Project Summary/Abstract A team of researchers from the Center for Health Enhancement Systems Studies (the Center) at University of Wisconsin?Madison College of Engineering and Marquette University School of Dentistry will test the effectiveness of an implementation science intervention called the NIATx Organizational Change Model (the NIATx model) in a multi-site study attempting to reduce dental appointment no-show rates. Our trial will be among the first RCTs to test a planned organizational strategy for instituting organizational change in dentistry. The NIATx model includes understanding and involving customers, flexibility to adapt, sensitivity to regulatory and payment considerations, just-in-time coaching, and leadership engagement within a multi-clinic learning community. We hypothesize that the NIATx model in dentistry will decrease appointment no-show rates as compared to the training alone approach that typically accompanies organizational changes in dentistry. The NIATx model has been applied in more than 3,300 organizations but has not yet been applied in or designed for dentistry. The systems engineering principles embedded in the NIATx model will attempt to reduce no- shows through the use of six evidence-based no-show practices in a two-arm trial (Arm 1 = Training Alone in the six targeted no-show practices & Arm 2 = NIATx + Training). The proposed study will measure the impact of the study arms on no-show rates in n=64 dental clinics (n=32 per arm) serving underserved populations in Illinois, New Mexico, Texas, and Wisconsin. We seek to understand whether the NIATx organizational intervention works (Aim 1) and specifically what organizational and no-show practices work best (Aim 2). We will conduct a staff debriefing to understand what helped or hindered organizational implementation of NIATx (Aim 3) and will then seek to quantify the magnitude of improvement in organizational efficiency associated with the intervention (Aim 4). The study will provide an evidence-based tool to reduce no-show rates and implement meaningful process change within dental care clinics, with the goal of helping the dental care field to become more adept at making organizational changes that support evidence-based care.