Change Project 911: What to Do When the Idea Well Has Run Dry

Mat Roosa, LCSW-R
NIATx Coach

We want to improve, and we have made some changes, but they have not worked. We don’t know what else to do.

Generating change ideas requires time and energy. Teams lose momentum when initial change efforts don’t succeed, and then struggle to develop option B (or C) to continue their improvement efforts. As teams attempt to move multiple priorities forward, they lose energy to exploring new ideas. Worst case scenario? They feel like just giving up and tolerating the problematic status quo.

So what is a busy team with limited resources to do? How can your team develop a new vision? The five ideas that follow can help organizations to generate new ideas to get the change process moving again.

1. Retreat
Whether it’s a quiet day of meditation, or a hasty maneuver on the battlefield, a retreat serves the singular purpose of establishing a safe space to regroup, reconsider, and establish a means of achieving a desirable future. Many teams hesitate to consider the retreat option because they worry about spending the day away from the office with the entire staff, and the prohibitive costs of a conference center and lost productivity. It is best to think of retreats as a process and not as an event. What can you do to create an environment that enables team members to pull back from day-to-day activities to consider alternative paths for the future? How can team members be encouraged to take a time out to consider new ways to solve old problems? Sometimes a single lunch meeting away from regular duties can spark fresh ideas that enable a team to generate new solutions. 

2. Do an NGT, again
The Nominal Group Technique is a structured brainstorming process designed to foster team inclusion. The NGT generates a high volume of diverse ideas based on answering a strong question. The simple rules of the NGT ensure that all members of the team can share their ideas. The lists of ideas that are generated should be saved and reviewed periodically. Conduct additional NGTs periodically to get a new set of responses to the same question. Retreat sessions (see no.1 above) are a perfect place to conduct a 45-minute NGT with the team.

 
3. Look for ideas from outside
This is one of the five NIATx core principles. Too often, organizational leaders only seek ideas from their own organization or industry. And these “inside” ideas tend to recycle the same set of values and assumptions. So even when leaders may be sharing a new best practice, they do so from a familiar orientation. Consider asking the following questions to find new ways of seeing old challenges.
      • Where else does this challenge arise?

      • How do other industries address this challenge?

      • How is their worldview different, and how does that different vision lead to different solutions?
4. Ask the newbies
Why do we do it that way? This curious question has been asked by thousands of new employees when encountering a practice or process in a new work setting. It is often followed by, “At my last job, we used to…” as a way of sharing an alternative strategy.

Too often the response to the first question is, “because that’s how we do it here”, and very quickly the opportunity to learn from new staff members is lost.
      • What if every newly hired member of the team were asked to keep a running list of every flaw, and every opportunity for improvement, during their first month of employment?

      • What if we harnessed the power of the curiosity of those who have yet to become comfortable with the business as usual?
It is likely that we would capture a rich set of ideas for change.

5. Crowdsource it
Maybe you have seen the show “Who Wants to be a Millionaire?” When the contestant asks the audience for the answer, the audience is almost always right. Engaging large groups through surveys harnesses a powerful array of experience and knowledge. The crowd will often produce ideas that a smaller team would not be able to generate. Crowds can include the broader staff from your organization, or a wider range of voices from outside of your organization. (See no. 3 above.)

Try any one or more of these five strategies to energize your team’s creative thinking and ignite new ideas to test in your next change project.


About Change Project SOS

Change Project SOS is a monthly blog post series covering common change project barriers and how to address them. Has your change project hit a wall that you're not sure how to tackle? Share your story in the comments section below, or email Change Project SOS at matroosa@gmail.com. We’ll offer solutions from our team of change project experts!


About our Guest Blogger

Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in quality improvement, organizational development and planning, and implementing evidence-based practices. Mat also serves as a local government planner in behavioral health in New York State. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration. You can reach Mat (Change Project SOS) at matroosa@gmail.com.

How do we Successfully Implement SUD Screening and Referrals in Title X Family Planning Settings? Integration of Services Is Key

Lena Marceno, MSc
Denise Raybon, MPH
Altarum

Can we talk of integration until there is integration of hearts and minds? Unless you have this, you only have a physical presence and the walls between us are as high as the mountain range. — Chief Dan George

How do we break down walls? How do we integrate health care services to holistically meet the needs of our community? Research has shown that integrating care can lead to improved patient experience and health outcomes. In particular, the integration of family planning (FP) services and services for those with a substance use disorder (SUD) is critical to ensuring the reproductive health needs of those with SUD are met.

People with SUD report an unmet need for family planning services, with only half reporting using contraception. Those who do use contraception rely mostly on “moderately effective” methods. These challenges are compounded by the fact that when people with SUD seek care from providers, they often experience stigma, judgment, and shame creating further barriers to their care. Yet the heightened stress, loneliness, and anxiety brought on by the COVID-19 pandemic has only exacerbated the unmet need for behavioral health care services in our communities.

Administered by the Office of Population Affairs (OPA), Title X family planning programs provide services to assist in achieving or preventing pregnancy, STI prevention, and a host of related prevention services. Family planning clinics are well positioned to screen for substance use, as they are often the primary entry point to the health care system for women. OPA strongly encourages its grantees to screen for substance use disorders and provide referrals, when appropriate. However, in a recent survey, only half of family planning clinics reported making external referrals for patients who screened positive for substance use disorder. Reaching a growing number of people with both family planning needs and substance disorders requires an interdisciplinary approach.


To learn more about the impact of this work, watch this short video featuring the voices of the community Altarum serves.

 
With funding from OPA, Altarum is breaking down walls by conducting a multi-faceted research study using an innovative cross-training model. The cross training brings together family planning and SUD providers from the same geographic region and is designed to equip providers with the skills and self-efficacy to effectively screen and refer their clients. As part of the training, participants engage, learn from, and network with one another and create concrete action plans to increase and sustain linkages.

The study also includes financial and economic analyses focusing on the benefits for individual clinics and providers, including expected increases in patient volumes, patient retention, and overall quality of care, as well as broader societal benefits.

The program is available to any Title X funded family planning provider and any behavioral health provider that provides services or treatment for substance use disorder nationwide. If you are interested in learning more, please visit the website, or reach out to Lena Marceno, Project Manager, at linkstudy@altarum.org.

Change Project 911: Help! Our change project is unmanageable!

 Mat Roosa, LCSW-R
NIATx Coach

Basket or cart?

It’s the first decision we usually make when we enter a large grocery store. When I am just buying a few items, I usually pick up a basket so that I can move more easily through the store. Often I find myself with a gallon of milk in one hand, an overflowing too heavy basket in the other, and wondering why I did not get a cart in the first place.

Rapid-cycle PDSA change is basket work. It requires that we focus on a single manageable change project to ensure effective implementation. But too often teams end up frustrated by complicated projects that yield confusing results.

So, what can we do to keep from overloading the process?

Keep it simple

The rapid cycle PDSA model asks you to test one change at a time in order to isolate and understand the impact of a single variable. This requires a thoughtful unbundling of complicated processes to find the single variable that can be tested. Teams new to the PDSA process should be particularly mindful to find simple initial changes that have fewer moving parts that might complicate the change project.

Keep it short

Just as a basket discourages overbuying of groceries, a brief time line for a change project discourages the creation of an unmanageable change project. Limiting the effort to a change that the team can complete in 2-3 weeks removes complex projects from the list, thereby reducing the risk of being bogged down in an unmanageable change effort.

Appreciate the need for practice

We all know the frustration of entering a large and unfamiliar grocery store with a long list when we are in a hurry. Effective implementation of rapid-cycle PDSA change requires familiarity that can only be gained through practice. Those who are new to the process should avoid trying to do too much too fast. Initial efforts should focus on learning the model, and creating a positive experience for the team.

Assume surprises

Change projects are almost always more complicated than expected. Elements that seemed simple at first glance may require more time and attention upon further inspection. Project resources that were initially available may be pulled away by new and unexpected priorities. It is best to expect the unexpected and to budget time and resources accordingly.

Plan ahead

If you want to shop quickly, purchase only what you need for the meal you are cooking, and avoid spending any extra money, you will need to make a detailed grocery list. All of the strategies above reflect the need for effective planning on the front end of a change project. Taking the time to front load the process with a thoughtful plan will lead to greater learning, an enhanced experience for the team, and measurable improvements.



About Change Project SOS

Change Project SOS is a monthly blog post series covering common change project barriers and how to address them. Has your change project hit a wall that you're not sure how to tackle? Share your story in the comments section below, or email Change Project SOS at matroosa@gmail.com. We’ll offer solutions from our team of change project experts!


About our Guest Blogger

Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in quality improvement, organizational development and planning, and implementing evidence-based practices. Mat also serves as a local government planner in behavioral health in New York State. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration. You can reach Mat (Change Project SOS) at matroosa@gmail.com.

Is the Term 'Marijuana' Racist?


Deena Murphy
Advanced Implementation Specialist (AIS)
Opioid Response Network STR-TA Consortium

Being culturally responsive means paying attention to language and ensuring we use person-centered language around substance use. So, when the ATTC Network Coordinating Office repeatedly heard commentary that the term “marijuana” was racist and we needed to replace it with cannabis, we quickly scanned any available published research to better understand this context and ensure we practiced cultural humility.

If you have not heard this commentary, here it is in a nutshell. Advocates for legalization outline a history where prohibition champions used the term marijuana to demonize cannabis use and criminalize its consumers. The Spanish word “marijhuana” (later anglicized to marijuana) reinforced anti-immigrant sentiment. Prior to the term marijuana being adopted in the Americas around 1890, cannabis and hemp were common terms. Part of this commentary stems from Isaac Campos’s 2012 book Home Grown: Marijuana and the Origins of Mexico's War on Drugs, which outlines the complex origins of marijuana in North American history. Media outlets such as NPR and The Guardian have approached this topic and subsequently, many other contemporary online posts have advocated for losing the term marijuana in favor of the word cannabis.

But is it really that simple? Would changing the term marijuana to cannabis decrease systemic racism and stigma around substance use? The prevailing sentiment seems to be that systemic racism—which includes arrests for marijuana use disproportionately impacting minorities--will not change by losing the term marijuana in favor of cannabis. In fact, Campos argued that changing this term ignores the important influence Mexican Americans have had on US culture. There is no doubt that we all want to see an end to stigma and systemic racism, but Mikos and Kam’s 2019 article “Has the “M” word been framed? Marijuana, cannabis, and public opinion” highlights their survey of 1600 adults, which found zero evidence to suggest that the public distinguishes between the terms “marijuana” and “cannabis.” As John Hudak of the Brookings Institute points out, the history of marijuana policy is an example of institutional racism enforced in specific communities. But there is nothing to suggest this history and the ongoing disproportionate impact on communities of color can be reversed by simply changing marijuana to cannabis.

Several years ago, the ATTC Network Coordinating Office produced a package of user-friendly videos, infographics and other materials called Marijuana Lit: Fact-Based Information To Assist You In providing SUD Services. This package was aimed at dispelling myths around marijuana, but now we are questioning if these products should be redone? Based on the available evidence and our commitment to practicing cultural humility, should ATTCs stop using the term “marijuana” and switch to “cannabis”?

We invite informed commentary on this topic and encourage you to leave a comment or engage in the conversation on Twitter by tagging @ATTCnetwork in your  tweets.

Change Project 911: Help! My Change Team has lost its energy!

Mat Roosa, LCSW-R
NIATx Coach

Sometimes a change team can feel like a phone with only 2 percent battery life left. Some teams start with a full charge that drains through time. Other teams get started with a lower level of energy and go downhill from there. The challenge of COVID-19 and other competing priorities and stressors can quickly diminish a change team’s energy and divert attention from the change project.

The Fix:

  •   Let the data be the driver

A strong data collection process that gives the team new data to consider at each meeting can enhance interest in a project. Data that shows that a change is making a positive difference can be incredibly motivating!

  • Executive sponsorship

Leaders can support team enthusiasm by giving members time to complete the change project and promoting the team's work to the broader organization. NIATx Principle no. 2: Fix Key Problems is based on the idea that change projects that fix key problems important to the CEO are more likely to succeed than those that are less important to the CEO. Enthusiasm rarely wanes when change teams pick projects that are relevant to the most pressing needs of the organization. The project should address concerns that keep the CEO awake at night, including fiscal and other urgent matters, to ensure a high energy level.

  • Know when to quit

Some teams tend to keep hammering away on a project while achieving little. The concepts of diminishing returns and sunk cost (resources already invested) bias can be critical to deciding when to end a change project effort. The diminishing returns of ongoing efforts can lead us to conclude that we have maxed out the project's benefits and are better off moving to a new project, even if we have not reached our goal. Projects that have not achieved any measurable results can sometimes lead teams to continue their efforts, as they do not want to waste their sunk costs. Team leaders can help shift the team toward framing the lack of progress as a critical lesson learned, and then moving the team toward a new project.
The support of someone experienced with the rapid-cycle change model can help you decide when it is time to end a change project and strike out in a new improvement direction. 



About Change Project SOS

Change Project SOS is a monthly blog post series covering common change project barriers and how to address them. Has your change project hit a wall that you're not sure how to tackle? Share your story in the comments section below, or email Change Project SOS at matroosa@gmail.com. We’ll offer solutions from our team of change project experts!


About our Guest Blogger

Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in quality improvement, organizational development and planning, and implementing evidence-based practices. Mat also serves as a local government planner in behavioral health in New York State. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration. You can reach Mat (Change Project SOS) at matroosa@gmail.com.