The hand-off: A hands-on approach to client transfers

One area in the treatment continuum that often proves to be problematic is the system by which a client is transferred between levels of care: the “handoff”. Any number of things that may go wrong during the handoff can be disruptive to the client's treatment and can contribute to dropouts. In this sense, the handoff process is part of the NIATx aim of increasing continuation.

What happens when a person first calls your agency for help? Does a live person answer the phone, or is the caller directed through an endless cycle of automated prompts? The caller might talk first to a receptionist, who then might hand off the call to somebody else, who then might invite the caller to leave a voicemail message. How many different people does a client meet with during a first intake appointment? How many forms does the client have to complete during the appointment - forms that request the same information multiple times? Every transition from one level of care to the next in addiction treatment is a handoff that presents a potential interruption or even an end to the client's recovery journey.

Think about a system outside the treatment field where handoffs are smooth and efficient. Maybe it's the pit crew of a champion in a NASCAR race or the passing of a baton between Olympic relay racers. What makes them so good? How can you learn what makes them so good and use those ideas in client care transitions?

NIATx has several resources to help you with handoffs. Check out the Increasing Continuation Between Levels of Care promising practices on the NIATx web site. And make sure to read the article “Don’t Fumble the Treatment Handoff” in Addiction Professional magazine.

The Aha!s of Change: What we can learn from the McRib

I find it difficult to clearly explain why it is so important to go outside the field for ideas on how to improve and how to get those ideas. So I am going to try again. One of these days I will get it right.

A lot of people are becoming pretty good at understanding the needs of their customers. The walk-throughs are being used pretty extensively as well as nominal group and focus group meetings. It is exciting to see that happening. And of course it is natural to say: "Well, now that we understand the problem, let's solve it.” I love rapid- cycle improvement!

But there is a risk that we will jump to an obvious solution. The obvious solutions are very likely to have been tried in SUD before. And they may have worked, or they may have worked a little, or worked a lot for a while and then stopped working. So it probably does not hurt to take a one-hour detour to cast a wider net for solutions. Where do we find those solutions? From concepts and problem-solving efforts of people who are tackling a similar problem but in a different industry.

Suppose we were trying to find a way to get people to keep coming back for treatment. What other industries worry about getting people to come back on a regular basis? Lets think out of the box for a second. Well, there is television. They try to get us to come back to their shows. And there are fast food restaurants. Of course there are many others. But let's go with those two for a minute.

We have found the industries. Now we need to find the best of the best in those industries. In many cases they will be obvious. In fast foods, it is probably McDonalds. They must invest enormous amounts of effort in getting people to return. How do they do it? One of us knew the head of marketing for McDonalds, but you could just as easily google. For instance, I googled "How does McDonalds get people to return?" I found millions of responses because many people have studied McDonalds. One thing that comes up over and over again in the few summaries I read was that they segment their customers and find out what those people respond to. Then they target those things people respond to.

The first article pointed out the McRib. Its nutrition is terrible and a lot of people hate it. But a big segment (typically young guys) of their customers really like it. So what? Well, McDonalds thinks about what would bring those people back. They hit TV programs with a young guy who is going on his honeymoon and he gets a text from a friend saying McRibs are back. For a few seconds he debates whether he wants to go on his honeymoon with this wife watching, perplexed.

What can that story tell us about how to keep our patients coming back? McDonalds would say that one size does not fit all. In our field some may respond to threats, others to reminders, others rewards, etc. But rarely do the same things work for everyone. What if we began to create a database of what our customers respond to? Try some things, see what happens, and then put those results into the database, so we know what to try (or not try) to get each person back.

How long would it take to: 1) Identify other industries that deal with a problem similar to ours? 2) Identify one of the best organizations at solving that problem in that industry? 3) Ask Google Scholar to identify what makes McDonalds (or whatever) so good. 4) Read at least the abstract of a couple of articles. 5) Ask, “What is it that they do that could be helpful for us?”

I would say one hour, two at most. I think it’s worth it.

More info, fewer clicks: the NIATx website update

The NIATx principle “understand and involve the customer” has helped guide the latest redesign of our website. What have we heard from our website customers? Frequently, we hear that www.niatx.net has tons of great resources—but they’re sometimes hard to locate. With that in mind, we’ve made a few changes to help you find what you’re looking for in just a click or two.

First, take a look at the home page. Mouse over any of the choices on the blue menu bar and see what pops up—a new menu that gives you a bigger, brighter picture of what’s behind each tab. Check out the reorganized Resource Center content. We revised the headings to guide you more quickly to some of our most popular content.

The NIATx story database, another feature on our website, now contains over 800 entries from organizations across the country. This is the place to go for inspiration, ideas, or tips on how to implement a particular promising practice! We’ve improved the search and sort features so you can more quickly find the stories that will help you the most.

Be sure to visit the NIATx Health Reform Resources page. It contains information and resources that participants in our recent health reform collaboratives have added. Along with a cleaner design, you’ll find a feature that allows you to filter results by project source, category and keyword.

We hope these changes help you navigate the site easier. Let us know how it’s working for you by emailing webmaster@niatx.net.

The Aha!s of Change: What I've Learned Over 50 Years In Organizational Change

Someone recently asked me the key things I have learned over nearly 50 years of working and studying organizational change. At my age, I am surprised that I remember. And in fact I bet I have forgotten many important things and elevated others that don't deserve to be. Furthermore, in thinking about the answers to the question I have come across some contradictions that confuse me.

I am starting this series because I would love to hear what you have learned and how it fits or competes with these. So I hope you jump in and question, argue, and tell me where I am full of it. Lets start today with one of them. Change teams.

A lot of folks think the change team is a key to success. It probably is but the literature and my experience suggests there are teams and then there are teams. What I have learned is that if everyone is in charge, no one is in charge. Andre Delbecq (one of my heroes) studied innovation in Silicon Valley. He found that teams of the really successful companies do it this way:

First, a team leader is chosen and this person is influential and respected. But interestingly, that team leader is personally responsible to make this project be successful and he or she is given the personal autonomy and resources to make it happen.

Second, the team leader is given the authority to pick the team members with the restriction that they, like the leader, must be passionate about the project. The team’s job is to help the team leader accomplish the goals. In several ways this is very different from typical views of teams where the team is the key instead of the leader and where the team has a central role in decision-making.

Third, the team is not held responsible for the success of the effort. So the organization is on the line (by giving resources and authority) and so is the leader. I think it makes for a very different dynamic.

Now for the contradiction. I also really believe it is important to engage the skeptics, but that is not mentioned a lot in what I have read about Silicon Valley. How can only the passionate advocates be on a team? Where do you get the reality testing? To some extent these issues are addressed in other ways that I will talk about later. So rip me apart. I love the pain.