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In Episode 10 of our ASAM Criteria Unplugged series, we invited Dr. Todd Molfenter to share his expertise on implementing the ASAM Criteria Guide.
About special guest, Todd Molfenter
Dr. Todd Molfenter is the president of the NIATx Foundation. He is a research professor and co-director at the Center for Health Enhancement Systems Studies, based in the Department of Industrial and Systems Engineering at the University of Wisconsin, Madison.
Sitting down with The Change Companies Chief Program Officer Valerie Bagley and Train for Change Senior National Director Scott Boyles, Dr. Todd Molfenter shares insights about implementation support for the ASAM Criteria.
Jump ahead to questions covered in this blog:
- What do we mean by systems change, implementation science and process improvement?
- What benefits do you see of using implementation science in addiction treatment?
- What would you say to a clinician or case manager who feels overwhelmed by the term system change?
- How can we successfully implement the ASAM Criteria to find solutions for key problem areas?
- What are some other ingredients of success for organizations implementing systems change?
- What are some common stumbling blocks or pain points when implementing organizational change?
- How can we address organizational issues and drive change effectively?
Q: What do we mean by systems change, implementation science and process improvement?
Todd Molfenter: The partnership with ASAM (American Society of Addiction Medicine) addresses challenges in implementing ASAM criteria in various clinical settings. ASAM approached us and asked for our expertise in evidence-based practices to enhance the usability of the criteria. This collaboration led to the development of an implementation guide aimed at bridging the gap between research and practice.
The guide focuses on integrating evidence-based innovations into organizational systems — such as admission processes, care continuums and assessment tools — all while aligning with ASAM principles. This is different from traditional evidence-based practices, which often focus on individual clinician changes. Instead, the implementation of ASAM criteria requires system-wide changes. This involves modifying how assessments and treatment plans are conducted at the organizational level, emphasizing both individual and systemic adjustments to ensure successful adoption of the criteria.
Q: What benefits do you see of using implementation science in addiction treatment?
Todd Molfenter: The intersection of implementation science and treatment happens when you focus on maintaining the passion and mission-driven work of providers, while improving organizational systems to enhance service quality. Early in my career, I often worked with founders of organizations who were deeply committed to their mission but typically trained as psychologists or social workers, lacking systems to monitor and improve quality. Over time, tools and frameworks — like those from NIATx — became essential to bridge this gap. The challenge — and opportunity — lies in balancing the mission's heart with implementing organizational systems that support clinicians, streamline best practices and ensure high-quality, effective care delivery.
Q: What would you say to a clinician or case manager who feels overwhelmed by the term system change?
Todd Molfenter: This is where collaborative approach comes in to improve organizational processes. Instead of focusing solely on high-level "systems issues," the focus is on forming teams of individuals directly involved in a process to identify and implement practical improvements. This approach ensures that changes are realistic, actionable and embraced by those affected — rather than imposed externally by consultants or management. While efficiency is essential, involving diverse voices in decision-making allows for a more integrated and effective system. The key is balancing individual responsibilities with broader organizational dynamics, especially in areas involving information flow, patient handoffs or management oversight.
Q: How can we successfully implement the ASAM Criteria to find solutions for key problem areas?
Todd Molfenter: Motivation plays a critical role in driving organization change. It's a myth that simply presenting a directive or evidence-based rationale will naturally inspire compliance. Instead, we need to connect changes to what motivates individuals, such as improving clinical care, reducing burnout or addressing job frustrations. At the organizational level, motivations might include financial concerns, regulatory compliance or leadership priorities. Successfully implementing change requires understanding and leveraging these motivations rather than relying on authority or mandates alone. The approach focuses on aligning changes with both personal and organizational drivers to foster genuine engagement and adoption.
Q: What are some other ingredients of success for organizations implementing systems change?
Todd Molfenter: There are five key factors that facilitate organizational change.
- Top management support: Change projects are more likely to succeed when they have clear sponsorship and backing from leadership. Without this, other priorities can derail well-intentioned initiatives.
- Day-to-day change leadership: Assigning a dedicated individual to oversee the project ensures accountability and follow-through. Committees alone are often ineffective as they lack clear ownership.
- Customer input: Identifying and incorporating feedback from the "customer" of the change — whether clients, staff or specific stakeholders — is crucial for success. For example, when implementing peer recovery elements, involving peer recovery staff as key contributors is essential.
- Pilot testing: Using a "plan, do, study, act" approach allows organizations to test changes on a small scale, gather feedback and refine before full implementation. This method builds confidence and minimizes resistance by involving participants in the process.
- Incorporating external ideas: Avoid recycling ineffective internal ideas. Bringing in fresh perspectives or best practices from outside the field can rejuvenate organizational strategies and foster innovation.
Q: What are some common stumbling blocks or pain points when implementing organizational change?
Todd Molfenter: Pain points can be a motivator to improve. There are some stumbling blocks that can come up that may be seen as motivation, rather than an obstacle.
Workload and burnout: Staff often feel overworked and burnt out, making reducing workload burdens a significant motivator for change.
Desire to help clients: A core motivator for individuals is improving the quality of services and achieving better outcomes for clients. High drop-off rates after initial sessions are a pain point that impacts morale.
Systemic and external pressures: Organizations face challenges from external entities (such as regulators or licensing bodies) imposing standards or criticizing implementations. These pressures can highlight systemic issues but may also seem inconsistent or subjective.
Addressing feedback and trends: If patterns emerge in external criticisms or operational challenges, addressing them systemically can lead to improvement. However, when inconsistencies arise, open dialogue with stakeholders or reviewers may help clarify expectations.
Limitations of systems: While some issues can be addressed at the individual or organizational level, broader systemic challenges (such as regulatory complexities) may require strategic conversations and adjustments rather than simple fixes.
Q: How can we address organizational issues and drive change effectively?
Todd Molfenter: The first step would be to assess the problem. If the issue isn't clear, you can use tools like process walkthroughs, data collection or inventory assessments to pinpoint the need. Then you can define the initiative. Clearly identify the focus of the change and establish measurable goals to track improvement.
Then you can seek support from leadership to provide momentum and ensure the initiative stays on track. While it's not always feasible, leadership backing significantly enhances success. You can also designate someone responsible for driving the initiative forward and maintaining focus.
You can also gather key input by involving essential voices from relevant parts of the organization. You might prioritize those with social or organizational influence, but avoid overcomplicating input processes.
Lastly, you can focus on fostering momentum. Build enthusiasm, passion and a clear identity around the initiative to keep it moving forward and sustain engagement.
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