ESS Support Services' Insights on their QI Project
Please describe the challenge or opportunity for improvement in your organization and why it was important to address it.
ESS Support Services is an Etobicoke-based community agency supporting seniors and adults with disabilities. We provide a range of programs to support their desire to remain in their own homes and communities.
For our learning collaborative project we focused on our Adult Day Services (ADS), and more specifically, the journey experienced by individuals joining the program and their families – from their first call to the first day of attending the program. Anecdotally, we recognized that there were many steps required for ADS admission as well as some extensive waits. We were concerned about this having a negative impact on their experience. Our participation in the Quality Advantage project enabled our organization to apply a framework for improvement that not only helped us to better understand the current state of the journey into our ADS, but also enabled us to make improvements within the journey.
Project Aim:
By December 31, 2015 we will improve the client experience with admission to ADS by 15%; and,
By December 31, 2015, we will decrease client wait times from assessment/trial visit to service initiation in ADS by 20%
Who was involved in your improvement project?
Our QI project team included the following positions:
Manager, Client Services
Senior Coordinator, ADS
Case Manager
Case Manager
Manager, Client Services
Team Lead – Director, Quality & Project Management
Executive Sponsor – Chief Executive Officer
Our team provided a multi-disciplinary approach, including staff who had a direct role in the client journey into ADS. Next time it would be important for our team to invite a client and / or caregiver to join the team.
What client outcome was your project intended to improve?
There were two client outcomes that our project intended to improve: (a) client/caregiver experience with admission to ADS; and (b) client wait times for ADS admission.
Baseline data was not available to our team in advance of starting the QA project. Prior to testing improvement ideas, we spent time collecting data so we could better understand baseline wait times and caregiver experience with admission to ADS.
What processes and tools did you use to truly understand the challenge you were addressing and the ideas that would lead to improvement? How did you determine the changes you needed to make to improve your program?
There were two main tools used by our team that truly helped us understand wait times and experiences during the ADS admission.
Run Chart – this is a tool created in an excel file that plots your data over time. It was easy to use and we did not need any advanced excel knowledge as this tool was provided to us during the Project. The run chart (a graph depicting our outcome measures over time) quickly and clearly painted a picture of not only our current client wait times but also the positive impact of our quality improvement efforts on wait times.
Experience Questionnaire and Emotional Mapping – The experience questionnaire was used to guide one-on-one conversations with caregivers who had a family member either recently begin attending our ADS or in the process of joining the program. The questionnaire outlined the different touch points/steps in the journey into the ADS, and we asked caregivers to describe their experience at each step. Using the Emotional Mapping tool, the positive and negative emotions and experiences shared during the interview guided by the questionnaire were clearly delineated. It was the experience questionnaire and subsequent emotional mapping that led our team to identify the key opportunities from our clients’ perspective and subsequently to specific quality improvement change ideas to address these areas of opportunity.
Once you identified the changes you wanted to make, how did you go about testing and implementing the changes? How did you know whether the changes were really being made, and what impact that had on your client outcome? How do you know the changes you made were really improvements?
We began testing improvement ideas on a very small scale: one client at one ADS site (in total we have 5 ADS sites). Our Case Manager and ADS Senior Coordinator were directly involved in testing the improvement ideas. Getting their feedback immediately was important as it reinforced what went well and what needed to be changed for each change idea. We slowly expanded our tests of change to include more clients/caregivers and ADS sites. Wait time data and caregiver experience were tracked throughout – this enabled our team to better understand whether the desired changes (shorter wait times, improved experience) were being realized.
What was your biggest a-ha moment during your project?
The biggest a-ha moment was when we mapped the experiences and emotions shared by caregivers. This tool allowed for the client voice to guide our work. This mapping clearly identified the touch point/step that needed our immediate attention in order to truly improve the client / caregiver experience. We continued to map the emotions of caregivers during the project and it enabled our team to focus on the client/caregiver experience, and how our tests of change impacted their experience.
What impact did this improvement project have on your clients and your organization?
We are still tabulating year-end data, and would be happy to share our results once available. Mid-year data showed that improvements were being made in both our outcome measures. Our wait times have dropped and caregiver /client experience at the one-identified touch point (time between the trial visit and first day of the ADS) has improved significantly. The change idea that enabled this success has been implemented throughout all our ADS sites. Once the year-end data, including caregiver experience, is tabulated, our team will review the results and determine next steps needed for continued improvements in the journey into our ADS. The model for improvement will definitely be used again. We are in the process of identifying our next Quality Improvement Project. Due to the amount of time required to adequately run an improvement project, one main project will be identified.
What are you doing to sustain the changes?
Communication has been and continues to be key to sustaining the changes. We have used a mix of formal and informal communication methods to share our improvements. Communication has been one-on-one, team or department specific, and all-staff. Continuing to track and share on-going data is also critical in sustaining the changes. As part of our year-end data tabulation, we are exploring how best to do this.
If you had to give advice to others starting on a project, what advice would you give?
We have 4 pieces of advice:
ESS Support Services is an Etobicoke-based community agency supporting seniors and adults with disabilities. We provide a range of programs to support their desire to remain in their own homes and communities.
For our learning collaborative project we focused on our Adult Day Services (ADS), and more specifically, the journey experienced by individuals joining the program and their families – from their first call to the first day of attending the program. Anecdotally, we recognized that there were many steps required for ADS admission as well as some extensive waits. We were concerned about this having a negative impact on their experience. Our participation in the Quality Advantage project enabled our organization to apply a framework for improvement that not only helped us to better understand the current state of the journey into our ADS, but also enabled us to make improvements within the journey.
Project Aim:
By December 31, 2015 we will improve the client experience with admission to ADS by 15%; and,
By December 31, 2015, we will decrease client wait times from assessment/trial visit to service initiation in ADS by 20%
Who was involved in your improvement project?
Our QI project team included the following positions:
Manager, Client Services
Senior Coordinator, ADS
Case Manager
Case Manager
Manager, Client Services
Team Lead – Director, Quality & Project Management
Executive Sponsor – Chief Executive Officer
Our team provided a multi-disciplinary approach, including staff who had a direct role in the client journey into ADS. Next time it would be important for our team to invite a client and / or caregiver to join the team.
What client outcome was your project intended to improve?
There were two client outcomes that our project intended to improve: (a) client/caregiver experience with admission to ADS; and (b) client wait times for ADS admission.
Baseline data was not available to our team in advance of starting the QA project. Prior to testing improvement ideas, we spent time collecting data so we could better understand baseline wait times and caregiver experience with admission to ADS.
What processes and tools did you use to truly understand the challenge you were addressing and the ideas that would lead to improvement? How did you determine the changes you needed to make to improve your program?
There were two main tools used by our team that truly helped us understand wait times and experiences during the ADS admission.
Run Chart – this is a tool created in an excel file that plots your data over time. It was easy to use and we did not need any advanced excel knowledge as this tool was provided to us during the Project. The run chart (a graph depicting our outcome measures over time) quickly and clearly painted a picture of not only our current client wait times but also the positive impact of our quality improvement efforts on wait times.
Experience Questionnaire and Emotional Mapping – The experience questionnaire was used to guide one-on-one conversations with caregivers who had a family member either recently begin attending our ADS or in the process of joining the program. The questionnaire outlined the different touch points/steps in the journey into the ADS, and we asked caregivers to describe their experience at each step. Using the Emotional Mapping tool, the positive and negative emotions and experiences shared during the interview guided by the questionnaire were clearly delineated. It was the experience questionnaire and subsequent emotional mapping that led our team to identify the key opportunities from our clients’ perspective and subsequently to specific quality improvement change ideas to address these areas of opportunity.
Once you identified the changes you wanted to make, how did you go about testing and implementing the changes? How did you know whether the changes were really being made, and what impact that had on your client outcome? How do you know the changes you made were really improvements?
We began testing improvement ideas on a very small scale: one client at one ADS site (in total we have 5 ADS sites). Our Case Manager and ADS Senior Coordinator were directly involved in testing the improvement ideas. Getting their feedback immediately was important as it reinforced what went well and what needed to be changed for each change idea. We slowly expanded our tests of change to include more clients/caregivers and ADS sites. Wait time data and caregiver experience were tracked throughout – this enabled our team to better understand whether the desired changes (shorter wait times, improved experience) were being realized.
What was your biggest a-ha moment during your project?
The biggest a-ha moment was when we mapped the experiences and emotions shared by caregivers. This tool allowed for the client voice to guide our work. This mapping clearly identified the touch point/step that needed our immediate attention in order to truly improve the client / caregiver experience. We continued to map the emotions of caregivers during the project and it enabled our team to focus on the client/caregiver experience, and how our tests of change impacted their experience.
What impact did this improvement project have on your clients and your organization?
We are still tabulating year-end data, and would be happy to share our results once available. Mid-year data showed that improvements were being made in both our outcome measures. Our wait times have dropped and caregiver /client experience at the one-identified touch point (time between the trial visit and first day of the ADS) has improved significantly. The change idea that enabled this success has been implemented throughout all our ADS sites. Once the year-end data, including caregiver experience, is tabulated, our team will review the results and determine next steps needed for continued improvements in the journey into our ADS. The model for improvement will definitely be used again. We are in the process of identifying our next Quality Improvement Project. Due to the amount of time required to adequately run an improvement project, one main project will be identified.
What are you doing to sustain the changes?
Communication has been and continues to be key to sustaining the changes. We have used a mix of formal and informal communication methods to share our improvements. Communication has been one-on-one, team or department specific, and all-staff. Continuing to track and share on-going data is also critical in sustaining the changes. As part of our year-end data tabulation, we are exploring how best to do this.
If you had to give advice to others starting on a project, what advice would you give?
We have 4 pieces of advice:
- Be very thoughtful when selecting your team members, ensuring there is representation of staff who are involved in the process you are focusing on. Their involvement is critical. If you are unable to have a client representative on the team, explore other options for getting their feedback.
- Narrow the scope of your improvement project. There is a lot of work involved in a quality improvement project. It’s better to start small and build upon successes, than start too broadly and lose your focus and enthusiasm.
- Schedule monthly Team meetings – select a date i.e. second Monday of each month, and put the meetings in your calendars now. Don’t wait to schedule them.
- Communicate often and with many. Don’t wait to tell other staff about your project; find ways to share what your team is doing – create a quality bulletin board, quality e-blasts, add it to all staff meetings. This will help with long-term sustainability of the project.
