Initiate and Manage Change

Is change needed? Any change process needs to begin with an analysis of the current state of affairs to see where the system, as currently functioning, is in need of change. This analysis gives consumers, stakeholders, and policy makers a clear purpose in making the changes and a clear set of outcomes they hope to achieve. In order to increase the potential for success, a change management process needs to be in place to turn intention into action to achieve the consumer benefits that are the promise of transformation. But, how can planners and stakeholders predict and manage change in complex human service systems? Anyone who has attempted change on any scale knows all too well how unexpected issues arise from unanticipated quarters to sink one initiative after another. Thus, a process for initiating and managing change needs to be in place that does not require one to attempt to predict every twist and turn yet instills confidence that the process of change can be managed responsibly.

The change management process consists of three key components:

  1. To begin the transformation process, policy-initiated changes are made that enable (i.e. make feasible or possible) the start up of new practices within an innovation zone. As explained below, an innovation zone is a place where innovations can be tried and where it is agreed that the usual rules/regulations will not apply during the testing period.
  2. The innovation begins to be implemented by communities, practitioners, and provider organizations in the innovation zone (i.e. using successful methods for implementation as explained throughout this website).
  3. The third essential component is a direct communication system between the policy and practice levels. Early in the transformation process weekly or monthly meetings commence between people at the top policy levels and people at the practice level to decide how to begin to use innovations. Once the innovation has begun, the monthly meetings continue with a focus a) on problems and issues that arise and b) on their solutions at policy, system, and organizational levels. This feedback system makes use of the plan-do-study-act (PDSA) cycle (see the Glossary for an explanation) that has been used with great success in business and manufacturing for the past century. The direct, open, and unfiltered information flow between those directly involved in front line practice and executive level policy makers seems to be essential to the success of transformation.

To achieve these transformative goals, the process starts with having a plan for initiating and managing change.  However, the real transformation process begins when innovations such as evidence-based programs start to be implemented in local provider agencies.  The implementation activity at the practice level exposes aspects of organizations and systems that are hindering the process of achieving better outcomes for consumers using these innovations.  Dealing with these non-supportive aspects in a constructive way at the policy and practice levels is the beginning of transformation.  The people who are directly involved in these change processes learn new skills and acquire experience as they deal with one set of issues after another at policy and practice levels.  They represent the beginning of a new state-based infrastructure that can sustain and improve the transformation process across human service systems and across time.
In this view, transformation is not a goal but a sustainable capacity for system change, a continuing process of reassessment and renewal focused on measurable improvement in consumer benefits.

The frequency of meetings and the richness of the information being communicated quickly results in practice-informed policy as new, desirable practices are carried out in the innovation zone, barriers are cleared away, and the necessary organizational and systems supports are discovered and developed. This method of managing the change process reduces risk to vulnerable citizens, increases the amount and frequency of information available to policy makers and managers, and keeps the focus clearly on the actions needed to accomplish the goals set out in policy (e.g. provide excellent services consistently, eliminate disparities).

In larger systems and organizations, change cannot happen all at once and, even if it could, the risks of being wrong and doing harmful new things with large groups of vulnerable citizens precludes transforming whole systems at one time. To avoid these excessive risks, change can be initiated in an innovation zone (a region of a state, an agency, or some identifiable part of a service system). An innovation zone is a place to try out new policies and plans and work out the methods to achieve success (also see Peters & Waterman’s 1982 discussion of “skunkworks” in creative business environments).

New ideas do not fare well in systems completely dedicated to current methods. Thus, in the innovation zone there needs to be agreement to suspend the usual rules in order to establish the operational value of a system change, evidence-based program, or other innovation. Initially restricting change to an innovation zone increases flexibility to more rapidly facilitate change, reduces the impact of mistakes, and allows the PDSA cycle to spin at a rapid rate to reach desired goals. Once transformation has been reached in the innovation zone, the innovation zone can be expanded to include more regions, agencies, or identifiable parts of the service system. Unlike other economic resources, knowledge is not depleted but gains in value with use. Thus, what is learned from “behaving on purpose” at each step is retained to inform the change activities in the next step. This expanding knowledge base is the first step toward developing a new state infrastructure to support transformation.