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The Transformation of Disabilities Organizations Robert L. Schalock and Miguel-Angel Verdugo
Abstract This article summarizes the five major characteristics of the transformation era and describes how intellectual and closely related developmental disabilities organizations can apply specific transformation strategies associated with each characteristic. Collectively, the characteristics and strategies provide a framework for transformation thinking, learning, and acting. Specific application examples are given. Key Words:
disabilities organizations; organization transformation; transformation era; transformation strategies
We live in a transformational era that focuses on change and creating value through innovation. Whether one is involved in economics, politics, business, health care, education, or human services, transformational change is happening in how organizations are structured and how they perform their key functions. The era excludes no one, including organizations providing services and supports to persons with intellectual and closely related developmental disabilities (IDD). The purpose of this article is to summarize the major characteristics of the transformational era and to describe through examples from IDD organizations how applying specific transformation strategies associated with the transformation era provides a framework for transformational thinking, learning, and action. The transformation of IDD organizations is occurring within the context of significant challenges faced today by nonprofit organizations. These challenges involve dwindling resources with an increasing need for services and supports, structural changes from top-down hierarchies built along vertical lines of authority to organizations built along horizontal lines of action, and increased social and political expectations and requirements of IDD organizations and systems to demonstrate meaningful outcomes, ensure efficient resource utilization, and maintain best practices. These challenges are being driven by four powerful social and political forces. First, funding and regulatory bodies and IDD organization leaders are reconsidering how resources are used within an organization to maximize the organization’s
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efficiency, develop effective services and supports, implement robust information systems that can be used for multiple purposes, and enhance personal outcomes. Second, there is an increasing emphasis on the personal and social benefits derived from the involvement of people with disabilities in education and rehabilitation programs. Third, there continues to be a change in where and how IDD services and supports are delivered. This change is reflected in the expansion and dispersal of services and supports, the growth of the Home and Community-Based Waiver, the movement toward consumer-directed funding, and the increasing conversation about what constitutes quality. Fourth, there is a shift towards individualized supports, an emphasis on self-determination and self-direction, and an expressed need for performance-based management and evidencebased practices. Collectively, these challenges and the factors driving them underscore the relevance of understanding the characteristics of the transformation era and their associated transformation strategies. These characteristics and strategies are discussed next.
Transformation Era Characteristics and Transformation Strategies From our analysis and synthesis of the literature, the transformational era can be described on the basis of five characteristics: the person is central, organizations are streamlined, information systems are performance based, quality improvement is a continuous process, and participative leadership is a
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key element in the transformational process. More specifically, in reference to the person as central, we have seen cultural changes based on the values of inclusion, equity, empowerment, and subjective well being (Goleman, 2009; Rochon, 1998; Schalock & Verdugo, 2012b; Schwartz, 2010; Shogren & Turnbull, 2010). We have also seen a significant movement away from vertically structured organizations to those that are more horizontally structured and streamlined (Covey, 2004; Senge, 2006; Slostak, 2010; Zaffron & Logan, 2009). Simultaneously, information systems have emerged that extend thinking beyond simple data collection and analysis to knowledge production through the use of performance-based perspectives and evidencebased indicators (Cascio, 2009; International Consortium on Evidence-Based Practices, 2013; Lombardo, 2010; Passig, 2007; Pinker, 2005; Tow & Gilliam, 2009). Across entities, the transformational era is also characterized by a commitment to continuous quality improvement (Grol et al. 2008; Heath & Heath, 2005; Nell, 2005) and a recognition of the essential role of participative leadership (Buntinx, 2008; Guttman, 2008; Heath & Heath, 2009; Heifetz et al., 2010; Kotter, 1996; Leadership For a New Era, 2012; Thaler, 2012). These five transformation era characteristics provide a framework for creative thinking and action regarding organization transformation. This framework is presented in Figure 1. As depicted in
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Figure 1, when the person is central, organizations recognize the importance of personal outcomes and the provision of individualized supports. When organizations are streamlined, they focus on alignment and the implementation of high performance teams. When organizations employ performancebased information systems, they center their data collection and analysis efforts on performancebased perspectives and evidence-based indicators. When organizations view quality improvement as a continuous process, they foster capacity building and a balanced approach to quality improvement. And when participative leadership is employed, thinking is expanded and synergy is manifest. The following sections provide a literaturebased overview of the specific transformation strategies associated with each of the five transformational era characteristics depicted in Figure 1. At the end of each section, a real-life (boxed in) example is presented that demonstrates how IDD organizations with which the authors are familiar are implementing the two strategies associated with each transformation era characteristic. Additional examples can be found in Schalock and Verdugo (2012a, 2012b).
Person as Central Consumers are no longer passive recipients of disability services. Increasingly, they are active
Figure 1. Framework for organizational transformation.
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contributors to an organization’s policies and practices. The values driving this new role are those related to inclusion, empowerment, selfdetermination, and equity. The centrality of the individual is reflected in two strategies: measuring and using personal outcomes and employing a system of supports.
Personal Outcomes Recognizing the importance of personal well-being and enhancing one’s quality of life (QOL) places the service/supports recipient (i.e., the person) at the center of the service delivery system. Personal outcomes are typically referenced to core QOL domains that reflect an individual’s personal development, self-determination, interpersonal relations, social inclusion, rights, emotional wellbeing, physical well-being, and material well-being (Schalock, Gardner, & Bradley, 2007; Schalock & Verdugo, 2012b). The measurement of personal outcomes is based on a conceptual and measurement framework that operationalizes these core domains on the basis of domain-referenced indicators. Within this framework, QOL domains are the set of factors that constitute personal well-being. Domain-referenced indicators are culturally sensitive perceptions, behaviors, and conditions that give an indication of the person’s well-being. The assessment of QOL domain-referenced indicators provides measures of personal outcomes. The interested reader can find examples of QOL assessment approaches and measures in Bonham et al. (2004), Cummins (2004), Claes, van Hove, van Loon, Vandevelde, and Schalock (2010), Edmonton Persons with Developmental Disabilities (2011), Verdugo, Schalock, Keith, and Stancliffe (2005), Walsh et al. (2010), and Wang, Schalock, Verdugo, and Jenaro (2010). As part of the transformation process, personal outcomes can be used at the level of the individual to provide feedback regarding the multidimensionality of human behavior and the domains of a life of quality, and as a framework for planning individualized supports. At the organization level, aggregated personal outcomes can be used as empirical benchmarks for strategic planning, reporting change over time, and comparing an organization’s aggregated personal outcomes to those of community members without a disability. At the systems level, aggregated personal outcomes can be used as a key outcome measure of systems change. From a
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research perspective, personal outcomes can be used as either dependent variables in multivariate research studies or as evidence in determining evidence-based practices (Schalock et al., 2007; Schalock, Verdugo, & Gomez, 2011).
Individualized Supports A system of supports encompasses the wide range of support strategies that can be used to enhance personal well-being. As described more fully in Schalock and Verdugo (2012b) and Thompson et al. (2009) elements of a system of supports include natural sources (e.g., family and friends, colleagues, generic agencies and businesses), technology based (e.g., assistive technology, information technology, smart technology, prosthetics), environment based (e.g., environmental accommodations), support staff strategies (e.g., providing incentives, fostering skill development, befriending, utilizing positive behavior supports), and professional services (e.g., medical, dental, psychological, psychiatric, OT/PT, nursing). From an organization transformation perspective, a system of supports model aligns specific support strategies to the individual’s assessed support needs and allows for the evaluation of the impact of the specific support strategies employed. This is best accomplished through a Support Team that is described later in the article. Collectively, measuring and using personal outcomes and employing a system of supports establish the central role of the person within a transformed organization. In addition, information regarding personal outcomes and the specific supports provided by an organization provide two essential components of a Provider Profile.
Publishing Provider Profiles IDD organizations nationally and internationally are incorporating personal outcomes and a description of individualized supports the organization provides into a Provider Profile. In most jurisdictions where used, the Profile is published annually both in hard copy and electronically as a vehicle to communicate to potential clientele, to meet accountability requirements and quality assurance standards, and to monitor organization and systems change. Provider Profiles typically include descriptive information about the organization (e.g., location, size, staff complement), a listing of the specific supports the organization provides, quality assurance and quality improvement activities, and aggregated personal outcomes such as QOL domain scores. These personal outcome measures are used as a basis for quality improvement activities. They also provide empirical benchmarks to compare the organization with itself over time, the
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organization to other organizations within the service delivery system, and the organization-based aggregated personal outcomes with comparable outcomes of community members without disabilities.
Streamlined Organizations Transformed organizations are more streamlined in their organization structures and more creative in overcoming challenges related to dwindling resources, increased demands for services and supports, and the need to demonstrate the organization’s effectiveness and efficiency. As disabilities organizations become more streamlined, they make structural changes from top-down hierarchies built along vertical lines of authority to organizations built along horizontal lines of action. Two transformation strategies facilitate this process: aligning service delivery components and developing high performance teams.
Alignment Identifying the key service delivery components and then aligning them horizontally and vertically is a key part of organization transformation. The alignment of service delivery components has a number of advantages. Chief among these are that such alignment facilitates policy development and organization change, clarifies for stakeholders the sequence of events from input through process to outcomes/outputs, and provides a framework for developing and implementing high performance teams (Schalock & Verdugo, 2012a, 2012b). This process of alignment is depicted in the program logic model presented in Figure 2. Horizontal alignment involves the logical sequence
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among input, throughput, and outcome/output service delivery components. At the individual level, horizontal alignment involves a logical sequence among the individual’s assessed support needs and personal goals, a system of supports, and assessed personal outcomes. At the organization level, horizontal alignment involves a logical sequence among resources, organization services, and aggregated personal outcomes. Vertical alignment involves the juxtaposition of individual and organization-level practices at each of the program logic components: input, throughput, and outcome/output. As depicted in Figure 2, vertical alignment occurs when the organization’s resources are used to address the individual’s assessed support needs and personal goals, organization services encompass a system of supports, and the same personal outcomes assessed at the individual level are aggregated at the organization level.
High Performance Teams High performance teams are horizontally structured work groups that promote a learning culture by focusing on teamwork, synergy, raising the performance bar, and ‘‘us accountability.’’ They are characterized by being involved, informed, organized, accountable, and empowered (Guttman, 2008; Schuh & Leviton, 2006). High performance teams reflect the structural changes that are occurring in both public and private organizations. They have emerged in the disability field within the context of the transformation of professional services, the emergence of new public management, the focus on consumer-driven and
Figure 2. Organizational transformation based on a systems and alignment approach.
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consumer-centered supports, and the need to increase the involvement of all organization personnel (Noordegraaf, 2007; Reinders, 2008). High performance teams facilitate the integration of tacit (i.e., experience based) and explicit (i.e., empirically based) knowledge into the transformation process. What they do within any organization depends on the organization’s goals, mission, and the specific services and supports provided. Across IDD organizations, high performance teams typically perform functions related to the assessment required for diagnosis and supports planning: Individual Support Plan (ISP) development, implementation, monitoring, and evaluation; data gathering, processing, analysis, and reporting; outcomes evaluation; developing and implementing quality improvement strategies; and crisis management (Schalock & Verdugo, 2012b). The following example describes how one type of high performance team—The Support Team—incorporates the transformational strategies associated with both the ‘person as central’ (personal outcomes and individualized supports) and the ‘streamlined organization’ (alignment and high performance teams).
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such as the following. First, there are a plethora of requirements from disparate funding, regulatory, and accreditation agencies that require reporting and monitoring discrete aspects (e.g., financial or quality assurance) of the organization. Second, information required for certification and licensure varies by jurisdiction and funding agency. Third, information needs vary depending on the respective stakeholder. Information that addresses the concerns of consumers and their family is typically different from that of interest or value to staff, auditors, community leaders, and board members. The net result of these three exemplary factors is that organizations have historically collected volumes of disparate data that, while meeting specific reporting and monitoring requirements, does not provide information based on a clear conceptual and measurement framework that facilitates transformation and change. A framework that provides this clarity is organized around performance-based perspectives and evidence-based indicators. These perspectives and indicators can be used for multiple purposes including reporting, monitoring, evaluation, quality improvement, and performance management.
Developing Support Teams A Support Team, which reflects one aspect of a streamlined organization, is composed of the individual receiving services and supports, his/her parents or family member, a case manager or supports coordinator, direct support staff who work closely with the person, and one or more professionals depending on the individual’s support needs. The primary responsibilities of the Support Team are to develop the ISP based on aligning the input, throughput, and output components shown in Figure 2 and to jointly implement the individual’s support plan. To this end, the Support Team: (a) determines what is important to the person in reference to personal goals and what is important for the person based on the assessment of the individual’s support needs; (b) identifies specific, individualized support strategies based on a system of supports to address personal goals and assessed support needs; (c) uses a personal outcomes-focused framework to specify a specific support objective for each support strategy; (d) indicates who is responsible for implementing each support strategy; (e) implements the ISP via user-friendly support plan formats (see later examples); (f) monitors the Plan on the basis of the status of the support objectives; and (g) evaluates the Plan on the basis of changes in the outcome categories used in item (c).
Information Systems Most disabilities organizations are data rich and information poor. This is due to a number of factors
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Performance-Based Perspectives A balanced approach to strategic planning, program implementation, and organization evaluation requires multiple perspectives on performance. Four commonly used perspectives are those of the person, the organization’s growth, the organization’s financial analyses, and the organization’s internal processes (Fuller, 1997; International Consortium on Evidence-Based Practices, 2013; Kaplan & Norton, 1996; Niven, 2008; Tsai, Chou, & Hsu, 2009; Wu, Lin, & Chang, 2011). The importance of these four perspectives in transforming IDD organizations is that they provide a balanced approach to performance management and a conceptual and measurement framework for the collection and analysis of evidence-based indicators.
Evidence-Based Indicators Evidence-based indicators encompass measurable processes and outputs that reflect best practices in the provision of services and supports to persons with disabilities, involve management strategies that facilitate an organization’s growth, include financial analyses that enhance an organization’s reportability and accountability, and incorporate
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logic models and information systems to enhance the organization’s capacity to self-evaluate and produce knowledge (Schalock et al., 2011; Shogren & Turnbull, 2010). Exemplary evidence-based indicators associated with each of the four performance-based perspective listed above are presented in Table 1. Information systems that incorporate performance-based perspectives and evidence-based indicators are essential components of performancebased management and organization transformation. Many IDD organizations are transforming the way they approach performance management by collecting, organizing, and using information based on the performance-based perspectives and evidence-based indicators summarized in Table 1. In the process, the organization is in a better position to be more evidence based and respond better to the need to be more effective in terms of achieving desired outcomes and more efficient in terms of producing the organization’s planned results in
relation to the expenditure of resources. This process is described in the following example.
Using Performance-Based Perspectives and Evidence-Based Indicators The transformation of information systems involves developing and using information that is based on those perspectives and indicators presented in Table 1. These perspectives and indicators are being used as a framework for strategic planning, as a template for program implementation, and as a balanced scorecard for program evaluation. In the process, the organization transforms its approach to capacity building, the development and implementation of evidence indicators, and the holistic approach it uses in the delivery and evaluation of services and supports. From an organization evaluation point of view, information obtained from evidence-based scores on each of the four perspectives presents a balanced scorecard from the perspective of the customer and the organization’s growth, financial analyses, and internal processes. In addition, an Effectiveness Index can be computed based on summing the customer and growth perspective scores, and an Efficiency Index can be computed based on summing the financial
Table 1 Performance-based perspectives and exemplary evidence-based indicators Performance-based perspective Customer
Growth
Financial processes
Internal processes
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Exemplary evidence-based indicators Aligns services/supports to identified needs Reports the number of clients living or working in more independent, productive, and community-integrated environments Measures personal outcomes Reports and analyzes aggregated personal outcomes Uses technology to enhance personal outcomes Articulates the organization’s mission and intended results Enters into partnerships Develops program options Utilizes and evaluates high performance teams Monitors job satisfaction and develops job enrichment programs Compares unit costs across different locations and service delivery platforms Reports percentage of budget allocated to client-referenced supports Monitors the relationship between social capital and agency-based fiscal capital Uses fixed and variable cost data to establish a baseline cost rate Analyzes overhead rate to increase efficiency Horizontally aligns input, throughput, and output components Vertically aligns an organization’s input, throughput, and output components to the corresponding individual-referenced input, throughput, and output component Demonstrates the relationship between units of service/supports provided and the clienteles’ assessed support needs Uses data related to personal outcomes and organization outputs for multiple purposes Uses evidence-based indicators for continuous quality improvement
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analyses and internal processes scores. This information is used for reporting, monitoring, evaluation, and as part of a continuous quality improvement loop to guide changes in the organization’s policies and practices.
Continuous Quality Improvement Quality improvement is not a discrete event, nor is it a single process. It is a continuous process that occurs most readily in organizations that have built the capacity to change, and in those organizations that take a balanced approach to its formulation and implementation. In addition to these two transformation strategies, it has been our experience with organizations undergoing transformation, that successful continuous quality improvement involves the following critical factors that act as catalysts: (a) a focus on the alignment of both the critical organization components depicted in Figure 1 and strategic planning, program implementation, and organization evaluation; (b) the use of a conceptual and measurement framework such as those summarized in Tables 1 and 2; (c) the development of empirical benchmarks that are used for self-comparison and feedback regarding the effectiveness or impact of the quality improvement strategies employed; (d) the use of both tacit and explicit knowledge to develop a learning culture; (e) the involvement of all stakeholders in the transformation process; and (f) the use of right-to-left thinking that establishes the mindset among personnel within the organization that change is possible by beginning the quality improvement process with the question, ‘‘What are our desired outcomes, and what needs to be in place for these outcomes to occur?’’ The interested reader can find additional information about these critical factors and catalysts in Bourgeois, Hart, Townsend, and Gagne (2011), Chen (2004), Drucker (1999), Hunter (2006), International Research Consortium on Evidence-Based Practices (2013), Kapucu, Healy, and Arslan (2011), Lick (2006), Linnell (2003), Miller (2005), Nichols (2002), Pluye, Potvin, Denis, Pelletier, and Mannoni (2005), and Sridharan, Go, Zinzow, Gray, and Barrett (2007).
Capacity Building Capacity building provides a ‘‘tool kit’’ that enables IDD organizations to operate effectively and efficiency in a nonprofit environment (Linnell, 2003; Schalock & Verdugo, 2012b). Capacity
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building includes developing and reinforcing a learning culture that is based on tacit and explicit knowledge and multiple-perspective information systems, accessing social capital, entering into collaborative partnerships, implementing a person-referenced system of supports, and providing a range of service delivery opportunities based on current best practices. Capacity building involves both content (i.e., the took kit), as just described, and processes. Chief among these processes are innovation, mentoring, evaluation, risk taking, scanning the environment to find new ways of doing things, involving all organization personnel, and reinforcing curiosity and openness to new approaches (Denning, 2012; Goleman, 2009; Jelps & Dickinson, 2008; Senge, 2006).
Balanced Approach A balanced approach to continuous quality improvement and organization transformation involves the four performance-based perspectives (i.e., the customer, and the organization’s growth, financial analyses, and internal processes) discussed earlier and the use of specific transformation strategies. Table 2 lists exemplary quality improvement strategies associated with each of the four perspectives. The specific quality improvement strategies listed in Table 2 reflect best practices used for capacity building. These best practice strategies are based on the work of Claes, van Hove, Vandevelde, van Loon, and Schalock (2012), the International Consortium on Evidence-Based Practices (2013), Kaplan and Norton (1996), Niven (2008), Schalock and Verdugo (2012b), Tsai et al. (2009), and Wu et al. (2011). In summary, quality improvement is challenging to IDD organizations that frequently are faced with ‘‘the daily crisis’’ and ‘‘keeping the ship above water.’’ Quality improvement is not something that a committee does by developing a quality improvement plan. As suggested in the preceding discussion, quality improvement is a continuous process that depends on many factors and players, and needs to be approached in a balance way based on the organization’s strengths and resources. As one approach to continuous quality improvement, the following example describes how right-to-left thinking can be used in quality improvement activities to integrate two performance-based perspectives (in this example, customer and financial) with the targeted use of quality improvement strategies.
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Table 2 Performance-based perspectives and exemplary quality improvement strategies Performance-based perspective Customer
Growth
Financial
Internal processes
Exemplary quality improvement strategies Align services and supports to assessed support needs and personal outcomes Implement individual supports plan based on assessed support needs and personal goals within a personal outcomes framework Implement a system of supports Increase personal involvement and motivation through active involvement in the Support Team and ownership of My Support Plan Develop measurable organization goals Allocate resources to the achievement of organization goals Develop program options Develop high performance teams Increase direct support staff motivation and involvement though involvement in high performance teams Provide direct support staff with a one- to two-page Support Staff Action Plan that summarizes specific support strategies and objectives for their client(s) Develop job enrichment programs Become knowledge producers and value-based businesses Bundle critical functions Develop an economy of scale based on fixed and variable costs Access social capital and natural supports Rethink the multiple nature of resources Base resource allocation on assessed support needs Engage in networking, consortia, and partnerships Use program logic models to align organization horizontally and vertically Develop web-based real-time information systems Use data for multiple purposes Implement quality improvement strategies and provide training in interpreting and using information Use the same quality improvement framework for strategic planning, program implementation, and organization evaluation
Basing Quality Improvement on Right-toLeft Thinking, Performance-Based Perspectives, and Targeted Strategies Many organizations approach quality improvement by engaging in right-to-left thinking. One commonly finds IDD organizations using this type of thinking regarding two performance-based perspectives: that of the customer and that of the organization’s financial analyses. In reference to the customer, the typical question asked is, ‘‘How can we enhance personal outcomes?’’ When this question is asked, organizations implement the following quality improvement strategies: aligning services and supports to personal goals and assessed support needs within a personal outcomes-focused framework, implementing a system of supports, and increasing the involvement of the person in supports planning and implementation. In reference to financial analyses, the typical
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question is, ‘‘How can we increase our financial accountability and/or status?’’ When this question is asked, organizations implement the following quality improvement strategies: bundling critical functions, developing an economy of scale based on fixed and variable costs, accessing social capital and natural supports, rethinking the multiple aspects of resources (e.g., time, experience, and expertise), basing resource allocation on assessed support needs, and engaging in networks, consortia, and partnerships.
Participative Leadership Participative leadership is all about bringing about change. Participative leadership involves inspiring people and organizations to expand their thinking and foster synergy.
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Expanded Thinking Organization transformation involves changing both mental models and thinking styles that form the vision and culture of an organization. As discussed by Senge (2006) and Shermer (2011) it is necessary to identify and understand these mental models, discuss their impact on individuals and organizations, and recognize that they frequently represent a limiting factor in organization transformation. Thus, as organizations embark on transformation they challenge historically based mental models and move toward future oriented mental models. This involve moving from viewing disablement based on defectology to a social-ecological model of disability; from approaching organizations as closed systems to organizations as open systems acting as bridges to the community; from emphasizing power over to power with; from managing organizations as vertically structured mechanistic entities to leading organizations that are horizontally structured and self-evaluating and improving systems; from emphasizing process to focusing on outcomes; from stressing what is important for the person to focusing on what is important to and for the person; and from committing to fixing the person to focusing on supporting the person (Schalock & Verdugo, 2012b). Moving towards future-oriented mental models is facilitated through expanding the thinking style of organization personnel to include systems, synthesis, and alignment. N Systems thinking focuses on the multiple factors that affect human functioning and organization performance: the mesosystem (e.g., the neighborhood, community, or organization), and the macrosystem (i.e., the larger population, country, or sociopolitical influences). N Synthesis involves the integration of information from multiple sources to improve the precision, accuracy, and validity of a decision. N Alignment positions the organization’s service delivery components into a logical sequence for the purposes of reporting, monitoring, evaluation, and continuous quality improvement (see Figure 2).
Synergy Synergy reflects the interaction of elements that when combined produce a total effort that is greater than the sum of the individual parts (Senge, 2006). Essential and sustained organizational change and
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transformation is based on a collective effort and the synergy that results. Thus, leadership should be participative and include personnel at all levels of the organization, including direct support staff. This process in enhanced when participative leadership roles are part of the organization’s culture (Blau & Magrab, 2010; Hackman & Wageman, 2007; Kaiser, Hogan, & Craig, 2008; Konzes & Posner, 2007; Sternberg, 2007). These roles relate to mentoring and directing (e.g., presenting new ideas, information, and translation tools), coaching and instructing (e.g., introducing and explaining concepts, strategies, and specific skills), inspiring and empowering (e.g., providing a vision, clear communication, motivation, and delegating tasks and authority), and collaborating and partnering (e.g., instituting trust, respect, and a joint problem-solving mindset). As described in the following real-life example, participative leadership involves more than just expanded thinking and synergy. It also involves providing the opportunity for Support Team members to be involved in the development and implementation of user-friendly ISPs.
Implementing User-Friendly Support Plans As IDD organizations develop Support Teams they also develop and implement user-friendly versions of the ISP. Transformed organizations have found that there is no place in an organization that is customer centered, streamlined, information focused, and improvement oriented for individual plans to be developed only to have them filed, reviewed every 3–6 months, and read and/or understood by few people. User-friendly support plans take multiple forms. Perhaps the most revolutionary and change-producing is a one-page ‘‘My Support Plan’’ that lists those goals and support needs that are important to the person. The Plan, which is in the client’s possession, lists the support strategies and objectives developed, along with the support objectives for which the client is responsible for implementing. Two additional user-friendly versions are the ‘‘Family Support Plan’’ and the ‘‘Support Staff Action Plan.’’ These are typically one to two pages long and list the individual’s personal goals and the assessed support needs that are important for the person. The goals and support needs are then aligned with specific support strategies and support objectives within a personal outcomes-focused ISP format. Each plan indicates those support strategies and objectives for which either the family or direct support staff is responsible for implementing. These three user-friendly versions are ‘‘cut and pasted’’ from the larger, complete ISP that aggregates the above information into an official document that also includes the support strategies and objectives for which the case manager/supports coordinator is responsible.
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Factors Contributing to Organization Transformation One of the Reviewers of the initial version of this article stated correctly that, ‘‘In my study of organization transformation, I have found it to be a process that entails significant serendipity, depends to a great extent on the culture of the organization, and the unique aspects of personalities of each organization.’’ We agree with this statement and suggest that our earlier discussions of mental models, participative leadership, alignment, high performance teams, information systems, capacity building, and a balanced approach to quality improvement and transformation explains the role of culture and personalities in organization transformation. In addition to the Reviewer’s observations, we have also seen the impact of three additional factors in IDD organizations that contribute significantly to an organization’s transformation. These three involve (a) realizing that change and transformation is a multiphase process, (b) targeting specific predictors of personal outcomes based on research-based literature that is beginning to identify specific strategies predictive of personal outcomes, and (c) recognizing the fact that considerable organization transformation is based on creativity.
Multiphase Process A growing body of literature (summarized in Schalock & Verdugo, 2012b) indicates that bringing about permanent change and organization transformation is a multistage process that involves creating a clear vision of the future, using simple communication to enhance knowledge and understanding, employing constructive engagement that involves empowering others to implement the change, generating short-term wins to provide immediate feedback and reinforcement, and anchoring the new approaches in the organization’s culture. N A clear vision conveys a picture of what the future will look like for the transformed organization. The vision needs to be operationalized succinctly so it is clearly understood and easily communicated. Although a clear vision provides guidance for decision making and action, it needs to be flexible enough to allow individual initiative and alternative responses in light of changing conditions (Reinders, 2008; Shermer, 2011). N Simple communication is clear, authentic, accurate, efficient, complete, timely, and focused. According
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to Kotter (1996, p. 89) the typical amount of communication regarding a change of vision is 13,400 words. This amount is equivalent to one 30minute speech, one hour-long meeting, one 600word article in the organization’s newsletter, or one 2,000-word memo. N Constructive engagement involves empowering others to implement change. Typically, that empowerment is manifest through the efforts of high performance teams, which provide an effective mechanism to empower people to implement quality improvement through participating in planning and implementation, providing values to guide the change, communicating a sense of vision and making structural changes compatible with the vision, aligning information and personal interests to the vision, explaining seeming inconsistencies, and confronting personnel who sometimes undercut needed change (Ashbaugh, 2008; Kotter, 1996; Miller, 2005). N Short-term wins are ensured when the organization’s transformation proceeds in small, obtainable steps that provide opportunities for self-reinforcement and celebration. Inherent in this transformation principle is the concept of a change threshold that can be lowered if necessary to reduce organization resistance to change. Once the threshold is crossed, the role that short-term wins play in bringing about permanent change will be apparent because crossing the threshold produces the opportunity to visibly recognize and reward people who made the change and win possible (Kotter, 1996). N Anchoring the transformation occurs when four conditions are met: the change becomes the established way of doing things; sufficient time is taken to ensure leadership development and succession; people are hired, promoted, and/or developed who can implement the innovation and change; and the change process is reinvigorated through conducting successful new projects that involve networking and consortia membership (Schalock & Verdugo, 2012b).
Literature-Based Research As organizations develop robust information systems that contain quantifiable service/support components and standardized outcome measures, they develop the potential to become knowledge producers who empirically identify significant outcome predictors that can be used in capacity building. For example, assessed personal outcomes
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can be used as dependent variables in multivariate analyses that determine the relationship between personal outcomes and personal characteristics, specific services and supports, and other contextual variables (Claes et al., 2012). Once identified, organizations can implement specific support strategies that enhance the effects of these predictor variables so as to improve one or more personal outcomes. This approach is exemplified in research reported by Claes et al. (2012), Schalock et al. (2007), and Walsh et al. (2010) that indicates that personal, QOL-related outcomes are significantly impacted by (a) organization-level factors such as support staff strategies (e.g., facilitative assistance, including communication support and ensuring a sense of basic security), support staff characteristics (e.g., teamwork and job satisfaction), management practices that reduce staff turnover and job stress, and employment programs (including opportunities for volunteerism); and (b) systems-level factors related to participation opportunities (e.g., contact with family members, friends, and people in one’s social network), normalized community living arrangements, and the availability of transportation.
Creativity Creativity is not a solitary process. It happens when talented people get together and when ideas merge with future-oriented mental models. Creativity needs ‘‘hubs’’ such as the five characteristics of the transformation era and their associated transformation strategies (see Figure 1). In addition to hubs, creativity needs ‘‘networks’’ through which it can be implemented. Transformed organizations provide these hubs and networks and allow the adoption of creative ideas (Center for Communities of the Future, 2012; Denning, 2012). Creativity also involves the generation of ideas that are original, novel, and useful. Creativity, which is based on divergent thinking, is fresh and inventive. Many organizations reinforce convergent thinking whereby personnel try to reduce a list of alternatives to a single correct answer. Although convergent thinking is frequently relevant, it is not the type of thinking one wants to encourage and reinforce when an organization is involved in innovation and change. As a part of organization transformation, creativity requires divergent thinking whereby organization personnel expand the range of alternatives and new approaches by standing outside the box and generating many
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possible alternatives. It also requires identifying and involving people who are autonomous, introverted, open to new experience, norm doubting, self confident, self-accepting, driven, and ambitious (Feist, 1998).
Conclusion Transformation does not occur in a vacuum, nor is it value free. Values related to dignity, equality, self-determination, family friendliness, nondiscrimination, and inclusion should guide the transformation process. Based on these values, IDD organizations need to continue to develop new and/or reconfigured approaches based on what we know about the characteristics of the transformation era and the 10 transformation strategies discussed in this article. We are not there yet in our understanding of all the factors that facilitate organization transformation, or in empirically demonstrating the long-term impacts of these transformation strategies. One fact is clear, however: those organizations that view themselves as selforganizing, transformable entities and that focus on ways to enhance their effectiveness, efficiency, and sustainability will be changed in terms of becoming more person centered, streamlined, information focused, quality oriented, and participative.
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organization and your life. San Francisco, CA: Jossey-Bass.
Submitted 9/11/12, first decision 5/3/13, final decision 5/22/13. Editor-in-Charge: Glenn Fujiura
Authors: Robert L. Schalock ([email protected]), Hastings College, Department of Psychology, PO Box 285, 2435 Cottonwood Creek Road, Chewelah, WA 99109, USA; Miguel-Angel Verdugo, University of Salamanca, Institute on Community Integration, PETRA.
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The Transformation of Disabilities Organizations Robert L. Schalock and Miguel-Angel Verdugo
Abstract This article summarizes the five major characteristics of the transformation era and describes how intellectual and closely related developmental disabilities organizations can apply specific transformation strategies associated with each characteristic. Collectively, the characteristics and strategies provide a framework for transformation thinking, learning, and acting. Specific application examples are given. Key Words:
disabilities organizations; organization transformation; transformation era; transformation strategies
We live in a transformational era that focuses on change and creating value through innovation. Whether one is involved in economics, politics, business, health care, education, or human services, transformational change is happening in how organizations are structured and how they perform their key functions. The era excludes no one, including organizations providing services and supports to persons with intellectual and closely related developmental disabilities (IDD). The purpose of this article is to summarize the major characteristics of the transformational era and to describe through examples from IDD organizations how applying specific transformation strategies associated with the transformation era provides a framework for transformational thinking, learning, and action. The transformation of IDD organizations is occurring within the context of significant challenges faced today by nonprofit organizations. These challenges involve dwindling resources with an increasing need for services and supports, structural changes from top-down hierarchies built along vertical lines of authority to organizations built along horizontal lines of action, and increased social and political expectations and requirements of IDD organizations and systems to demonstrate meaningful outcomes, ensure efficient resource utilization, and maintain best practices. These challenges are being driven by four powerful social and political forces. First, funding and regulatory bodies and IDD organization leaders are reconsidering how resources are used within an organization to maximize the organization’s
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efficiency, develop effective services and supports, implement robust information systems that can be used for multiple purposes, and enhance personal outcomes. Second, there is an increasing emphasis on the personal and social benefits derived from the involvement of people with disabilities in education and rehabilitation programs. Third, there continues to be a change in where and how IDD services and supports are delivered. This change is reflected in the expansion and dispersal of services and supports, the growth of the Home and Community-Based Waiver, the movement toward consumer-directed funding, and the increasing conversation about what constitutes quality. Fourth, there is a shift towards individualized supports, an emphasis on self-determination and self-direction, and an expressed need for performance-based management and evidencebased practices. Collectively, these challenges and the factors driving them underscore the relevance of understanding the characteristics of the transformation era and their associated transformation strategies. These characteristics and strategies are discussed next.
Transformation Era Characteristics and Transformation Strategies From our analysis and synthesis of the literature, the transformational era can be described on the basis of five characteristics: the person is central, organizations are streamlined, information systems are performance based, quality improvement is a continuous process, and participative leadership is a
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key element in the transformational process. More specifically, in reference to the person as central, we have seen cultural changes based on the values of inclusion, equity, empowerment, and subjective well being (Goleman, 2009; Rochon, 1998; Schalock & Verdugo, 2012b; Schwartz, 2010; Shogren & Turnbull, 2010). We have also seen a significant movement away from vertically structured organizations to those that are more horizontally structured and streamlined (Covey, 2004; Senge, 2006; Slostak, 2010; Zaffron & Logan, 2009). Simultaneously, information systems have emerged that extend thinking beyond simple data collection and analysis to knowledge production through the use of performance-based perspectives and evidencebased indicators (Cascio, 2009; International Consortium on Evidence-Based Practices, 2013; Lombardo, 2010; Passig, 2007; Pinker, 2005; Tow & Gilliam, 2009). Across entities, the transformational era is also characterized by a commitment to continuous quality improvement (Grol et al. 2008; Heath & Heath, 2005; Nell, 2005) and a recognition of the essential role of participative leadership (Buntinx, 2008; Guttman, 2008; Heath & Heath, 2009; Heifetz et al., 2010; Kotter, 1996; Leadership For a New Era, 2012; Thaler, 2012). These five transformation era characteristics provide a framework for creative thinking and action regarding organization transformation. This framework is presented in Figure 1. As depicted in
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Figure 1, when the person is central, organizations recognize the importance of personal outcomes and the provision of individualized supports. When organizations are streamlined, they focus on alignment and the implementation of high performance teams. When organizations employ performancebased information systems, they center their data collection and analysis efforts on performancebased perspectives and evidence-based indicators. When organizations view quality improvement as a continuous process, they foster capacity building and a balanced approach to quality improvement. And when participative leadership is employed, thinking is expanded and synergy is manifest. The following sections provide a literaturebased overview of the specific transformation strategies associated with each of the five transformational era characteristics depicted in Figure 1. At the end of each section, a real-life (boxed in) example is presented that demonstrates how IDD organizations with which the authors are familiar are implementing the two strategies associated with each transformation era characteristic. Additional examples can be found in Schalock and Verdugo (2012a, 2012b).
Person as Central Consumers are no longer passive recipients of disability services. Increasingly, they are active
Figure 1. Framework for organizational transformation.
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contributors to an organization’s policies and practices. The values driving this new role are those related to inclusion, empowerment, selfdetermination, and equity. The centrality of the individual is reflected in two strategies: measuring and using personal outcomes and employing a system of supports.
Personal Outcomes Recognizing the importance of personal well-being and enhancing one’s quality of life (QOL) places the service/supports recipient (i.e., the person) at the center of the service delivery system. Personal outcomes are typically referenced to core QOL domains that reflect an individual’s personal development, self-determination, interpersonal relations, social inclusion, rights, emotional wellbeing, physical well-being, and material well-being (Schalock, Gardner, & Bradley, 2007; Schalock & Verdugo, 2012b). The measurement of personal outcomes is based on a conceptual and measurement framework that operationalizes these core domains on the basis of domain-referenced indicators. Within this framework, QOL domains are the set of factors that constitute personal well-being. Domain-referenced indicators are culturally sensitive perceptions, behaviors, and conditions that give an indication of the person’s well-being. The assessment of QOL domain-referenced indicators provides measures of personal outcomes. The interested reader can find examples of QOL assessment approaches and measures in Bonham et al. (2004), Cummins (2004), Claes, van Hove, van Loon, Vandevelde, and Schalock (2010), Edmonton Persons with Developmental Disabilities (2011), Verdugo, Schalock, Keith, and Stancliffe (2005), Walsh et al. (2010), and Wang, Schalock, Verdugo, and Jenaro (2010). As part of the transformation process, personal outcomes can be used at the level of the individual to provide feedback regarding the multidimensionality of human behavior and the domains of a life of quality, and as a framework for planning individualized supports. At the organization level, aggregated personal outcomes can be used as empirical benchmarks for strategic planning, reporting change over time, and comparing an organization’s aggregated personal outcomes to those of community members without a disability. At the systems level, aggregated personal outcomes can be used as a key outcome measure of systems change. From a
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research perspective, personal outcomes can be used as either dependent variables in multivariate research studies or as evidence in determining evidence-based practices (Schalock et al., 2007; Schalock, Verdugo, & Gomez, 2011).
Individualized Supports A system of supports encompasses the wide range of support strategies that can be used to enhance personal well-being. As described more fully in Schalock and Verdugo (2012b) and Thompson et al. (2009) elements of a system of supports include natural sources (e.g., family and friends, colleagues, generic agencies and businesses), technology based (e.g., assistive technology, information technology, smart technology, prosthetics), environment based (e.g., environmental accommodations), support staff strategies (e.g., providing incentives, fostering skill development, befriending, utilizing positive behavior supports), and professional services (e.g., medical, dental, psychological, psychiatric, OT/PT, nursing). From an organization transformation perspective, a system of supports model aligns specific support strategies to the individual’s assessed support needs and allows for the evaluation of the impact of the specific support strategies employed. This is best accomplished through a Support Team that is described later in the article. Collectively, measuring and using personal outcomes and employing a system of supports establish the central role of the person within a transformed organization. In addition, information regarding personal outcomes and the specific supports provided by an organization provide two essential components of a Provider Profile.
Publishing Provider Profiles IDD organizations nationally and internationally are incorporating personal outcomes and a description of individualized supports the organization provides into a Provider Profile. In most jurisdictions where used, the Profile is published annually both in hard copy and electronically as a vehicle to communicate to potential clientele, to meet accountability requirements and quality assurance standards, and to monitor organization and systems change. Provider Profiles typically include descriptive information about the organization (e.g., location, size, staff complement), a listing of the specific supports the organization provides, quality assurance and quality improvement activities, and aggregated personal outcomes such as QOL domain scores. These personal outcome measures are used as a basis for quality improvement activities. They also provide empirical benchmarks to compare the organization with itself over time, the
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organization to other organizations within the service delivery system, and the organization-based aggregated personal outcomes with comparable outcomes of community members without disabilities.
Streamlined Organizations Transformed organizations are more streamlined in their organization structures and more creative in overcoming challenges related to dwindling resources, increased demands for services and supports, and the need to demonstrate the organization’s effectiveness and efficiency. As disabilities organizations become more streamlined, they make structural changes from top-down hierarchies built along vertical lines of authority to organizations built along horizontal lines of action. Two transformation strategies facilitate this process: aligning service delivery components and developing high performance teams.
Alignment Identifying the key service delivery components and then aligning them horizontally and vertically is a key part of organization transformation. The alignment of service delivery components has a number of advantages. Chief among these are that such alignment facilitates policy development and organization change, clarifies for stakeholders the sequence of events from input through process to outcomes/outputs, and provides a framework for developing and implementing high performance teams (Schalock & Verdugo, 2012a, 2012b). This process of alignment is depicted in the program logic model presented in Figure 2. Horizontal alignment involves the logical sequence
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among input, throughput, and outcome/output service delivery components. At the individual level, horizontal alignment involves a logical sequence among the individual’s assessed support needs and personal goals, a system of supports, and assessed personal outcomes. At the organization level, horizontal alignment involves a logical sequence among resources, organization services, and aggregated personal outcomes. Vertical alignment involves the juxtaposition of individual and organization-level practices at each of the program logic components: input, throughput, and outcome/output. As depicted in Figure 2, vertical alignment occurs when the organization’s resources are used to address the individual’s assessed support needs and personal goals, organization services encompass a system of supports, and the same personal outcomes assessed at the individual level are aggregated at the organization level.
High Performance Teams High performance teams are horizontally structured work groups that promote a learning culture by focusing on teamwork, synergy, raising the performance bar, and ‘‘us accountability.’’ They are characterized by being involved, informed, organized, accountable, and empowered (Guttman, 2008; Schuh & Leviton, 2006). High performance teams reflect the structural changes that are occurring in both public and private organizations. They have emerged in the disability field within the context of the transformation of professional services, the emergence of new public management, the focus on consumer-driven and
Figure 2. Organizational transformation based on a systems and alignment approach.
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consumer-centered supports, and the need to increase the involvement of all organization personnel (Noordegraaf, 2007; Reinders, 2008). High performance teams facilitate the integration of tacit (i.e., experience based) and explicit (i.e., empirically based) knowledge into the transformation process. What they do within any organization depends on the organization’s goals, mission, and the specific services and supports provided. Across IDD organizations, high performance teams typically perform functions related to the assessment required for diagnosis and supports planning: Individual Support Plan (ISP) development, implementation, monitoring, and evaluation; data gathering, processing, analysis, and reporting; outcomes evaluation; developing and implementing quality improvement strategies; and crisis management (Schalock & Verdugo, 2012b). The following example describes how one type of high performance team—The Support Team—incorporates the transformational strategies associated with both the ‘person as central’ (personal outcomes and individualized supports) and the ‘streamlined organization’ (alignment and high performance teams).
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such as the following. First, there are a plethora of requirements from disparate funding, regulatory, and accreditation agencies that require reporting and monitoring discrete aspects (e.g., financial or quality assurance) of the organization. Second, information required for certification and licensure varies by jurisdiction and funding agency. Third, information needs vary depending on the respective stakeholder. Information that addresses the concerns of consumers and their family is typically different from that of interest or value to staff, auditors, community leaders, and board members. The net result of these three exemplary factors is that organizations have historically collected volumes of disparate data that, while meeting specific reporting and monitoring requirements, does not provide information based on a clear conceptual and measurement framework that facilitates transformation and change. A framework that provides this clarity is organized around performance-based perspectives and evidence-based indicators. These perspectives and indicators can be used for multiple purposes including reporting, monitoring, evaluation, quality improvement, and performance management.
Developing Support Teams A Support Team, which reflects one aspect of a streamlined organization, is composed of the individual receiving services and supports, his/her parents or family member, a case manager or supports coordinator, direct support staff who work closely with the person, and one or more professionals depending on the individual’s support needs. The primary responsibilities of the Support Team are to develop the ISP based on aligning the input, throughput, and output components shown in Figure 2 and to jointly implement the individual’s support plan. To this end, the Support Team: (a) determines what is important to the person in reference to personal goals and what is important for the person based on the assessment of the individual’s support needs; (b) identifies specific, individualized support strategies based on a system of supports to address personal goals and assessed support needs; (c) uses a personal outcomes-focused framework to specify a specific support objective for each support strategy; (d) indicates who is responsible for implementing each support strategy; (e) implements the ISP via user-friendly support plan formats (see later examples); (f) monitors the Plan on the basis of the status of the support objectives; and (g) evaluates the Plan on the basis of changes in the outcome categories used in item (c).
Information Systems Most disabilities organizations are data rich and information poor. This is due to a number of factors
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Performance-Based Perspectives A balanced approach to strategic planning, program implementation, and organization evaluation requires multiple perspectives on performance. Four commonly used perspectives are those of the person, the organization’s growth, the organization’s financial analyses, and the organization’s internal processes (Fuller, 1997; International Consortium on Evidence-Based Practices, 2013; Kaplan & Norton, 1996; Niven, 2008; Tsai, Chou, & Hsu, 2009; Wu, Lin, & Chang, 2011). The importance of these four perspectives in transforming IDD organizations is that they provide a balanced approach to performance management and a conceptual and measurement framework for the collection and analysis of evidence-based indicators.
Evidence-Based Indicators Evidence-based indicators encompass measurable processes and outputs that reflect best practices in the provision of services and supports to persons with disabilities, involve management strategies that facilitate an organization’s growth, include financial analyses that enhance an organization’s reportability and accountability, and incorporate
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logic models and information systems to enhance the organization’s capacity to self-evaluate and produce knowledge (Schalock et al., 2011; Shogren & Turnbull, 2010). Exemplary evidence-based indicators associated with each of the four performance-based perspective listed above are presented in Table 1. Information systems that incorporate performance-based perspectives and evidence-based indicators are essential components of performancebased management and organization transformation. Many IDD organizations are transforming the way they approach performance management by collecting, organizing, and using information based on the performance-based perspectives and evidence-based indicators summarized in Table 1. In the process, the organization is in a better position to be more evidence based and respond better to the need to be more effective in terms of achieving desired outcomes and more efficient in terms of producing the organization’s planned results in
relation to the expenditure of resources. This process is described in the following example.
Using Performance-Based Perspectives and Evidence-Based Indicators The transformation of information systems involves developing and using information that is based on those perspectives and indicators presented in Table 1. These perspectives and indicators are being used as a framework for strategic planning, as a template for program implementation, and as a balanced scorecard for program evaluation. In the process, the organization transforms its approach to capacity building, the development and implementation of evidence indicators, and the holistic approach it uses in the delivery and evaluation of services and supports. From an organization evaluation point of view, information obtained from evidence-based scores on each of the four perspectives presents a balanced scorecard from the perspective of the customer and the organization’s growth, financial analyses, and internal processes. In addition, an Effectiveness Index can be computed based on summing the customer and growth perspective scores, and an Efficiency Index can be computed based on summing the financial
Table 1 Performance-based perspectives and exemplary evidence-based indicators Performance-based perspective Customer
Growth
Financial processes
Internal processes
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Exemplary evidence-based indicators Aligns services/supports to identified needs Reports the number of clients living or working in more independent, productive, and community-integrated environments Measures personal outcomes Reports and analyzes aggregated personal outcomes Uses technology to enhance personal outcomes Articulates the organization’s mission and intended results Enters into partnerships Develops program options Utilizes and evaluates high performance teams Monitors job satisfaction and develops job enrichment programs Compares unit costs across different locations and service delivery platforms Reports percentage of budget allocated to client-referenced supports Monitors the relationship between social capital and agency-based fiscal capital Uses fixed and variable cost data to establish a baseline cost rate Analyzes overhead rate to increase efficiency Horizontally aligns input, throughput, and output components Vertically aligns an organization’s input, throughput, and output components to the corresponding individual-referenced input, throughput, and output component Demonstrates the relationship between units of service/supports provided and the clienteles’ assessed support needs Uses data related to personal outcomes and organization outputs for multiple purposes Uses evidence-based indicators for continuous quality improvement
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analyses and internal processes scores. This information is used for reporting, monitoring, evaluation, and as part of a continuous quality improvement loop to guide changes in the organization’s policies and practices.
Continuous Quality Improvement Quality improvement is not a discrete event, nor is it a single process. It is a continuous process that occurs most readily in organizations that have built the capacity to change, and in those organizations that take a balanced approach to its formulation and implementation. In addition to these two transformation strategies, it has been our experience with organizations undergoing transformation, that successful continuous quality improvement involves the following critical factors that act as catalysts: (a) a focus on the alignment of both the critical organization components depicted in Figure 1 and strategic planning, program implementation, and organization evaluation; (b) the use of a conceptual and measurement framework such as those summarized in Tables 1 and 2; (c) the development of empirical benchmarks that are used for self-comparison and feedback regarding the effectiveness or impact of the quality improvement strategies employed; (d) the use of both tacit and explicit knowledge to develop a learning culture; (e) the involvement of all stakeholders in the transformation process; and (f) the use of right-to-left thinking that establishes the mindset among personnel within the organization that change is possible by beginning the quality improvement process with the question, ‘‘What are our desired outcomes, and what needs to be in place for these outcomes to occur?’’ The interested reader can find additional information about these critical factors and catalysts in Bourgeois, Hart, Townsend, and Gagne (2011), Chen (2004), Drucker (1999), Hunter (2006), International Research Consortium on Evidence-Based Practices (2013), Kapucu, Healy, and Arslan (2011), Lick (2006), Linnell (2003), Miller (2005), Nichols (2002), Pluye, Potvin, Denis, Pelletier, and Mannoni (2005), and Sridharan, Go, Zinzow, Gray, and Barrett (2007).
Capacity Building Capacity building provides a ‘‘tool kit’’ that enables IDD organizations to operate effectively and efficiency in a nonprofit environment (Linnell, 2003; Schalock & Verdugo, 2012b). Capacity
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building includes developing and reinforcing a learning culture that is based on tacit and explicit knowledge and multiple-perspective information systems, accessing social capital, entering into collaborative partnerships, implementing a person-referenced system of supports, and providing a range of service delivery opportunities based on current best practices. Capacity building involves both content (i.e., the took kit), as just described, and processes. Chief among these processes are innovation, mentoring, evaluation, risk taking, scanning the environment to find new ways of doing things, involving all organization personnel, and reinforcing curiosity and openness to new approaches (Denning, 2012; Goleman, 2009; Jelps & Dickinson, 2008; Senge, 2006).
Balanced Approach A balanced approach to continuous quality improvement and organization transformation involves the four performance-based perspectives (i.e., the customer, and the organization’s growth, financial analyses, and internal processes) discussed earlier and the use of specific transformation strategies. Table 2 lists exemplary quality improvement strategies associated with each of the four perspectives. The specific quality improvement strategies listed in Table 2 reflect best practices used for capacity building. These best practice strategies are based on the work of Claes, van Hove, Vandevelde, van Loon, and Schalock (2012), the International Consortium on Evidence-Based Practices (2013), Kaplan and Norton (1996), Niven (2008), Schalock and Verdugo (2012b), Tsai et al. (2009), and Wu et al. (2011). In summary, quality improvement is challenging to IDD organizations that frequently are faced with ‘‘the daily crisis’’ and ‘‘keeping the ship above water.’’ Quality improvement is not something that a committee does by developing a quality improvement plan. As suggested in the preceding discussion, quality improvement is a continuous process that depends on many factors and players, and needs to be approached in a balance way based on the organization’s strengths and resources. As one approach to continuous quality improvement, the following example describes how right-to-left thinking can be used in quality improvement activities to integrate two performance-based perspectives (in this example, customer and financial) with the targeted use of quality improvement strategies.
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Table 2 Performance-based perspectives and exemplary quality improvement strategies Performance-based perspective Customer
Growth
Financial
Internal processes
Exemplary quality improvement strategies Align services and supports to assessed support needs and personal outcomes Implement individual supports plan based on assessed support needs and personal goals within a personal outcomes framework Implement a system of supports Increase personal involvement and motivation through active involvement in the Support Team and ownership of My Support Plan Develop measurable organization goals Allocate resources to the achievement of organization goals Develop program options Develop high performance teams Increase direct support staff motivation and involvement though involvement in high performance teams Provide direct support staff with a one- to two-page Support Staff Action Plan that summarizes specific support strategies and objectives for their client(s) Develop job enrichment programs Become knowledge producers and value-based businesses Bundle critical functions Develop an economy of scale based on fixed and variable costs Access social capital and natural supports Rethink the multiple nature of resources Base resource allocation on assessed support needs Engage in networking, consortia, and partnerships Use program logic models to align organization horizontally and vertically Develop web-based real-time information systems Use data for multiple purposes Implement quality improvement strategies and provide training in interpreting and using information Use the same quality improvement framework for strategic planning, program implementation, and organization evaluation
Basing Quality Improvement on Right-toLeft Thinking, Performance-Based Perspectives, and Targeted Strategies Many organizations approach quality improvement by engaging in right-to-left thinking. One commonly finds IDD organizations using this type of thinking regarding two performance-based perspectives: that of the customer and that of the organization’s financial analyses. In reference to the customer, the typical question asked is, ‘‘How can we enhance personal outcomes?’’ When this question is asked, organizations implement the following quality improvement strategies: aligning services and supports to personal goals and assessed support needs within a personal outcomes-focused framework, implementing a system of supports, and increasing the involvement of the person in supports planning and implementation. In reference to financial analyses, the typical
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question is, ‘‘How can we increase our financial accountability and/or status?’’ When this question is asked, organizations implement the following quality improvement strategies: bundling critical functions, developing an economy of scale based on fixed and variable costs, accessing social capital and natural supports, rethinking the multiple aspects of resources (e.g., time, experience, and expertise), basing resource allocation on assessed support needs, and engaging in networks, consortia, and partnerships.
Participative Leadership Participative leadership is all about bringing about change. Participative leadership involves inspiring people and organizations to expand their thinking and foster synergy.
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Expanded Thinking Organization transformation involves changing both mental models and thinking styles that form the vision and culture of an organization. As discussed by Senge (2006) and Shermer (2011) it is necessary to identify and understand these mental models, discuss their impact on individuals and organizations, and recognize that they frequently represent a limiting factor in organization transformation. Thus, as organizations embark on transformation they challenge historically based mental models and move toward future oriented mental models. This involve moving from viewing disablement based on defectology to a social-ecological model of disability; from approaching organizations as closed systems to organizations as open systems acting as bridges to the community; from emphasizing power over to power with; from managing organizations as vertically structured mechanistic entities to leading organizations that are horizontally structured and self-evaluating and improving systems; from emphasizing process to focusing on outcomes; from stressing what is important for the person to focusing on what is important to and for the person; and from committing to fixing the person to focusing on supporting the person (Schalock & Verdugo, 2012b). Moving towards future-oriented mental models is facilitated through expanding the thinking style of organization personnel to include systems, synthesis, and alignment. N Systems thinking focuses on the multiple factors that affect human functioning and organization performance: the mesosystem (e.g., the neighborhood, community, or organization), and the macrosystem (i.e., the larger population, country, or sociopolitical influences). N Synthesis involves the integration of information from multiple sources to improve the precision, accuracy, and validity of a decision. N Alignment positions the organization’s service delivery components into a logical sequence for the purposes of reporting, monitoring, evaluation, and continuous quality improvement (see Figure 2).
Synergy Synergy reflects the interaction of elements that when combined produce a total effort that is greater than the sum of the individual parts (Senge, 2006). Essential and sustained organizational change and
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transformation is based on a collective effort and the synergy that results. Thus, leadership should be participative and include personnel at all levels of the organization, including direct support staff. This process in enhanced when participative leadership roles are part of the organization’s culture (Blau & Magrab, 2010; Hackman & Wageman, 2007; Kaiser, Hogan, & Craig, 2008; Konzes & Posner, 2007; Sternberg, 2007). These roles relate to mentoring and directing (e.g., presenting new ideas, information, and translation tools), coaching and instructing (e.g., introducing and explaining concepts, strategies, and specific skills), inspiring and empowering (e.g., providing a vision, clear communication, motivation, and delegating tasks and authority), and collaborating and partnering (e.g., instituting trust, respect, and a joint problem-solving mindset). As described in the following real-life example, participative leadership involves more than just expanded thinking and synergy. It also involves providing the opportunity for Support Team members to be involved in the development and implementation of user-friendly ISPs.
Implementing User-Friendly Support Plans As IDD organizations develop Support Teams they also develop and implement user-friendly versions of the ISP. Transformed organizations have found that there is no place in an organization that is customer centered, streamlined, information focused, and improvement oriented for individual plans to be developed only to have them filed, reviewed every 3–6 months, and read and/or understood by few people. User-friendly support plans take multiple forms. Perhaps the most revolutionary and change-producing is a one-page ‘‘My Support Plan’’ that lists those goals and support needs that are important to the person. The Plan, which is in the client’s possession, lists the support strategies and objectives developed, along with the support objectives for which the client is responsible for implementing. Two additional user-friendly versions are the ‘‘Family Support Plan’’ and the ‘‘Support Staff Action Plan.’’ These are typically one to two pages long and list the individual’s personal goals and the assessed support needs that are important for the person. The goals and support needs are then aligned with specific support strategies and support objectives within a personal outcomes-focused ISP format. Each plan indicates those support strategies and objectives for which either the family or direct support staff is responsible for implementing. These three user-friendly versions are ‘‘cut and pasted’’ from the larger, complete ISP that aggregates the above information into an official document that also includes the support strategies and objectives for which the case manager/supports coordinator is responsible.
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Factors Contributing to Organization Transformation One of the Reviewers of the initial version of this article stated correctly that, ‘‘In my study of organization transformation, I have found it to be a process that entails significant serendipity, depends to a great extent on the culture of the organization, and the unique aspects of personalities of each organization.’’ We agree with this statement and suggest that our earlier discussions of mental models, participative leadership, alignment, high performance teams, information systems, capacity building, and a balanced approach to quality improvement and transformation explains the role of culture and personalities in organization transformation. In addition to the Reviewer’s observations, we have also seen the impact of three additional factors in IDD organizations that contribute significantly to an organization’s transformation. These three involve (a) realizing that change and transformation is a multiphase process, (b) targeting specific predictors of personal outcomes based on research-based literature that is beginning to identify specific strategies predictive of personal outcomes, and (c) recognizing the fact that considerable organization transformation is based on creativity.
Multiphase Process A growing body of literature (summarized in Schalock & Verdugo, 2012b) indicates that bringing about permanent change and organization transformation is a multistage process that involves creating a clear vision of the future, using simple communication to enhance knowledge and understanding, employing constructive engagement that involves empowering others to implement the change, generating short-term wins to provide immediate feedback and reinforcement, and anchoring the new approaches in the organization’s culture. N A clear vision conveys a picture of what the future will look like for the transformed organization. The vision needs to be operationalized succinctly so it is clearly understood and easily communicated. Although a clear vision provides guidance for decision making and action, it needs to be flexible enough to allow individual initiative and alternative responses in light of changing conditions (Reinders, 2008; Shermer, 2011). N Simple communication is clear, authentic, accurate, efficient, complete, timely, and focused. According
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to Kotter (1996, p. 89) the typical amount of communication regarding a change of vision is 13,400 words. This amount is equivalent to one 30minute speech, one hour-long meeting, one 600word article in the organization’s newsletter, or one 2,000-word memo. N Constructive engagement involves empowering others to implement change. Typically, that empowerment is manifest through the efforts of high performance teams, which provide an effective mechanism to empower people to implement quality improvement through participating in planning and implementation, providing values to guide the change, communicating a sense of vision and making structural changes compatible with the vision, aligning information and personal interests to the vision, explaining seeming inconsistencies, and confronting personnel who sometimes undercut needed change (Ashbaugh, 2008; Kotter, 1996; Miller, 2005). N Short-term wins are ensured when the organization’s transformation proceeds in small, obtainable steps that provide opportunities for self-reinforcement and celebration. Inherent in this transformation principle is the concept of a change threshold that can be lowered if necessary to reduce organization resistance to change. Once the threshold is crossed, the role that short-term wins play in bringing about permanent change will be apparent because crossing the threshold produces the opportunity to visibly recognize and reward people who made the change and win possible (Kotter, 1996). N Anchoring the transformation occurs when four conditions are met: the change becomes the established way of doing things; sufficient time is taken to ensure leadership development and succession; people are hired, promoted, and/or developed who can implement the innovation and change; and the change process is reinvigorated through conducting successful new projects that involve networking and consortia membership (Schalock & Verdugo, 2012b).
Literature-Based Research As organizations develop robust information systems that contain quantifiable service/support components and standardized outcome measures, they develop the potential to become knowledge producers who empirically identify significant outcome predictors that can be used in capacity building. For example, assessed personal outcomes
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can be used as dependent variables in multivariate analyses that determine the relationship between personal outcomes and personal characteristics, specific services and supports, and other contextual variables (Claes et al., 2012). Once identified, organizations can implement specific support strategies that enhance the effects of these predictor variables so as to improve one or more personal outcomes. This approach is exemplified in research reported by Claes et al. (2012), Schalock et al. (2007), and Walsh et al. (2010) that indicates that personal, QOL-related outcomes are significantly impacted by (a) organization-level factors such as support staff strategies (e.g., facilitative assistance, including communication support and ensuring a sense of basic security), support staff characteristics (e.g., teamwork and job satisfaction), management practices that reduce staff turnover and job stress, and employment programs (including opportunities for volunteerism); and (b) systems-level factors related to participation opportunities (e.g., contact with family members, friends, and people in one’s social network), normalized community living arrangements, and the availability of transportation.
Creativity Creativity is not a solitary process. It happens when talented people get together and when ideas merge with future-oriented mental models. Creativity needs ‘‘hubs’’ such as the five characteristics of the transformation era and their associated transformation strategies (see Figure 1). In addition to hubs, creativity needs ‘‘networks’’ through which it can be implemented. Transformed organizations provide these hubs and networks and allow the adoption of creative ideas (Center for Communities of the Future, 2012; Denning, 2012). Creativity also involves the generation of ideas that are original, novel, and useful. Creativity, which is based on divergent thinking, is fresh and inventive. Many organizations reinforce convergent thinking whereby personnel try to reduce a list of alternatives to a single correct answer. Although convergent thinking is frequently relevant, it is not the type of thinking one wants to encourage and reinforce when an organization is involved in innovation and change. As a part of organization transformation, creativity requires divergent thinking whereby organization personnel expand the range of alternatives and new approaches by standing outside the box and generating many
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possible alternatives. It also requires identifying and involving people who are autonomous, introverted, open to new experience, norm doubting, self confident, self-accepting, driven, and ambitious (Feist, 1998).
Conclusion Transformation does not occur in a vacuum, nor is it value free. Values related to dignity, equality, self-determination, family friendliness, nondiscrimination, and inclusion should guide the transformation process. Based on these values, IDD organizations need to continue to develop new and/or reconfigured approaches based on what we know about the characteristics of the transformation era and the 10 transformation strategies discussed in this article. We are not there yet in our understanding of all the factors that facilitate organization transformation, or in empirically demonstrating the long-term impacts of these transformation strategies. One fact is clear, however: those organizations that view themselves as selforganizing, transformable entities and that focus on ways to enhance their effectiveness, efficiency, and sustainability will be changed in terms of becoming more person centered, streamlined, information focused, quality oriented, and participative.
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organization and your life. San Francisco, CA: Jossey-Bass.
Submitted 9/11/12, first decision 5/3/13, final decision 5/22/13. Editor-in-Charge: Glenn Fujiura
Authors: Robert L. Schalock ([email protected]), Hastings College, Department of Psychology, PO Box 285, 2435 Cottonwood Creek Road, Chewelah, WA 99109, USA; Miguel-Angel Verdugo, University of Salamanca, Institute on Community Integration, PETRA.
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