Develop a Sustainable Infrastructure
All of this planning and effort is for naught unless the site capitalizes on these experiences and opportunities to create a permanent site-based capacity for continuing the transformation process with success. The transformation process is depicted in the accompanying figure. As the PDSA cycle plays out in the monthly communication meetings and in all the activities in between meetings, the “Act” part begins to affect how provider organizations are run (procedures) and how the human service bureaucracy functions (structures).
This is a critical step toward establishing a sustainable infrastructure station site (in the organization; in the state). This begins in the innovation zone with the initial implementation of an innovation. As work progresses, the people at the practice level bump into organizational and systems issues that do not support the innovation. As these come to light and are made part of the monthly process analysis and problem solving meetings, barriers are reduced and the policy makers begin to create policies and regulations and provider organizations begin to create structures and roles that more fully facilitate the new ways of work. In this way form (organizational and bureaucratic supports) follows function (what is needed to have effective practices in place to benefit consumers). After success is achieved in the first innovation zone, the innovation zone is expanded to a new area of the site and the change management process continues until, finally, the innovation zone is the entire human service system. By that time, every provider organization and every part of the supporting infrastructure will have been examined and changed as needed as part of the ongoing process analyses. Given the ever-changing nature of people and society, this process will never end. Every system will need a sustainable capacity for system change, a continuing process of reassessment and renewal focused on incremental improvement in consumer benefits.
