Drug Treatment Matrix cell D2: Organisational functioning: Generic and cross-cutting issues

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Organisational functioning

Key studies on the how the characteristics and functioning of treatment organisations affect implementation and effectiveness. Learn to see the organisational context as part of the treatment, about two evidence-based US quality improvement resources, and consider what makes treatment services engaging and whether they should extend that engagement into long-term continuing care. See the remaining four cells in row 2 of the matrix for more on generic features of medical and psychosocial therapies.

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text Unfold supplementary text

S Chronic care for chronic conditions (2002; alternative free source at time of writing). Truly treating addiction of the kind seen by treatment services as analogous to a chronic disease means evaluating success by what happens during – not after – treatment, and demands continuing care which is attractive to and manageable by the patient and elicits their cooperation. For discussion click here and scroll down to highlighted heading.

S Goal-oriented, well organised and supportive workplaces maximise patient progress (1998). US services which emphasised mission-oriented and effective organisation, were clear what they expected from staff, and which engaged their staff, also had more engaged patients who made greater progress and were more likely take up aftercare. Similar study (1997) from same research stable found patient participation and outcomes best in services which communicate high expectations for patient functioning, emphasise clear rules and procedures, and have a strong psychosocial treatment orientation, concluding that the strength of a service’s treatment philosophy “is more important [than] the particular theory underlying that orientation”. For discussion click here or here and scroll down to highlighted headings.

K ‘Open to change’ UK services have more engaged patients (2009). Clients engaged best when substance use services fostered communication, participation and trust among staff, had a clear mission, but were open to new ideas. In the USA feeding back scores from the organisational health assessment questionnaire used in this study has been found to motivate agencies to improve. For related discussions click here, here or here, and scroll down to highlighted headings.

K Place your agency in front of a potentially unflattering mirror (2007; free source at time of writing). US study found that feeding back scores from the organisational health questionnaire used in a British study motivated less well functioning agencies to commit to an improvement programme.

K Organisational correlates of post-treatment drug use (2008). Using advanced methods and large sample of services, this US study asked what makes for an effective treatment agency. Being constrained by funders in terms of services and ability to individualise treatments was the clearest negative factor, quality accreditation the clearest positive.

K Few extra benefits from integrating addiction case management with primary care (2013; alternative free source at time of writing). Disappointing results of first randomised trial of an explicit chronic care management model for drug dependent patients were perhaps due to addiction treatment not being delivered at the clinic but by linkage to other services, which made little difference to whether patients engaged in treatment. For discussion click here and scroll down to highlighted heading.

K Organisational features which help improvement initiatives ‘stick’ (2017). Follow-up of a US trial of the ‘improvement collaborative’ model developed by the NIATx quality improvement resource listed below. Focused on what is about some treatment organisations which helped sustainably embed the process in the service’s operations. For discussion click here and scroll down to highlighted heading.

R Policy strategies for improving outcomes (2011). Two of the world’s most respected addiction researchers also with top-level policy experience explore the evidence that patients’ prospects are improved by organisational changes like strengthening managerial capacity and business practices and submitting the organisation to external scrutiny. For related discussion click here and scroll down to highlighted heading.

R Organisational dynamics of the change process (2011). US review structures findings from the most comprehensive and systematic attempt yet (see studies 1 2 from the same team) to map the processes involved in effective treatment, including the organisational dynamics of implementing and sustaining innovations. As in a study and guidance from England, openness to change (“general readiness to embrace innovation”) emerged as important quality. For discussion click here and scroll down to highlighted heading.

R Implementing aftercare and continuing care (2011). How to ensure patients who need it receive long-term care or aftercare. Since “People treated for substance use often remain precariously balanced between recovery and relapse”, argues for “Assertive linkage to continuing care” and efforts to enhance engagement and retention in recovery resources such as mutual aid groups. Another review found evidence supporting the direct and proactive provision of aftercare. Related guidance below. For discussion click here and scroll down to highlighted heading.

G Clinical governance in drug treatment ([English] National Treatment Agency for Substance Misuse, 2009). Guidance for providers and commissioners on establishing systems to deliver and demonstrate that the quality and safety of their services are of a high standard that is continually improving.

G English inspectorate’s criteria for quality services (CQC), accessed 2020). Official inspector of health and social care services in England asks five key questions of specialist NHS and independent substance use services: whether they are safe, effective, caring, responsive to people’s needs, and well-led. More on these criteria in appendices to prior consultation. Standards based on the CQC’s requirements listed below.

G Scotland’s vision of a high quality service (Scottish Government and Convention of Scottish Local Authorities, 2014). What for the Scottish Government quality consists of in substance use services. Sets out what patients can expect, what services should provide, and how they should relate to patients. “At their heart is a person-centred, holistic, recovery-focussed approach where services and those seeking to address their problematic substance use work in partnership to achieve agreed outcomes.”

G Quality standards for alcohol and drug services ([Irish] Health Service Executive and Ana Liffey Drug Project, 2013). Update adopted by the Irish government of the QuADS standards developed for UK drug and alcohol services. Consists of a checklist of practices which for different types of services constitute quality in management, service delivery, and upholding service users’ rights.

G English drug services define their own quality standards (2016). From bodies representing the addictions treatment sector in England, standards developed after consultation and piloting with services. Designed to guide services in assessing how they support people into and through recovery and the quality of vital aspects of their organisations. Can act as a check list for provider organisations as well as managers and commissioners. Consists of: standards for non-residential services (2016); implementation guide (2016) for these standards; and standards for residential rehabilitation (2016). Based partly on the CQC’s requirements; see documents listed above.

G Strategies to promote continuing care (2009). Expert US consensus on practical strategies to promote aftercare/continuing care based on review of principles of addiction treatment. Related review above. For related discussion click here and scroll down to highlighted heading.

G Assessing readiness for change and the implementation process ([US] Substance Abuse and Mental Health Services Administration, 2009). Practical, hands-on guide to how to assess an organisation’s capacity to identify priorities, implement changes, evaluate progress, and sustain quality-improvement programmes, and how to implement these programmes.

G Organisational features underlying successful improvement programmes ([US] NIATx, accessed 2020). Web-based service whose model for improving addiction treatment services is based on five principles such as involving the customer and seeking ideas from other fields. See also case studies (2012; free source at time of writing) of the principles’ roles in improving US services and the attributes which experts say (2011; free source at time of writing) determine whether an organisation will not just implement, but sustain improvements. NIATx’s aims include cutting waiting times and the number of ‘no-shows’, for which see cell C2. Related study above. For discussion click here and scroll down to highlighted heading.

more Search for all relevant Effectiveness Bank analyses or for sub-topics go to the subject search page. See also hot topic on why some treatment services are more effective than others.

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