A detailed look at lessons from mental health systems change and transformation initiatives in this presentation.

1. Managing Change: Tools and Techniques Vijay Ganju Director, Center for Mental Health Quality & Accountability NASMHPD Research Institute, Inc. 703.739.9333 ext. 132 [email_address] Lessons from Mental Health Systems Change and Transformation Initiatives Presentation at the CMS Conference: New Freedom Initiative Access to Community Living Transforming Systems: Keys to Success Baltimore, Maryland  April 10-12, 2006

2. Mental Health System Recovery / Resilience Transformation Mental Health / Health Consumer / Family Driven Eliminate Disparities Early Intervention Evidence-Based Practices Training / Research Technology & Information

3. The Quality Pyramid Performance Measurement SYSTEM OUTCOMES Evidence-Based Practices Quality Improvement

5. Number of States Implementing EBPs: FY 2003 N = 47

6. Implementation of Evidence-Based Practices for Children, 2003 N = 47

9. Lessons Learned from “Toolkit” Trainers, Consultants and Evaluators Desired Consumer Outcomes Practitioners Consumer Family Agency Implementing EBP Steering Committee State or County Mental Health Authority Strategies for Consumer/Family Strategies for the SMHA Strategies for the Agencies Strategies for the Steering Committee Training/TA Strategies for Practitioners

13. Lessons Learned from National EBP Demonstration Project INFORMATION TECHNOLOGY Implementation Leading to Transformation System Leadership/ Implementation Plan Policies and Procedures Organizational Structures Funding Methods Human Resource Capacity Quality/ Performance Improvement

20. Organizational Culture of a Mental Health System Solidarity Sociability Networked Communal Fragmented Focused

25. Tool: Team Competency/Influence Tool: Team Competency – A useful tool to help the team determine if they have the right team members relative to the competencies and influence necessary to execute the initiative Competency/Influence Team Member H = High M=Medium L=Low Uses: This exercise is particularly useful for two situations: (1) when initially forming the team, it can help the sponsor and/or team leader determine who should be on the team; (2) if the team is already in place and they may be struggling due to lack of ability to do certain facets of the initiative, this tool can be used to determine if adjustments in team members are warranted. Timing: Before starting the initiative and/or anytime during the initiative when the team seems to be struggling due to lack of competency or influence. This often occurs when a new phase of the initiative begins.

30. Tool: Threat/Opportunity Matrix 1 3 2 4 Tool: “Best Practice” organizations know how to frame a change initiative as more than a short-term threat. They work to find ways to frame it as both a threat and an opportunity. By doing so, they are able to create a sense of urgency and commitment among key stakeholders. Threat Opportunity Short Term Long Term Uses and Timing: Building the case for change is one of the most important tasks of the team. This simple tool helps it to redirect the initial focus on short-term threats and generates a clear sense of why the initiative is essential. Gain Pain

34. Attitude Charting Innovators (5%) Early Adopters (10%) Early Majority (35%) Late Majority (35%) Resistors (15%)

35. Stakeholder Analysis Steps: 1. Plot where individuals currently are with regard to desired change. (  = current) 2. Plot where individuals need to be (X=desired) in order to successfully accomplish desired change-identify gaps between current and desired 3. Indicate how individuals are linked to each other, draw lines to indicate an influence link using an arrow to indicate who influences whom 4. Plan action steps for closing gaps Names Strongly Against Moderately Against Neutral Moderately Supportive Strongly Supportive

36. Example #1: Stakeholder Analysis Chief of Surgery Dr. Bobbitt Dr. Clampett CEO Chief of Staff Medical Director Chief of Medicine CFO Asst. Med. Director Chief Administrator Dr. Barnes Chief of Nursing Sharon Reams, RN       Strongly Against Moderately Against Neutral Moderately Supportive Strongly Supportive       

37. Example #2: Stakeholder Analysis Chief of Surgery Dr. Bobbitt Dr. Clampett CEO Chief of Staff Medical Director Chief of Medicine CFO Asst. Med. Director Chief Administrator Dr. Barnes Chief of Nursing Sharon Reams, RN       Against Moderately Against Neutral Moderately Supportive Strongly Supportive       

38. Example #3: Stakeholder Analysis Chief of Surgery Dr. Bobbitt Dr. Clampett CEO Chief of Staff Medical Director Chief of Medicine CFO Asst. Med. Director Chief Administrator Dr. Barnes Chief of Nursing Sharon Reams, RN       Against Moderately Against Neutral Moderately Supportive Strongly Supportive       

40. “ They always say time changes things, but you actually have to change them yourself.” ~Andy Warhol