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 matroosa@gmail.com. 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 matroosa@gmail.com.

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.

Change Project 911: Help! My Change Team has lost its energy!

Mat Roosa, LCSW-R
NIATx Coach

Sometimes a change team can feel like a phone with only 2 percent battery life left. Some teams start with a full charge that drains through time. Other teams get started with a lower level of energy and go downhill from there. The challenge of COVID-19 and other competing priorities and stressors can quickly diminish a change team’s energy and divert attention from the change project.

The Fix:

•   Let the data be the driver

A strong data collection process that gives the team new data to consider at each meeting can enhance interest in a project. Data that shows that a change is making a positive difference can be incredibly motivating!

• Executive sponsorship

Leaders can support team enthusiasm by giving members time to complete the change project and promoting the team's work to the broader organization. NIATx Principle no. 2: Fix Key Problems is based on the idea that change projects that fix key problems important to the CEO are more likely to succeed than those that are less important to the CEO. Enthusiasm rarely wanes when change teams pick projects that are relevant to the most pressing needs of the organization. The project should address concerns that keep the CEO awake at night, including fiscal and other urgent matters, to ensure a high energy level.

• Know when to quit

Some teams tend to keep hammering away on a project while achieving little. The concepts of diminishing returns and sunk cost (resources already invested) bias can be critical to deciding when to end a change project effort. The diminishing returns of ongoing efforts can lead us to conclude that we have maxed out the project's benefits and are better off moving to a new project, even if we have not reached our goal. Projects that have not achieved any measurable results can sometimes lead teams to continue their efforts, as they do not want to waste their sunk costs. Team leaders can help shift the team toward framing the lack of progress as a critical lesson learned, and then moving the team toward a new project.

The support of someone experienced with the rapid-cycle change model can help you decide when it is time to end a change project and strike out in a new improvement direction. 

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 matroosa@gmail.com. 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 matroosa@gmail.com.

Welcome the New ITTC Network by Attending its Virtual Launch Event

The new International Technology Transfer Center (ITTC) Network develops and strengthens the workforce, organizations and systems that provide substance use prevention, treatment, and recovery support services across the world.

Much like ATTCs, ITTCs are based in universities and research centers, and they utilize a variety of strategies to accelerate the implementation of scientifically-based and culturally appropriate practices. ITTCs currently exist in South Africa, Ukraine and Vietnam, with more countries being added in the near future. These Centers are brought together in a coordinated network through the leadership of the ITTC Network Coordinating Office in partnership with the International Consortium of Universities on Drug Demand Reduction (ICUDDR).

An exciting and informative virtual event to officially launch the ITTC Network is scheduled for 8 a.m. CST, Feb. 24, 2021. All are welcome to attend and learn more about the ITTC model of technology transfer, hear about the experiences of the existing ITTCs, and meet the network’s leaders and key stakeholders.

The ITTC virtual launch event will be held in English with simultaneous translation into Spanish. To find out what time the virtual launch event begins in your city, use The Time Zone Converter: https://www.thetimezoneconverter.com/

Renowned implementation science expert Dean Fixsen, PhD, will serve as the keynote speaker for the virtual launch event.

The National Rehabilitation Centre (NRC) in Abu Dhabi is hosting this virtual event. The future home of United Arab Emirates ITTC, the NRC is already a leader in promoting the adoption and implementation of science-based prevention, treatment and recovery services in the UAE and throughout other parts of the Middle East. ICUDDR and the existing ITTCs are honored to include NRC in the ITTC Network.

Registration for the ITTC virtual launch event is now open via Zoom. You can also RSVP for the event on Facebook, and like and follow the ITTC Facebook page for updates and news from the network.

Change Project 911: Help! My Project Is Dragging on Too Long

Mat Roosa, LCSW-R
NIATx Coach

The Problem 

Change projects are not meant to be open-ended. They’re meant to move quickly and efficiently to extract the maximum benefits. Dave Gustafson, who developed the NIATx model, recommends limiting change projects to no more than a few weeks. Some change projects can be completed successfully in as little as a day. If you find your team in the middle of a never-ending project, try to diagnose the root cause that’s derailing the project.

Any one of these underlying problems could make a change project drag on:

1. Vague aim statement. A change project without a specific, time-limited goal can drag on indefinitely.

 

The Fix:  Watch your “altitude.”

Some aim statements aim too high (“Improve service quality”) and do not provide any focus for the team. These vague aims are like asking where to find a product in a big-box hardware store and being told, “Yeah, we have that! It’s in the store somewhere.” That’s not enough detail to move you in the right direction.

Other aim statements may aim too low: “Improve the friendliness of the first statements delivered to customers on their first visit.” These types of aim statements are too specific to create much energy or have much impact. Sometimes these low altitude aims end up looking more like a specific strategy. Start with a more straightforward “mid-altitude” aim to ensure clarity for your team. For example: “Improve the first session experience for clients to increase the session 2 show rate by 30%.”

Ask the following key question to identify low-hanging fruit:

What can we do right now that we all agree would result in an improvement?

Solutions:

1. Fix simple technology glitches that reduce access. Any easy fix? Update a long or obsolete voicemail menu.

2. Create a welcoming environment. A fresh coat of paint on the walls and a new lamp are inexpensive improvements that can go a long way in enhancing the customer experience.

3. Engagement scripts. Follow the lead of many customer service efforts in retail environments: train staff to use key language and phrases to connect with clients and increase continuation in care.

• Use a simple aim statement recipe:  "Increase A from B to C by Date D." Almost any change project aim can be plugged into this formula to add clarity.

• Limit the project length!  It’s easy to forget that we call it Rapid-Cycle Change for a reason. Establishing a shorter time frame will push the team to choose projects that can have a measurable impact in the shorter term. “Sometime early next year” does not count as a completion date. Deadlines can help create a sense of urgency that can motivate the team to keep things moving. The “T” in SMART goals stands for “time-bound” as the project's time frame is critical to a precise aim.

• Pick a measure that the team can monitor easily and frequently. Imagine that you are driving down a twisty country road in the dark. Now imagine that your headlights only shine once every 10 seconds for a single second. How long would it take you to complete your journey? Teams find themselves in a similar dilemma when measuring elements with low frequency or elements for which data is not frequently available. The team is then stuck moving very slowly toward its goal, with limited capacity to gauge success.

2. Lack of regular change team meetings. Projects can flounder if change teams don’t meet regularly to monitor PDSA cycles, analyze data, and brainstorm.

Solutions:

• Use existing meetings Sometimes a change team meeting can be tacked on to the front or the back of a standing staff meeting to ensure attendance and efficient use of time.

• Keep change team meetings short A brief and frequent approach to meetings can foster attendance, as members feel a stronger return on their time investment.

• Executive sponsorship Leaders can be critical in setting expectations for the change team related to regular meetings and project status updates.

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 matroosa@gmail.com. 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 matroosa@gmail.com.