Network for the Improvement of Addiction Treatment

The Network for the Improvement of Addiction Treatment (NIATx) is a community of drug and alcohol treatment centers that apply process improvement strategies to the management and delivery of addiction treatment services. In this entry, the development of NIATx is described, basic principles of process improvement are outlined, and initial evaluation results are summarized.

NIATx began in 2003 as a public-private partnership through the Robert Wood Johnson Foundation's Paths to Recovery program (Paths) and the Center for Substance Abuse Treatment's (CSATs) Strengthening Treatment Access and Retention (STAR) initiative. Ten Paths awards and 13 STAR awards were coordinated and integrated through the National Program Office at the University of Wisconsin (David Gustafson, director), and a second round of 15 Paths awards were added in 2005 (one additional treatment center participated without an award). The goal is to treat alcohol and drug disorders more efficiently and effectively.

Process improvement strategies were originally developed to reduce error and improve product quality in manufacturing settings and were based on statistical process control theory. Subsequently the approach has been extended and applied to organizational management and service delivery. The Institute of Medicine's Crossing the Quality Chasm series, moreover, recommends the application of these strategies to health care and to treatments for alcohol, drug, and mental health disorders. The challenge for addiction treatment agencies is to gain perspective on the delivery of treatment as a process of care and identify errors in service delivery that lead to inefficiency and weaken patient outcomes. Missed appointments, for example, might be considered errors in treatment retention processes that lead to lower counselor productivity and loss of revenues. Reductions in missed appointments, conversely, enhance productivity and generate increased revenues.

NIATx members use learning sessions, coaching, interest circles, and Web pages and learn to test rapid cycle changes that reduce days to admission, enhance retention in care, increase admissions, and minimize appointment no-shows. Five simplified process improvement principles guide organizational change initiatives.

The first principle is to understand and involve the customer (the client in substance abuse treatment). Focus on the customer is a key to process improvement. To gain insight into client experiences, the organization's change team walks through the processes that they seek to improve. Programs often begin with client intake processes. A member of the change team assumes the client role and calls for an appointment and, after waiting the typical period, arrives for the assessment and completes the intake interview. A second member of the change team acts as a family member and accompanies the "client" to help record impressions of the intake process (e.g., Was the telephone call for an appointment answered promptly and politely? Did the client speak with a real person? Were directions clear? Was the interview held in a confidential location and conducted with [Page 633]sensitivity?). These insights help the change team identify processes that require improvement and help the treatment organization become more responsive to client needs and expectations.

The second guiding principle is to address important problems the problems that vex program leadership. Typically, the problems affect the agency's revenues and expenses. Delays in admission lead to poor attendance at scheduled appointments. No-shows reduce counselor productivity and increase expenses. Change efforts should be directed at solving problems that hamper agency operations.

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