How to make your business more efficient

Process improvement is not a new concept. Many industries, notably manufacturing, have used process improvement and similar tools to drive out costs and improve efficiency for many years. But these tools have not necessarily been implemented widely in addiction treatment settings.

However, as treatment centers look for ways to do more with less, process improvement is becoming an important item on the performance agenda.

Consider the impact process improvement has had on Addictions Recovery Center in Medford, Ore. A lengthy intake process was causing the center to lose 42% of its clients before they had their first clinical visit. The reason? In trying to cover all the bases, client intake had expanded to a 15 day process before clients were fully enrolled in the program.

“This is a time-sensitive situation,” says Michael Clingan, managing partner of Metis, Inc., a consulting firm. “You have to get someone into treatment quickly before they go off in a different direction.”

By undertaking process improvement, the center in Oregon was able to streamline intake, which now only takes about an hour. For example, the intake coordinator now has the tools and ability to manage intakes when many patients arrive in short period of time—which is a common issue for the center—and connect those to a clinician immediately rather than scheduling appointments for another time.

“This is a typical of the opportunity that exists in addiction centers,” says Clingan. “However, behavioral health is just finding its way when it comes to process improvement so these organizations are probably a little bit behind the adoption curve.”

Integrating process improvement

Treatment centers that integrate process improvement into their operations have an even better chance of effecting real change to their operations.

With 350 staff members, LifeSpring Health Systems, an integrated treatment center in Jeffersonville, Ind., that also provides primary care, has been leveraging process improvement for the past several years. The center has a performance improvement committee with a mandate to re-engineer processes to make them more effective.

“We have made process improvement part of strategic planning so that we look closer at business and clinical processes” on a regular basis, says Terry Stawar, the organization’s president and CEO, who is also a Behavioral Healthcare blogger.

Process improvement begins by identifying issues that interfere with overall performance. Pay close attention to atypical results showing up in a routine report, such as an exceptional number of incidents occurring in a short period of time. Patient falls or medication issues are incidents to monitor over specific time periods, for example. Oftentimes, such outliers have the highest potential for improvement.

By comparing an analysis of its own financial metrics with peer benchmarks, LifeSpring recognized what an outlier its charity care caseload had become. While the average facility in Indiana had a charity caseload of 14% of revenue, LifeSpring’s had grown to 32% of revenue.

To address the gap, the organization had to understand the underlying issues that contributed to the high number. After internal and external interviews, data analysis and other tools did not identify any one cause. It became clear that the problem was the result of a “cascade of issues,” says Stawar.

Therefore, the process improvement team decided to identify and address the areas of operations that had a major impact on charity care. For example, the organization did not collect insurance copays, and many of its clients, while eligible for Medicare, Medicaid and other programs, were not covered or did not know they were eligible to apply for coverage.

To address this, LifeSpring established a benefit acquisition program to make sure the 25% of clients who were eligible for certain programs were able to obtain those benefits. Since these and other changes have taken hold, LifeSpring’s charity care caseload has dropped from 32% to 12%—more aligned with benchmarks.

Introducing process improvement

Treatment centers interested in process improvement should consider a few key issues before undertaking any change effort. The most important is identifying goals for the strategy. Cost savings are likely to factor heavily in any process improvement effort, but they should not necessarily be the sole focus.

“Some look at process improvement as a way to squeeze cost out of the system but that is not likely to be sustainable,” says Clingen.

He cautions that organizations can only reduce costs for so long, and those gains may wear down staff and clinician engagement in process improvement. Instead, organizations can frame process improvement as a way to best utilize existing resources and to free up new resources to provide more and better services.

Identifying where to focus process improvement efforts is also important. Benchmarking performance against peers and industry norms is a good place to start. Another approach is to identify problem areas then examine existing internal processes to see if they are causing or contributing to those issues.

Deep dives like these also lend themselves to opportunities to identify key internal processes that are critical to operations and need to be running smoothly for the organization to achieve its broader objectives. Communicate the importance of those priority processes to the entire staff.

Above all, treatment center personnel need to be open minded when considering where to use process improvement. For example, there may be no one reason behind a certain operational hiccup. In those cases, looking more broadly at processes and how they can run better could help generate incremental improvement.

“Looking for one definitive answer discourages a lot of people because they may not be able to find that answer,” says Stawar.

Finally, process improvement requires support and buy-in from all levels. Process improvement requires time and organization credibility that must come from the organization’s leadership. Senior managers, in particular, might feel threatened by and resist process improvements, so their buy-in is critical.

Stakeholders who work across disciplines and departments are another key constituency because they have the knowledge of the process and will be on the front lines of implementing any resulting improvements. For example, the chief of clinical operations might be included in big-picture priorities across the enterprise.

A long-term commitment

In general, process improvement is not a one-time event. Organizations must consistently monitor operations for inefficiencies and improvement opportunities. For example, Sheppard Pratt Health System in Towson, Md., has been leveraging process improvement for the past six years and now employs a director of Lean transformation to support these efforts. Lean is a concept used in many industries that aims to identify wasted or redundant activities and eliminate them to achieve more value for clients.

“There are a lot of patient needs, clinician needs and regulator needs,” says Sunil Khushalani, MD, Lean facilitator and service chief of the system’s Co-Occurring Disorders Unit and Adult Day Hospital. “We wanted to find a common way of improving things.”

With patients who often have two or three mental health conditions in addition to co-occurring substance use disorder, and who spend only six to eight days in the unit, “we have to meet very complex needs in a short amount of time,” says Khushalani.

That also makes discharge-related processes crucial to effectively handing off patients to subsequent levels of care. By reworking discharge planning over the past two years, the organization has developed a discharge planning checklist of 25 items and developed a better process for relaying such information to the next level provider.

Before process improvement, discharge summaries were delivered only 60% of the time and those summaries were too long and too detailed to be of use to providers taking on those patients.

By reworking the process to include electronic delivery and reducing the information provided to only the most pertinent, such as the patient's current diagnosis and medications, the organization was able to eliminate $350,000 in cost related to this process and deliver summaries within one day 95% to 97% of the time.

“You cannot wait until you are forced to change by insurance companies or regulators,” says Khushalani. “You have to get in and change the systems yourself to be a good advocate and steward of all of the resources that you have.”