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Organisational functioning; Generic and cross-cutting issues

Key studies on the how the characteristics and functioning of treatment organisations affect implementation and effectiveness. Learn to see organisational context as part of treatment and about two evidence-based US quality improvement resources, and consider what makes treatment services engaging and how they could extend 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 Support and experience at work needed for training to strengthen commitment to working with drinkers (1980). English studies showed that without being able to experience working with problem drinkers, the support of experienced colleagues, and work settings which value, prioritise, and provide time for this work, training alone is of limited value in generating positive therapeutic attitudes. For discussion click and scroll down to highlighted heading.

S Goal-oriented, well organised and supportive workplaces maximise patient progress (1998). US services which were effectively mission-oriented, clear what they expected from staff, and which generated staff involvement and commitment, had more engaged patients who made greater progress and were more likely take up aftercare. Same research stable found (1997) patient participation and outcomes best in residential services which communicated high expectations for patient functioning, emphasised clear rules and procedures, and had a psychosocial treatment orientation; a strong treatment philosophy was “more important [than] the particular theory underlying that orientation”. For discussion click and scroll down to highlighted heading.

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

Is this evidence treatment failed – or that it worked?

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

K UK services which are ‘open to change’ 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. The Organizational Readiness for Change or ‘ORC’ questionnaire used in this study formed the basis for a study and reviews (1 2) listed below. For discussions click here and here and scroll down to highlighted headings.

K Improvement initiatives ‘stick’ best in client-centred services (2017). Follow-up of a US trial of the ‘improvement collaborative’ model developed by the NIATx resource listed below. Focused on what is about some treatment organisations which helps sustainably embed improvements; one factor was commitment to client-centred practice. See also study (2015; free source at time of writing) of what influences enrolment and participation in the same kind of change programmes; management support and concordance with organisational aims emerged as factors. For discussion click and scroll down to highlighted heading.

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 an organisational ‘health’ assessment motivated less well functioning agencies to commit to an improvement programme. The Organizational Readiness for Change or ‘ORC’ questionnaire used in this study formed the basis for a UK study listed above and reviews (1 2) listed below. For discussion click and scroll down to highlighted heading.

R A team of reviewers based in Ireland and the UK investigated relationships between a substance use treatment agency’s organisational health and: 1. the adoption of innovations (2017; free source at time of writing); 2. outcomes for patients and clients (2017; free source at time of writing). Implications included: organisational health partly determines whether improvement attempts succeed; in particular, that a positive organisational climate is important in determining the success of innovations in staff training and treatment methods and is associated with good staff/client relationships, less substance use, and stronger engagement with treatment; and that organisational deficits revealed by such assessments can motivate change, but may need to be rectified before it is successful. All the studies in the review used the ORC questionnaire used in studies from England and the USA listed above. For discussions click here and here and scroll down to highlighted headings.

R Policy strategies for improving outcomes (2011). Two of the world’s most respected addiction researchers, each 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 and scroll down to highlighted heading.

R Organisational dynamics of the change process (2011). Structures findings from the most comprehensive and systematic attempt yet (see studies 1 2 from the same team listed above) 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 an important quality. For discussion click and scroll down to highlighted heading.

R Implementing long-term care/aftercare (2011). Since “People treated for substance use often remain precariously balanced between recovery and relapse”, argues for “Assertive linkage to continuing care” and promoting engagement and retention in recovery resources such as mutual aid groups. Another review (2009) advocated the direct and proactive provision of aftercare – taking it to the patient rather than relying on them to attend a clinic and/or determinedly contacting patients and making aftercare easy to access. Related guidance below. For discussion click and scroll down to highlighted heading.

G Strategies to promote continuing care (2009; free source at time of writing). Expert US consensus on practical strategies to promote aftercare/continuing care based on official US statement of the principles of addiction treatment. Recommendations have implications for organisational structure and coordination with other services. Related review above. For discussion click and scroll down to highlighted heading.

G English inspectorate’s criteria for quality services (Care Quality Commission [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 are listed below.

G English drug services define their own quality standards (2016). From bodies representing the addictions treatment sector in England, standards 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 listed above.

G Scottish government’s vision of a high quality substance use service (Scottish Government and Convention of Scottish Local Authorities, 2014). Sets out what patients can expect, what services should provide, and how they should relate to patients. “At [the guidelines’] heart is a person-centred, holistic, recovery-focused 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 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, plus 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. Specific aims include cutting waiting times and the number of ‘no-shows’, for which see cell C2. Related study above. For discussion click 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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