Mat Roosa, LCSW-R
Understand and involve the customer.
This is the first and most important of the five NIATx principles. Much of our NIATx work involves working to understand the customer/client/patient experience—because the customer experience is the critical factor in all service delivery. Strategies to understand and involve the customer can include client interviews, focus groups, or including clients on a change team.
The walk-through, one of the five essential NIATx tools, is a role-play exercise designed to give staff the chance to walk in their clients’ shoes. The walk-through allows staff members to focus on a specific part of the service process and gather critical insights into what it feels like to schedule an appointment, find the program, sit in the waiting room, fill out the paperwork, or complete an assessment session.
Walk-throughs have helped thousands of people understand the customer experience and identify improvement opportunities. That’s the good news.
And now for the bad news: Too often, people just don’t finish the walk-through.
Doing an incomplete walk-through is like taking half of your antibiotics. “Half” of a walk-through can be worse than no walk-through because it can reinforce inaccurate assumptions and may lead you to think that you know things that you do not know. Improvement efforts are difficult to achieve with such a hazy vision.
So, what do we mean by an “incomplete” walk-through? The tips that follow will ensure that your walk-through is complete and will help you gain the clear and critical vision required for meaningful improvement.
Don't look at it, do it.
Looking at your waiting room from behind the reception window and sitting in the waiting room for 20 minutes waiting for an appointment are two very different experiences. Observing is not the same as doing. The complete walk-through duplicates the client experience.
Stay in character...both of you.
As you plan the walk-through, develop a character that includes all of the core details needed to complete the process. If you’re seeking admission to a mental health service, show up with your demographic information and symptoms clearly defined, and stay in character for the entire process. Try to understand the experience through your character’s lens. What would it be like to be having this experience, given this background and current need? If a staff member who is completing part of the process with you starts to step out of character by saying, "At this point in the process, we would typically do X," gently remind them that you want to follow the normal process. We want them to avoid commentary about 'X' and to just do 'X.'
Do a chunk of the process. (Not all of it.)
People tend to skip parts of the walk-through process because they have limited time and are trying to do too much. If you only have 90 minutes, don't try to walk-through a process that takes three hours. Plan ahead and dedicate your energies to a manageable part of the process. Select something that you suspect has some challenges that warrant further attention.
Do every part of that chunk. (Don’t skip steps.)
Now that you have been selective in your choice for a walk-through, be diligent about completing every part of the sequence. Remember that you are trying to understand both the nuts and bolts of the sequence and how the sequence feels. Skipping some of the forms on the intake clipboard will not give you a true impression of what it feels like to do that paperwork. Many of the stressors that our clients experience are cumulative. Each of our forms or data gathering processes might be easy to complete. But stressors can emerge when a client is asked to complete eight sets of forms and provide the same address and phone number on four of them.
Be open to learning. (You don’t already know it.)
"We can skip this part. I already know how this works" is a phrase often heard in an incomplete walk-through. Work to maintain a humble and curious posture when doing the walk-through. Assume that there are many things that you do not know about the process. This can be challenging when exploring familiar territory, but remember that you are familiar with the staff experience side of the process. The process looks very different from the other side of the desk.
Visit the NIATx website to learn more about the walk-through and other process improvement tools.
Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in quality improvement, organizational development and planning, and implementing evidence-based practices. Mat also serves as a local government planner in behavioral health in New York State. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration. You can reach Mat (Change Project SOS) at firstname.lastname@example.org.
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