The NIATx MethodThe NIATx Method Process Improvement atProcess Improvement at

The Substance Abuse and Mental Health The Substance Abuse and Mental Health Services AdministrationServices Administration

What is this stuff?What is this stuff?

Why should I care?Why should I care?

OK, how do I do it?OK, how do I do it?A bird’s eye view of process improvement

Bruce Waltuck, M.A., CC&CSenior Advisor for Process Improvement, SAMHSA

Chair, Government Division, ASQ

240-276-2005 bruce.waltuck@samhsa.hhs.gov

SAMHSA – A Life in the Community for EveryoneSAMHSA – A Life in the Community for Everyone

NIATx – a Three-Way PartnershipNIATx – a Three-Way Partnership

SAMHSA’s Center for Substance Abuse SAMHSA’s Center for Substance Abuse TreatmentTreatment– Strengthening Treatment, Access, and Recovery Strengthening Treatment, Access, and Recovery

(STAR)(STAR)

The Robert Wood Johnson FoundationThe Robert Wood Johnson Foundation– Paths to RecoveryPaths to Recovery

CHESS – University of WisconsinCHESS – University of Wisconsin– Center for Health Enhancement System StudiesCenter for Health Enhancement System Studies– Led by Dr. David GustafsonLed by Dr. David Gustafson

ProcessProcess

Why did the chicken cross the road?Why did the chicken cross the road?How will the chicken cross the road?How will the chicken cross the road?

– For the greater good.For the greater good. PlatoPlato– The confluence of events in the cultural gestalt The confluence of events in the cultural gestalt

necessitated that individual chickens cross roads at this historical necessitated that individual chickens cross roads at this historical

juncture.juncture. Carl JungCarl Jung– The problem we have here is that this chicken won't realize that The problem we have here is that this chicken won't realize that

he must first deal with the problem on 'THIS' side of the road he must first deal with the problem on 'THIS' side of the road before it goes after the problem on the 'OTHER SIDE' of the before it goes after the problem on the 'OTHER SIDE' of the road. What we need to do is help him realize how stupid he's road. What we need to do is help him realize how stupid he's acting by not taking on his 'CURRENT' problems before adding acting by not taking on his 'CURRENT' problems before adding 'NEW' problems.'NEW' problems. Dr. PhilDr. Phil

– it is a core part of the chicken’s business.it is a core part of the chicken’s business.

Process ImprovementProcess Improvement

What happens when the chicken crosses What happens when the chicken crosses the road?the road?

What would we like to happen when the What would we like to happen when the chicken crosses the road?chicken crosses the road?

What are the options?What are the options?

How will we know what to do?How will we know what to do?

How will we know how we did?How will we know how we did?

Common elements of successCommon elements of success

Process focusProcess focus

Collaborative problem-solvingCollaborative problem-solving

Analysis and decisions based on data, not Analysis and decisions based on data, not opinionopinion

Decisions by consensusDecisions by consensus

Respectful dialogueRespectful dialogue

Intention of seeking continuous Intention of seeking continuous improvementimprovement

The basic NIATX principles The basic NIATX principles Understand and involve the customers of Understand and involve the customers of the process (internal and external)the process (internal and external)

Find opportunities for improvement that Find opportunities for improvement that are “key problems,” important to the are “key problems,” important to the CEO.CEO.

Get ideas both in and out of your Get ideas both in and out of your organization and fieldorganization and field

Conduct short test cycles to check Conduct short test cycles to check promising improvement ideaspromising improvement ideas

The Five QuestionsThe Five Questions(from the NIATx method) (from the NIATx method)

Base your process improvement efforts on Base your process improvement efforts on the answers to these questions:the answers to these questions:– What are we trying to accomplish?What are we trying to accomplish?– What is like to be a customer of this process?What is like to be a customer of this process?– How will we know if a change is actually an How will we know if a change is actually an

improvement?improvement?– What changes can we test, to see if a What changes can we test, to see if a

promising idea is really an improvement?promising idea is really an improvement?– How can we sustain the improvement we How can we sustain the improvement we

implement?implement?

Data. . .uhh… what is it good for?Data. . .uhh… what is it good for?(Absolutely (Absolutely Everything)Everything)

Any path will get you Any path will get you there, if you don’t know there, if you don’t know where you’re going.where you’re going.

Known knowns; known Known knowns; known unknowns; unknown unknowns; unknown unknowns.unknowns.

It isn't what we don't know It isn't what we don't know that gives us trouble, it's that gives us trouble, it's what we know that ain't what we know that ain't so. – so. – Will Rogers Will Rogers

We do it that way because We do it that way because it’s the way we have it’s the way we have always done italways done it

What are we AIMing at?What are we AIMing at?

Any path will get you there if you don’t Any path will get you there if you don’t know where you’re goingknow where you’re going

What should be the 3-4 main aims for What should be the 3-4 main aims for SAMHSA in improving our processes of SAMHSA in improving our processes of work?work?

Alignment with Strategic ObjectivesAlignment with Strategic Objectives

Simple Conversation Café methodSimple Conversation Café method

Executive Leadership makes the final Executive Leadership makes the final decision on key aimsdecision on key aims

Four words, plus oneFour words, plus one

PlanPlan– What are we aiming to achieve?What are we aiming to achieve?– What results would really be improvement?What results would really be improvement?

DoDo– Test and assess promising ideas.Test and assess promising ideas.

StudyStudy– Analyze your data. Reach conclusions. Decide.Analyze your data. Reach conclusions. Decide.

ActAct– Make the improvement the new process standard.Make the improvement the new process standard.– Measure results. Listen to process customers.Measure results. Listen to process customers.

Repeat Repeat

Why should I care?Why should I care?

How do you want to feel at the end of the day?How do you want to feel at the end of the day?

What do you think,What do you think, when we ask you to do this? when we ask you to do this?

WIIFM is not a Nintendo radio station. WIIFM is not a Nintendo radio station.

WIIFY is not wireless internet service.WIIFY is not wireless internet service.

WIIFU is the win-win state we seek.WIIFU is the win-win state we seek.

OK, you convinced me to try.OK, you convinced me to try.Now, how do I do this work?Now, how do I do this work?

It isn’t rocket science.It isn’t rocket science.It is simple, but not always easy.It is simple, but not always easy.

““How’m I Doin’ ?”How’m I Doin’ ?” Ed Koch, former Mayor of New York CityEd Koch, former Mayor of New York City

SAMHSASAMHSA– 12 current process improvement teams12 current process improvement teams– Approximately 15% of the workforce involvedApproximately 15% of the workforce involved– More than 10 new process improvement teams chartered and beginning More than 10 new process improvement teams chartered and beginning

their worktheir work– Significant improvements inSignificant improvements in

Cycle time to answer constituent correspondence (avg. 30+ days to under 6)Cycle time to answer constituent correspondence (avg. 30+ days to under 6)Cycle time to issue new hire ID (21+ days to under 7)Cycle time to issue new hire ID (21+ days to under 7)Design of purchase waiver form- new template; successive improvements; Design of purchase waiver form- new template; successive improvements; extensive trainingextensive trainingResponse to callers seeking substance abuse or mental health treatment Response to callers seeking substance abuse or mental health treatment (treatment locator system)(treatment locator system)

NIATxNIATx– 39 treatment organizations provided with collaborative learning and 39 treatment organizations provided with collaborative learning and

technical assistance for process improvement aimed at four defined technical assistance for process improvement aimed at four defined goalsgoals

– Over 200 local service providers in the nationwide network, using the Over 200 local service providers in the nationwide network, using the process improvement methodprocess improvement method

Two wordsTwo words

AttentionAttention– Observe the processObserve the process– Understand the processUnderstand the process– REALLY understand the processREALLY understand the process

IntentionIntention– What do we want?What do we want?– Why?Why?– What can we do to get there?What can we do to get there?

Additional ResourcesAdditional Resources

A Leader’s Framework for Change – Snowden and Boone, HBR A Leader’s Framework for Change – Snowden and Boone, HBR (available from Bruce in pdf)(available from Bruce in pdf)Evidence-Based Management, Pfeffer and Sutton, HBR (available Evidence-Based Management, Pfeffer and Sutton, HBR (available from Bruce as pdf)from Bruce as pdf)A Quantum Change for Public Health, Resnicow and Page, Am Jr A Quantum Change for Public Health, Resnicow and Page, Am Jr Pub Health (available from Bruce in pdf)Pub Health (available from Bruce in pdf)Jazz Improvisation as Metaphor for Change in Organizations, Frank Jazz Improvisation as Metaphor for Change in Organizations, Frank Barrett (available from Bruce as pdf)Barrett (available from Bruce as pdf)Facilitating Organization Change, Eoyang and Olson (available soon Facilitating Organization Change, Eoyang and Olson (available soon in SAMHSA library)in SAMHSA library)A Simpler Way, Margaret Wheatley (available soon in SAMHSA A Simpler Way, Margaret Wheatley (available soon in SAMHSA library)library)Navy Benchmarking Handbook (available from Bruce in pdf)Navy Benchmarking Handbook (available from Bruce in pdf)See also-See also-– www.niatx.netwww.niatx.net– www.margaretwheatley.comwww.margaretwheatley.com– www.conversationcafe.orgwww.conversationcafe.org