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Organisational functioning; Generic and cross-cutting issues

Seminal and key studies, reviews and guidance on the how the qualities and functioning of treatment organisations affect the implementation and effectiveness of treatment for problem drinking.

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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S Support and experience at work needed for training to strengthen commitment to working with drinkers (1980). English studies spotlighted the availability of experience in working with problem drinkers, support of experienced colleagues, and constraints at work including time, prioritisation, and organisational policy. Conclusion was that formal training alone is of limited value in generating therapeutic attitudes unless combined with support and experience on return to work. Discussion in bite’s Highlighted study section.

S Goal-oriented, well organised and supportive workplaces maximise patient progress (1998). US services which emphasised mission-oriented good organisation, were clear what they expected from staff, and which generated staff commitment to their work and feelings of being supported and encouraged to make decisions, had more engaged patients who made greater progress and were more likely take up aftercare. Similar study (1997) from the same research stable added that the strength of a service’s treatment philosophy “is more important [than] the particular theory underlying that orientation”. Discussion in bite’s Issues section.

Is post-treatment bounce-back of dependent drug use a sign treatment was working?

S Chronic care for chronic conditions (2002). Alternative source. Profound implications of truly treating addiction of the kind seen by many treatment services as analogous to a chronic disease, including continuing care which partners with and is attractive to and manageable by the patient, and is evaluated by what happens during treatment figure. Discussion in bite’s Issues section.

K UK services open to change have more engaged patients (2009). Clients engaged best when services fostered communication, participation and trust among staff, had a clear mission, but were open to new ideas. Organisational health assessment questionnaire used in this study has been recommended for the UK. In the USA, feeding back scores from the tool has been found to motivate agencies to improve. Discussion in bite’s Issues section.

K Place your agency in front of a potentially unflattering mirror (2007). In the USA, feeding back staff responses to the organisational health questionnaire used in a British study motivated less well functioning agencies to commit to an improvement programme. Discussion in bite’s Issues section.

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.

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 an English study and guidance, openness to change (“general readiness to embrace innovation”) emerges as important quality. Discussion in bite’s Issues section.

R Implementing continuing care interventions (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. Discussion in bite’s Issues section.

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. Discussion in bite’s Issues section.

G English inspectorate’s criteria for quality services ([English] Care Quality Commission, 2015). Official inspectorate of health and social care services ask five key questions of substance use services: whether they are safe, effective, caring, responsive to people’s needs, and well-led. Says governance and management should aim for a service which delivers “high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture”. More on these criteria in appendices.

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 Theory into practice strategies ([Australian] National Centre for Education and Training on Addiction, 2005). From one of the world’s major workforce development agencies for the addictions field. Chapter on managing organisational change includes the organisational factors which impede or promote change and how to manage them. Discussion in bite’s Issues section.

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 Establishing and running non-residential programmes ([US] Substance Abuse and Mental Health Services Administration, 2006). US consensus guidance. Includes strategic planning, working with a board of directors, relationships with strategic partners, hiring and retaining employees, staff supervision, continuing education and training, performance improvement, outcomes monitoring, and promotion of the program to potential clients, funding agencies, and government officials.

G Organisational features underlying successful improvement programmes ([US] NIATx, accessed 2018). Web-based service supported by US government. Model for improving addiction treatment services is based on five principles such as understanding and involving the customer and seeking ideas from other fields. See also these case studies of the principles’ roles in improving US services and the Sustainability Model developed with the British NHS to help services choose and implement sustainable improvement projects. Specific aims include cutting waiting times and the number of ‘no-shows’, for which see cell C2. Discussion in bite’s Where should I start? section.

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