NIATx

2013 iAWARDS: Innovation, integration, implementation

2013-04-18T12:08:00.000-05:00

By Kim Johnson, Deputy Director, NIATx

The 2013 NIATx Summit and SAAS National Conference is fast approaching: July 14-16 in San Diego. Again this year, with funding from SAMHSA, we’re recognizing several organizations with the Innovation in Behavioral Healthcare Services Award, otherwise known as the iAWARD. The two winning organizations have been selected, from a very competitive pool. Four others were selected as Honorable Mentions. Each of the six embodies this year’s conference theme: “Innovation, integration, implementation: the business of behavioral healthcare.”

Winning organization Drug Abuse Comprehensive Coordinating Office (DACCO) of Tampa, Florida focused on the community’s growing problem of opioid dependence among pregnant women. The Comprehensive Coordinated Care program it developed in collaboration with the nearby University of Florida College of Medicine integrated substance abuse treatment with primary care, promoted implementation of evidence-based practices such as medication-assisted treatment, and improved care for pregnant women and their newborns.

Technology plays a key role in health care innovation—as the iAWARD winner Holy Cross Hospital of Taos, New Mexico demonstrates. Holy Cross partnered with local primary and specialty care providers to reduce high-utilization of its ER by people with co-occurring disorders. The hospital’s information technology developed an automatic email that alerts social worker whenever patients from this high need population appear in the ER. Improved communication allows a social worker to connect patients to treatment and other resources before they leave the ER.

Four other organizations were selected for 2013 iAWARD Honorable Mentions:

· The Zucker Hillside Hospital, Queens, New York

· Kentucky River Community Care Inc., Hazard, Kentucky

· McLeod Addictive Disease Center, Charlotte, North Carolina

· Christus St. Vincent Regional Medical Center, Santa Fe, New Mexico

All will present their innovations during a special session at the Summit. We hope you’ll join us in San Diego to recognize them, spend a few days with us, share new ideas on innovation, integration, and implementation, and connect with your colleagues from across the country.

See you in San Diego?

Healthcare reform: Implications for organizational systems

2012-11-01T10:45:00.000-05:00

By Todd Molfenter, NIATx Deputy Director

One of the goals of the Patient Protection and Affordable Care Act (ACA) is to lower the cost and improve the quality of care for everyone. Behavioral healthcare providers may be uncertain about the future of the legislation and what impact it will have. But the national trend toward fee-for-service and managed care—which also aims to lower the costs and improve quality of care—is requiring behavioral healthcare leaders to develop the same competencies they’ll need to be fully prepared for the changes anticipated with healthcare reform.

These competencies include understanding and implementing health information technology (HIT), especially electronic health records (EHR) to improve quality, contain costs, and give patients greater control of their personal health.

Integration with primary care, another component of the ACA, is already happening, as behavioral health works to operate in conjunction with the broader health system. In the HealthReform Readiness Index survey administered by NIATx, the percentage of behavioral health organizations that offer primary care increased from 6% to 15% from 2010 to 2012.

The movement toward managed care and fee-for-service reimbursement has been accompanied by changes in state funding. Behavioral healthcare providers are learning to expand their payer mix and their business skills, developing new systems for billing, managing accounts receivables, and reducing claim denials. Providers will need to have these systems firmly in place to accommodate both the Medicaid expansion anticipated with ACA and the Health Insurance Exchanges that will emerge—the new competitive markets that will allow consumers to purchase affordable private insurance plans.

· Enrollment: Changes in state funding are requiring providers to help their patients determine their eligibility for public or private insurance coverage. Efficient enrollment systems will also be essential with Medicaid expansion and HIEs.

· Workforce development: Today’s changes in funding and reimbursement are also driving the need for a workforce with the credentials and clinical competence that payers require.

· Using outcomes to influence clinical decision-making: State governments and managed care increasingly require documentation that demonstrates quality indicators are being tracked and a plan to continuously improve performance.

Whether or not the ACA is fully implemented as designed, behavioral health care providers who are working on these areas are setting themselves up for success in a funding environment that’s changing rapidly.

If you haven’t yet embarked on making the transition to this new environment, or if you’re not sure where to begin, take a look the HealthReform Readiness Index (HRRI) that NIATx developed. It’s a quick (under 15 minutes) survey that will let you know immediately where you are on the readiness spectrum. You might find that you’re in the early stages in one area, but well on your way in another. The HRRI is just one of many tools that you can use to help plan how to adapt your organization’s systems to the transformation of the behavioral healthcare field.

Ready or Not, Here it Comes: Health Reform

2012-10-29T14:30:00.000-05:00

Kim Johnson, Deputy Director, NIATx

With Election Day fast approaching, healthcare reform is a hot topic. Many believe the election results will determine the future of the Affordable Care Act, which is designed to extend health insurance coverage to more than 30 million Americans. Yet regardless of who wins in November, behavioral healthcare providers need to adapt to changes that are already taking place and are not likely to be reversed.

The Mental Health Parity and Addiction Equity Act, passed in 2008, requires insurance plans that offer coverage for mental illness and substance use disorders provide those benefits at the same level as medical and surgical procedures. The Affordable Care Act will require all insurance plans to provide coverage for mental illness and substance abuse disorders. Both pieces of legislation present behavioral health providers with the option of billing third-party payers for the services they provide—for some new sources of revenue to replace rapidly shrinking state and federal grant funds.

While some states oppose making changes required to prepare for the ACA, others are moving forward with Accountable Care Organizations and Health Insurance Exchanges. Treatment organizations need to stay on top of what’s happening in their states. Rather than “wait and see,” the best approach may be build capacity to bill for services, because no matter who gets elected, grant funds are not likely to increase.

States across the country have slashed funding, and we can’t assume that the federal block grants for mental health and substance abuse treatment are going to continue at their current level, especially with the “fiscal cliff” of tax increases and spending cuts looming ahead of us at the end of 2012 if Congress doesn’t act. It’s likely that we’ll see more cuts. Finding other sources of revenue will be even more crucial.

Aside from healthcare reform, other forces are driving change in the addiction treatment field. The Partnership at Drugfree.org recently reported that visits to physicians for substance use disorders, primarily opioid abuse, increased by 70% between 2003 and 2009. With an increase in the awareness of addiction as a treatable disease, more people will seek treatment from their primary care providers. Specialty treatment programs need to consider partnering with these providers, or addiction treatment may go the way of depression treatment–with most people seeking medication, and counseling becoming an ancillary service.

The health reform ball has been rolling for some time now for behavioral health providers. What happens in November may slow it down or adjust its course, but not stop it. Now’s the time to prepare.

Where are we with parity?

2012-10-15T10:49:00.000-05:00

This month marks the anniversary of the Wellstone and Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), signed into law on October 3, 2008. Behavioral health care providers welcomed this legislation. It requires group health plans that cover mental illness and substance use disorders to provide those benefits at the same level as medical and surgical benefits.

While MHPAEA was intended to eliminate unequal coverage and inequities in access to behavioral health treatment, providers and their patients continue to face challenges in making sure the law is fully understood and implemented.

Patrick Gauthier, Director of AHP Healthcare Solutions, addressed these issues in a recent presentation for NIATx, “Parity & Equity Compliance Checker: Disputing the Decisions that Affect Your Bottom Line.”

“MHPAEA was and continues to be an important victory for all Americans,” said Gauthier. “It’s as much a civil rights success story as it is an insurance reform. Viewed in relation to the Affordable Care Act…MHPAEA is our gold standard for behavioral health benefits. We should all be actively involved in its implementation and enforcement. That work must happen at the state and community levels.”

The October 15 issue of Alcoholism and Drug Abuse Weekly discusses problems with parity implementation in the article “Some payers still defy parity law with ‘fail-first’ and reviews.” Do you work with any health plans that fail to adhere to the federal parity law? If so, what action have you taken in response?

What makes a great conference?

2012-07-13T14:26:00.000-05:00

The 2012 SAAS National Conference and NIATx Summit in New Orleans reminded me once again what makes a great conference: people, of course.

As always, the attendees at our conference helped make it great. Your dedication to the field and the clients you serve really energized the event. I’d like to thank you for attending and helping make this conference a success.

Other people helped make this a great conference, too. That includes the conference advisory committee, co-chairs, and members of the NIATx, SAAS, and Site Solutions Worldwide teams involved in the planning and execution of the conference: from choosing a location, to selecting and scheduling presenters and workshops, to producing the conference program, and just in general, taking care of the hundreds of details involved in hosting a national event.

In New Orleans, these teams and the Blue Crew once again came through with their characteristic flexibility, making quick adjustments behind the scenes when necessary-so if there was a glitch anywhere, you never knew it. This year's exhibitors presented another great array of products and services, and the staff at the New Orleans Marriott showed us the hospitality the city is famous for. And some pretty good food, too!

You can find the conference workshop and Deep Dive materials on the conference web page, along with details of next year’s event in San Diego, July 14-17. I hope to see you there!

Of course we want next year to be even better. So post a comment and let us know your thoughts. And again, thank you for attending.

Using a smartphone app to intervene before relapse into alcohol abuse: preliminary results

2012-03-12T17:08:00.001-05:00

ACHESS is a mobile phone-based relapse-prevention system that offers support to alcohol dependent people when and wherever it is needed. Developed at the Center for Health Enhancement Systems Studies (CHESS), of which NIATx is a part, the ACHESS smart phone app is now being studied in a randomized clinical trial.

CHESS Researcher Andrew Isham presented some initial findings on the study at the 2011 Medicine 2.0 Congress last September. Click here to read a summary of his presentation.

Interested in using ACHESS? Click here for more information on using ACHESS through the CHESS Health Education Consortium.

Process Improvement and Technology

2012-03-01T07:47:00.000-06:00

Process improvement increases efficiency, and so does technology. As NIATx Director Dave Gustafson pointed out in his January 23 blog post, communications technology is playing a bigger role in efforts to increase efficiency and serve customers better. Technology can help close the gap between the 20 million people in the United States who need treatment for a substance use disorder and the three to four million who actually receive it.

Kentucky River Community Care is one organization that is using both process improvement and technology to meet customer needs. This organization serves eight counties in eastern Kentucky, and was a grantee in the first NIATx initiative, Paths to Recovery. “Technology and process improvement go hand in hand in helping us adapt to the rapidly changing behavioral healthcare environment,” says KRCC Director Mike Kadish, who credits NIATx with helping his organization create a culture of change. Read more about KRCC’s innovations in the February 6, 2012, issue of Mental Health Weekly.

Building a Culture of Quality Improvement

2012-02-02T11:25:00.000-06:00

A few weeks ago we highlighted the great work being done at St Christopher’s Inn, a substance abuse treatment facility that has been working with NIATx from the very beginning. Through the years they have built a culture of quality improvement at their agency. David Gerber, Director of Counseling and Shelter Services, says, “…it becomes a part of you. I can be having a casual conversation with an employee who will come up with an idea and I will say "Hey that sounds like a NIATx process improvement", and we will get to work on something.“

Another long time NIATx member, Denver Health, was featured in the January 23, 2012 edition of Alcoholism and Drug Abuse Weekly. Denver Health has used NIATx along with the Toyota LEAN philosophy to improve services throughout the organization. NIATx improvement projects have increased the 90-day retention rate in Denver Health’s methadone clinic; increased admissions of HIV clients to substance abuse treatment, and helped women in the detox unit get access to prenatal care.

Lisa Gawenus, Associate Director of Signal Behavioral Health, the managed services organization that distributes public addiction funding dollars in Colorado, said in the article, “A lot of times performance improvement can lead you into a quagmire of work, but [NIATx] is a data-driven method that's manageable. Denver Health has done really well in instituting a process improvement culture.”

Read more about Denver Health and their change projects to increase admissions of HIV positive patients and to help women in detox gain access to prenatal care.

How have you used the NIATx model to improve systems across your organization, beyond access to and retention in treatment?

Interactive Health Communications (their present and future)

2012-01-23T15:17:00.001-06:00

It wasn't long ago that cell phones were considered innovative and that personal computers were the center of an individual's access to information and communication technologies. More recently, the field has grown so much that that it has become a major focus of research and development. As a result one of the most respected journals in the health systems research field is the Journal of Medical Internet Research. We now can be confident that computers can improve quality of life and some data suggests it can reduce the costs of care and improve clinical outcomes.

The capability of smart phones continues to increase. Features such as GPS, accelerometers, two way cameras, light sensors, fuzzy matching, optical object recognition and sound are continuously improving. Further more, add-ons make it possible for a smart phone to be able to read bar codes and RFID chips. And the increasing brute strength of smart phones, tablets, and data services will reach the point that they function as fast as one's home computer.

Recently health and healthcare have become a prominent focus for developers of apps for smart phones. Specifically, more and more apps are being produced to help people deal with their health needs. By November 2011 nearly 13,000 health apps were available for smart phones, many related to substance abuse and behavioral health more generally.

Of course, quantity rarely equals quality. And because of the wide variation in quality, it has become hard to differentiate good from bad, useful from harmful. The old Latin expression caveat emptor is very important in this context where they may be a lot of good stuff out there but it is very hard to find. In fact we completed a randomized clinical trial a few years ago where we compared breast cancer patients with access to the Internet to patients without it. We found that if anything, Internet users did more poorly than those who had no such access.¹

In a sense, it makes sense. When you go to the Internet, you're faced with myriads of websites that offer conflicting information and operate in very different ways. Feelings of frustration, fear, anger and uncertainty are close to the surface. Smartphone and tablet apps can bring on the same feelings.

Computers (including tablets and smartphones) can be frustrating in and of themselves. But here, unlike the Internet, there is hope for the future. As those of you who know me already realize, I am older than dirt. Three years ago I had a heart transplant. The anti-rejection drugs that I take have had two side effects. First I am getting cataracts from the Prednisone. Second, my hands tremble from the Prograf. Believe me I am very happy to have these minor inconveniences rather than the alternative. But they do have implications for smart phone use. First, it is hard to see the small screen and second, it is hard to type in messages. Of course if you are young, you probably don’t have these problems, but many of us do.

The exciting thing is that the world is changing. Smartphones are very close to being completely navigable by voice. Apple's Siri is a recent example of how close we are. And text-to-voice lets users listen to content rather than just ready it. And sensors (many already built into the smart phone – like GPS, accelerometers, cameras, etc.) now allow us to measure the quality of sleep by putting the phone under the mattress, identify if you are approaching a favorite bar with GPS, measure your heart rate with the camera, etc. Right now they are pretty accurate but in the near future they will be very good and just the beginning for what is to come.

Moreover, research is already demonstrating the power of computer apps. It is pretty clear that computer programs (including some apps) can improve quality of life, change behavior, improve coping, act as motivators and can provide emotional and instrumental support². What is less clear is how to distinguish the great programs from others, because no matter what problem you have, there really is an app for that.

So what can I tell you? Well, start out by being skeptical. Assume that most of the stuff you find is a gimmick, and commit yourself to being very careful before you buy. I just purchased an app to take my heart rate and blood pressure. I was excited because I had heard that such devices do exist. The description sounded good and it had a four-star rating out of five. So I downloaded it for just 99¢. It seemed like my only way to try it out. What the description did not say was that you used your standard way to collect the data (your home blood pressure monitor or by counting). So all it really does is store and display information that I put into the phone. What it does, it does well. But it was not what I had expected. I should have been skeptical when only 20 people had reviewed it. I should have read the description more carefully. I should have tried to find out whether the system had been tested. I should have read the reviews instead of just looking at the average rating score. Caveat emptor, after all.

But having said that, apps are not going away, thank heavens. The good apps and the more sophisticated programs like CHESS³ and TES⁴ , have been carefully reviewed and proven to be effective. In fact we currently have a research consortium where agencies are using A-CHESS for different purposes and jointly finding best practices for effectively implementing the technology. And there are many more great programs to come that will revolutionize our fields. We will know so much about a person and we will know it when it happens, not three weeks later. We will be able to intervene just in time. And the technology will be able to deliver care anytime and anywhere, with a consistently high degree of quality.

But one more caveat. We won’t be able to just take these innovations and plop them down in the middle of an existing treatment system. Agencies who have tried distance counseling know that the way you counsel when a person is in the same room with you is very different than if you are doing it by Skype or some other video communication system. Retraining may be needed. Incentives, policies and job descriptions may need to change. The scary part of this is that it may actually be easier to start from scratch than to get organizations to change. And there in lies the challenge. Do we want to be the buggy whip manufacturers of old or do we have the energy to lead the revolution?

Gustafson, D.H., Hawkins, R., McTavish, F., Pingree, S., Chen, W.C., Volrathongchai, K., Stengle, W., Stewart, J.A., & Serlin, R.C., (2008). Internet-based interactive support for cancer patients: Are integrated systems better? Journal of Communication, 58(2), 238-257. PMCID: PMC3144782
Gustafson, D.H., Boyle, M.G., Shaw, B.R., Isham, A., McTavish, F., Richards, S., Schubert, C., Levy, M., & Johnson, K. (2011). An e-Health solution for people with alcohol problems. Alcohol Research & Health, 33(4), 327-337. NIHMSID: NIHMS316851
Gustafson, D.H., Shaw, B.R., Isham, A., Baker, T., Boyle, M.G., & Levy, M. (2011). Explicating an evidence-based, theoretically informed, mobile technology-based system to improve outcomes for people in recovery for alcohol dependence. Substance Use and Misuse, 46(1), 96-111. PMCID: PMC3179272
Marsch, L. A., Grabinski, M. J., Bickel, W. K., Desrosiers, A., Guarino, H., Muehlbach, B., Solhkhah, R., Talfique, S., & Acosta, M. (2011). Computer-assisted HIV prevention for youth with substance use disorders. In Special Issue on Technology and Substance Use Disorders (Guest Editor: Marsch, L. A.) Substance Use and Misuse, 46, 46-56

NIATx: Quality improvement with staying power

2012-01-12T12:51:00.000-06:00

St. Christopher’s Inn in Garrison, New York, was among the first organizations to test whether the NIATx model could improve processes in substance abuse treatment settings. The Inn's Chief Operating Officer, Marianne Taylor Rhoades, got the Inn started by submitting a successful proposal for the first NIATx learning collaborative, the Robert Wood Johnson Foundation-funded Paths to Recovery. St. Christopher's was one of only ten selected out of the more than 300 proposals submitted.

St. Christopher’s first change project aimed to increase admissions by reducing time to return phone calls. A walk-through revealed the Inn's nationally advertised toll-free number went to a voice mailbox–that was never checked. And having all staff take lunch at the same time—leaving the phones uncovered—was contributing to missed calls. Within a month of correcting these issues with simple changes, the Inn saw increases in admissions and revenue.

That was back in 2003. Since then, process improvement has become part of the culture at St. Christopher’s Inn. Taylor Rhoades and David Gerber, Director of Counseling and Shelter Services, credit the NIATx model with contributing to the overall quality of the Inn's treatment services—and its recent recognition by the New York State of Alcoholism and Substance Abuse Services (OASAS).

In December 2011, OASAS for the first time released to the public a scorecard of all licensed chemical dependency treatment programs in New York State. Outpatient chemical dependency programs were ranked in 11 categories to determine program quality. St. Christopher's Inn was the only Day Rehabilitation Program in New York State to receive the highest scores (5 stars) in 9 of the 11 categories, signifying that St. Christopher's Inn is among the highest performing and most successful programs in New York State. In the 2 categories that SCI did not receive 5 stars in, the Inn met state averages. (View scorecard here.)

Congratulations to all the staff at St. Christopher's Inn!

We know that the NIATx model has become part of the way many treatment organizations “do business” – from the veterans of our first demonstration projects to those who learned about NIATx more recently, from a colleague or a visit to our web site. We’d love to hear from you! Send us a blog comment, an e-mail, or post on our Facebook page.

What gives the NIATx model staying power in your organization?

NIATx Year In Review - 2011

2012-01-06T13:23:00.000-06:00

The success of the NIATx model in substance abuse and mental health treatment settings sparked an increase in projects in other human services areas in 2011: aging, criminal justice, HIV/AIDS, and programs for pregnant and parenting women. NIATx also introduced process improvement to several state agencies in our home state of Wisconsin.

While we expanded to other areas of behavioral health and social services, in 2011 we continued to offer new programs and tools for our original customer, the substance abuse treatment field.

Read all about it in the NIATx Year In Review - 2011.

ACHESS: Using Smartphones to Prevent Relapse

2011-12-23T10:12:00.001-06:00

Arapahoe House, a substance abuse treatment facility in Aurora, Colorado is one of several organizations around the country implementing ACHESS, a relapse prevention smartphone app. The app, created at the Center for Health Enhancement Systems Studies, of which NIATx is a part, offers support, information and other resources to patients leaving residential care.

This article from the Denver Post highlights the use of ACHESS at Arapahoe House.

Currently, agencies that are members of the CHESS Health Education Consortium have access to ACHESS. Click here for more information on ACHESS or the CHESS Health Education Consortium.

Spark change in your organization: Think weird

2011-12-16T14:57:00.002-06:00

Sometimes even innovative organizations hit a change plateau.

Read about some "weird but proven ways" to kick start change and challenge attitudes in your organization.

Weird Ideas That Spark Innovation.

And watch this TED talk for ideas on how to make your PowerPoint presentations really come alive:

http://www.ted.com/talks/lang/en/john_bohannon_dance_vs_powerpoint_a_modest_proposal.html

Don Berwick: Possibility for change has never been greater

2011-12-09T15:06:00.001-06:00

Don Berwick, former administrator for the Centers for Medicare & Medicaid Services, spoke at this year's Institute for Healthcare Improvement's National Forum. He shared his thoughts on the future of health care and health care reform. You can read a summary of his comments at boston.com.

You can also listen to an interview with Don on Boston NPR.

The hand-off: A hands-on approach to client transfers

2011-11-29T13:57:00.000-06:00

One area in the treatment continuum that often proves to be problematic is the system by which a client is transferred between levels of care: the “handoff”. Any number of things that may go wrong during the handoff can be disruptive to the client's treatment and can contribute to dropouts. In this sense, the handoff process is part of the NIATx aim of increasing continuation.

What happens when a person first calls your agency for help? Does a live person answer the phone, or is the caller directed through an endless cycle of automated prompts? The caller might talk first to a receptionist, who then might hand off the call to somebody else, who then might invite the caller to leave a voicemail message. How many different people does a client meet with during a first intake appointment? How many forms does the client have to complete during the appointment - forms that request the same information multiple times? Every transition from one level of care to the next in addiction treatment is a handoff that presents a potential interruption or even an end to the client's recovery journey.

Think about a system outside the treatment field where handoffs are smooth and efficient. Maybe it's the pit crew of a champion in a NASCAR race or the passing of a baton between Olympic relay racers. What makes them so good? How can you learn what makes them so good and use those ideas in client care transitions?

NIATx has several resources to help you with handoffs. Check out the Increasing Continuation Between Levels of Care promising practices on the NIATx web site. And make sure to read the article “Don’t Fumble the Treatment Handoff” in Addiction Professional magazine.

The Aha!s of Change: What we can learn from the McRib

2011-11-22T14:05:00.001-06:00

I find it difficult to clearly explain why it is so important to go outside the field for ideas on how to improve and how to get those ideas. So I am going to try again. One of these days I will get it right.

A lot of people are becoming pretty good at understanding the needs of their customers. The walk-throughs are being used pretty extensively as well as nominal group and focus group meetings. It is exciting to see that happening. And of course it is natural to say: "Well, now that we understand the problem, let's solve it.” I love rapid- cycle improvement!

But there is a risk that we will jump to an obvious solution. The obvious solutions are very likely to have been tried in SUD before. And they may have worked, or they may have worked a little, or worked a lot for a while and then stopped working. So it probably does not hurt to take a one-hour detour to cast a wider net for solutions. Where do we find those solutions? From concepts and problem-solving efforts of people who are tackling a similar problem but in a different industry.

Suppose we were trying to find a way to get people to keep coming back for treatment. What other industries worry about getting people to come back on a regular basis? Lets think out of the box for a second. Well, there is television. They try to get us to come back to their shows. And there are fast food restaurants. Of course there are many others. But let's go with those two for a minute.

We have found the industries. Now we need to find the best of the best in those industries. In many cases they will be obvious. In fast foods, it is probably McDonalds. They must invest enormous amounts of effort in getting people to return. How do they do it? One of us knew the head of marketing for McDonalds, but you could just as easily google. For instance, I googled "How does McDonalds get people to return?" I found millions of responses because many people have studied McDonalds. One thing that comes up over and over again in the few summaries I read was that they segment their customers and find out what those people respond to. Then they target those things people respond to.

The first article pointed out the McRib. Its nutrition is terrible and a lot of people hate it. But a big segment (typically young guys) of their customers really like it. So what? Well, McDonalds thinks about what would bring those people back. They hit TV programs with a young guy who is going on his honeymoon and he gets a text from a friend saying McRibs are back. For a few seconds he debates whether he wants to go on his honeymoon with this wife watching, perplexed.

What can that story tell us about how to keep our patients coming back? McDonalds would say that one size does not fit all. In our field some may respond to threats, others to reminders, others rewards, etc. But rarely do the same things work for everyone. What if we began to create a database of what our customers respond to? Try some things, see what happens, and then put those results into the database, so we know what to try (or not try) to get each person back.

How long would it take to: 1) Identify other industries that deal with a problem similar to ours? 2) Identify one of the best organizations at solving that problem in that industry? 3) Ask Google Scholar to identify what makes McDonalds (or whatever) so good. 4) Read at least the abstract of a couple of articles. 5) Ask, “What is it that they do that could be helpful for us?”

I would say one hour, two at most. I think it’s worth it.

More info, fewer clicks: the NIATx website update

2011-11-09T13:39:00.000-06:00

The NIATx principle “understand and involve the customer” has helped guide the latest redesign of our website. What have we heard from our website customers? Frequently, we hear that www.niatx.net has tons of great resources—but they’re sometimes hard to locate. With that in mind, we’ve made a few changes to help you find what you’re looking for in just a click or two.

First, take a look at the home page. Mouse over any of the choices on the blue menu bar and see what pops up—a new menu that gives you a bigger, brighter picture of what’s behind each tab. Check out the reorganized Resource Center content. We revised the headings to guide you more quickly to some of our most popular content.

The NIATx story database, another feature on our website, now contains over 800 entries from organizations across the country. This is the place to go for inspiration, ideas, or tips on how to implement a particular promising practice! We’ve improved the search and sort features so you can more quickly find the stories that will help you the most.

Be sure to visit the NIATx Health Reform Resources page. It contains information and resources that participants in our recent health reform collaboratives have added. Along with a cleaner design, you’ll find a feature that allows you to filter results by project source, category and keyword.

We hope these changes help you navigate the site easier. Let us know how it’s working for you by emailing webmaster@niatx.net.

The Aha!s of Change: What I've Learned Over 50 Years In Organizational Change

2011-11-04T15:25:00.000-05:00

Someone recently asked me the key things I have learned over nearly 50 years of working and studying organizational change. At my age, I am surprised that I remember. And in fact I bet I have forgotten many important things and elevated others that don't deserve to be. Furthermore, in thinking about the answers to the question I have come across some contradictions that confuse me.

I am starting this series because I would love to hear what you have learned and how it fits or competes with these. So I hope you jump in and question, argue, and tell me where I am full of it. Lets start today with one of them. Change teams.

A lot of folks think the change team is a key to success. It probably is but the literature and my experience suggests there are teams and then there are teams. What I have learned is that if everyone is in charge, no one is in charge. Andre Delbecq (one of my heroes) studied innovation in Silicon Valley. He found that teams of the really successful companies do it this way:

First, a team leader is chosen and this person is influential and respected. But interestingly, that team leader is personally responsible to make this project be successful and he or she is given the personal autonomy and resources to make it happen.

Second, the team leader is given the authority to pick the team members with the restriction that they, like the leader, must be passionate about the project. The team’s job is to help the team leader accomplish the goals. In several ways this is very different from typical views of teams where the team is the key instead of the leader and where the team has a central role in decision-making.

Third, the team is not held responsible for the success of the effort. So the organization is on the line (by giving resources and authority) and so is the leader. I think it makes for a very different dynamic.

Now for the contradiction. I also really believe it is important to engage the skeptics, but that is not mentioned a lot in what I have read about Silicon Valley. How can only the passionate advocates be on a team? Where do you get the reality testing? To some extent these issues are addressed in other ways that I will talk about later. So rip me apart. I love the pain.

Budget Cut Survival Skills

2011-10-27T08:01:00.000-05:00

Maureen Fitzgerald, NIATx editor, gave me a copy of the last issue of Alcoholism and Drug Abuse Weekly with a note saying “Why don’t you blog about this?”. It was attached to an article on Washington state’s budget proposal to eliminate adult substance abuse treatment funding. My first thought was, “Why would I want to write about more depressing state budget news? Everyone knows about that already.” But as I gave it more thought over the weekend, I decided maybe she was right.

First, Washington is not the first state to propose drastic cuts. Almost every state is facing similar problems and proposing similarly draconian solutions. Providers in Illinois, Maine, and other states have fought off huge cuts in addiction treatment budgets through advocacy and finding other places in state government administrative costs that made more sense to cut. So the first thing to do is know your state budget and get to know your legislative representatives and make sure they know and appreciate you. Good advocacy is your first line of defense.

An equally important second line of defense is preparing for reduced government funding by diversifying revenue streams. Any business that is reliant on a single customer is vulnerable, whether that customer is government or General Motors. Over 70% of people who need treatment have insurance. They either are not seeking treatment or not seeking treatment from you. Many businesses are self-insured. If you can demonstrate positive outcomes and get their employees back to productive employment, they will use you over and over again. These are the obvious sources of new revenue. What are some less obvious sources that you have found?

Another important thing to do is to streamline and automate to reduce costs. This is what NIATx teaches. Maybe you have done a few changes to reduce wait times or increase retention. If you have only partially adopted process improvement or only done a few projects, it’s time to dig in and look at every process at your organization and ask “How can we simplify? Is it possible to automate this and how cheaply can we do that?”

It's hard to think about the second line of defense when you are freaking out about the first. But you can't neglect potential revenue streams or cost reduction if you are going to ride this wave of change in the funding environment. NIATx has developed some resources to help you in these tough budget times, including the NIATx Third-party Billing Guide and new Promising Practices related to increasing reimbursement.

Let us know the creative ways that you have managed funding transitions. I know there is a lot we are missing sitting here in our ivory tower and it would be great if those of you who have been managing budget cuts since 2007 had some words of wisdom for the folks in Washington and other states who may be experiencing their first year of panic.

Data Is Your Friend!

2011-10-20T09:44:00.000-05:00

When you're conducting a change project, it's easy to get swept up in the excitement of developing and testing different changes. It's crucial to remember that what you are ultimately seeking is a new process that will not only be a change from the old way of doing things, but an improvement on it.

Through data collection and analysis you can determine whether the change you are testing is actually an improvement, or if it's just a different way to get the same unsatisfactory outcome.

Collecting data may sound like a complex process, but we've developed some resources to help. The How to Collect Data page on the NIATx website is a great resource that includes a step-by-step guide to data collection. And the NIATx Tracking and Measuring Tools provide a set of data collection forms and spreadsheets that help you track, evaluate, and graph your data.

Ready, Aim, Improve

2011-10-13T13:51:00.000-05:00

If you plunge into a change project without first defining your aim, you and your team are likely to flounder. It's like setting out on a road trip with no clear idea of your final destination. If you have only a vague notion of where you want to end up, you can waste a lot of time and a lot of gas and may decide to just turn around and go home.

A good aim statement keeps you focused on the process you want to improve. It's something you can return to throughout your project, especially when you and your team find yourselves drifting away from your targeted aim.

A good aim statement is specific. It should answer two questions: What are we trying to accomplish? And how will we know if the change is an improvement?

Here's an example: Reduce no-shows to assessment appointments by 50% from an average no-show rate of 80% to 40% by February 1, 2012.

Remember, the aim statement guides your entire change project.

How has a good aim statement helped you and your teams make progress toward your targeted aim?

Check out the Top Ten List for aim statements from the MD Anderson Cancer Center at the University of Texas: http://www3.mdanderson.org/streams/FullVideoPlayer.cfm?xml=perfImp%2Fconfig%2Fcs138_CFG

Using the walk-through in nursing homes

2011-10-06T11:02:00.001-05:00

NIATx is participating in a collaborative research program to help older people live independently and stay in their homes.

Named the Active Aging Research Center, this program is funded through a grant from the federal Agency for Healthcare Research and Quality (AHRQ), whose mission is to improve health care for all Americans.

Key NIATx tools like the walk-through will play an important role in this program. I found the following 2-minute video an interesting example of how one man is using the walk-through to help him design better nursing homes.

http://www.wmtw.com/video/29191411/detail.html

Rapid-Cycle Testing and PDSA Cycles: Not the Same Thing

2011-10-03T13:23:00.000-05:00

What does "rapid-cycle testing" mean to you? One of the five NIATx principles, rapid-cycle testing gives change teams a way to try out change ideas to see how they work.

I was at a wrap up session of a learning collaborative last week and one of the participants said, "We did PDSA but we didn't do rapid cycle and I think that was our problem". I think she was right. They did their change projects using a Plan-Do-Study-Act method, but they selected changes that took a long time to complete and measure and did not break them down into "small bites" (her own words).

Have you taken too big a bite in a PDSA Cycle only to find that you weren't doing rapid-cycle change at all? How did you regroup? Coaches, what do you do to help people make sure they are making their change cycles small enough to be done in a rapid-cycle way?

Medicine 2.0: technology transforming health care delivery

2011-09-22T12:43:00.000-05:00

Last week I attended the Fourth World Congress on Social Media and Web 2.0 in Health, Medicine and Biomedical Sciences, also known as Medicine 2.0. This conference, held at the Stanford University School of Medicine, brought together some of the world's leading experts in using social media and mobile applications to create new ways of delivering health.

How can we use the Internet and social media to improve health as well as patient-caregiver relationships? I came away with loads of ideas to try out with mobile applications like A-CHESS that NIATx is developing.

One recurring theme throughout the conference was how much patients, no matter what their health condition, benefit from networking with others. Social media tools like Facebook and Twitter have become new tools for building the social support patients need. Some other new applications that you'll be hearing about include Google + and www.patientslikeme.com.

This innovative conference also introduced me to some new technologies that transformed my conference experience. We hope to give you a sample of the same at the 2012 NIATx Summit/SAAS National Conference - next year, your Summit conference badge might also be the conference program!

It is becoming increasingly evident that our prediction is true: wireless devices (smart phones, tablets and sensors) will play a critical, even revolutionary role in health care in the future. We look forward to working with you to collaboratively set the future for our field by embracing these technologies.

Recovery Month 2011: No one should have to suffer twice

2011-09-14T10:35:00.001-05:00

September, National Recovery Month, (http://www.recoverymonth.gov/) celebrates people in recovery and the treatment providers and support groups that help them.

For NIATx, Recovery Month underscores our mission to help treatment providers remove barriers to treatment and recovery. Recovery Month reinforces our belief that no one should have to suffer twice: first from a chronic disease such as addiction, and again by not having access to appropriate treatment.

One of our newest projects is developing a smartphone application to help people maintain recovery. Click here to watch a video about this project.