1. Leading in Difficult Times: Build It and They Will Come
Lynn M. Madden, PhD, MPA
CEO, APT Foundation

2. A Systems Thinking Orientation
Starting Assumptions:
Your current system is perfectly designed to produce the results it is currently producing.
To produce different results you must change the system.

4. Opioid Use Disorder: Prevalence & Burden
Between 2000 and 2013, estimated number of individuals with opioid use disorder quadrupled1,2
Elevated risk of mortality, HCV and HIV transmission, and psychosocial problems3-5
Costs to US annually exceed $53 billion6
Chronic relapsing disorder7
Office of Applied Studies. National and state estimates of the drug abuse treatment gap: 2000 National Household Survey on Drug Abuse. SAMHSA
SAMHSA. Results from the 2013 national survey on drug use and health: summary of national findings
Hser et al. A 33-year follow-up of narcotics addicts. Arch Gen Psychiatry. 2001;58:503-8.
Nelson et al. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs. The Lancet. 2011;378(9791):571-83
Mathers et al. Global epidemiology of injecting drug use and HIV among people who inject drugs. The Lancet. 2008;372(9651):
Birnbaum et al. Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med. 011;12(4):
McLellan et al. Drug dependence, a chronic medical illness. JAMA. 2000;284(13):

5. The Public Health Policy Challenge
According to the Office of Applied Studies at SAMHSA, more than 21 million people in the US need treatment for a substance use disorder in any given year, but fewer than 10% enter treatment. (2015).
In the area of opioid misuse disorder alone, currently being discussed as an ‘epidemic’, the 2012 estimated gap between available evidence based treatment and need is approximately 1.3M people (Jones et al.,2015).

6. The Public Health Policy Challenge
Despite an increase in excess of 230% between 2003 and 2012 in the estimated number of people in the general population with opioid use disorder, the number of opioid treatment programs operating in the US increased by only 9.4% while the number of patients receiving treatment with methadone increased by only 37.3% (from 227,003 to 311,718). (Jones et al.,2015). Overdose deaths currently exceed 100 people/day.

7. Chronic Relapsing Illnesses
Relapsing to drug use is more common than not, yet our cultural expectation, and the expectation of many payers, is that a person will recognize their shortcomings and simply stop using.  In fact, relapse to drug use is no more common than relapse rates for other chronic medical illnesses such as diabetes, hypertension, and asthma.
(McLellan, Lewis, O'Brien, & Kleber, 2000).

8. Relational Transformation
A defining characteristic of organizations is one of interpersonal relationships.
A conscious relationship is one that exists for a purpose and with direction.
For the organization, purposeful relationships are more resilient and able to change when needed.

9. Enterprise Transformation
Consciousness of the enterprise points to people’s degree of awareness of a particular endeavor and their collective understanding of its scope, risks and intricacies.

10. How Do You Inspire Others?
Transformational leaders make others feel strong. They “enable others to take ownership by enhancing their competence and…by listening to their ideas…by involving them in important decisions, and by acknowledging and giving them credit for their contributions.”
Kouzes and Posner, The Leadership Challenge
What if we did this with our patients?

11. A Compelling Situation
21 million Americans need treatment.
10% are able to access treatment.
50% of those in treatment do not complete.
The way services are delivered is a barrier to both access and retention.

12. A Shift in Relationships
In order to become the go-to provider of any service or good it is critical to continuously rethink the relationship with customers and with staff.
What do people want? How do you know?

13. Historically, consumers use the services we have available to them, when available i.e. appointments

14. Assessment As A Service
What if assessment was a service designed to help customers understand their current situation and their options?
One opportunity for changing the organization is to change its relationship with its customers.

15. Overview of NIATx Procedures
Select an aim
Collect baseline data
Select a process change to pilot test
Conduct a rapid-cycle PDSA
PDSA cycles
Plan the change
Do the plan
Study the results
Act on the new knowledge
Rapid cycle changes
Changes should be doable in 3 weeks

16. Hunches Theories Ideas Changes that Result in Improvement
Change Cycles A P S D
DATA
Hunches Theories Ideas
Changes that Result in Improvement
Standard slide – please do not modify.
Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide 16

17. Access Evaluation
Patient Strengths: (based on strengths, needs, abilities and preferences) S: N: A: P: Formulation/Summary: (If the client has presented with issues around harm to self or others or has some impairment of judgment and the decision has been made not to hospitalize immediately, this section should include a statement to the effect the patient did not meet criteria for involuntary commitment).

18. Access Evaluation
Treatment Recommendation: Treatment Goals (in client’s own words): Initial Problem Statement: Initial Treatment Plan: AN INVITATION!

19. Wait Days to Admission 2006-2017

20. Patient census July 2006 - July 2017

23. Percentages of annual total revenue comprising state block grants and net income between fiscal years