Table 2 Interview participants’ perceptions of key facilitators of pre-admission metric performance

I. Wait time

1. Efficient screening processes

“…we don’t schedule face-to-face screens. So there’s no time in between like when we get the consult and then we close the consult, we’re not setting up another additional evaluation meeting with the Veteran that they have to come here which would potentially delay their admission, as far as I know.”

“So as we get referrals throughout the day—whether it’s 9:00 or 2 p.m.—we’ll get the referral and we’ll do the screening that day. Prior to the Lean Thinking initiative, we would have one time a day where we would meet at like 11 a.m. But if you get the referral at noon then you gotta wait all the way till 11 a.m. the next day.”

2. Effective patient flow

“We meet daily for a staffing meeting for 15 minutes to decide, to talk about who’s coming, who’s going, what the plan for the people who are here are, how people are doing in treatment, and that’s when we discuss who’s on the list and how we can get them in.”

“…one of the things that we did was add a fourth day and open up the possibility of doing two admissions on 1 day when our census is low. So we’re trying to be a little bit more flexible, a little more accommodating and we’ve also sort of decreased the requirements for being admitted to the program. So we used to have a hard line that they had to have a TB test, for example, prior to admission. Now we can do a test on the day of admission and if they have symptoms, isolate them…”

3. Available beds

“Okay, we actually had about 120 beds for the Domiciliary which makes us a very large Domiciliary. And that’s a good size for the community and what our needs are. And so generally, it was a fairly short period of time that someone needed to wait to come in.”

“And then what’s great about the SA side is that it’s a 45-day program so we can turn around beds a little bit easier.”

II. Engagement while waiting

1. Accessible outpatient services

“…we open all of our groups up to anybody that is interested in participating. We try to individualize that care to the Veteran. So we will let them look at our group schedule and if there’s one or two groups that they can make during the week then we go ahead and invite them in until they get into the inpatient part of the program…And they have some evening groups too that are available like 3 days a week, I believe, 4 days a week, which I think helps.”

“There may be a wait to get into a residential bed, but we’ll get you screened quickly and what we do in the interim then if we don’t have a residential bed available, we have an early recovery group, we have individual options for some people and sometimes we’ll even have them do a little bit of our IOP program until a bed opens. So they should be getting services pretty quickly.”

2. Strong patient outreach

“And we work really hard at calling them if they don’t show up and just really an intensive outreach process. I think because it seems the nature of the population is that they easily disappear, so we work really hard to try not to let that happen.”

3. Strong encouragement of pre-admission outpatient treatment

“So, anyone on the list, we tell them if you’re coming to outpatient, you’re staying involved and we can see that you’re maintaining and motivated and someone doesn’t show, well, we’re going to come to outpatient and say, ‘Hey somebody didn’t show’ or ‘Someone left AMA.’ And so, it gives you a better chance of getting into the program quicker and the fact that we’re all on the same floor, I think that, you know, they can check in with us on a daily basis even if they want to.”

“Well, I think that one of the things is that we tell people it’s an expectation. So, when we screen them, and say our wait is like two and a half weeks at this point or something, we tell them a couple of things, that we’re really requiring you to do outpatient unless there’s really some legitimate reason, like you live too far away or whatever, to not come.”

“But when the patients are screened, they automatically are enrolled or scheduled for, number one, a pre-treatment group that we call “Preparation Group,” that meets twice a week and that’s done in the outpatient clinic.”