Alpha Program Shortens Wait Time, Reduces No-Shows

The BCI Alpha Drug Free Program is seeing our clients engage in treatment more quickly after admission. At the same time, we see the fewest no-shows we've ever had for appointments. These are our latest successes in Paths to Recovery, patient-focused process improvement without additional costs or staff.

In the month of April, our clients progressed from admission to their first unit of service (individual or group) in an average of 9 days, which is the fastest in two years. Our average had been 12 days.

These results came after we introduced a new service called the Meet & Greet. This is the first time the client returns after admission. On average, it's 4 days afterward. They meet their assigned counselor, review the program rules, view a ten-minute orientation video, and schedule their first individual appointment. It’s a much more streamlined version of how we used to do orientation. Previously, clients would not meet their counselor until the first individual, nearly a week later. Knowing how important it is to establish the therapeutic alliance, we made it a priority to push this meeting up as early as possible.

Also in the month of April, our no-show rate dropped to 19%, which is our lowest in two years. This is for individual appointments for all active clients. Our average had been 26%. Client retention is also better, with more people staying in the program past the 45 day benchmark.

This came about because of our new, retooled motivational incentives. Since February 2008, each client draws from the fishbowl once at every individual and every group. They can win credits of $1, $5, $10, or $50 which they can bank and redeem for prizes including gift cards, bus passes, and 12 Step items.

This is a real turnaround after we had used motivational incentives for a year without seeing improved no-shows. Before, there were fewer chances to win since draws were not done in groups. There were also “Good Job” certificates mixed in with the prizes which had no value in dollars, only as motivation. Turns out, they weren’t very motivational! So the “Good Jobs” are now gone, and every draw wins something. And the best part is, the cost to the program is about the same. Banking of credits is also new, giving clients a choice to cash in right away or save up for something they really need.

Both of these projects took a long time to fine tune and perfect. The Alpha change team worked at this week after week at our lunchtime meetings. Our ideas made sense, and we expected them to work, but if the numbers didn’t show it, it was back to the drawing board. In terms of the PDSA cycle, it seemed like we were stuck on "A" for “adapt.” It just shows that process improvement in addiction treatment is hard work. It doesn’t get any easier just because you’ve been working at it for nearly5 years.

So it is all the more rewarding when we do get the great stats we’ve been waiting for. Good Job! I mean, Good Work, team!