Process Redesign Rethinks Approaches to SUD Referrals

Workshop participants discuss real-time solutions and the “future state.” Following the success of the first Substance Use Disorder (SUD) workshop on May 19, 2017 (newsletter article here), MHVC held a deeper dive session on July 25, 2017, in Tarrytown, with participants representing seven organizations, and MHVC team members.

“We built upon the energy and synergy of the first workshop, and expanded our goals to include real-time solutions for present problems, and for potential opportunities in the future,” said Emily Thorsen, MHVC Project Specialist. The intensive, all-day workshop focused on three topics:

— Collaboratively build a future state workflow for SUD referrals;

— Create standardized referral phone screen and referral forms; and

— Develop organization-specific Plan-Do-Study-Act (PDSA) plans for workflows that support a seven-day turnaround between inpatient discharge and outpatient intake assessment.

“The May 19th workshop shaped the agenda for this meeting; our partners analyzed the current state for SUD patient referrals to an outpatient organization and identified opportunities for improvement,” said Natalee Hill, Director of Quality and Innovation. “MHVC is being proactive, collaborating with partners to better understand gaps in the current SUD care delivery system so we can strategically respond to those identified regional needs.”

“Having a process that facilitates two-way communication ensures that the client receives the best care and coordination,” Kristin Woodlock, MHVC Behavioral Health (BH) subject matter expert, said. The future state best practice will start when the client arrives at inpatient organizations, and end with the client scheduling their second outpatient appointment, and incorporates several opportunities for standardization. The July workshop facilitated development of three standardization tools identified in the workflow:

1) a phone screen to help the inpatient and outpatient organizations determine whether the client referral would be appropriate;

2) a referral form to provide the outpatient organization critical information so necessary staff and resources are ready upon client arrival; and

3) a loop-back form so that the outpatient organization can, consent permitting, inform the inpatient organization on whether the client kept their appointment and whether the intake assessment confirmed program fit.

The MHVC team reinforced MHVC’s emphasis on PDSA, which is a cyclical strategy to improve process. The PDSA helped partners link the future state process and protocol standardization efforts back to their MHVC Project Implementation Milestones (PIMs), which drive completion of outpatient intake assessments within seven days of inpatient discharge. “The PDSA helps partners operationalize the future state vision by incrementally testing and implementing workflow changes,” explained Thorsen.

Dr. Damara Gutnick, MHVC Medical Director, and Woodlock, concluded the workshop with a discussion of how MHVC is exploring ways to standardize and improve the SUD referral and scheduling process within the network. The group discussed making sure partner websites are up-to-date with appropriate referral information. Another idea was to create clinical pathways for top SUD conditions, similar to the work that MHVC did earlier this year for Crisis Stabilization.

”An important result of this workshop was the need to not only standardize SUD treatment, but to also weave those processes and protocols together with MHVC’s BH initiatives. We recognize the influence of each on the other,” Dr.Gutnick concluded. “We are using these workshops to learn from our partners significant efforts to date and build on that momentum to see where we need to go with our network.”

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