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8/14/2019 U of MD SSW Org Change
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Organizational Change Case
Analysis:EAP Crisis-Management and
On-Call SystemMichael Heitt, PsyD
Associate Director
Faculty and Staff Assistance Program& Student Assistance Program
Johns Hopkins University & Hospital
www.fasap.org
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FASAP Organization
Internal EAP for JHU, JHH, etc
SAP for BSPH & SOM
WORKlife Programs
33,000+ Faculty, Staff, Students and their
families
Confidential and free services
Client and Organizationally oriented
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FASAP Staffing & Funding
Director (0.5 FTE) Associate Director (1.0 FTE) Medical Director (0.2 FTE)
Research Assistant (0.8 FTE) Six clinicians (4.8/1.2 FTE) Five support/administrative staff (2.45/2.45 FTE)
Separate budgets for FASAP, SAP and WL FASAP budget is funded by Human Resources and JAA
funds FASAP budget totals just under $800,000
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Statement of Problem:
Crisis-Management Appointment-basis office structure
Customer-service oriented program
Triage all walk-ins and take all calls
33K employees (and families): 6 clinicians
1-2 week wait for scheduled appointment Manager feels comfortable in crises
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MichaelHeitt
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Current On-Call System
On-call and back-up on-call schedule
Crises go to first person available
If no one is available on-call clinician is
interrupted
After-hours coverage provided by external
contractor
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Problems with Current System
Always on-call
No protected time
Urgent displaces emergent
Unfair distribution of crisis coverage?
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Baseline Data(February & March, 2005)
Emergent Contact Urgent Contact Walk-In
Front Desk Direct Font Desk Direct Emergent Urgent
Total 17.2 19.8 28.8 117.2 19.6 14.8
Mean/Wk 2.2 2.5 3.6 14.7 2.5 1.9
Mean/Dy 0.4 0.5 0.7 2.9 0.5 0.4
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Data Discussion
1 walk-in per day (5 min 4 hrs ea)
2-3 emergent calls & 3-4 urgent calls forwarded
from admin staff per week (2 - 60 min ea) >17 phone calls (2-3 emergent) received directly
per week, (2 - 60 min ea)
Emergent Contact Urgent Contact Walk-In Total
Mean/Day 0.5 hours 3.5 hours 1.5 hours 5.5 hours
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Contributing Factors Hybrid program structured upon traditional EAP core technology yet
staffed by licensed clinicians and supervised by psychiatric faculty Affects the identity of the program and its staff
Dictates the clinical evaluation, intervention and documentation expectations
More time intensive than a non-clinical problem assessment
Institutional culture of crisis response Lots of VIPs at Hopkins
Budgetary constraints
Significant staffing change/turnover Retirements, promotions, new hires
Loss of Institutional Wisdom and career/life experience
Professional inflexibility
Admin staff change project
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Objectives
Appropriate, timely and efficient crisis triaging
and intervening with minimal disruption
Empowering the clinical and administrative staff,raising their expertise level and reducing their
anxiety when dealing with crises
Protecting clinicians non-clinical time so they
feel a greater sense of control over their workdays
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Strategies
Urgency: Baseline data
Change-management education and exercises:
Piggyback on Admin Staff Change Skill-building: Fundamentals of EAP, Crisis Call
Handling, Suicide Assessment, WPV Risk Assessment
Technology: Call center implementation
Engagement: Brainstorming ideas/options
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How may I direct your call? Doctor-assisted or Regular?
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Action Steps
1. Strengthen the protective buffer of the administrative staff
2. FASAP leadership will reinforce a generalist approach to EAPwork
3. Administrative staff will be encouraged to utilize a warm-line
transfer from FASAP to a ProtoCall counselor4. FASAP clinical and administrative staff will continue to discuss
the differences between emergent and urgent situations
5. A new on-call schedule will be implemented on a pilot basis Administrative staff will direct crises to the on-call clinician first, then
the back-up clinician.
The on-call clinician will enjoy a limited or light day of scheduledactivity of no more than two new scheduled evaluations (typicallyscheduled for two hours each)
On-call clinician will be devoted to handling all crisis situations thatarise, and spare time can be spent on administrative duties such aspaperwork, event planning and writing.
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Outcome Measures
Repeated assessment of frequency data and
comparison to baseline data
Assess negative impact on wait time forscheduled appointment
Subjective rating of stress, control, sense of
overwhelm and overall satisfaction
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