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What are we trying to accomplish? Maximize enrollment and retention of adults and children in Medicaid, SCHIP and Food Stamps (where applicable) by improving county and state eligibility processes ·
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Testing and Implementing Change
Learning Session 2November 14, 2002
Vicki Grant&
Ron Moen
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
Act Plan
Study Do
What are we trying to accomplish?
Maximize enrollment and retention of adults and children in Medicaid, SCHIP and Food Stamps (where applicable) by improving county and state eligibility processes
·
M1=Caseload
Cases beginning of month + approvals in month - closures in the month
M2=% Approvals
100 x approvals in the month/total application decisions made in the month
M3=% Denials
100 x denials in the month/total application decisions made in the month
M3.1=Denials by reason
100 x denials by reason /total denials
M4=% Closures
100 x closures in the month/cases at beginning of month + approvals
M4.1 Closures by reason
100 x closures by reason /total closures
100 x renewal closures in month / cases up for renewal in month
M4.2% Closed Renewals
How will we know that a change is an improvement?
Improve Customer service Improve Policy/Procedures Improve Work FlowChange Work Environment Improve Intra-system CommunicationsError ProofingEliminate WasteFocus on Variation
What changes can we make that will result in an improvement?
Aim: Improve the notification system
Redesigning the Medicaid notice will improve communication
Improved communicatio
n
A PS D
APS D
A PS DD S
P A
DATAD SP A
Cycle 1:Test on employees
Cycle 2:Field test on customers in 1 office in 1 week
Cycle 3:Field test at a different site for 1 week
Cycle 4: Field test at pilot site for 1 month
Cycle 5: Implement and spread to county/state
Project: Cycle #: 2 Date: Sept. 6, 2002
Objective: Determine if the redesign of the Medicaid notice will improve communication to our customers
Plan
Questions Predictions1. Did we simplify the sentences? (Yes, because we “unpacked” them)2. Did we simplify the vocabulary?(Yes, used a language they can read)3. Is the new format easier to understand? (Yes, better organization
makes the text less busy)
What data will be collected during this time? (Forms to be used) Preference scale (Which is better: current or new)
Who: Next customer after 8:00, 9:00, 10:00, etc Administered and observation by Bob from our team
What: Preference test with the new Medicaid notice
When: Tues-Thursday collect data, Team will analyze data on FridayWhere: Field test at the Glendale site
Use the PDSA Cycle for :
Testing or adapting a change idea Implementing a change Holding the gains Spreading the changes to the rest
of your system
3 Principles for Testing a Change
Test on a small scaleCollect data over timeBuild knowledge sequentially and
include a wide range of conditions in the sequence of tests
Testing on a Small Scale
• Have others that have some knowledge about the change review and comment on its feasibility
• Test the new product or the new process on the members of the team that developed the change before introducing it to others
• Incorporate redundancy in the test by making the change side-by-side with the existing process or product
Testing on a Small Scale (Cont.)
• Conduct the test in one facility or office in the organization, or with one customer
• Conduct the test over a short time period
• Test the change on a small group of volunteers
• Develop a plan to simulate the change in some way
Decrease the Time Frame for a PDSA Test Cycle
YearsQuartersMonthsWeeksDaysHoursMinutes
Drop down next “two levels” to plan Test Cycle!
Conserve Measurement Resources
• Integrate into daily work• Use sampling
Length of Stay for Main ED Discharged Patientsn=1 per week
50
100
150
200
250
300
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29Week
LO
S (M
in.)
Avg=180, SD=50
Avg=135, SD=35
Median Length of Stay for Main ED Discharged Patientsn=14 per week
100
120
140
160
180
200
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29
Week
LO
S (M
in.)
Median Length of Stay for Main ED Discharged Patientsn=28 per week
100
120
140
160
180
200
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29
Week
LO
S (M
in.)
Median Length of Stay for Main ED Discharged Patientsn=300 per week
100
120
140
160
180
200
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29
Week
LO
S (M
in.)
Team examples of testing
Use teams reports and story boards to fill in here
Minnesota: Use of credit card payments
Delaware: Test verification check-list
Nassau County: Telephone survey of mail recertification process
Testing – Trying and adapting existing knowledge on small scale. Learning what works in your system.
Implementation – Making this change a part of the day-to-day operation of the system (Not after just one test!)
Testing vs. Implementation
Cycles for Implementation
The change is permanent - need to develop all support processes to maintain change.
High expectation to see improvement (no failures).
Increased scope will lead to increased resistance.
Generally takes more time than tests.
Approaches to ImplementationParallel
Changes run parallel as current processes are running
When old processes “turn off”, the new ones “turn on”
Sequential Incorporates changes over time (completeness)
or by location (coverage)“Just Do It”
One cycle to study the effect of the change Used for simple changes only
Holding the Gains Communicate
As soon as aim is chosen Continuing as project progresses through
storyboards, newsletters, etc. Successes and learning
StandardizationDocumentationMeasurementTraining
Spread
Spread means making improvements beyond the scope of the Collaborative Team
Readiness Success of collaborative team Intention Organizational priority Leadership responsibility
Target Population for Spread
Population of Focus for your BTS Aim
Spread
- Other offices - Other departments
- Other counties - Other key systems