Healthy Addiction Treatment (HAT) Recovery Model

Leadership in healthcare has generated considerable interest as our lives are strongly impacted by good leadership. The topic is of importance because it can teach us not only about who we are as individuals, but perhaps more importantly, who we are as members of a group within and beyond the work setting.

Leadership is the business and responsibility not only of the individual but of the collective. Distributed leadership has emerged as an innovative alternative to the traditional top-down leadership structure. It has been seen many times over that effective leaders within an organisation may not necessarily be in a position of authority while those in authority may not necessarily be effective leaders. Distributed leadership enables the action and influence of people at all levels within an organisation and supports interventions from wider communities of health professionals.

While definitions of advanced or senior nursing and other healthcare practices may differ across international organisations, a key common component is leadership and a high standard of education. This is reiterated and recognised by the World Health Organisation. They state that a high standard of nursing education is essential for the active involvement of nurses in leadership, health policy, system improvement, research and evidence-informed practice. Often in practice, nurses, midwives and other health and social care professions are confronted with leadership issues.

By virtue of the known prevalence of drugs and alcohol use, many professionals will be confronted by the challenges of addiction or problematic drug and alcohol use among their client groups. This challenge faced the leadership of one large city nursing team working in an established addiction treatment centre. The staff found that they were reactive in their practice, their client list was growing and they had little time for planning and innovation or working constructively with individual clients. The team decided to tackle this challenge collectively.

Developing the HAT Recovery Model

The nursing service in collaboration with a team of researchers decided to obtain their client views of their nursing service and measure their needs. Responsibility for the delivery and success of the project was distributed across the team and all results were fed back and reviewed by the nursing team where final decisions were made collectively. The result of this distributed leadership process, whereby each team member contributed and led on one aspect of the wider project, was the development of the evidence-informed, ‘Healthy Addiction Treatment’ (HAT) recovery model for addiction nursing.

The findings on client needs emphasised the need to address clients’ mental health within a range of settings. The model prioritised each client’s individual need in a dedicated one-on-one session with their addiction nurse. The team decided they would provide six one-on-one sessions with a volunteering client and work with them in their setting, be it anxiety due to a pending court appearance or fears in relation to a new pregnancy.

Implementing the HAT Model

Within the implementation stage, distributed leadership again contributed to successful implementation. At each monthly meeting the implementation of the HAT model was a standing agenda item. Each team member brought their implementation challenge and their proposed solution to the meeting. An implementation framework which identified four stages from exploration, installation, initial implementation to full implementation was used to evaluate the roll out of the model. During roll out and implementation of the model it was clear from the nursing and client feedback that the model did not always work in practice.

We know that implementation involves managing change, deploying data systems and initiating improvement cycles. The notion of improvement cycles is well documented in the area of change management within health services, one such cycle is known as a ‘Plan, Do, Study, Act’ (PDSA) cycle, more details on the PDSA cycle is provided in article 3.8 in the context of implementation frameworks.

Working together the nursing teams initiated a series of PDSA cycles and together they refined the operationalisation of the HAT model. This was a clear example of using Distributed Leadership in addiction nursing practice for the benefit of both the clients of the service and the nursing professionals. To ensure they had time to work with the model with clients, nurses agreed to stop doing some tasks and re-allocate them to other staff, this provided them with more time to work individually on the HAT model with volunteering clients.

References

^{Comiskey C. Distributed Leadership Interventions at Advanced Clinical Practitioner Level In: Curtis E, Beirne M, Cullen J, Norway R, Corrigan S, editors. Distributed Leadership in Nursing and Healthcare. United Kingdom: Open University Press; 2021.}