Addressing Organizational Readiness and Culture

Some organizations or practices may experience significant reluctance from leadership, providers, or other office staff when implementing medication-assisted treatment (MAT). This hesitation may be due to discomfort with treating substance use disorders or concerns about increased demands on their time and resources. Achieving buy-in from staff may need to start with steps to address organizational culture.

North Star

Practice staff and leadership all endorse the organization’s decision to offer MAT services, and they treat patients with substance use disorders with respect and compassion.

How Do You Do It?

Consider Readiness for Change

Before jumping into the implementation process, practices and organizations should consider whether their staff are ready to offer MAT services. Ask the following questions:

  1. Are staff interested? Are members of leadership driving this change with a top-down approach or do they have support across levels of the organization? Have providers indicated they are willing to seek a buprenorphine waiver? Have other members of the clinical care team and front office staff expressed interest or support for implementing MAT?
  2. What are their concerns? What challenges or barriers are staff worried about when offering MAT? Are these barriers attitudinal or logistical in nature?
  3. What next? What steps will be taken to increase staff interest or to address staff concerns? Is someone in the practice willing to lead these efforts?

It is important to meet people where they are. Some providers may not have considered offering MAT services, while others may be ready to take action. Don’t be discouraged if your practice is not ready to implement MAT. Many other strategies are available to help care for and support individuals with opioid use disorder. In the meantime, you can begin to take small steps to lay the groundwork for a MAT program.

Seek Staff Buy-In

To successfully implement MAT, you will need to achieve buy-in from staff at all levels of the organization. Staff may be concerned about starting MAT services, as they may feel uncomfortable working with individuals with substance use disorders. It is important to emphasize that these individuals are already part of the current patient population, and many of them desperately want help. The following strategies may help gain staff buy-in:

  • Facts and Figures. You may have to advocate to staff why it is important to start offering MAT services. For some staff, presenting information will help convince them of the need. You can design messaging or presentations that provide State- and county-level statistics about the opioid epidemic to contextualize and localize the issue. Highlighting the treatment gap and the lack of waivered providers may help encourage some to offer MAT services. Others who are skeptical of MAT may need to see the evidence base for MAT and its impact on patient outcomes.
  • Testimonials. Sharing personal experiences and real-world success stories can be a powerful tool to humanize individuals with substance use disorders and show that recovery is possible. Invite individuals in recovery who have received MAT or their families to speak with practice staff. Or, if staff are willing to speak about their own experiences with individuals with substance use disorders, either in their personal or professional life, they can make a powerful argument to others.

Educate Staff on Addiction and MAT

Stigma is often driven by fear or misunderstanding. All providers and office staff should receive education about the science of addiction and MAT, even those who will not be working directly with MAT patients. This education should dispel the myths and misconceptions about MAT and emphasize:

  • Addiction as a chronic relapsing, disease;
  • The difference between physical dependence and addiction;
  • Recovery as an achievable goal; and
  • The mechanisms of action of medications to treat opioid use disorder.

Avoid Stigmatizing Language

The language we use to speak about MAT and individuals with substance use disorders can implicitly reflect and reinforce stigmatizing attitudes. This language can contribute to the shame and isolation people with substance use disorders experience and discourage them from seeking treatment.

Avoid words that…

  • Imply substance use disorders are a result of a moral failing (e.g., junkie, drug abuser, clean or dirty urine); and
  • Reinforce inaccurate myths about MAT (e.g., replacement therapy, substitution therapy).

Instead, promote the use of language that…

  • Has clinical utility and value (e.g., continued substance use, recurrence of use, opioid-negative or opioid-positive urine drug screens); and
  • Is person-centered (e.g., people with opioid use disorder).

What Not To Do

  • Don’t dismiss providers’ and staff’s concerns about treating patients with opioid use disorder. Listen to and acknowledge their concerns, as they may have had negative experiences with individuals with substance use disorders, but brainstorm ways to address them.
  • Don’t take a top-down approach. You will need to involve staff across the organization to achieve buy-in.
  • Don’t expect change overnight. Organizational culture change takes time and messages need to be continuously reinforced.