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Use of change teams in improving substance abuse

treatmentKatherine J. Riley, Ed.D.1

Eldon Edmundson, Ph.D.1

Gwyneth M. Moya, M.P.H.2

1Public Health & Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., CB669, Portland, OR 97239 Contact email: rileyk@ohsu.edu

2Robert Wood Johnson Foundation, P.O. Box 2316, Princeton, NJ 08543

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SettingNetwork for the Improvement of

Addiction Treatment (NIATx) – collaborative of the Robert Wood Johnson Foundation and the Center for Substance Abuse Treatment Project goals: increase client access and

length of treatment Participants: 49 agencies throughout the

US; this study focuses on preliminary findings from 23 agencies over first 18 months

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Intervention componentsExecutive sponsorshipFormation of change teams – focus of

this studyChange leadersCoachingLearning collaboratives (conferences) Interest circle callsWebsite with resource information

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MethodsData source: Interviews

TimingAnnual visitsQuarterly phone calls

Who:Executive SponsorsChange LeadersStaff membersFocus groups

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Methods, cont.Analysis:

Coding of statements using Atlas.ti software

Qualitative identification of themes

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QuestionsHow did the change teams function?

What influence did the change team have on the agency?

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Results: 1. How did the change teams function? Characteristics of successful teams Team members include wide representation

“Two or three change team meetings ago, we decided that if we do a change that's going to involve a certain person in clerical we're going to bring that person into the change team meeting so we eliminate any communication difficulties. We've decided to do this after realizing that we weren't communicating very well.”

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Team process followed predicted patterns Forming Storming Norming“The other piece of this meeting is that we

just naturally evolved to make sure that everyone is heard. We go around the table and everyone takes a turn and everyone has an equal and valued voice.”

Performing Adjourning - celebrations

Spirals - negative or positive

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Change team leadership facilitated or hindered change The change leader is given power and has

influenceChange teams made key decisions

A champion needs to support the team

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“One problem they encountered was that they tried to do too many changes at once, so they didn't know what was working. Also, the first change leader was not as directive and "out there" as the later change leader. If there was conflict, the first change leader would shy away. The second change leader didn't have that problem but had "other problems." Now they have picked a small core group of people to work on changes. They say "here's the problem we discussed together" and then the Executive Sponsor makes the decision about what to do. This has worked better “

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Appropriate changes are selected Developed from the client’s perspective

“When they first received the grant and found out what they were going to do, she called the agency to see what it would be like to be a client calling to request services and the phone ran for a long time. This opened their eyes to take a look at things. They kept meeting and listening to other people and learning from them. This has helped them take a look at what they are doing.”

Based upon data Focused Time-limited Small number

(usually 1 at a time)

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The team prevents negative spirals“The Change Leadership was cognizant that the

changes made needed to be monitored to ensure that staff did not revert to previous practices. Experience had proved that staff occasionally "slipped" and started doing things the old way. Monitoring efforts corrected for this problem, as well as highlighted changes that needed further modifications. Finally, the Change Leadership also underlined the importance of holding regularly scheduled change meetings in order to sustain the team's focus and momentum.”

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2. What influence did the change team have on the agency?Communication is critical: : The rest of

the organization needs to buy into the change Communication within the agency is

necessary“Management has communicated with staff

through email, the website, the change teams and other staff meetings. There probably isn't a meeting where we are not talking about it. Minutes from meetings are distributed and placed on the website.”

External communication is helpful

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Culture change within the agency changed its operation and philosophy

“A year later, she feels staff agency-wide have embraced the project or at least the site directors at each site have. She reported that each site director/manager receives minutes of the Change Team meetings and that they read them and write back if they agree or disagree or have suggestions. She also felt that the grant involved a lot of line staff which would not have occurred with changes being studied and/or implemented by CQI. The agency’s' CQI committee is made up of senior managers - all of the site managers/directors and no line staff.”

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Future directions: The team seeks new challenges Changes are sustained

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Pitfalls to be avoided The wrong people are on the team

Wrong people in wrong role? Things are going badly—is it a spiral?

Change task is ambiguous or diffuse Too many changes

The change leader may have the power but not the influence

The rest of the organization does not buy into the change

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“One problem they encountered was that they tried to do too many changes at once, so they didn't know what was working. Also, the first change leader was not as directive and "out there" as the later change leader. If there was conflict, the first change leader would shy away. The second change leader didn't have that problem but had "other problems." Now they have picked a small core group of people to work on changes. They say "here's the problem we discussed together" and then the Executive Sponsor makes the decision about what to do. This has worked better.”

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Pitfalls, cont. Data is not used to make decisions The team becomes bored Changes are not sustained

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Conclusions:

The use of change teams can be an effective strategy to increase substance abuse treatment agency effectiveness in improving client access and retention.

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Questions to ask about your own team 1. How do we handle leadership/facilitation in

the group?

2. How do we finalize decisions? (majority vote, consensus, power block, etc.)?

3. Do we use each other's expertise and resources as well as possible?

4. Are conflicts identified? Are there major sources of disagreement?

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5. How do we resolve conflicts/disagreements?

6. What factors help us?

7. What improvements can we make in our team?

8. What other observations and experiences of our behavior are important for us to recognize?

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