ATTC’s Pearls of Wisdom: The Legacy and Future of the NIATx Model and the Great Lakes ATTC

 By Todd Molfenter, PhD, director of Great Lakes ATTC, MHTTC, & PTTC

How can I successfully make “organizational change?”

This is the fundamental question that started the NIATx movement. Simply stated, NIATx is a set of tools and techniques used to make organizational change: whether it be improving the admissions process, implementing an evidence-based clinical practice (like MOUD!), improving linkages between health systems of care, or hiring more staff. And change is not easy!

The NIATx change model was developed to make us better at facilitating change in organizational settings. 

Over the past 20 years, the NIATx model has been part of numerous research trials, applied by more than 3,000 organizations, and is now supported by over 60 peer-reviewed publications. 

What’s more, the NIATx approach has been a key ingredient in the Great Lakes ATTC's mission to promote both knowledge of evidence-based practices and how to implement them.

So, what have we learned over the past 20 years?

1. Leadership Motivation Matters

Yes, we know leadership is important and we can’t forget that. Some of the new information we have learned comes from the Motivational Interviewing field. Not only is it important to have a leader that commits to supporting the change, but it is important to clarify why. For example, if asking the question, “Why do you want to implement contingency management in your organization?” make sure to integrate the reasons why into the implementation approach. Furthermore, make sure the desired goals are met, and remind the executive leader of these reasons should team motivation and executive buy-in begin to wane.

2. Champions Save the Day

It is not only Marvel movies where heroes save the day. In change management efforts, the champions are the heroes. They are the people that keep projects moving forward and provide critical internal promotion and marketing for the project. In addition to clinical champions, sometimes it is critical to have champions from the medical, technical, and administrative ranks to make a project a success.

3. The Power of External Incentives

We are all busy, stressed people, and these conditions have only become more acute as labor shortages limit the number of hands available. This is where external incentives in the form of reimbursement or funding support, expectations of key payers, community pressure, licensure expectations, etc. will aid in making sure that the change initiative is a success and becomes a priority among the many other priorities being faced. Look for and embrace external incentives.

4. Easy, Easy

Easy to implement, easy to maintain. Every ounce of extra effort by already overburdened staff becomes a disincentive to make the targeted change. This means great effort should go into making the change as easy as possible to implement and maintain. A simple planning tool is to make sure that a change will result in no extra effort by the staff who are to apply the change. If the change requires more work, relapse to pre-existing behaviors is almost guaranteed.

5. “Nothing About Us Without Us”

This is a commonly quoted phrase from the recovery community. Why is that? Well, because if you plan changes for that community without their input a) you will probably get it wrong, and b) even if you get it right, they likely are going to be very unwilling to implement the change. And they’re right. In this era of community engagement, community participatory research, and the like, you need to understand the desired change the community is seeking to implement as well as how they want the process to occur. The first NIATx principle is to gain the voice of the customer. The customer is anyone who is the recipient of the intended change. Take the time to understand their wishes and success will be more likely.

The Great Lakes ATTC has taken the lessons learned from NIATx and combined them with the emerging implementation science movement along with classic engineering principles to address the pressing and emerging issues in addiction treatment and recovery. 

In our region, this approach has helped us make impressive gains in addressing the opioid crisis and making recovery-oriented systems of care a customary practice. 

The NIATx model has been a key tool for supporting the ATTC Network’s mission over the past decade, and we look forward to the challenges and successes that lie ahead.

About the author:

Dr. Todd Molfenter is the deputy director of the Center for Health Enhancement Systems Studies at UW–Madison. He is also the director of three SAMHSA-funded technology transfer centers: the Great Lakes ATTC, MHTTC, and PTTC.  

Todd’s research specialty is implementation science, which studies methods to promote the use and uptake of evidence-based practices into routine practice. Todd helped to develop and refine the NIATx model of process improvement and has directed several multi-state studies focused on organizational and systems change. He has also guided hundreds of change teams on effective use of NIATx tools and techniques.   

Todd is the 2020 recipient of the Bollinger Academic Staff Distinguished Achievement Award, awarded by the UW-Madison College of Engineering for excellence in research.