Process Benchmarking to Enhance Client Engagement and Retention

Transcription

1 Process Benchmarking to Enhance Client Engagement and Retention Paul M. Lefkovitz, Ph.D. President, Behavioral Pathway Systems April 27, 2010

2 Objectives You will learn about > The National Council s Process Benchmarking Initiative on Client Engagement/Retention > The impact of implementing the findings of the initiative on client retention > The concepts and methods underlying process benchmarking for use in your own setting 2

3 Basic Principles of Process Benchmarking > Based on observation that methods used by top performers differ from others > Process benchmarking systematically contrasts methods used by top performers with others > Methods that distinguish top performers from others viewed as potential best practices

4 Process Benchmarking In Action > How do they do it? > The identification of best practices

5 Client Engagement and Retention > Powerful dynamic in the provision of efficient and effective care > Many ways of defining and understanding client engagement and retention > Operational definition adopted was based on the percent that did not drop unilaterally withdraw from care > Limited to adult sample

6 Process Benchmarking Initiative Phase I-Method > On-Line survey conducted among National Council members in September, 2008 > 178 respondents > 72 Completed entire survey

7 Client Engagement Measure > Survey solicited measure of engagement/ retention based on percent of adult outpatient clients that did not withdraw from care, drawn from discharge status data > Mean of overall sample was 70.3% > This data was used as criterion variable to identify Top Performer and Comparison Groups > Top performers: Organizations with engagement/ retention rate of 85% or higher (Mean=90%) > Comparison group: Organizations with engagement/retention rate of 67% or less (Mean=53%)

8 Strategies Examined > Survey elicited information about the methods that are used to promote client engagement/retention > Respondents asked to respond to questions such as Does your organization provide staff with any special training in client engagement? > 34 Methods, tactics and strategies examined Initial Telephonic Request The Intake Process Clinical Service Delivery Staff Qualifications & Training Organizational Characteristics

9 Practices of Top Performers Compared with Others > The responses of the Top Performer group were contrasted with others > Percent Yes responses calculated for both groups > Difference Index Score=Difference between the two groups in the percentage of yes responses > Difference Index Score of 20 considered meaningful

10 Findings-Initial Telephonic Request > 1 Finding out of 7 Items (14.3%) > 0 Negative Findings

11 Does your organization avoid the use of voic at least 95% of the time when persons make their initial call to request outpatient services? Top Performers Comparison Group Difference Index 93% 71% 23

12 Findings-The Intake Process > 4 Findings out of 9 Items (44.4%) > 1 Negative Finding

13 Does your organization s intake process take an hour or less, on average? Top Performers Comparison Group Difference Index 47% 16% 31

14 Is it standard practice in your organization to personally introduce a client to a member of his or her treatment team during or immediately after intake? Top Performers Comparison Group Difference Index 53% 24% 29

15 Do your organization s clinicians typically call clients before the initial face-to-face appointment to introduce themselves? Top Performers Comparison Group Difference Index 33% 4% 29

16 In your organization, do your staff routinely assess and discuss potential barriers to care with the client as part of the intake process? Top Performers Comparison Group Difference Index 93% 64% 29

17 Findings: Clinical Service Delivery > 3 Findings out of 11 items (27.3%) > 0 Negative Finding

18 Do your organization s clinicians call clients that no-show or cancel two times in a row? Top Performers Comparison Group Difference Index 67% 32% 35

19 Does your organization have an ACTIVE ongoing discharge planning process in place that is defined by policy and/or training? Top Performers Comparison Group Difference Index 87% 60% 27

20 Is there a standard, scripted approach used by clinicians in your organization when a client requests to reduce or terminate treatment? Top Performers Comparison Group Difference Index 27% 4% 23

21 Findings: Staff Qualifications and Training > 0 Findings out of 5 items > 0 Negative Finding

22 The Evolution of Best Practices > Findings illustrate the evolutionary nature of best practices to customary practices > Early stage: Clinicians calling clients prior to first session > Mature stage: Avoiding the use of voic > Customary practice: Client involvement in treatment planning

23 Phase II: Implementation of Potential Best Practices > Findings shared with participating organizations > Volunteers sought for Phase II to determine impact of adopting potential best practices that were identified > 185 organizations volunteered of which 178 reported that they planned on implementing process benchmarking findings > However, only 63 provided baseline measure of engagement (% that did not drop out) > Follow-up survey conducted 6 months later

24 Implementation Findings > Of 63 that provided base-line measure of retention, only 29 responded to the follow-up survey > Of the 29, only 11 provided the postimplementation measure of retention > Only 8 could be matched to baseline measures > Retention did increase by 2.35% but due to small sample size, difference was not statistically significant

25 Narrative Findings > Impact was apparent in narrative data, as evidenced by the examples that follow: > By focusing and implementing the best practices we have focused on, it has allowed us to strengthen our continuous quality improvement structure. We have also received more staff buyin due to implementing these best practices and, most importantly, our addressing more of our client needs to improve the quality of their lives.

26 Narrative Findings (Continued) > The best practices that we strengthened have increased direct service hours for the clinicians > Outreach to clients who no-show has helped keep some people in treatment longer, and it has eliminated people who really did not want to commit to treatment. We were unable to locate a large number of our drop-outs, so we do not know what led to their discontinuing treatment too soon.

27 Narrative Findings (Continued) > The no-show rate for intake appointments has improved considerably, thus providing more access to potential clients. > I think it has made our workers more aware that there are practices that can impact treatment retention. I was surprised at some staff resistance to implementation. Staff seem to have a difficult time with change!!

28 Narrative Findings (Continued) > More clients are getting treatment that need it. > Better communication, increased participation by clients, improved coordination of care

29 Lessons Learned > Criterion measure might have been a bit difficult for a project of this nature > More contacts during 6 month period might have been helpful to maintain interest > More aggressive reminders and encouragement to respond to follow-up survey > Might have been helpful to survey all 178 that planned to implement findings rather than just 63 with base-line measure

30 Other Process Benchmarking Implementation Findings > Process benchmarking initiative was conducted in a Midwest state in the area of access > Several potential best practices identified > One year follow-up revealed that organizations that had implemented or strengthened at least one practice reported a 50% improvement in access

31 Conducting Process Benchmarking > Internal or external process benchmarking > Identify a measurable focus area > Gather performance data/identify top performers > List potential best practices in the form of questions > Conduct a survey or a structured workshop and systematically pose the questions of participants > Identify questions that successfully differentiate between top performers and others > Discuss those potential best practices and develop list