1. 1 Overview Lever ’ s of whole Systems Change in the Adoption of EBP NIATx Summit Advancing Recovery Program Meeting July 29,2009 Tucson,Az

2. 2 The Message AR was created because our field was using ‘what works’ too infrequently Health reform is coming.. and the expectations are greater, but We haven’t moved the needle far or fast enough….. We cant afford to fail.. its life and death for many.

3. 3 Obituary Anchorage Daily News July 17-19,2009 ….., 35, died July 12, 2009, at his Eagle River home from the disease of alcoholism. A private family viewing was Friday. A memorial service will be at 1 p.m. Monday at Alaskan Heritage Memorial Chapel, 440 E. Klatt Road in Anchorage. Friends and family are welcome. XXXXXX was born Dec. 29, 1973, in Sioux City, Iowa. He attended Brookings High School and the University of Alaska Anchorage. Todd lived in the Copper River area for several years after arriving in Alaska in 1996. He was an ASE Certified Auto Technician. He worked at several repair shops throughout the Anchorage Bowl, Glennallen and South Dakota. His family said: "He loved anything on wheels and had a passion for speed. He was a gifted diagnostic technician and took great pride and satisfaction in his ability to troubleshoot and fix anything mechanical. Todd's love of family ran deep. He was respected for his generosity and compassion toward others. He had a strong work ethic and a brilliant sense of humor. Words cannot express how deeply he will be missed."

4. 4 How will you accommodate…? His brother and everyone else that calls that day is covered by insurance, and that insurance pays for treatment The contracts that we have relied on are diminishing The brother was sent to you by his primary care doctor

5. 5 The situation Patient accountability Come to us, courts Primary care, handoffs TreatmentMix of EBP, experience, program EBP, Performance measures, outcomes Infrastructureundercapitaliz ed EMR, Integ clinical and bus systems Work force< 50% licensed >70 % lic, include MD, RN

6. 6 Three Actions Start looking at your services.. absent state contracts.. and with insurance payments…and thinking about adjustments you have to make Look at the National Quality Forum standards of care for Addiction what are you missing... not doing? Meet with primary care providers in your service area:understand how they work.

7. 7 How Do we Change Complex systems? Conditions Levers for Change: Analysis Supports

8. 8 Conditions Leadership commitment Clear aim, purpose Business case Understand customer need

9. 9 Levers for Change Financial plan (cost, reimbursement, payment) Interorganizational plan (who gets what for what) Regulatory, policy impact (what are the ‘rules’ that govern the situation) Operations impact (who, what, where delivers service) Customer impact ( what is customer response, pattern)

10. 10 Supports Partnership Rapid cycle change Learning collaborative, coach, technical assistance