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NIATx in New Places: RHRP

By: Mat Roosa, LCSW-R

“How can we improve our workforce?”

In a human service environment filled with open positions, understaffed programs a low rates of worker retention this seems like a perfectly reasonable question. 

As NIATx has continued to explore new places, we have turned our attention to trying to support the workforce challenges of health and human service organizations. The critical need for this support emerged from the experience of attempting to support programs in implementing NIATx based change projects, but finding that the change leader supervisors were struggling to keep enough staff to operate the program, and had little energy for improvement. Some consultants and providers of technical assistance have been struck by the level of stress related to workforce concerns that supervisors are experiencing. Too many supervisors express a high level of stress and moral injury, as they find themselves unable to pursue the mission that they care deeply about, because they do not have the staff to do it. 

So, we decided to use our improvement model to help organizations to answer that question: “How can we improve our workforce?”  And upon further inspection we found that this might not be the right question to ask.

One of our NIATx principles is to get ideas from other industries, and so we found ourselves thinking about how a similar question might play out in another environment. What if a customer went into a grocery store and asked the front-end manager, “Where can I find the dinner food?” We all know why this would not be an appropriate question. It is just too generic to be meaningful. The response would likely be some version of “It depends on what you want to eat.”  

The work of Deming teaches us that everything we do can be defined as a process. And workforce issues are no exception. It became clear that any effort to support workforce improvements needed to use our NIATx tools to break down the issue into the specific processes. These included recruitment, hiring, retention, and promotion (RHRP). The NIATx tools of the walk through and flow charting could then be used to understand the potential applicant or interviewee’s experience associated with that specific process. Nominal group technique brainstorming could then help to define specific strategies for recruitment, or hiring that could be tested using the PDSA (plan, do, study, act) change model. 

We have begun to use this approach to train supervisors and managers to make specific changes and to measure the results to see if they can recruit more diverse candidates, get more people to apply for positions, enhance the interview experience, etc. In addition to the NIATx model, we have also included other key factors, including cultural responsiveness, wellness, and coaching/ mentoring to provide additional support to the workforce improvement effort.

There is certainly no single fix to the complex economic drivers of workforce challenges. But the use of focused data driven change projects can help an organization or a broader system, to find strategies that can make a difference. Harnessing the wisdom of a change team to find new paths forward is a key part of NIATx. Using PDSA change cycles is helping leaders to impact these workforce challenges in simple and powerful ways.

Mat Roosa, LCSW-R

Mat Roosa is a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant and trainer in the areas of process improvement, evidence-based practices implementation, and organizational development and planning. Mat’s experience also includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human services agency administration.

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The opinions expressed herein are the views of the authors and do not reflect the official position of the Department of Health and Human Services (DHHS), SAMHSA, CSAT or the ATTC Network. No official support or endorsement of DHHS, SAMHSA, or CSAT for the opinions of authors presented in this e-publication is intended or should be inferred.