Improving Quality of Care in Substance Abuse Treatment Using Five key Process Improvement Principles

  • Kim A. Hoffman
  • Carla A. Green
  • James H. Ford II
  • Jennifer P. Wisdom
  • David H. Gustafson
  • Dennis McCarty


Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: (1) understand and involve the customer, (2) fix key problems, (3) pick a powerful change leader, (4) get ideas from outside the organization, and (5) use rapid cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate successful applications of each principle. Results suggest that organizations can successfully integrate and apply the five principles as they develop and test change strategies, improving access and retention in treatment, and agencies’ financial status. Upcoming changes requiring increased provision of behavioral health care will result in greater demand for services. Treatment organizations, already struggling to meet demand and client needs, will need strategies that improve the quality of care they provide without significantly increasing costs. The five NIATx principles have potential for helping agencies achieve these goals.


Motivational Interview Substance Abuse Treatment Behavioral Health Care Robert Wood Johnson Foundation Change Leader 



We appreciate the support and participation of the treatment programs that have participated in NIATx. The Network for the Improvement of Addiction Treatment (NIATx) was funded by grants from the Robert Wood Johnson Foundation and cooperative agreements from the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. The National Evaluation Team at Oregon Health and Science University was supported through awards from the Robert Wood Johnson Foundation (46876 and 50165), the Center for Substance Abuse Treatment (through subcontracts from Northrop Grumman—PIC-STAR-SC-03-044, SAMHSA SC-05-110), and the National Institute on Drug Abuse (R01 DA018282). National Program Office activities at the University of Wisconsin were supported through awards from the Robert Wood Johnson Foundation (48364), and the Center for Substance Abuse Treatment (through a subcontract from Northrop Grumman—PIC-STAR-SC-04-035). We are especially grateful for the cooperation and collaboration from the 38 members of NIATx.

Conflicts of interest

The authors have declared that no conflict of interest exists.


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Copyright information

© National Council for Community Behavioral Healthcare 2011

Authors and Affiliations

  • Kim A. Hoffman
    • 1
  • Carla A. Green
    • 2
  • James H. Ford II
    • 3
  • Jennifer P. Wisdom
    • 4
  • David H. Gustafson
    • 3
  • Dennis McCarty
    • 1
  1. 1.Department of Public Health and Preventive MedicineOregon Health & Science UniversityPortlandUSA
  2. 2.Center for Health ResearchKaiser Permanente NorthwestPortlandUSA
  3. 3.Department of Industrial EngineeringUniversity of Wisconsin – MadisonMadisonUSA
  4. 4.Department of PsychiatryNew York State Psychiatric Institute, Columbia UniversityNew YorkUSA

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