or decades, communities across the country have battled a seemingly insurmountable foe—opioid addiction. Despite countless efforts to combat this epidemic, the healthcare industry’s attempts have fallen short due to lack of systemic collaboration and coordinated support.

Dedicated to finding a better solution, the University of Utah Health Regional Network, a formal collaboration among independently owned and operated regional healthcare entities led by University of Utah Health, set out to build a program that could unite multiple hospitals and clinics across four states for a common cause.

With everyone in the country independently fighting the opioid epidemic, our initial goal was to establish a method to manage collaborative project work across different organizations, states, and experiences.

Learning to collaborate at scale

Start with shared purpose. To help focus our efforts and learn how to collaborate, we began by picking a small goal—the disposal bag project. Leftover opioid prescriptions that are given away, sold or taken from the original prescription-holder are one of the leading causes of misuse. Disposal bags provided by pharmacies and government agencies are a proactive way to remove those extra drugs before they enter the market.

Build a guiding coalition. We then selected local task force champions from each site who formed cross-functional teams at their respective facilities. While composition of teams varied, organizations were encouraged to include a physician, a pharmacist, a nurse and a representative of the quality department and administration.

Establish accountability. Teams met for a monthly call to brainstorm, review challenges, analyze results and discuss action items for the next few weeks. We also arranged an annual in-person meeting every fall.

Adversity breeds collaborative momentum

As we implemented efforts across the network, we began to experience growing pains that revealed four key pain points:

• Dissimilar regulatory requirements: Prescribing requirements for opioids vary state to state. As a multi-state endeavor, we had to identify and compile all the regulations in one source document to ensure all requirements were met.
• Lack of formal incentive: Also, since our project wasn’t hospital-mandated or CMS-driven, our teams had to carve out time independently to prioritize the work. While ultimately effective, the going was slow.
• Quality expertise gap. Our initial efforts did not pair quality experts with clinical teams. Without the expertise quality teams bring, clinical teams struggled to manage regulatory burden. We later introduced quality experts with expertise in mandates, requirements, and accreditations, which helped bridge the gap. Working together, we achieved system-wide implementation.
• Managing capacity and capabilities: At first, we struggled to match the capacity of a given facility with the pace at which individual teams could manage with limited resources. It took years of slow growth and learning, but eventually we saw success. 

While ultimately unsuccessful implementing across all systems, the disposal bag project helped us identify key gaps in our collaborative processes.

It proved that our teams could work together successfully regardless of location.

Building upon our shared experience, with support from the Regional Network, we had a unique opportunity to apply for a HRSA implementation grant—turning our sights to larger solutions to opioid misuse.

Building on our collaborative strengths

Tackling complex social problems such as opioid misuse and addiction is much like peeling an onion—with each layer, a new root challenge emerges. The disposal bag project helped us shed light and bring in to overall conversation that overprescription wasn’t the only obstacle to overcome (as primarily targeted in the early days of response to the opioid crisis).

Drawing on our collaborative strengths, we began focusing on ways to combat substance use disorders, suicides, illnesses and behavioral health problems that stem from (or in many cases lead to) opioid abuse. With the structured support and reporting-back mechanisms of the HRSA grant, we created the Rural Addiction Implementation Network (RAIN) program.

Partnering with the Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), an addiction medicine team from University of Utah’s College of Medicine’s Internal Medicine Department, we used the funding to implement 15 core activities across the network. We divided the activities on prevention, treatment, and recovery between four participating hospitals and clinics.

Engaging our local communities

Next, we focused on community engagement. For example, we helped rewrite a seventh-grade health curriculum to educate children on the impact of substance use. We’ve also funded and created a sustainability program for a Healthy Living program for postpartum women, who may be more at risk for opioid misuse. In one extremely remote area we have worked with first responders to help them upgrade their licensing and training to achieve paramedic certifications.

In implementing the core activities, we have worked with local school boards, law enforcement, first responders, counseling resources, local public and private partners, and others.

Moving forward, we are creating addiction medicine training and educational materials for providers to share with patients of all backgrounds. At this point we are on track to finish implementing all 15 core activities with at least one of the participant facilities by the end of 2024. 

Planning our next steps

Our next challenge will be to identify better ways to collect data so we can benchmark our work against each other and as a system, creating a model that can be followed by others. While our network’s champions continuously push for improvement, we need to establish ways to document and measure it.

Finally, we’ll begin to educate our teams on lean programming. We’re creating organized training, geared towards rural healthcare facilities, to help teams learn about continual process improvement and proactive operating systems.

We hope to build a network that will become a national model on collaboration that transcends location.