The Role of Management in Establishing and Sustaining a Patient Advisory Committee

1. Addiction Research and Treatment CorporationDeveloping and Implementing Patient Advisory Committees in Opioid Dependency Maintenance Programs

2. Presented by:Robert E. Sage, Ph.D., CASACMonica A. Joseph, CSW, M.Phil.Ralph E. Savarese, M.Ed.

3. The Role of Management in Establishing and Sustaining a Patient Advisory Committee Robert E. Sage, Ph.D. Senior Vice President Addiction Research and Treatment Corporation

4. Addiction Research & Treatment Corporation (ARTC) • Beny J. Primm, Executive Director • Established in 1969 • Seven (7) Opioid Treatment Programs • Manhattan and Brooklyn • 3,000 patients/ 95% minority

5. ARTC • Three (3) Outpatient Drug Free Programs • Research, Evaluation and Continuous Quality Improvement • CARF Accredited • Comprehensive Care

6. Rationale for Establishing a Patient Advisory Committee (PAC)

7. Identifying the unmet needs of the agency • :Perception of opioid treatment • Perception of program in the community • Building staff-patient alliances • Obtaining patient feed-back • Patient recruitment and retention • Creating a clinic community • Enhancing accreditation outcomes

8. Identifying Unmet Needs of Patients • Alternative ways to enhance treatment • Patient input in program policy (clinic policy vs regulations/ standards • Enhancing initial patient integration and socialization within the program • Outlet for complaints and suggestions • Leadership potential • Pre-vocational activities

9. Identifying and Meeting Your Patient Advisory Committee (PAC) Objectives

10. Developing Pride in the Treatment Modality • PAC members become mentors • PAC presents positive image to staff and other patients • Patients oriented towards treatment

11. Enhancing Program Image in the Community • PAC leaders become spokespersons • Community projects and events • Representatives of the program • Encourage feedback from the community

12. Developing Patient Leaders • Organizing and maintaining a component • Developing and organizing clinic activities • Mentors or “buddies” to new patients • Working within a component • Encouraging patients to become “part of the solution” • Enhancing treatment progress

13. Enhancing Patient Feedback and Input • Presenting ideas to administration and staff • Assisting with patient complaints/ feedback • Administering Satisfaction Surveys

14. Initiating a Patient Advisory Committee (PAC) Component

15. Support from Executive Staff • Commitment to addressing needs • Perceiving PAC as a positive strategy • Commitment to outcomes

16. Support from Program Managers and Staff • Addressing and reducing concerns • Identifying positive aspects • Developing a unified mission • Addressing workload issues • Building the staff into the process

17. Selecting a PAC Coordinator Central Office Program Specific One site vs Multi-Site

18. Clinical Staff Investmentin Developing and Implementing Patient Advisory Committees Monica A. Joseph, CSW, M.Phil. Vice President of Treatment Services, Addiction Research and Treatment Corporation

19. Patient Advisory Committee (PAC) Developmentas a Social Process

20. Agency Culture • Each agency has culture of its own, i.e. accepted norms, values (Glisson, 2000), ways of doing • Established by management, but staff must support • Dynamic as agency as a whole must respond to the internal and external environment for survival

21. Agency Culture • Individual staff must also grow/ respond for survival • Not all staff equally responsive • Majority will not buy into the value of new initiatives until they see that others are okay with and already participating • Initiatives such as PAC must thus be spread through a social process

22. Social Process • Social Process called Diffusion • Diffusion Theory (Rogers, 1995) similar to Social Learning (Bandura, 1977) • Stresses that persons adapt observed behaviors through modeling • Diffusion, however, focuses on the outcome, i.e. • What will staff adopt or reject • What role will staff’s social networks play

23. Importance of Clinical Staff • Must get clinical staff (supervisors, direct practitioners, medical and non-medical staff, etc.) involved and invested: • Constitute the treatment team • Have the most contact with patients (especially direct practitioners) • Are in the best position to influence the choices that patients make • Are integral to bridging the gap between patient and programmatic activities

24. Facilitating the Diffusion Process

25. Cultivating the Critical Mass • Management must focus on getting a core group of staff to buy into/ adopt the idea of PAC and the underlying philosophy • Psycho-graphic profile of the staff can impact, i.e. the combination of their psychological and social/demographic characteristics (Moore, 1991), which can influence their willingness to invest

26. Stages of Diffusion • Must be mindful that staff buy-in will occur in stages: (i) Early Adoption (ii) Middle Adoption (iii) Late Adoption

27. Targeting Staff • Must also be mindful based on assessment of staff who will be more likely to be the: (i) Innovative Staff • Early Adopting Staff • Early Majority Adopting Staff • Late Majority Adopting Staff • Laggards (Moore, 1991)

28. Early Adoption Strategies Goal: • To get to the critical mass of staff, who will in turn, encourage patients and other staff to buy-in to PAC

29. Early Adoption Strategies • Step 1: Senior management must champion PAC sending a meta-communication that staff needs to get on board • Step 2: Select and target Innovative Staff, potential Early Adopters, i.e. supervisors, counselors, etc. • Must demonstrate energy, effective interpersonal skills • Must be willing to act as leaders

30. Early Adoption Strategies • Send a clear and direct message to the core group about the value of PAC • Get group to begin to sell PAC to other staff and patients • PAC Coordinator can act as leader • Create climate for staff to demonstrate creativity, e.g. by allow some flexibility with PAC agendas and activities

31. Incentives • Make participation attractive by using tangible and intangible incentives, e.g.: • Reductions in staff workload (even if minimal, can still be effective) • Opportunities for staff and patients to share their success with others • Transportation assistance • Refreshment • Good old praise

32. Remember! • More productive to depend on a smaller core group of motivated staff • Ultimately they hold more influence and can establish strongercritical mass • Once reach critical mass, initial development has taken root

33. Middle Adoption Strategies Goal: To expand the circle of staff and patients who are involved and invested in the PAC implementation and integration process

34. Expanding staff investment • Target staff who have the potential to become Early Majority and Late Majority Adopters • Early Majority persons want to know that PAC is working before they buy into them • Late Majority Adopters will get on the PAC bandwagon only when they have to

35. Interactivity • Utilize critical mass (innovators, early adopters) to influence other staff by creating opportunities for staff interactivity • Interactivity is the degree to which staff in a communication process can exchange roles in, and manage their interaction (Williams, Rice, & Rogers, 1988) • Allows staff to begin to process: (i) How can contribute to PAC; (ii) How can adapt the roles to make easier on selves

36. Interactivity • Facilitates peer to peer feedback as it allows staff to develop a better understanding of what PAC is, what is positive and what is not positive • More benefits perceived, the greater the likelihood that staff will be convinced to adopt • Allows negative feedback to be dealt with appropriately by the Innovators and Early Adopters (critical mass) as they are already invested

37. Interactivity • Facilitate interactivity between managerial staff and clinical staff • Management’s role is to continue to shape staff’s perceptions of PAC by indicating that: • This continues to be desirable • Its implementation is inevitable • A core group of staff/patients (the critical mass) have already bought in to the process

38. Patient Benefits • Crucial for staff to connect PAC’s benefits to patients • Disseminate the responsibility for interacting with patients about PAC to as many staff as possible • Facilitate by integrating PAC as a treatment tool

39. Patient Benefits • Integrate PAC into the treatment process: • Discuss with patients during intake, orientation • Include as part of the strategies for attaining and maintaining abstinence on the treatment plan • Utilize as a natural support system for ongoing case management • Encourage patients who have completed treatment to continue to participate

40. Late Adoption Strategies Goal: To continue to expand and strengthen clinical staff’s support for the viability of the PACs

41. Dealing with the Laggards • Still need to deal with clinical staff who are Late Adopters, Laggards • Simply don’t want to be part of the process • Can impact the momentum and cause earlier gains to be lost • Only way would become involved is if have no choice

42. Dealing with the Laggards • Integrating PAC as part of treatment planning helps to ensure that these staff make some kind of contribution • Managers must be alert for non-productive messages sent by staff in these groups • Counter these with ongoing interactivity and keeping a high profile for PAC

43. Dealing with the Laggards • Use information dissemination, regular updates on PAC progress, i.e. posting bulletins, circulating brochures, etc. to keep the message upfront • PAC must encounter problems with patients, consensus, etc. Address these • Engage both staff and patients in the problem solving process

44. Demonstrate PAC is Working • Let patients assume an increasingly dominant role to demonstrate that the underlying philosophy is working, i.e. • That patients have the capacity to contribute meaningfully to their own treatment • That patients can provide valuable feedback to improve the organization • That patients can enhance their civic environment

45. Summary • Developing, implementing and integrating PAC is a social process • Diffusion principles provide a framework to facilitate staff adoption of PAC • Getting a critical mass can provide the momentum to integrate PAC across the treatment process • Having a PAC Coordinator can guide and nurture the process

46. Role of a PAC Coordinator in Mobilizing and Sustaining Patient Advisory Committees Ralph E. Savarese, M. Ed. Director of Training Addiction Research and Treatment Corporation

47. Getting Started

48. Building the Foundation • Setting the stage: • Support from Senior Vice President • Senior Staff Liaison • Clinic Staff Liaison • Effective communication • Obtaining cooperation and collaboration for patient selection

49. Early Implementation • Identifying specific themes and agendas • Developing Meeting Protocol and Bye-Laws • Ensuring democracy (elections) • Dealing with power issue

50. Making it Work • Integrating the clinic components: • Clinical • Recreational • Cultural • Advocacy • Fund Raising