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Organizational Development

Undertaking and Evaluating Continuous Quality Improvement Initiatives:

There are limited studies on the feasibility, effectiveness, and sustainability of CQI approaches in recovery treatment facilities. Delineated in this selection of study resources with annotates are current themes and issues applicable to quality assurance at residential addictions treatment facilities.

Billingham, D. D., Kelly, P. J., Deane, F. P., Crowe, T. P., Buckingham, M. S., & Craig, F. L. (2012).  Clinically significant change to establish benchmarks in residential drug and alcohol treatment services. International Journal of Mental Health and Addiction, 10(6), 890–901.

Kedesh Rehabilitation Services (KRS) Quality Improvement demonstrated their ability to calculate the proportion of individuals who regularly demonstrate reliable and clinically meaningful change. Advocated for was the use of this information by management to monitor the standard of care provided within the organization. That data can also help establish aspirational goals to guide continuous quality improvement initiatives.

Dale, B. G., Bamford, D. R., & der, W. A. van. (2016).  Self-Assessment, Models and Quality Awards. In Managing quality: An essential guide and resource gateway. Essay, John Wiley & Sons, Inc.

The authors highlight their introduction on the prospects of supplanting Strategic Process Improvement and total quality management with excellence in award models, coupled with an overview of Deming, MBNQA and EFQM models. There is also some discussion on an active "self-assessment process" and related challenges.

De Andrade, D., Elphinston, R. A., Quinn, C., Allan, J., & Hides, L. (2019). The effectiveness of residential treatment services for individuals with substance use disorders: A systematic review. Drug and Alcohol Dependence, 201, 227–235.


This study boasts a meta-analysis of twenty-three research papers on the effectiveness of residential treatment with only "moderate quality evidence" supporting the effectiveness of residential treatment in improving outcomes across numerous substance use and life domains.

Enos, G. (2017). Treatment community needs to unite around standards in 2017, Leaders Say. Alcoholism & Drug Abuse Weekly, 29(1), 1–5.

One leader interviewed for the study commented, "We do better as an industry when we can drive the cart."… "When we don't do a good job, that’s when outside influences come in." That is something, I would argue, about which health care providers strive to be proactive. Other subthemes discussed in the article includes building on an unprecedented opportunity, addressing insurance and labor issues while staying in the know on "policy shifts" at the different levels of government.

Fields, D., & Roman, P. M. (2010). Total Quality Management and performance in Substance Abuse Treatment Centers. Health Services Research, 45(6), 1630–1649.

Taken from this study and viewed through a policy lens, treatment facilities should strive to implement quality management processes that improve performance when providing high-quality care and cost-effectiveness of treatment services over time.

Hamm, F. B. (1992). Organizational change required for paradigmatic shift in addiction treatment. Journal of Substance Abuse Treatment, 9(3), 257–260

The paradigmatic shift entails shifting staff accustomed to conceptualizing addiction treatment as a fixed-length program to programmatic changes. Needed is the use of new criteria for patient placement and flexible movement between levels of care while remaining cognizance for the principles of organizational change and adult education.

Hunter, S. B., Rutter, C. M., Ober, A. J., & Booth, M. S. (2017). Building capacity for continuous quality improvement (CQI): A pilot study. Journal of Substance Abuse Treatment, 81, 44–52. 

Revealed in this study was that CQI adopted initiatives, while shown to be feasible and sustainable, demonstrating its effectiveness using administrative data for the researchers proved challenging. The take-away from this paper is the need to better align performance measurement systems with CQI efforts. Further, although most staff in the study were enthusiastic about utilizing an approached that embraced CQI, it was shown that time is needed to implement and sustain it.

Jaskyte, K. (2004). Transformational leadership, organizational culture, and innovativeness in non-profit organizations. Nonprofit Management and Leadership, 15(2), 153–168. 


As in so many other studies, leadership is seen to be an important predictor of innovation, yet in this this study it did not correlate with organizational innovativeness. Reinforced from

this study is that understanding the connection between leadership and organizational culture is important for understanding the relationship between leadership and innovation.

Klingemann, H., & Bergmark, A. (2006). The legitimacy of addiction treatment in a world of smart people. Addiction, 101(9), 1230–1237. 


Discussed in this article is the legitimacy of professional interventions and the future of service provision. The conclusion is that it depends largely on the relationship between the professional and the lay referral system. The authors contend that the process is incumbered by the trend towards evidence-based practice, which demands transparency and rigorous procedures and carries with it the basis for distrust in expert knowledge.

L, J. (2019, February 20). Social Model Program for Addiction treatment. Last Door. Retrieved June 18, 2022.

LAST DOOR’s website with resources advocates for enabling a social model environment within residential programs that empower mutual aid of peers and in the functions of program leadership that endorses reinforcing processes supportive of a recovery-oriented culture.

Mark, T. L., Dowd, W. N., & Council, C. L. (2020). Tracking the quality of addiction treatment over time and across states: Using the Federal Government's "signs" of Higher Quality.  RTI Press.  RTI Press Research Report No. RR-0040-2007 

This longitudinal study in the United States tracked trends in the signs of higher-quality addiction treatment as defined by the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Addiction, and the Substance Abuse and Mental Health Services Administration. While improvements were found on some quality assurance descriptors, performance on several measures remained low

Moos, R. (1997). Evaluating treatment environments. Transactions Publishers.


In his book, Moos explains how to monitor and improve addictions programs, and assesses program implementation. Considered also are treatment environments, examining factors that shape the treatment environment, patients' satisfaction with and participation in program activities, patients' adaptation and community living skills, and patient-program congruence and the influence of treatment environments on patients with different levels of impairment.

Woodroof, P. J., Howie, K. M., & Peasley, M. C. (2020). Non-profit quality: What is it and why should non-profits care? Journal of Philanthropy and Marketing, 26(1). 


This study examines a quality-oriented philosophy in a non-profit context utilizing semi-structured interviews with non-profit executive directors. The findings indicate that a quality-oriented approach to non-profit governance affects an organization's ability to

secure funding and address the mission of the respective organization more efficiently and effectively. It is recommended that incorporating a quality-oriented philosophy creates a competitive advantage for non-profit organizations in an increasingly saturated market.

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