Get Started

The Quick Start Roadmap for System-Level Change provides a high-level overview of the components of process improvement at the system-level.

Note: Click the boxes in the Roadmap to navigate to that section of the toolkit.

system level toolkit road map diagram leadership Payer-Provider Partnerships System-Level Change Projects Performance Management Provider Change Projects Spread Improved Outcomes
Download a PDF version of the NIATx Quick Start Roadmap. Add to portal

Leadership Team

At the beginning of your system-level improvement project, it’s important to clearly identify the project team and the roles of each team member. Identify an Executive Sponsor (often the SSA Director), a system-level Change Leader, a data coordinator, a financial coordinator, and other key system-level team members. It’s also important to identify key representatives of the provider community and other key stakeholders—funders, policy makers, etc.

Payer-Provider Partnership

Once you have constructed the system-level leadership team, convene a process improvement collaborative that includes provider organizations from across the system. Select and recruit participants and then gather together to identify improvement opportunities at both the system and provider levels. Use this opportunity to establish the foundation for ongoing collaboration by assigning providers coaches, by planning communications, and by creating a collegial atmosphere.

System-Level Change Projects

At the system level, provide process improvement education and training and begin to work with a process improvement coach with system-level experience. Make system-level changes to improve the areas that the system leadership team and the collaborative have identified as barriers to access and retention: regulation and licensing, paperwork, contracting and incentives)

Provider Change Projects

Help develop the process improvement capacity of providers by providing process improvement education and training, targeted technical assistance, and by facilitating an ongoing process improvement collaborative. Support and encourage provider-level changes.

Performance Management

Improve the system-level data system to support process improvement by enabling ways to gather, analyze, and report on access and retention measures. Start using this data for process improvement and provider feedback.


Once you have a cadre of experienced successful organizations, it is time to begin spreading process improvement to the whole system. The successful agencies can become the sales force for your efforts. Have them share their stories at conferences and at provider association meetings. They can help recruit new providers to your learning collaborative and they can act as peer mentors for people just beginning.

Improved Outcomes

Research suggests increased access to and retention in treatment contributes to the improvement of both primary and distal outcomes for clients and provider agencies.

Where Do I Begin?

The STAR-SI program and other NIATx initiatives attribute much of their success in making and sustaining system changes to the following factors:

The organizational assessment that follows can help you determine if these key components are in place for your Change Project. Your state may have already implemented payer/provider partnerships. Your next step may be to examine internal systems. There may be regulation or data collection issues that you can improve at the state level.

A learning collaborative that encourages participants to share their failures as well as their triumphs will also support your systems change effort. What strategy will you use to build your learning collaborative?

No matter where the assessment directs you to start, remember that a strong payer/provider partnership is the foundation of your improvement effort. By collaborating with provider agencies, you can maintain the focus on provider-level process improvement while addressing state- or system-level barriers to access and retention.