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100 Walkthroughs in 100 Days: Change Projects Initiated by Programs as a Result of Conducting a Welcoming Walkthrough

Seventy-four programs completed an OASAS survey describing what they learned as well as changes that will be implemented as a result of conducting a Welcoming Walkthrough.

Several providers sent OASAS their observations on the value of the process.  Here's what they had to say about the walkthrough process:

It provided an excellent opportunity to experience our internal systems from a client and staff perspective.  We have begun to implement program wide changes that will enhance the quality of client care.  We have made client satisfaction our number one goal for our administrative staff and implemented a training program focusing on gold star service.  From a clinical perspective, we are revising our protocols for working with significant others during the assessment process.  We have also committed resources to review all the paperwork and to provide additional advanced clinical training for assessment counselors.  Many of our staff have since volunteered to do a walkthrough and we will be integrating it into our staff development program.” 
-- Laura Lessa, LMSW, Director of Operations, Inter-Care

We were very glad we participated in the walkthrough. It gave us insight from the clients view and we were able to make intake and discharge more streamlined because of it.  We have better informed consumers which gives them less stress.  The entire unit runs more efficiently and professionally. Thank you for the opportunity to improve our services
-- Geneva Simonds, Director of Medically Monitored Withdrawal Crisis Service, Project Renewal, Inc.

The walkthrough not only helped me learn about needed improvements in our program, but it also had the side benefit of reminding my team of how much their director cares about what is happening on the front line.
-- Barbara Kistenmacher, Director of Addictions Treatment, Bronx-Lebanon Hospital Center

This experience was a rewarding and valuable opportunity.  We plan on continuing to use this exercise periodically to better serve our clients and use it as a quality assurance procedure.
-- Julia Floyd-Ventura, CASAC, Director of Mental Health Services, Phoenix House

We have summarized the changes made by programs under the sections of the Walkthrough process that were most closely aligned.  These practices may be changes that other programs could replicate:

Initial Call | Locating the Program | Building Appearance | Reception Area | Completion of Initial Paperwork

Initial call to request an appointment:

  • When making an appointment for the first time, the receptionist will give detailed information to individuals about what they can expect to do at this first appointment. For example, meet with a counselor who will take a brief history, fill out and sign forms and make a second appointment to see the medical director. They will also be told how much time the first visit will take.
  • Succinct and improved phone protocol for scheduling intake appointments to avoid placing prospective client on hold.
  • Developed checklist for relaying helpful information to the client regarding their first appointment (travel directions, parking availability, anticipated length of 1st intake appointment, and documents needed).
  • Respond to messages left on the intake phone within one hour if the call comes in by 3 p.m. For calls left after the intake office is closed, the return will be within 2 hours of the start of the next day.
  • Implementing a reminder phone call to new intakes about their upcoming appointment at the program.
  • Intakes are notified if the agency is closed for snow, and intake appointments are given the snow number.
  • The receptionist will take a written message with call back information and indicate that the Clinical Director will return their call within 24 hours.
  • Front desk staff will have guidelines regarding letting clients know what to expect at the intake appointment.
  • When applicants call the program, they will be informed about the potential for a wait and informed when the wait might be at its lowest.
  • Installed on hold [telephone voice] tones for callers waiting to be connected.
  • When it is not possible to have a bi-lingual person available at the front desk, there will be a list of basic sentences in Spanish to allow for message taking for non-English speakers.
  • Initial calls are forwarded directly to an available counselor.
  • Added an additional evening intake appointment.
  • Limiting the phone screening to less than 5 minutes thereby reducing the number of questions needed to obtain an appointment.
  • Developed a script for the receptionist for callers with multiple questions or concerns about treatment and the intake process.
  • A welcome letter to be sent out immediately after the initial contact with a site map and directions included.
  • Changed the admission process by informing potential clients to arrive at 8:30 a.m. in lieu of 10 a.m. enabling a faster transition to admission.
  • It's helpful to greet the clients in their native language, when possible, as this immediately helps to establish rapport.

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Ease of locating the program:

  • Directions to the facility have been printed and are available to send to clients who need them.
  • We will provide public transportation information to clients calling to set up an intake appointment.
  • Secretary/receptionist will go online to www.hopstop.com to get and provide travel directions (bus, subway, or walking) to all incoming patients prior to their first appointment.
  • Signs developed for facility's street-level entrance door, bell panel and elevator.
  • All posted signs have been translated in Spanish.
  • Program brochures were ordered.
  • Give directions to the new location at every intake appointment scheduled.
  • Ensured that front entrance signs are adequately informing, easy to read and welcoming.
  • Relocation of signs to the front entrance.
  • Additional signs and clearer directions were placed within building to assist in navigating a complex and difficult hallway structure.

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Appearance of external building:

  • The signage on the outside of the building is being updated to reflect that it is a Community Center and the address numbers were made more visible.
  • The external building's signage has been upgraded.
  • Parking spaces were reassigned for new admissions.
  • The front lobby was painted. A new window for enhanced natural lighting will be installed.
  • A welcome sign will be placed on the door of the waiting area.
  • The website will be updated to display feature more positive pictures of the program.
  • The sign in front will be updated to include directions regarding what to what to do upon entering.
  • The aesthetic appearance of the clinic will be improved.

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Reception area:

  • Instead of remaining behind the glass-enclosed reception area, the secretary will come into the waiting room to take new patients aside privately and assist them in understanding and completing initial paperwork.
  • Changed the order of the admission process to accommodate three to four admissions arriving at the same time from the bus station.
  • Patients will be given an orientation and a brief walkthrough of the facility by the counselor doing the assessment.
  • Family members will be given a brief tour of the facility.
  • The lighting will be improved in the waiting room.
  • We updated our magazines and will have a rack for clients' access.
  • OASAS/treatment-related literature was added to the information rack.
  • A welcome sign was added in the reception area.
  • We will offer coffee, tea and acces to the bathroom.
  • The whole program has been painted and redecorated with welcoming pictures.
  • We repositioned furniture and added amenities to the environment that would be much more welcoming to clients and their families.
  • More chairs were added to the reception area.
  • Patient handbooks and information on visitation was made available.
  • Additional staff were scheduled to help assist in intake process.
  • The reception area staff were given training on how to be more welcoming, engaging and pleasant when greeting clients.
  • The front desk staff be informed on the need to promptly greet clients in the waiting area.
  • Twelve-step self-help meeting lists in lobby.
  • Facility information and pamphlets will be available in the entry/waiting area.
  • Music (or TV) will be incorporated into the lobby area.
  • A sign was placed in the reception area to help direct clients where to check-in and make them aware of what to expect.
  • Counselors' doors will be closed to ensure for confidentiality, especially when retrieving messages using speaker phones.
  • The on-site manager will greet applicants in the waiting area to discuss wait times, if applicable, with client and collaterals.
  • First admission applicants will sign-in so that wait times can be better monitored.
  • A new doormat was ordered.
  • Staff scheduled for an admission will meet each new patient as they enter the lobby to welcome and explain the admission process.
  • Staff will minimize personal conversations when they are in the waiting room area.
  • A welcome packet handed out at first appointments.
  • The program will have a small table for morning coffee and snacks.
  • Our coat rack was moved away from the fire extinguisher.
  • Program materials were updated to make them easier to understand and read.
  • We posted signs identifying staff offices.
  • Mints were ordered for clients required to complete oral drug screens.
  • The location of the intake office has been changed to ensure more privacy.
  • Nicotine patches or nicotine gum will be made available in the downstairs nursing office for clients who smoke.
  • More Recovery posters were placed in the waiting area.
  • Ancillary activities in the reception area will be reduced to minimize the possibility of distracting incoming patients.
  • A designated welcoming area is being developed.
  • Our reception area and client files are kept in the same area with the need to ensure for confidentiality.
  • We do not have a staff member present in the reception area, thus a new sign to explain that the individual should ring the bell on the desk and that a staff member will be posted shortly.
  • We are contacting the Albany County Department of Social Services to explore possibility of using Welfare to Work participants to greet new intakes.

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Completion of initial paperwork:

  • Social Security numbers are to be requested, but not insisted, during the intake phone call.
  • Our goal is to complete the admission process within 45 minutes or less. This includes the from the time when the patient walks in the door to being shown to their bedroom.
  • Determinations about intake will be made on same day as intake.
  • Combine contact with family member and client to streamline process and not overwhelm potential clients or their families with multiple meetings and paperwork.
  • Applicant has access to speak directly to a problem gambling expert.
  • If the client provides written consent, family members can be included in the interview with the client.
  • Program release forms (and other documents) have been updated to include the new agency logo.
  • Questionnaires/paperwork will be divided between two assessment visits to prevent the client from feeling overwhelmed during the first visit.
  • We revised the clinical services agreement to reflect a more engaging approach to the onset of treatment.
  • A session was added to the admission/orientation process. This should decrease stress with the amount of information needed at admission.
  • As a result of photocopying and cross-outs, forms needed to be updated and made current and readable.
  • The duties of financial/medical staff were clarified to expedite intake process on initial visit.
  • We are scheduling part two of the intake within the same week to enable clients to engage in treatment as soon as possible.
  • Reduced and consolidated paperwork related to the initial treatment visit.
  • We identified paperwork that can be completed after clients' admission.
  • The patient paperwork was reorganized.
  • The application and intake process were scheduled for two sessions instead of one.
  • The initial intake assessment and medical screening were changed.
  • We are beginning an orientation group for new clients. 
  • The initial documentation redundancy has been removed and has reduced the amount of paperwork by more than one third.

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More results from the 100 Walkthroughs in 100 Days campaign:

Approximately seventy-five percent (75.6%) of the participating programs that reported their experience to OASAS indicated that the walkthrough enabled them to reflect on what it is like to be a client at their program.

In addition to the one Welcoming change that the participants identified in the survey, approximately 60 percent of the programs identified or initiated an additional rapid-cycle change. Moreover, as a result of the walkthrough, approximately 55 percent of the participants identified other areas in their program that they would like to address via a rapid-cycle Plan-Do-Study-Act project.

New Treatment Process Walkthrough

OASAS has adapted the Welcoming Walkthrough process to focus on the continuum from patient assessment to treatment planning to assess both regulatory compliance and the effectiveness of administrative and clinical processes.  A protocol is available upon request.  If your program is interested, please contact Henri Williams at HenriWilliams@oasas.ny.gov