The Five Principles

Research conducted in Europe, the United States, and Canada generated a list of 80 factors critical to fostering change (Gustafson and Hundt, 1995).

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
2. Fix key problems; help the CEO sleep
3. Pick a powerful Change Leader
4. Get ideas from outside the organization or field
5. Use rapid-cycle testing to establish effective changes

1. Understand and involve the customer

Understanding the customers' needs presents a challenge to the field of substance abuse treatment. With budget constraints and high staff turnover, treatment agencies face pressure to treat more patients with fewer resources. Therefore, customer involvement may be perceived as a luxury that organizations cannot afford. However, taking the time to involve customers, get their reactions to and advice about improvements, and prepare them for anticipated changes are all ways that substance abuse treatment agencies can better meet their customers' unique needs.

Successful companies that are committed to understanding their customers typically:

• Assume they do not know what their customers need and actively involve the customer in the improvement process;
• Ensure that the customer sees the improvement as significant and that it meets the customers key needs;
• Survey customers on a regular basis; and
• Educate customers about new improvements.

2. Fix the key problems (and help the CEO sleep at night)

Which problems keep the executive director awake at night? Research indicates that focusing on key organizational goals in a change project is crucial. If the project addresses problems that concern the executive director, she or he will actively support the project, helping to make it a success.

3. Pick a powerful Change Leader

Effective Change Leaders have authority and respect from their colleagues, as well as the time to dedicate toward improvement activities. The Change Leader needs to have sufficient influence in the organization so that he or she feels confident calling the CEO anywhere, at any time, when faced with a problem. A powerful Change Leader, furthermore, needs the organization's leadership to demonstrate enthusiastic commitment to the goals and processes required to make process improvement part of their organization's culture. When the CEO authorizes and supports a Change Team and its efforts, she or he increases their probability of success.

4. Get ideas from outside the organization or field

Because of the unique population that addiction treatment agencies serve, examining ideas and practices from other fields may seem unrealistic. What could addiction treatment centers learn, for example, from the hospitality industry? However, observing how a hotel with excellent customer service engages and schedules customers reveals relevant principles that can lead to new and effective changes. Simply put, organizations that look to other fields for fresh ideas are more likely to succeed. This does not imply that "outsiders" have all the answers, but it highlights the importance of learning from others' successes and failures. Looking outside the organization is a way to find fresh ideas that can lay the foundation for a truly innovative improvement.

5. Use rapid-cycle testing to establish effective changes

The last key principle is to use rapid-cycle testing to examine changes carefully before putting them in place. In rapid-cycle testing, staff implements an idea on a small scale to see how it works. The Change Team tests the change, modifies it, tests it again, and continues this cycle until the change meets the needs of customers. Only then does it become a permanent change.