Wait List Revisited: How a Northwest Indiana behavioral healthcare provider used lean to increase capacity

Tuesday, November 29 2016

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Preparing for the future of Regional Mental Health Center (RMHC), President and CEO Bob Krumwied initiated a process to develop selected members of the staff as potential future leaders within the organization. To execute his vision, he partnered with Purdue Healthcare Advisors (PHA) in April of 2016 to develop experiential training in the principles of lean service systems and continuous improvement.

PHA began working with seven RMHC leaders to teach and coach through the Lean Practitioner (LP) Certification process. Initial training included a four-day, onsite training program followed by two PHA-facilitated Rapid Improvement Events (RIEs) to launch the LP certification. The chosen RIE focused on the organization’s outpatient drug and alcohol abuse treatment program, which had been struggling to accommodate clients in a timely fashion. From the time RMHC received a referral from the courts or a state agency, an average of 18 days passed before a client began treatment. Even walk-in clients had to wait that long.

“We knew our waitlist was way too long, especially for treatment a client may or may not be fully committed to taking part in. We were under the assumption, however, that we just didn’t have the capacity to get people in sooner,” said Amy Lopez, RMHC’s Chief Administrative Officer. “The wait caused us to spend a lot of time trying to track down ‘no show’ clients, and encourage them to begin treatment. Not surprisingly, many would disappear or change their mind in the interim.”

The RIE team gathered all employees relevant to the intake process, and together they performed a root cause analysis. What they found was that RMHC was using only 46% of its total capacity. The major cause of treatment delays was determined to be the intake process, which hinged on a lengthy assessment by specific employees who were overbooked. The team also came to the realization that, although Southlake Center for Mental Health and Tri-City Community Mental Health Center had merged to form RMHC more than seven years ago, the consolidated organization was not leveraging all the sites across their organization to accommodate clients’ needs.

RMHC Lean Team: Mona Elsalaymeh, Patrick Barry, and Kathy Hartman-McCarthy

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With this knowledge in hand, the team established its RIE target: to cut the outpatient wait list in half from 18 to nine days. To meet their goal, additional workers were cross-trained to perform intake. In addition, a shared drive was set up to track capacity across the organization. When openings were not found, clients were encouraged to attend less intensive treatment sessions until a more appropriate slot for their situation became available.

“Purdue Healthcare Advisors was so artful in their ability to know what to do, and how to facilitate the process to bring the discussion back to the needs of the customer,” said Lopez. “With Purdue’s help, and some amazing work by the lean team, the mindset at RMHC began to change. We started focusing on what really mattered…the client’s journey to recovery. A wait list was no longer an acceptable option.”

Following the RIE and its subsequent lean daily improvement exercises (daily huddles, etc.), the average wait time was reduced from 18 days to three days, greatly exceeding the initial target. “RMHC is now treating more than 260 outpatients at any given time, increasing use of available capacity across all sites from 43% to 83%,” said Purdue Healthcare Advisors’ Managing Advisor Melanie Cline, RN, MSN. “The additional capacity means patients in need of drug and alcohol treatment are placed into treatment without delay, improving access to services for this regional center and improving the clinical, quality and financial outcomes for the organization. Best of all, RMHC isn’t losing 60% of its clientele to other agencies or to the street.”

Next steps for RMHC’s Lean Practitioners-in-training is execution of their individual projects this fall, which will be supported by remote coaching from PHA to finalize certification requirements. Future plans include an additional group of LP trainees, and an expansion of the leadership development of the team to support a broader adoption of lean leader skills throughout the organization.

 

Source:  Melanie Cline, RN, MSN, Managing Advisor-Process Improvement, Purdue Healthcare Advisors, (317) 481-9398; cline3@purdue.edu

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Tags: Process & Cost Improvement (LEAN)