Planning for Success: The Building Blocks of a Successful D&I … · Planning for Success: The...
Transcript of Planning for Success: The Building Blocks of a Successful D&I … · Planning for Success: The...
Planning for Success: The Building Blocks of a
Successful D&I Research Project
David H. Gustafson PhD,Todd Molfenter, PhD
Andrew Quanbeck, PhDCenter for Health Enhancement Systems Studies
University of Wisconsin – Madison
Speaking for many, many other people
NIDA grant 5 R01 DA020832-05 (PI: Gustafson)
Conflict of interest statement
We are shareholders in a corporation formed in 2014 to market some software we have developed. We have conflict of interest
management plan approved by the University of Wisconsin-Madison.
So many colleagues to thank
Tom Hilton Wilson Compton Redonna Chandler Jay Ford Alice Pulvermacher Anna Wheelock Jim Robinson Dennis McCarty John McConnell Kim Hoffman Mike French Jim Kadunc Victoria Sviridova Bobbie Johnson Victor Cappocia
• Kyle Grazier• John Oruongo• Nataliya Batina• David Zimmerman• Mike Ellis• Mike Botticelli• Mark Steinberg• Phil Chvojka• Karen Wheeler• Dagan Wright• Shawn Clark• Fritz Wrede• Eric Larson• Susan Brandau• Dawn Lambert-Wacey
• Fran Cotter• Paul Roman• Don Holloway• Dean Lea• Skyler Neylon• Helene McDowell• Fiona McTavish• Kim Johnson• Andrew Isham
– And many, many more…
A lazy day on the Amazon
Near the Tahuayo river in PeruTa-why-o
There are several ways to skin . . . .
Dissemination & Implementation
Research Dissemination something; see if it works.
Study different ways to disseminate.
We will do both.
What are we disseminating?
The NIATx Way
(Network for Improvement of Addiction Treatment)
A simple quality improvement approach
Plan dissemination from the start.
The problem – Addiction Treatment.
A canyon of complexity
• 18 million people are addicted
• Only 2 million can get treated
• A chronic disease where timing is everything
• Very dedicated staff
• Long wait to get treatment
• People drop out
• Costs of addiction: #3
NIATxPretty successful Over 3,700 organizations “adopted” it.
“We got NIATx’d”
Led to some pretty interesting changes
Eliminate appointments
Use technology
How did it happen? Building blocks for D&I research? This was big, but points hold for smaller projects.
Building Blocks of Dissemination
Preparation
Explore Problem
Explore Knowledge
Implement
Test and Adapt Solution
Disseminate
Research
Prepare. Explore Problem, Knowledge, Solution. Implement.
Started with a phone call
Visionaries – Victor Capoccia; Fran Cotter
RWJF and Feds funded
Program office of outsiders (That would be us)
Small team: Dean, Todd, Don, Victor, Fran
Name (Paths to Recovery NIATx)
Marketing (Day long’s; Congress; Journal page.)
Competition and Reward ($100K awards).
Preparation Building Blocks
Didn’t really know what innovation was
Had a simple goal: time, retention, admits
Ongoing opinion leader support: Victor, Fran
Small team: Don, Dean, Dave, Todd None of use knew anything re addiction
$ incentives to join
Market, Market, Market, Market
External evaluation Team.
Prepare. Explore Problem, Knowledge. Testing, Implement
Walk through (I got admitted)
Thru site visits we saw agencies first hand
(Filled to capacity)
Created stories and got attention
Affirmed key goals:
Time to treatmentRetention
Admissions
Problem Exploration Building Blocks
Deeply understand your customer(Walk through)
Stick to a few simple, precise goals
Time to treatmentRetention
Admissions
Prepare, Problem, Explore Knowledge, Test. Implement.
Deeply know your customerBuy into CEO goals
Influential Change leaderIdeas from outside the field
Rapid cycle testingOne or two measures.
The Essential Ingredients from innovation literature
Gustafson, D.H., & Hundt, A.S. (1995). Health Care Management Review, 20(2), 16-33. Findings of innovation research applied to quality management principles for health care.
Knowledge Exploration
Problem: how do you retain your customers?
Reaching OutsideOutside leaders ID promising practices
McDonalds:
Two customers; 5 menu items; Fast
Any time.
Television:
Return next time (not whole season)
The Solution: The NIATx Way Deeply understand your customer (walk-through)
Simple, precise goal
One measure
Pick problem that CEO wants
Find irresistibly influential change leader
Get ideas for improvement from outside the field.
Rapid cycle testing &refinement (3 cycles/30 days)
Knowledge Exploration Building Blocks
Reach outside the field for ideas
Analogous problems in other fields
Find best organization in that field
What makes them so good.
Prepare, Problem, Knowledge, Test. Implement. Research
Tried on 12 agencies (competition)
External evaluator interviewed agencies
Modified our model
Not enough cycles
Projects too complex
Measures too complex
Had second round of new agencies
Building Blocks of Testing
One Simple Measure
Anything worth doing is worth doing poorly, at 1st
Seek and celebrate criticisms
Adaptation
Rapid, Cycles of Tests
Prepare, Problem, Knowledge, Test. Implement. Research
• Took applications for small grants.
• Selected 12 (change something in 3 weeks).
• National conferences (800 people)
• Market, Market, Market, Market, Market.
• Developed for variant for state level dissemination
• 5 states at first; then total of 39
• “55,000 lives” campaign (Kim) = 3700 agencies
• ATTC to keep it going.
Spread via More Tests
Many more demonstrations (150? more sites)
Federally sponsored program
State led programs (another RQJF national program
Move from administrative to clinical practices (EBPs)
With and without financial incentives
Cadre of coaches
Change leader academies
D & I Building Blocks
Must test under multiple conditions
Demo Widely
External evaluator builds credibility
Incentives to adopt.
Sustain (ATTC).
.
• Active ingredients of NIATx• 5 states (MA, MI, NY, OR, WA)• 201 addiction treatment organizations• 18 months (three 6-month segments) on:
Time, Retention and Admissions.
Prepare, Problem, Knowledge, Test. Implement. Research
Finally an RCT (1st of 6)!
Interest Circles = Attention control
-10
-5
0
5
10
15
20
25
Coaching Collaboratives Combination Interest Circles
Waiting time Retention Admissions
Coaching was more cost effective
Collaboratives did not do well.
Bottom line: Coaching was best.
Not the usual approach: surveillance, scolding, etc.
Our minimalist approach:One-day site visit
Monthly callFind answers.
\
Building Blocks for D & I Research
Be bold (large sample; make a difference).
Control group
Make a good argument for TAU or
Use attention control or comparative effectiveness.
Avoid existing databases unless it measures exactly
what you want.
Hard to be innovative w risk averse study sections.
But it is no fun to be safe. Make a difference.
Take home messages
Do you want to disseminate or research dissemination?
Personally experience what customer is going through
Have a few precise goals
Ideas from outside the industry
Market, Communicate, Market, Communicate, Market, One or two simple measures
Anything worth doing, is worth doing wrong, at 1st
Seek and celebrate criticism, and do it early
Rapid, Cycles of Pilot Test
That is all folks.
The NHS Sustainability Index
A Multi-attribute Utility Model
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
Benefitsbeyondhelpingpatients
Credibility ofthe benefits
Fit with organization’s strategic aims
and culture
Effectivenessof the system
to monitorprogress
Adaptability ofimprovedprocess
Staffinvolvement
and training tosustain the
process
Staff attitudestoward
sustaining thechange
Seniorleadership
engagement
Clinicalleaders
engagement
Infrastructurefor
sustainability
Max possible score (per domain) Access (n=9) IFH (n=6)
✓
Madison (n=9) Bronx (n=6)
Readiness to Sustain scores
Maher L & Gustafson D. 2007. The sustainability model. British National Health Service.
✓
The Innovation
Need BIG changes as well as small Convened 20 really innovative people Addicts and family Nano technologists Pharmacologists Social Networking Psychologists Biomedical engineers Futurists Two creative addiction treatment experts
Create technology based treatment system.
ACHESS:57% fewer heavy drinking days
23% better abstinence
105% better retention in treatment
all significant at p ≤ .01
N = 349
JAMA Psychiatry. doi:10.1001/jamapsychiatry.2013.4642. online March 26, 2014.
ACHESS RCT Results
The result
There are several ways to skin a . . . .
Oh, never mind !
Three approaches to D&I
Influentials and the Intervention (Rogers)• Rogers E. (1982). Diffusion of Innovations. Free Press.
Welcoming environment (PPM)• Van de Ven A. (1980) Problem solving, Planning and Innovation: test of the program planning
model. Human Relations. 33(10); 771-.
Processes (NIATx)• Gustafson D, Johnson K, et al (2011). The NIATx Model. The Center for Health
Enhancement Systems Studies; University of Wisconsin-Madison.