STAR-SI is a partnership between the Center for Substance Abuse Treatment and the Robert Wood Johnson Foundation, and is administered through NIATx.

One of the best but forgotten

NIATx Tools; Workshop

Eric Preuss, Clinical Project and QA Coordinator, Community and Family Resources

Gena Hodges, Iowa STAR-SI Project Coordinator,Iowa Department of Public Health

2009 SAAS/NIATx Conference (Tucson, AZ)

Objectives

• Discuss the Five Key Principals of the NIATx Model and Nominal Group Techniques’ role in flowcharting

• Flowcharting as a process tool

• Create a flowchart

• Identify one process at your agency to flowchart

Five Key Principals

1. Understand and involve the customer

2. Fix key problems that keep the CEO awake at night

3. Pick a powerful change leader

4. Get ideas from outside the organization or field

5. Use rapid cycle testing to establish effectiveness of changes

Nominal Group Technique (NGT)

•Getting everyone’s input

•No wrong ideas

•Every idea is valued

•Method at a glance

Seven Step Process

1. Preparation

2. Silent idea generation

3. Round-robin recording of ideas

4. Serial discussion of ideas

5. Preliminary voting (rank/rate)

6. Discussion of preliminary vote

7. Final voting, follow-up and nextsteps

Let’s test the steps

Need a change leader for each group

~ Timed activity working through the NGT

~ Leader picks the historian

~ First (4) steps we’ll do together

Step – 1 Preparation

• Focus1. What’s keeping the CEO awake at night?

Determine the initial question –

2. Send out the focus prior to the day of the meeting

• Logistics 1. Location of meeting

2. Save the date - out to team 2-3 weeks ahead

3. Agenda – one week ahead

4. Set up room with tools needed before the meeting starts

Step 2. Silent Idea Generation

Initial Question: What can we do to get tothe Summit on time?

• Think about current process - what was your process this morning?

Step 3 – Round Robin Recording• ironed clothes• got out of bed at ____?• took a shower for ___ minutes• brushed teeth, shaved put on make-up• rode an elevator• took medication/vitamins • read the newspaper, e-mail or watched T.V.• ate breakfast• Made phone calls, answered e-mail• exercised • dressed, put on deodorant/cologne • made bed/tidied room

Step 4 – Serial Discussion

• Take each idea and discuss it one at a time to clarify.

Step 5 – Preliminary vote on ideas (rating and ranking )

• Each member gets to make an independent judgment on the ideas they feel will (most likely) solve the question issue/focus.

Step 6 – Discuss Preliminary Vote

• Not to change participants minds; goal is to discuss any consistencies or inconsistencies in the voting patterns

Step 7 – Final Vote on Ideas

This is when independent judgments become group decision.

The final vote helps:• Determine the outcome of the meeting• Provides a sense of accomplishment, and should serve as a record of the final group judgment in relation to the initial question

Moving on …

• The information from step seven will be used to flowchart

• Don’t forget to type up findings and share with team and other staff ~ could be done through a flowchart

Why Flowcharting

• Learning is more effective with a visual

• Mapping tool to describe new/existing processes

• Forces organizational focus on process

• Helps achieve continuity of care

• Share tried practices with co-workers

• Diagnosis bottlenecks

Flow charting identifies:

• Name of the process

• Where the process begins

• Where the process stops

• What is and is not included

• Key stake holders

• Process owners

Common Key Symbols for Flowcharts

Are you ready for clothes?

No

Yes

A square identifies a step in the process

A diamond is a decision point in the process and asks a “yes or no” question. Named the decision tree because it needs two lines leaving it like branches

Action

Post-It Notes are great for flowcharting.

Extra ~deodorant

Get Dressed

Start

Common Flowchart Symbols Continued

= document symbol, such as materials or components, i.e. a document or script will be used or developed for use

= outputs/database symbol, represents a change or issue of the data/base

= connector symbol, connects

ideas, treatment episodes, pages, of information that is not on the flowchart.

= terminator symbol, used to start and to end the flowchart process.

Monday

+ feedback

Clients happy that they only

have one release form

now.

Clients happy that they only

have one release form

now.

It works!

Need assistance

Make your own symbols

Make your own symbols

REMINDER

Types of flowcharts

• Client/Consumer• Staff • Team• Reporting • Administrative/Board of Directors• Strategic Planning/Modernization Act• Organizational• Personal• Others

CFR Experience

• Client Management Information System

• 8 County Agency

• 12 locations

• Multiple Levels of Care (Adult and Adolescent)

• Mandate to create uniform client flow/processes

What we discovered

• Time allotment – Flow Charting Fridays

• Each location had different process

• Who had the “right” process

• Nominal Group Process

• Consumer/Staff friendly

• Staff Training

• Sustainability

Flowcharting Steps

• Step 1 ~ Define objective

• Step 2 ~ Define process

• Step 3 ~ Define first and last steps

• Step 4 ~ (Quite 1) Have each person write down process steps on yellow Post-it notes

• Step 5 ~ Have everyone place their yellow Post-it notes on wall paper to create a flowchart.

Flowcharting Steps Continued

• Step 6 ~ Review flowchart

• Step 7 ~ (Quiet 2) Have each person use lime Post-its to identify and record bottlenecks and blue Post-its to describe suggestions for process improvements

• Step 8 ~ Place blue and lime Post-its on flowchart

• Step 9 ~ Review suggested changes

Flowcharting Steps Continued

• Step 10 ~ (Quiet 3) Ask each participant to pick the three changes that offer the best combination of ease of implementation and impact on objective

• Step 11 ~ Conduct multi-vote to select changes to initially pilot test

• Step 12 ~ Discuss next steps

Flowchart the morning process items

• Goal/objective: Arrive on time to Summit’s morning sessions

• Parameters

• Small groups

• Nominal group process

• Flowchart

Do you have outdated processes that lack client friendliness?

• Identify one process at your agency that could be improved by flowcharting.

• Anything you’d like to change?

Wrap up

• Questions

Participants asked for the contact information of the software company EFR used to flowchart their agency processes.

Here’s the link to Anasazi http://www.anasazisoftware.com/

Contact information

Eric Preuss

e-mail ericp@cfrhelps.org

Phone: 515-576-7261 opt. #4 extension 1102

Gena Hodges

e-mail: ghodges@idph.state.ia.us

Phone: 515-281-8465

www.niatx.net for resources and instructions on tools