Organizational Change Case Analysis: Eap Crisis-management And On-call System

Organizational Change Case Analysis: EAP Crisis-Management and On-Call System Michael Heitt, PsyD Associate Director

Faculty and Staff Assistance Program & Student Assistance Program Johns Hopkins University & Hospital www.fasap.org

FASAP Organization • • • •

Internal EAP for JHU, JHH, etc SAP for BSPH & SOM WORKlife Programs 33,000+ Faculty, Staff, Students and their families • Confidential and free services • Client and Organizationally oriented

FASAP Staffing & Funding • • • • • •

Director (0.5 FTE) Associate Director (1.0 FTE) Medical Director (0.2 FTE) Research Assistant (0.8 FTE) Six clinicians (4.8/1.2 FTE) Five support/administrative staff (2.45/2.45 FTE)

• Separate budgets for FASAP, SAP and WL • FASAP budget is funded by Human Resources and JAA funds • FASAP budget totals just under $800,000

Statement of Problem: Crisis-Management • • • • • •

Appointment-basis office structure Customer-service oriented program Triage all walk-ins and take all calls 33K employees (and families): 6 clinicians 1-2 week wait for scheduled appointment Manager feels comfortable in crises

Michael Heitt

Current On-Call System • On-call and back-up on-call schedule • Crises go to first person available • If no one is available on-call clinician is interrupted • After-hours coverage provided by external contractor

Problems with Current System • • • •

Always on-call No “protected” time Urgent displaces emergent Unfair distribution of crisis coverage?

Total

Baseline Data (February & March, 2005) Emergent Contact

Urgent Contact

Walk-In

Front Desk

Font Desk

Emergent

Direct

Direct

Urgent

17.2

19.8

28.8

117.2

19.6

14.8

Mean/Wk

2.2

2.5

3.6

14.7

2.5

1.9

Mean/Dy

0.4

0.5

0.7

2.9

0.5

0.4

Data Discussion • 1 walk-in per day (5 min – 4 hrs ea) • 2-3 emergent calls & 3-4 urgent calls forwarded from admin staff per week (2 - 60 min ea) • >17 phone calls (2-3 emergent) received directly per week, (2 - 60 min ea)

Mean/Day

Emergent Contact Urgent Contact

Walk-In

Total

0.5 hours

1.5 hours

5.5 hours

3.5 hours

Contributing Factors • Hybrid program structured upon traditional EAP core technology yet staffed by licensed clinicians and supervised by psychiatric faculty – Affects the identity of the program and its staff – Dictates the clinical evaluation, intervention and documentation expectations – More time intensive than a non-clinical “problem assessment”

• • • •

Institutional culture of crisis response Lots of VIPs at Hopkins Budgetary constraints Significant staffing change/turnover – Retirements, promotions, new hires – Loss of Institutional Wisdom and career/life experience – Professional inflexibility

• Admin staff change project

Objectives • Appropriate, timely and efficient crisis triaging and intervening with minimal disruption • Empowering the clinical and administrative staff, raising their expertise level and reducing their anxiety when dealing with crises • Protecting clinicians’ non-clinical time so they feel a greater sense of control over their workdays

Strategies • Urgency: Baseline data • Change-management education and exercises: Piggyback on Admin Staff Change • Skill-building: Fundamentals of EAP, Crisis Call Handling, Suicide Assessment, WPV Risk Assessment • Technology: Call center implementation • Engagement: Brainstorming ideas/options

“How may I direct your call? Doctor-assisted or Regular?”

Action Steps 1. 2. 3. 4. 5.

Strengthen the protective buffer of the administrative staff FASAP leadership will reinforce a generalist approach to EAP work Administrative staff will be encouraged to utilize a “warm-line” transfer from FASAP to a ProtoCall counselor FASAP clinical and administrative staff will continue to discuss the differences between emergent and urgent situations A new on-call schedule will be implemented on a pilot basis • • •

Administrative staff will direct crises to the on-call clinician first, then the back-up clinician. The on-call clinician will enjoy a limited or “light” day of scheduled activity of no more than two new scheduled evaluations (typically scheduled for two hours each) On-call clinician will be devoted to handling all crisis situations that arise, and spare time can be spent on administrative duties such as paperwork, event planning and writing.

Outcome Measures • Repeated assessment of frequency data and comparison to baseline data • Assess negative impact on wait time for scheduled appointment • Subjective rating of stress, control, sense of overwhelm and overall satisfaction