Payers have employed numerous strategies for spreading process improvement. These strategies include:
Many states have offered agency-based educational training, including Understanding Process Improvement and the NIATx Change Leader Academy, to orient new agency Change Leaders in the methods of process improvement. Other states have offered peer mentor training, where experienced agencies that have been successful in adopting process improvement visit new agencies to share insights. And, still others conducted NIATx Coach Academy training, where promising candidates are trained and certified as NIATx process improvement coaches.
States have also included NIATx process improvement training in existing training sessions that are regularly offered to providers and have even worked with local colleges and/or community colleges to integrate NIATx into their curricula. For example, Oregon added a process improvement component to their CADC 2 Supervisor Training.
In addition to training, it is important to “get the word out” about process improvement throughout the system. This can be accomplished by developing and sending newsletters that communicate the importance of process improvement and keep stakeholders apprised of relevant events. Most states hold some type of annual meeting for providers, which provides a great setting to incorporate reports from agencies who have process improvement success stories to share. Finally, spreading PI concepts to the prevention community and other community advocates for addiction treatment can be an effective way to reach out to individuals and organizations that may be new to process improvement.
Training and diffusion based strategies are discussed in Spreading Change at the Provider Level.
Payers may also leverage their authority in overseeing their provider networks to encourage the spread of process improvement. Some states have established incentive based contracts and/or pay-for-performance reimbursement systems that establish standards for key access and retention measures. The NIATx model of process improvement is increasingly viewed as an evidence-based management practice that can be built into state licensing rules or requests for proposals (RFPs) for state funding.
Just as it is important to have a designated Change Leader at the provider level who is responsible for enacting change, payers (states, etc.) should also appoint a coordinator who will manage the spread of process improvement. This coordinator may work to actively spread process improvement through other state agencies as well as other with system stakeholders, including fiscal intermediaries.
States and payers generally collect information from providers that can serve as the basis for system monitoring and improvement. It is important to provide IT support and data collection and analysis, as well as performance feedback reports that allow providers to monitor their progress on key system measures.
Contracting and licensing strategies, organizational strategies, and information systems strategies are further discussed (along with examples) in Spreading Change at the System Level.