Planning for Success: The Building Blocks of a

Successful D&I Research Project

David H. Gustafson PhD,Todd Molfenter, PhD

Andrew Quanbeck, PhDCenter for Health Enhancement Systems Studies

University of Wisconsin – Madison

Speaking for many, many other people

NIDA grant 5 R01 DA020832-05 (PI: Gustafson)

Conflict of interest statement

We are shareholders in a corporation formed in 2014 to market some software we have developed. We have conflict of interest

management plan approved by the University of Wisconsin-Madison.

So many colleagues to thank

Tom Hilton Wilson Compton Redonna Chandler Jay Ford Alice Pulvermacher Anna Wheelock Jim Robinson Dennis McCarty John McConnell Kim Hoffman Mike French Jim Kadunc Victoria Sviridova Bobbie Johnson Victor Cappocia

• Kyle Grazier• John Oruongo• Nataliya Batina• David Zimmerman• Mike Ellis• Mike Botticelli• Mark Steinberg• Phil Chvojka• Karen Wheeler• Dagan Wright• Shawn Clark• Fritz Wrede• Eric Larson• Susan Brandau• Dawn Lambert-Wacey

• Fran Cotter• Paul Roman• Don Holloway• Dean Lea• Skyler Neylon• Helene McDowell• Fiona McTavish• Kim Johnson• Andrew Isham

– And many, many more…

A lazy day on the Amazon

Near the Tahuayo river in PeruTa-why-o

There are several ways to skin . . . .

Dissemination & Implementation

Research Dissemination something; see if it works.

Study different ways to disseminate.

We will do both.

What are we disseminating?

The NIATx Way

(Network for Improvement of Addiction Treatment)

A simple quality improvement approach

Plan dissemination from the start.

The problem – Addiction Treatment.

A canyon of complexity

• 18 million people are addicted

• Only 2 million can get treated

• A chronic disease where timing is everything

• Very dedicated staff

• Long wait to get treatment

• People drop out

• Costs of addiction: #3

NIATxPretty successful Over 3,700 organizations “adopted” it.

“We got NIATx’d”

Led to some pretty interesting changes

Eliminate appointments

Use technology

How did it happen? Building blocks for D&I research? This was big, but points hold for smaller projects.

Building Blocks of Dissemination

Preparation

Explore Problem

Explore Knowledge

Implement

Test and Adapt Solution

Disseminate

Research

Prepare. Explore Problem, Knowledge, Solution. Implement.

Started with a phone call

Visionaries – Victor Capoccia; Fran Cotter

RWJF and Feds funded

Program office of outsiders (That would be us)

Small team: Dean, Todd, Don, Victor, Fran

Name (Paths to Recovery NIATx)

Marketing (Day long’s; Congress; Journal page.)

Competition and Reward ($100K awards).

Preparation Building Blocks

Didn’t really know what innovation was

Had a simple goal: time, retention, admits

Ongoing opinion leader support: Victor, Fran

Small team: Don, Dean, Dave, Todd None of use knew anything re addiction

$ incentives to join

Market, Market, Market, Market

External evaluation Team.

Prepare. Explore Problem, Knowledge. Testing, Implement

Walk through (I got admitted)

Thru site visits we saw agencies first hand

(Filled to capacity)

Created stories and got attention

Affirmed key goals:

Time to treatmentRetention

Admissions

Problem Exploration Building Blocks

Deeply understand your customer(Walk through)

Stick to a few simple, precise goals

Time to treatmentRetention

Admissions

Prepare, Problem, Explore Knowledge, Test. Implement.

Deeply know your customerBuy into CEO goals

Influential Change leaderIdeas from outside the field

Rapid cycle testingOne or two measures.

The Essential Ingredients from innovation literature

Gustafson, D.H., & Hundt, A.S. (1995). Health Care Management Review, 20(2), 16-33. Findings of innovation research applied to quality management principles for health care.

Knowledge Exploration

Problem: how do you retain your customers?

Reaching OutsideOutside leaders ID promising practices

McDonalds:

Two customers; 5 menu items; Fast

Any time.

Television:

Return next time (not whole season)

The Solution: The NIATx Way Deeply understand your customer (walk-through)

Simple, precise goal

One measure

Pick problem that CEO wants

Find irresistibly influential change leader

Get ideas for improvement from outside the field.

Rapid cycle testing &refinement (3 cycles/30 days)

Knowledge Exploration Building Blocks

Reach outside the field for ideas

Analogous problems in other fields

Find best organization in that field

What makes them so good.

Prepare, Problem, Knowledge, Test. Implement. Research

Tried on 12 agencies (competition)

External evaluator interviewed agencies

Modified our model

Not enough cycles

Projects too complex

Measures too complex

Had second round of new agencies

Building Blocks of Testing

One Simple Measure

Anything worth doing is worth doing poorly, at 1st

Seek and celebrate criticisms

Adaptation

Rapid, Cycles of Tests

Prepare, Problem, Knowledge, Test. Implement. Research

• Took applications for small grants.

• Selected 12 (change something in 3 weeks).

• National conferences (800 people)

• Market, Market, Market, Market, Market.

• Developed for variant for state level dissemination

• 5 states at first; then total of 39

• “55,000 lives” campaign (Kim) = 3700 agencies

• ATTC to keep it going.

Spread via More Tests

Many more demonstrations (150? more sites)

Federally sponsored program

State led programs (another RQJF national program

Move from administrative to clinical practices (EBPs)

With and without financial incentives

Cadre of coaches

Change leader academies

D & I Building Blocks

Must test under multiple conditions

Demo Widely

External evaluator builds credibility

Incentives to adopt.

Sustain (ATTC).

.

• Active ingredients of NIATx• 5 states (MA, MI, NY, OR, WA)• 201 addiction treatment organizations• 18 months (three 6-month segments) on:

Time, Retention and Admissions.

Prepare, Problem, Knowledge, Test. Implement. Research

Finally an RCT (1st of 6)!

Interest Circles = Attention control

-10

-5

0

5

10

15

20

25

Coaching Collaboratives Combination Interest Circles

Waiting time Retention Admissions

Coaching was more cost effective

Collaboratives did not do well.

Bottom line: Coaching was best.

Not the usual approach: surveillance, scolding, etc.

Our minimalist approach:One-day site visit

Monthly callFind answers.

\

Building Blocks for D & I Research

Be bold (large sample; make a difference).

Control group

Make a good argument for TAU or

Use attention control or comparative effectiveness.

Avoid existing databases unless it measures exactly

what you want.

Hard to be innovative w risk averse study sections.

But it is no fun to be safe. Make a difference.

Take home messages

Do you want to disseminate or research dissemination?

Personally experience what customer is going through

Have a few precise goals

Ideas from outside the industry

Market, Communicate, Market, Communicate, Market, One or two simple measures

Anything worth doing, is worth doing wrong, at 1st

Seek and celebrate criticism, and do it early

Rapid, Cycles of Pilot Test

That is all folks.

The NHS Sustainability Index

A Multi-attribute Utility Model

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Benefitsbeyondhelpingpatients

Credibility ofthe benefits

Fit with organization’s strategic aims

and culture

Effectivenessof the system

to monitorprogress

Adaptability ofimprovedprocess

Staffinvolvement

and training tosustain the

process

Staff attitudestoward

sustaining thechange

Seniorleadership

engagement

Clinicalleaders

engagement

Infrastructurefor

sustainability

Max possible score (per domain) Access (n=9) IFH (n=6)

✓

Madison (n=9) Bronx (n=6)

Readiness to Sustain scores

Maher L & Gustafson D. 2007. The sustainability model. British National Health Service.

✓

The Innovation

Need BIG changes as well as small Convened 20 really innovative people Addicts and family Nano technologists Pharmacologists Social Networking Psychologists Biomedical engineers Futurists Two creative addiction treatment experts

Create technology based treatment system.

ACHESS:57% fewer heavy drinking days

23% better abstinence

105% better retention in treatment

all significant at p ≤ .01

N = 349

JAMA Psychiatry. doi:10.1001/jamapsychiatry.2013.4642. online March 26, 2014.

ACHESS RCT Results

The result

There are several ways to skin a . . . .

Oh, never mind !

Three approaches to D&I

Influentials and the Intervention (Rogers)• Rogers E. (1982). Diffusion of Innovations. Free Press.

Welcoming environment (PPM)• Van de Ven A. (1980) Problem solving, Planning and Innovation: test of the program planning

model. Human Relations. 33(10); 771-.

Processes (NIATx)• Gustafson D, Johnson K, et al (2011). The NIATx Model. The Center for Health

Enhancement Systems Studies; University of Wisconsin-Madison.