Propose “Future State” Process Map

The Team consulted with the Sponsor and other members of the Center staff. They endorsed many of the prioritized recommendations, including eliminating the Client Assignment sub-process and establishing walk-in appointments for the C&AI process. The proposed “future state” C&AI process map is shown in Figure 2.2.

Establish Implementation Plan for “Future State” Process

The Team invited additional members of the Center staff to join them in implementing the endorsed recommendations. This new Implementation Team helped the original Team work through the staffing details needed to prepare for a transition to walk-in appointments, redesign student forms, draft job duties required by the new process for front desk staff, walk-in

Proposed future state process map - Consultation and Assessment Interview

Figure 2.2 Proposed future state process map - Consultation and Assessment Interview.

counselors, and emergency services counselors; and immediately implement a variety of other improvements to the C&AI process. (Additional endorsed recommendations were deferred given currently available staff resources.) The Implementation Team was in regular communications with Center staff, acknowledging and addressing their questions and concerns over this significant change to the C&AI process. They developed clear, written protocols (e.g., staff duties, forms, paper flow, and file management) for walk-in and emergency services, including a new referral process for instances where assigning walk-in students to an alternate counselor or therapy was in the best interest of students, for example, expertise in eating disorders. The Center broadly communicated the new services to students, families, advisors, and academic areas, implementing the new C&AI process at the beginning of the next fall semester.

“Report Out” by the RIE Team

The Team (including the Sponsor and Center Director) presented the results of the RIE to the senior leadership of the Division of Student Affairs (in which the operations of the Counseling Center resided). Additionally, the facilitator and a Team member (i.e., the Center’s receptionist, to highlight the democratic nature of the RIE team) presented the results of the RIE to BGSU’s senior leadership team, the President’s Cabinet.

As the RIE formally concluded, Center members on the Implementation Team continued to make incremental “continuous improvement” changes to fine-tune the newly implemented C&AI process. In addition, the Team shared additional recommendations for improvement it had identified with the Center’s leadership team for future implementation. Despite the significant improvements, all acknowledged that even after implementing all these changes, the value-added time in the new improved process was only 10% - indicating further opportunities for continuous improvement.

Implement the New Process

A comparison of the C&AI process maps in Figure 2.1 (i.e., the original process) and Figure 2.2 (i.e., the new process) projected a marked reduction in the number of steps (e.g., provider steps were reduced from eleven to four), and the value-added time of the improved process increased from 1% to 10%. The new process eliminated waste and created a more simplified flow, increased the value to the beneficiaries (student, parent, academic advisor, etc.), and demonstrated that the Counseling Center staff could apply LHE to make dramatic improvements in student mental health assessment and therapy services without any increase in staffing.

The Team collected data on the new C&AI process and compared outcomes on performance metrics to the previous fall semester. (An additional performance metric, self-reported student satisfaction with the walk-in process, was also collected.) Table 2.3 summarizes additional gains achieved following the RIE to improve the C&AI process. Overall, the delivery of services improved significantly. Walk-in C&AI appointments dramatically reduced waiting time for students; with walk-in service and immediate assignment to this counselor for any continuing therapy,12 students were now able to schedule their first therapy appointment that same day (with that appointment depending only on mutually convenient times for the student and counselor). Appointment “no shows” dropped dramatically (as would be expected with walk-in service), which eliminated the suboptimal use of counselors’ time when students fail to show for appointments. The number of self-identified mental health emergencies decreased 41% with the availability of walk-in service for all students. Most impressively, the reduction of both “no show” and emergency appointments, coupled with the elimination

Table 2.3 Performance Metrics for the Consultation and Assessment Interview Process - Before and after RIE

Performance Metrics

Fall

Semester before RIE

Fall Semester after RIE

% Change

Student waiting time until initial appointment (days)

5

<1 (Same day)

Decreased 100%

Student waiting time from initial appointment to assignment to individual counselor (days)

16

<1 (Same day)

Decreased 100%

Number of unscheduled emergency assessment/counseling services interviews

356

213

Decreased 41%

Percentage of "no shows" for Consultation and Assessment Interviews

20%

<1%

Decreased >95%

% Student satisfaction with "Walk-In" counseling appointment process3

n/a

100%

Total number of students requesting counseling services

761

950

Increased 25%

a "Strongly Agreed" or "Agreed" that "walk-in services were easy to use."

of the Client Assignment sub-process, freed up considerable staff time to support the improved C&AI process, avoiding the need to hire additional staff while providing improved services. All of these improvements took place at the same time the number of student requests for service increased approximately 25% (perhaps due to the improved availability of “just-in- time” services). As might be expected, student satisfaction with this new service delivery model was extremely high as measured by student self-report surveys. Although not formally assessed, the Counseling Center received positive reactions from campus offices that commonly refer students to the Center.

 
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