The Network for the Improvement of Addiction Treatment (NIATx), a national program co-funded by the Robert Wood Johnson Foundation and the Center for Substance Abuse Treatment, was established in 2003. As a co-founder, we identified five key principles of organizational change which served as the foundation for applying health systems engineering techniques and quality improvement tools to improve processes of care in behavioral health organizations. This pioneering work has benefited multiple organizations nationally and internationally improve process outcomes, such as wait times or no-shows, or clinical outcomes including but not limited to medication access.