person, support staff, consumer representative, a clinician, a program director. The change team also included a representative from the probation department, since the office treats clients with alcohol and drug related convictions.   

The change team conducted three walk-throughs at three different times. These exercises raised several red flags. Poor signage made it hard for people to find the building.  Calls frequently went to voicemail, requiring clients to have to wait for a callback to schedule an appointment.  Another problem identified through the walk-throughs was that the clinic did not offer appointments past 3:30 in the afternoon, creating a barrier for clients who work a typical 9 to 5 schedule.  Clients were also informing clinic staff that they needed to postpone admission in order to “save up” for the $100.00 assessment fee for admission.  These barriers contributed to the long wait time for initial assessment: 31 days.

The change team selected “Reduce waiting time” as the aim for its change project. The first PDSA Cycle focused on adding appointment slots in the evenings. This change did not have a significant effect on wait time. The next PDSA Cycle tested offering five hours of walk-in appointments, both during the day and in the evening. With this change, the team began to see a modest decrease in wait time.

A key factor for the first two PDSA Cycles was that they were limited to self-pay clients and clients with Medicaid. The change team began to see a greater decrease in wait times when the next PDSA Cycle made the walk-in spaces available to any client, regardless of payer source.

A subsequent PDSA Cycle involved customer feedback.  As described above, the team learned that customers were accepting a longer wait for a first appointment—rather than a more immediate walk-in appointment—because they needed time to budget for the $100 assessment fee.

With this information, the change team decided to offer a discount on the assessment fee to those who accepted a walk-in appointment.  “A client could either take a scheduled appointment for $100 or a walk-in for $50,” says Nancy. “That’s when the walk-in clinic gained momentum and we really began to see wait time go down.”

After several PDSA Cycles conducted over a six-month period, the walk-in clinic was seeing between 40 and 50 clients per month, as compared to less than 10 at the beginning of the change project. 

“Our goal was to reduce waiting time from 31 to 7 days,” says Nancy. “It’s been holding steady at about 10 days and we have sustained the change.” 

Nancy notes that the walk-in clinic offers potential for more process improvement.
“We continue to look at the assessment fee and how to process client paperwork,” she says. “Support staff are still expressing some anxiety about the walk-in process.”

She and the change team plan to turn to their executive sponsor for direction on the next change project.

The reduced waiting time has had a positive impact, not only on customer satisfaction, but also for referral sources and the community overall.

Nancy feels confident that the NIATx model will become part of the organizational culture of CMHC. “It gives middle managers the tools to influence change,” says Nancy. “For me, it’s very empowering to say to an executive leader, ‘What keeps you awake at night? Let’s work on it!’”