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 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

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.