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 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

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

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