(This Success Story is adapted from a “5x5” presented during a NIATx Change Leader Academy on October 19, 2010 by Dan Pender, MA MFT, New England Regional Quality Assurance Director, Program Director & Clinical Supervisor of Arbor House TSS, a program of Phoenix Houses of New England.)
Arbor House is a Phoenix House program providing 30-day Transitional Support Services. Residents typically follow a structured daily schedule that includes psycho-educational groups, 12-Step meetings, recreation hours, and case management.
The program director conducts a weekly group focused on customer service and program improvement. At one meeting, residents requested more “off the floor” time, during which residents may return to their dorm rooms to have some private time and take a break from the otherwise structured day.
Addressing the issue with NIATx
Applying the NIATx principle “Understand and Involve the Customer,” the existing change team asked residents to develop a protocol for increased off the floor time and finalize it with staff. The protocol for residents included restrictions on common activities, no talking, and returning to their rooms; staff took turns periodically supervising the dorm space, and otherwise had some unstructured time also.
Changes tested through a series of Plan-Do-Study-Act Cycles included:
- A temporary change to the master daily schedule that offered one hour of private time.
- A choice of one hour of private time either in their dorm rooms or at the YMCA.
- Progressively increasing the number of days per week on which the changed schedule was implemented, from one to three days, over a three-week period.
The staff and the change team reviewed resident progress weekly. At Week Four residents voted unanimously to implement the change to the daily schedule. Staff unanimously agreed and increased the changed schedule from three to six days per week. Through the continuing review process, the time was increased to 1 ½ hours off the floor, and continues 6 days per week.
Increased Resident motivation and engagement:
- Residents missed fewer Case Manager appointments.
- Clinical progress notes showed that residents were also more active during group activities.
- Residents appeared more rested and rejuvenated for the second half of the program day.
- Using peer leaders builds greater accountability.
- Inviting the residents to partner with the staff on the change project (understanding and involving the customer) led to a more positive atmosphere and ongoing partnership on other change projects.
Increased Staff satisfaction and effectiveness – an unintended but welcome outcome!:
- Staff report the pause in activity makes them feel rejuvenated, too.
- Staff are more effective when they take short breaks to supervise residents off the floor.
- The periodic, rotating dorm monitoring duties allowed staff time to take care of other work tasks they previously could not due to the need for constant resident monitoring. The new, discretionary time increased the quality and amount of tasks completed, relieving a source of stress. It also gave a more relaxed time in which to have lunch or take a break.