Glossary

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A

Access

Ability to enter the treatment system.

Administrative practice

Processes that related to office procedures that are not performed by clinical staff.

Admission

The point at which paperwork is completed to admit a client to treatment.

Agency, provider, site, organization

Used interchangeably.

Aim, project aim

Answers the question: what are we trying to accomplish?

Aim, measure

Answers the question: how will we know if a change is an improvement?

Aim statement

Specific to a project and describes the aim you expect to achieve. It sometimes includes a baseline and target measure for the project. Example: Reduce no-shows to assessment appointment from 40 to 25 percent.

Assessment

Determination of the need for treatment and if yes, the appropriate level of care; sometimes called evaluation.

Attendance

The number of people who actually show for a group or individual session, often compared with the number that were expected.

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B

Barriers

Reasons that might keep a client from attending an assessment appointment or treatment sessions.

Baseline measure

The data collected for the aim or cycle measure for the period of time prior to making any changes.

Bottom line

The difference between revenue and expense.

Business case—provider level

Refers to the impact of process improvement on the organization as it relates to financial performance, staff retention / workforce development, or strategic intent. Often used to refer to the “bottom line,” the difference between revenue and expense.

Business case measure—provider level

The measure that a change team uses to evaluate the impact of process improvement on the business of the organization. Example measures: the bottom line, (the difference between revenue and expense), staff turnover rate.

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C

Change cycle

Change cycle and PDSA Cycle are used interchangeably.

Change Project—provider level

Defined by one aim, one level of care, at one location, with one population. If one of these specifications changes, the Executive Sponsor creates and charters a new project.

Change Project—state level

A process improvement initiative to promote a system change.

Change Leader

Appointed by the Executive Sponsor to provide day-to-day leadership, energy, enthusiasm, and coordination for Change Projects. The Change Leader’s work is reallocated so (s)he can dedicate adequate time to Change Projects. The Change Leader has the power and prestige to influence all levels of the organization. He/she motivates and inspires the team to fulfill the Change Project charter.

Change Project Form

The Change Leader and team members use the Change Project Form to document the plans for the Change Project and the actual changes made, along with the results.

Charter

The directive given to a Change Team, signed by the Executive Sponsor, specifying a Change Project’s aim, level of care, location, and population. It is the first page of the Change Project Form.

Change Team

A Change Team is a small group of employees appointed by the Executive Sponsor to identify business process barriers and determine and implement rapid-cycle changes designed to improve the process.

Continuation

This is a NIATx aim measured by the number of clients who attend four units of service (i.e., treatment sessions) within 30 days of their admission to treatment. The definition of a unit of service varies by level of care. For outpatient, a unit of service is a treatment session provided on a distinct date.

Client, patient, customer

Addiction treatment service recipients; used interchangeably.

Clinical practice

Processes that relate to how clinicians or counselors provide treatment.

Cycle measure

A measure that tells whether a change made during a particular PDSA Cycle was an improvement. The cycle measure may vary from one PDSA Cycle to the next, whereas an aim measure will remain the same for the entire change project. See Plan-Do-Study-Act (PDSA) Cycle.

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E

Engagement

A consumer's commitment to and maintenance of treatment. For NIATx purposes, engagement refers to continuation in treatment. See continuation.

Evidence-based practice

An administrative or clinical practice supported by research findings and/or demonstrated application that has proven effective at improving a specific project aim.

Executive Sponsor

The Executive Sponsor is a senior leader in the organization who is passionate about improvement and who “loses sleep” over issues that need change. In the NIATx model of process improvement, the Executive Sponsor appoints a Change Leader and Change Team and works to remove all barriers to the Change Project. He/she motivates the Change Team through encouragement, attending team meetings periodically, monitoring the progress of the team, and acknowledging and rewarding team efforts. The Executive Sponsor is often the Chief Executive Officer of the organization.

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F

First contact/first request for service

A client’s first call or visit to request service.

Flow chart

A drawing using a sequence of symbols connected by arrows. Each symbol includes a short statement about one step in a process. Flowcharts encourage an organizational focus on processes. They help identify bottlenecks, duplication, errors, and unnecessary steps; can describe a new or existing process.

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I

Intake

Collection of information to begin the assessment process.

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K

Key problem

An organizational problem that the Executive Sponsor wants solved.

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L

Level of care

A way to define treatment based on intensity, location, duration and assessment of a client’s needs for clinical support and/or medication. In substance abuse treatment, levels of care include detoxification, residential, inpatient, outpatient, intensive outpatient, and after care or continuing care. States define these levels differently.

Location

The specific place or office within an agency or site where a change project is taking place.

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M

Motivation

Readiness, willingness, and ability to change.
(from Motivational Interviewing by Miller and Rollnick)

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O

On-demand service

Service that is available when the client requests it. Also referred to as same-day service, walk-in service.

Outcome measure

The outcome measure evaluates the long-term impact of the Change Project for the client by assessing, for example, treatment continuation rates, employment, housing, etc.

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P

Payer

The entity paying for treatment services.

PDSA Cycle

The NIATx change model relies on the Plan-Do-Study-Act (PDSA) Cycle to turn a change idea into action. The PDSA Cycle uses a series of short rapid cycles, with each cycle from planning through implementation taking only a couple of weeks.

Population

A Change Project focuses on one aim, in one level of care, with one population, at one location. In this context, population describes the group of clients or the program where the change will be tested, i.e., pregnant women, adolescents, homeless adult males, etc.

Process

The structure or series of steps used to perform work.

Process improvement

Changing the way that work is performed so that it is more efficient and effective.

Promising practice

Administrative or clinical practice that has proven effective at achieving a specific aim, and holds promise for other organizations.

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R

Rapid-cycle change

Change on a small scale, rapid-cycle change allows a Change Team to try a change for a short period of time to see if it is an improvement. Sometimes referred to as “pilot test” or PDSA Cycle.

Referral source

The person or agency who recommends that a client to a particular treatment provider.

Retention

Keeping clients involved in treatment activities and receiving required services. See continuation.

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S

Same-day service

Service is available on the same day that the client makes first contact.

Site

See agency, provider, site, organization.

Sustain

The continuation of an improvement beyond a six-month period after implementation. Sustainability largely involves the concept of continuous improvement, where initial changes adapt and evolve as necessary to maintain the gain. Any change that reverts to the old work process is not considered to be sustained. Examples of sustainability would be embedding the process in policy and procedure manuals, orientation for new staff, etc.

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T

Transition

The movement of a client from one level of care to another.

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U

Unit of service

The measure of treatment service, which varies depending on the level of care. For outpatient, one unit of service is a treatment session on a distinct date.

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W

Walk-through

A walk-through is an exercise where staff members walk through the treatment processes just as a 'customer' does.

Wraparound services

Services provided in addition to substance abuse treatment, which may include for example, finding and arranging for housing, employment and/or childcare.

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