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DevelopingWorkflowsfor BehavioralHealthIntegration

CPAA/AIMSCenterTrainingProgram December2018

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Introductions

DebraMorrison

ProjectManagerandPracticeCoach

AnnaHink,MSW,LICSW

ClinicalTrainer

JuliannSalisbury

ProgramCoordinator

Announcements

• InPersonTrainingUpdate

– Nowonlyoneday! – When:Tuesday,February5,2019 – Where:LaceyCommunityCenter – CEUavailable– moreinformationcomingsoon!

• Welcome,PediatricsNorthwest/HopeSparks!

TrainingWebsite

https://aims.uw.edu/wastate/content/wholeperson caretrainingprogram#

SessionLearningObjectives

Bytheendofthissession,cohort1teamswill:

• Sharetheirprogressoncreatingworkflows
• Learn/reviewthebasicstepsinworkflow

development

• Learn/reviewPDSAcyclesforimprovingworkflow
• Shareanticipatedchallengesofimplementingnew

workflows

“Ifyoucan'tdescribe whatyouaredoingasaprocess, youdon'tknowwhatyou'redoing.”

W.EdwardsDeming

TeamSharing CurrentState

• Areyoustartingfromscratchormodifyingan

existingprocess?

• Whathaveyoudonesofarindevelopingnew

workflows?

• Areyouwillingtoshareaprocessmap?

QuestionsandDiscussion

DevelopYourClinical WorkflowforIntegratedCare

WorkflowDesign/Redesign101

• Whoisinvolved?
• Howisitdone?
• Whatarethesteps?

– Identifycurrentworkflow – Designfuturestate(ideal)workflow

• Whatisthefinalproduct?

UsedwithpermissionfromQualisHealth.

BreakWorkflowsinto PhasesofClinicalCare

• Screening(Reception,MA,RN)
• WarmConnections(MA,PCP,BH)
• Treatment(BH,PCP,Psych)
• Treatmentmodification(BH,PCP,Psych,RN)
• DischargefromTreatment(PCP,BH)

Identify,DefineandAssignTasks TeamBuildingandWorkflowGuide ScreeningQuestionstoConsider

• Howarepatientsidentifiedaheadofthevisitwhomayneed

treatment,whohaveaBHdiagnosis,orwhohavenotbeen screenedpreviously?

– Thinkabouthuddles,EHRprompts,reminders,frontdeskforms

• Howisthepatientgivenascreeningform?

– Location,howoften,verbalvswritten – Doyougivethistoallofyourpatients?

• How/whorecordsthepatient’sscore?
• Howistheproviderinformedofthescreeningscore?
• Whatareyourprotocolstomanagesuicidalityandcrisis

situations?

– Who,where,how

• Whatisyourtrainingplan,competencycheckthatyoudo

withnewandcurrentstaffandprovidersaroundscreening?

ProcessMapping

StickyNoteMethod MaterialstoGetMapping

• 3”x3”squarestickynotes
• 4”x6”rectangularstickynotes
• Blackfinepointsharpie(s)
• 4’to6’lengthofbutcherpaper
• Bluepainter’stapetoaffixbutcherpapertowall
• Flipchartpaperor2’lengthofbutcherpaperto

designate“ParkingLot”

• Cleartapetotapethestickynotestothebutcher

paperifthemapwillbetakendownandtransported

UsedwithpermissionfromQualisHealth.

ComponentsofaProcessMap

Start Point Action Steps Decision Direction Flow End Point

• Startingpoint

– Processtrigger

• Action(s)

– Action/step – Decision(s)

• Endpoint

– Processstops

Direction Flow

UsedwithpermissionfromQualisHealth.

TheProcessMapTellstheStory

• Sequenceoftasks
• Involvementofpeople
• Useofdocuments,systemsandothersources
• finformation

UsedwithpermissionfromQualisHealth.

DraftedWorkflowviaStickyNoteMethod

ReviewandRefinewithYourTeam

Front Desk Staff

Hands out Screening form to patients 12 and older and parents of younger children

Patient checks-in for Pediatric appointment. Medical Assistant / RN Collects, scores, and enters scores in EMR if applicable Score is High Risk Score is Low Risk Medical Assistant / RN

If patient interested in IBH services, give screener to BH care manager and have patient schedule appt. put screener in Care Coordinator’s inbox If patient not interested, give screener to PCP to review and shred

Medical Assistant /RN

MA contacts BHCM for a team hand-off if pt interested If BHCM is available, give screener to BH provider, BH provider to enter special populations patients into registry If BHCM is not available, give screener to PCP to review and have patient schedule f/u with BHCM if interested. Put screener in BHCM’s inbox

Behavioral Health Care Manager (BHCM)

Adds patient to their schedule & completes BH visit Adds patient to registry and has patient schedule follow up appointment as needed

PCP

Reviews the form with patient

• Assesses for suicidality and recommends follow-up

appointment with BHCM BHCM is not available. BHCM is available.

ScreeningWorkflow Example

ContinuousImprovementCycles

• P
• D
• S
• A
• Pickateameagertomakeitwork
• Testitinasinglepractice,witha

singlepatient,asingleday

• Whatworked?Whatdidn’t?
• Modifyittomakeitworkbetter
• Testitagain,expandtomore

patients,moreteams

RapidProcessImprovementCycles

Plan Do Study Act

Repeated Use of the PDSA Cycle

Thefuture stateyou planned Thefuturestateas itevolvedusing rapidprocess improvement A P S D A P S D

Planningfor“KickOff”

• Communicatestartdateandexpectationsfor

rolechangeswithwholeclinic

• StartSMALL(oneclinic,oneprovider)
• Scheduleteammeetingsofteninfirstweeks
• Schedulestafflightlyifpossible
• Provideincentives/rewardsforstaffbehavior

change

Reflection&Discussion

• TeamsShareChallenges

– Whereareyouanticipatingproblemsincreating yourinitialworkflow? – Wheredoyouseeproblemswithimplementing youridealinitialworkflow?

• Whattoolsandresourceswouldbehelpful

fromtheAIMSCenter?

HowAreWeDoing?

• Completebriefpollquestions

– Responsesareanonymous

• Werelyonyou toletusknow

howwecanbestsupportyour work!

• ContactDebra

dmorris1@uw.edu with additionalfeedback

What’sNext

Inthecomingweeks,cohort1teamswill:

• Utilizeideasfromtodaytocreate/improveyourown

workflowforscreeningandreferralstoBHproviders

• Startplanningyour“KickOff”

– Setthedate – Communicatetheworkflowwithclinicstaff – Preparenewtools(registry,forms,etc.)

• Attendnextwebinar1/10/19121PM

– MeasurementBasedCareUsingaRegistry