[The total-quality-management-analysis of the continuation and discontinuation of alcohol family treatment: a grassroots approach].
A family support/treatment program was provided to thirty-three cases where a drinking family member (identified patient) had shown alcohol related problems but not yet admitted the problem. After a period of between thirteen and twenty-one months of family treatment, fourteen (42.4%) identified patients started their own treatment. The only statistically significant factor that was related to the patients' treatment program participation was the continuation of family members' involvement in a family treatment program. Among the thirty-three cases, a little less than one half (48.5%) continued the family program. In order to increase the patients' participation, it is crucial to encourage family members to continue their family support/treatment program. In order to identify factors that contribute treatment continuation as well as dropouts, workshops were held with those who dropped out and those who continued the family treatment program. The Total-Quality-Management (TQM) affinity and arrow diagram techniques were employed to classify the participants' statements and to find cause-effect relationships among the identified factors, respectively. Five family treatment discontinuation factors were identified: 1) a lack of information about family support program, 2) resistance against a "family change" orientation in family treatment program, 3) family member burnout, 4) a misfit between family needs for immediate problem solutions and what family program offers, and 5) a temporal improvement of patients' drinking problems. While widely varied factors were found to contribute discontinuation, only a very few factors were identified to facilitate the treatment continuation. It was concluded that treatment discontinuation, rather than continuation, was the norm among the families of problem drinkers. Based on the above findings, three kaizen plans were proposed. First, in order to make sure that family members obtain necessary information about the family support/treatment program, a pamphlet would be created and handed out to those who come to family treatment. Second, family support efforts would be emphasized more. Treatment staff is expected to become more cautious with regard to the family behavior change facilitation, especially at the early stage. Third, treatment staff is expected to become more aggressive about contacting family group members when they do not show up to a meeting.
Nishikawa
K
K
Department of Social Welfare, Faculty of Nursing and Welfare, Fukui Prefectural University, 4-1-1 Kenjyojima, Matsuoka-cho, Yoshida-gun, Fukui 910-1195, Japan.
Tatsuki
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000628:therapy*; D005196:Family Therapy / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010352:Patient Dropouts; D017749:Total Quality Management