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Resource Center > System-Level Toolkit > System-Level Change Projects > How to Use the NIATx Model at the System Level

How to Use the NIATx Model at the System Level

Five key principles guide the NIATx model. Research conducted in Europe, the United States, and Canada generated a list of 80 factors critical to fostering change (Gustafson and Hundt, 1995 Add to portal). Tests for statistical significance revealed that only five of these factors consistently influenced efforts to overcome barriers to process improvement.

1. Understand and Involve the Customer

This is by far the most important factor. Do not assume the customer’s needs are known or are being met. Actively involve the customer in the development of the improvement. Make sure the improvement is noticeable to the customer and that it will meet one of the customer’s key needs. Survey customers on a regular basis. Educate customers about new improvements.

At the state or payer level:

  • The customer is the addiction treatment provider agency—and particularly the CEO/Executive Director. Each agency’s director of treatment, finance, and quality control/MIS data are also key players.
  • If there is no mechanism for cooperation and collaboration with the providers, establish one as soon as possible, particularly in the areas of substance abuse services and accountability or performance management.
  • Understanding the customer includes assessing providers for readiness for change. We strongly recommend using a tool to measure readiness for change and not to waste time and effort trying to recruit providers who are not ready for change.
  • The needs of provider agencies vary and it may help to differentiate between those needs regarded as basic and those that may regarded as goals for future improvement. For example, providers would regard organizational survival as a basic need, while process improvement may not rank high on the “need list,” but may be regarded as a goal.
  • The SSA may be able to convert a goal into a need. For example, the SSA could set client or process outcome objectives as grant or contractual requirements or as elements of performance funding.
  • Identify providers who have truly embraced client or process outcomes as basic organizational needs. If at all possible, use these providers to help diffuse the NIATx model of process improvement throughout the system.

2. Fix Key Problems

What is keeping the CEO awake at night? Our research indicates that it is crucial to select a project that addresses a key organizational goal. If the project can help CEOs sleep better, they will actively support the project and do everything in their power to make the project a success.

The SSA should undertake Change Projects that are most important to:

  • Providers
  • The SSA’s supervisor and major funders
  • State policy makers

The SSA should ask each provider CEO to list the two state-level changes that the CEO would make should he or she become the SSA. The SSA should then use the NIATx model to address the priority state-level changes. If the changes cannot be done because of policy or legal reasons, the SSA must make sure that the providers are thoroughly convinced of the SSA’s helplessness in this regard. Projects undertaken to satisfy the SSA’s supervisor, major funders, and policy makers must also be related to one or more primary needs of the providers.

3. Pick a Powerful Change Leader

If you want to improve something, the person in charge of improving it must have power, prestige, and influence in the organization. They must also understand and respect the needs of the staff members (internal customers) who will be involved in the implementation process. Change Leaders with inadequate time dedicated to their role are not as effective.

  • Recruit a Change Leader from existing SSA staff.
  • The Change Leader must be in the position of having power, prestige, and influence not only in the SSA but also among the providers. The Change Leader must also have a record of accomplishment, particularly in managing projects, performance management, budgeting, and quality improvement.
  • The SSA must reallocate tasks to allow the Change Leader adequate time to devote to leading the system-wide change projects.

There are additional areas that should be represented on the Change Team:

  • The SSA’s information technology staff
  • The state treatment coordinator and his or her team

The SSA Change Team should be highly functioning and stress situational leadership.

4. Get Ideas from Outside the Organization and Field

This doesn’t mean that outsiders or experts have all the answers; rather, it draws attention to the importance of learning from others’ successes and failures. Looking outside the organization is an efficient way to find fresh ideas—the kinds of ideas that lay the foundation for a tailored and truly innovative improvement.

5. Use Rapid-cycle Testing

Pilot test all changes with clients to make sure they really are an improvement and that they make things better for the staff. Do not implement changes on a large scale until you have tested them on a small scale and know they work. This process often requires several tries or cycles before all the bugs or errors are resolved. This is common—rarely is a change perfect upon the first try.