Organizational change for services integration in public human service organizations: experiences in seven counties.
Article Type: Report
Subject: Organizational change (Forecasts and trends)
Health care industry (International aspects)
Health care industry (Forecasts and trends)
Health care industry (Social aspects)
Public health administration (Research)
Authors: Packard, Thomas
Patti, Rino
Daly, Donna
Tucker-Tatlow, Jennifer
Pub Date: 03/22/2012
Publication: Name: Journal of Health and Human Services Administration Publisher: Southern Public Administration Education Foundation, Inc. Audience: Academic Format: Magazine/Journal Subject: Government; Health Copyright: COPYRIGHT 2012 Southern Public Administration Education Foundation, Inc. ISSN: 1079-3739
Issue: Date: Spring, 2012 Source Volume: 34 Source Issue: 4
Topic: Event Code: 010 Forecasts, trends, outlooks; 290 Public affairs; 310 Science & research Computer Subject: Health care industry; Market trend/market analysis
Product: SIC Code: 8000 HEALTH SERVICES
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 304050535
Full Text: Ensure Top Management Support and Commitment

In the structurally integrated counties, the department heads were mentioned by 69 percent of respondents as prime movers for the change. A priority for leaders in the more successful change projects was building an executive level core action system committed to the changes sought and willing to spend personal energy and professional capital to achieve them. Sometimes this involved bringing into the team new persons with energy and commitment, but it also involved seeking the participation of the team in planning and implementation and in most cases the building of trust and mutual understanding among executive team members if these were not already present. Commenting upon the importance of creating a collaborative culture among leaders, one respondent said "moving chairs around is not as important as having the right people in the chairs." The philosophy and attitude of individual workers and managers were seen as key variables, more important than structural arrangements.

In several counties, the commitment to and support for the changes sought were reflected in the creation of offices placed high in the hierarchy whose primary function was to facilitate integration and/or collaboration. There appeared to be a decided advantage to having a highly placed instrumentality for facilitating integration and/or collaborative arrangements.

In non-integrated counties, the counterpart to building the executive team was forging alliances with other agency executives. A similar process of building trust and mutual understanding is necessary in these kinds of collaborations. Successful collaboration seemed very dependent upon the mutual perception that the interests of all the agencies were being served, that none would exploit the collaborative to achieve unfair advantage, and that all partners understood the limitations and vulnerabilities of the others. In one county, the fact that the directors of social services and other departments already had effective and trusting working relationships was seen as valuable in getting staff committed to the new or enhanced collaborative agreements.

Successfully pursuing a strategy of structural reorganization or one of interagency collaboration, depended on the ability of leadership to "market" (as several respondents put it) the change efforts to the Board of Supervisors, key community constituencies such as various other agencies and consumer groups, agency management, and front line staff, especially those with strong professional identifications such as mental health staff.

The experiences of these counties, reflected in interviews with management staff, suggest strongly that successfully marketing core values requires a committed executive team. In most counties studied, a committed executive staff made it possible for the director to convey a constant and consistent message out to community and inward to staff and to receive feedback that could be helpful in implementing plans. In one county that experienced initial resistance to integration, respondents observed that the agency prime mover spent little time trying to articulate the vision, receive input, and get others on board. It was only through later efforts at the middle management level that collaboration began to take hold.

Where marketing with staff and community was not effectively done,

it was at least partly due to the director's inability or failure to mobilize the executive team around the ideas and strategies. This, in turn, undermined efforts to build agency wide consensus, slowed implementation of the reorganization and may have, in one or two cases, jeopardized the entire change effort. One county had to replace a visionary director with an interim director who had a different and less dynamic leadership style. This change may have affected the strategies that had been in place to build commitment. The temporary loss of "visionary" leadership was cited by half of the respondents in this county as critical.

Successful marketing efforts were broadly based and used multiple media. Newsletters, conferences and retreats, videos, speeches and presentations, and communication liaisons were among the tactics used with varying degrees of success. What seemed important was that these communication efforts were persistent and prolonged. Kotter's (1996) proposition that one cannot "overcommunicate" when seeking to change organizations very much describes the practices in those counties that were most successful in getting staff and community buyin.

Build External Support from Political Overseers and External Stakeholders

As noted by Kelman (2005) and Rossotti (2005), external political forces can be huge factors in large-scale change. The change goals sought in these counties--services integration and increased coordination--had external support in advance and, in fact, were largely initiated by elected officials and top county executives. For counties which had structurally integrated, 73 percent of respondents mentioned the County Board of Supervisors (elected officials) or the county chief executive as the prime movers.

Interviews with county officials suggested that the most compelling motivation for this change was that collaboration has come to enjoy broad acceptance in political and professional circles as a way to address a variety of problems in the human service system. Projects appear to have been initiated at this level largely because they were seen as important ways to improve county government. Thirty seven percent of respondents noted concerns about duplication or lack of coordination of services, and 35% mentioned a desire to improve access or quality of services. Second, the policy environment, reflecting conventional wisdom on collaboration, is replete with exhortations, mandates, and other incentives for public agencies to work across agency boundaries. Third, all the agencies studied were more or less interested in improving their credibility with important governmental and community constituencies. Integration and/or collaboration provided visible means for improving public perceptions by promising, and sometimes delivering, better client access, enhanced service and planning coordination, economies of scale, and more creative financing.

In all the counties studied, these and related reasons were very much in the minds of prime movers and created substantial incentives for structural reorganization and/or the building of collaboratives.

Provide Adequate Resources to Support the Change Process

Many staff, especially those at middle and lower administrative levels, thought that greater preplanning and more sensitivity to staff concerns would have increased staff buy in, avoided burnout, and lessened some of the turnover that was attributed to these changes. More planning was suggested by 21% of respondents in integrated agencies and 45% in collaborative departments (remember that each focus group, which had an average of 10 participants, was treated as one respondent for data collation purposes). In these counties, time ended up being a key resource, particularly in terms of the pressures to make changes happen fast. While the cases reported here actually spanned periods of years, many staff felt, especially in the earlier stages, overwhelmed by the time pressures. One common suggestion by staff, already mentioned, was to introduce change incrementally.

Another aspect of support is providing staff the training they will need to participate in the change process and function in the new system. One focus group suggested that "staff need to be taught [about] the ambiguity that trying something new means there will be challenges and some things are unknown. Staff need to be taught to manage the flux that will inevitably occur during the change."

Institutionalize Changes

In the four counties that were structurally integrated, institutionalization of the new structures was initially reflected through changes in the formal organizational chart and reporting relationships. Displacing "old patterns of behavior" (Fernandez and Rainey 2006, 7), however, required additional leadership and change tactics. The change to a new culture cannot be underestimated. According to one executive, "people need to know they are not just changing jobs, they are changing who they are."

Both the structurally integrated and collaborative agencies explicitly addressed the merging of professional cultures through cross-training, staff development, and team building (noted by 27% of respondents in integrated counties and 55% in collaboration counties). In one county, continuing bi-weekly meetings of executives to strategize ways to get more buy-in were seen as useful.

Pursue Comprehensive Change

The nature of the change goal here-comprehensive integration of services and systems across departments or agencies-was inherently comprehensive. Planners understood that changing systems to this extent would affect all aspects of the agency. In fact, the lack of connectedness across service delivery systems, such as when clients were involved, for example, with child welfare, mental health, and income maintenance, was seen as a problem that needed to be addressed.

STUDY LIMITATIONS

Several limitations should be kept in mind when assessing this research and its implications. First, as noted above, four organizations integrated structurally and three integrated only through coordination mechanisms. This may suggest different change management approaches; but as also noted above, the organizations had key similarities such as being government organizations providing similar services with the common change goal of improving services through integration at the service deliver level. At this stage of research in this field, and because of the realities of organizational life, studying change processes will rarely involve comparisons between nearly identical settings. Researchers will need to clearly identify relevant variables in their studies to advance knowledge on the success of specific applications of change tactics.

Respondents in all of these counties reported notable successes with their integration efforts, but a causal connection between the change strategies and tactics employed and success in implementing the change cannot be claimed. While substantial progress was noted in staff surveys about the extent of collaboration which existed after these initiatives (Patti, et al., 2003), the lack of pretests or comparison groups means that the results cannot be attributed directly to the change processes used. Ideally, this study would have also looked at equivalent counties which had similar problems and change goals but had not had success with organizational change; but, of course, creating or finding such quasi-experimental conditions would be a huge logistics challenge. Methodological challenges such as these will be discussed further below.

Related to this, the study did not look at other variables, or even gather precise, quantitative data on factors such as leadership style or organizational culture, which could have been assessed with the use of standardized instruments, and which could have contributed to successful outcomes. Finally, this sample of seven cases, while rich in detail, cannot be directly generalized to other agencies. These departments all had long-standing directors who had given a great deal of time and energy to the development of interagency collaboratives and had developed extensive interagency networks. In this sense these county agencies may not be representative of others. Nevertheless, strategies, outcomes, and lessons learned here can be of value to other researchers and agencies interested in the conscious use of principles of planned organizational change.

IMPLICATIONS FOR PRACTICE AND RESEARCH

French and Rainey's (2006) review of the literature suggested that eight propositions and several sub-propositions are associated with successful organizational change. These guided the structure of the analysis here, and were generally supported by this study's findings.

Implications for Practice

Some practice implications which emerged from this study may seem like statements of the obvious. Some reinforce existing theory or research, adding weight to existing prescriptions for practice. Others offer new insights that show promise for advancing organizational change practices in public human service agencies. For example, success factors cited by Rubino and French (2004) in their study of Los Angeles County, including "clarity and consistency of vision, training and preparation for change, communication, [and] support and involvement" (p. 74) were all seen in this study. The use of these principles and others cited above (e.g., strong leadership, extensive information sharing, including regarding the plans for the change process, cross-training and teambuilding, developing a shared vision) could be expected to enhance prospects for success in organizational change.

Expectations from political leaders and executives and agency values and goals can be the initial drivers for change, but trusting relationships among the leaders and staff of participating organizations are essential to making things happen. These conditions form the scaffolding for such efforts, but implementing change that is widely accepted in the organization requires a painstaking process involving middle and front line staff in the decision processes that directly affect their work. In these agencies, collaborations often altered the fundamental ways of doing business. They introduced real uncertainty; entailed additional work, and challenged professional and personal interests. For all these reasons, agency leaders and managers need to be sensitive to how much change can be absorbed and sustained lest the pace of change itself become an issue and a source of resistance. Because of the stresses and workload demands of comprehensive change, many respondents recommended developing a long-term vision and implementing incrementally to increase staff buy-in and avoid burnout.

One county had success by approaching integration incrementally with a focus on integrating services (through the implementation of an interdepartmental network for children's services) rather than structurally reorganizing staff. In another county, incremental change was helpful in securing buy-in and maintaining flexibility throughout the process. Overall, however,_this was generally a dilemma in the cases here. Participants often felt too much simultaneous change was overwhelming for staff and contributed to low staff morale. One participant characterized this as "change fatigue."

From a managerial perspective, slowing implementation may risk losing momentum. Focusing on staff concerns could be perceived as providing an opportunity for opposition to consolidate. In some cases, where timelines have been determined by external policy bodies, there may be little discretion in the speed of implementation. Many of these agencies were under timelines set by County policy makers and had little choice regarding the pace of change. Still, these findings and the literature (Carnochan and Austin, 2002) point to the benefits of incremental change and careful planning to address the personal and professional concerns that inevitably emerge in far-reaching organizational change.

To address the concern expressed earlier, related to fears of diluting professional expertise and compromising service standards, it should be recognized at the outset that professional and program loyalties are highly salient to human service workers and reflect commitments to craft and to the needs of client populations. It is important that those attempting to build collaboration avoid dismissing the legitimate concerns of program and professional specialists and commit instead to supporting the standards and protecting the special expertise that is found in these groups. This should not mean exempting such groups from involvement in collaborative undertakings, but rather mobilizing them in a cause that transcends their specific interests while honoring their ethical commitments.

One county had success by establishing ten "Charter Teams" to address the concerns of staff, clients, and community-based organizations (CBOs) and to develop strategies for pilots and address concerns such as how to handle confidentiality and how to design an integrated database. Another county held "town hall" informational meetings for all staff several times a year. Yet another county found that, in spite of early negative reactions to agency reorganization, ongoing clarification of the plan, involving employees, seeing success in initial integration of administrative functions, and reinvesting savings from eliminating management positions into enhanced services led to gradual acceptance of the new agency model. In one focus group, the process was described in the following way: "It's a little bit like marriage. You don't know each other's habits. But, you don't really know until you get in there and then you start to learn things." Another participant commented, "and divorce is not an option."

Structural changes such as staff co-location and regionalization appeared to facilitate interaction and joint problem solving at the program level, but these structural strategies needed to be supplemented with training and team development to help build understanding and trust across program and professional cultures.

To ensure success of change beyond minimal compliance, leadership is essential. Agency leaders need to be champions of change and articulate a compelling vision. Leaders need to aggressively involve constituencies and stakeholders in planning and implementation throughout the project. Involvement in implementation planning, training and actual experience with the new processes are essential for staff acceptance. "Leader" here refers not only to a chief executive, but also to a strategically aligned and committed executive team. A highly functioning team, which can speak and lead with a common voice, is an important success factor.

Change leaders cannot overcommunicate about the benefits, costs, progress, and consequences of implementing change. Outcome data such as results of successful pilot projects can be used to reinforce the change goals as well as to maintain political support.

Since these change initiatives were concerned with structural integration and collaboration, they may be of particular interest to public managers who are contemplating ways of better-integrating services and work processes to improve client service and coordination. The use of successful change strategies and tactics may also be relevant for application to other large-scale change goals in governmental agencies and even large not-for-profit organizations. Further research can look at variations which may be appropriate across sectors and types of agencies.

Implications for Research

The findings here suggest several implications for future research, in the spirit of Fernandez and Rainey's call for "additional research to further validate or refine these propositions" (2006, 17). The findings in this study were generally consistent with their principles, but suggestions are made below for possible refinements and further testing.

The most prominent implication for research has to do with the role of employee participation in the change process noted in Fernandez and Rainey's third proposition: "Build internal support and overcome resistance". Based on our findings and other research, we believe that this proposition could be better focused on the broader benefits of participation, with less of an emphasis on resistance. The literature on employee participation suggests that involving employees in decision making can have at least two goals or outcomes: building a sense of ownership which can both reduce resistance and enhance commitment to implementation of the plan, and improving the quality of the decisions and resulting plans. The second goal seems to warrant greater attention.

Notably, for example, a major priority of the National Performance Review (Gore 1993) was "to empower employees to get results'" (italics added). Rainey (1998) reinforced this rationale, noting that the purpose of the NPR Reinvention Labs was to "encourage bottom-up innovation" (p. 164). Osborne and Plastrick (1997) listed empowering employees and one of five key "levers" of change.

We found extensive concern among respondents regarding tactics related to the proposition of building internal support. Active participation by staff in both planning and implementation seemed to be a key factor; and many respondents said that more participation in the development of the plan, as well as fuller communication of it, would have helped. Both instrumental and emotional support (Fernandez and Rainey 2006, 11) were important here and warranted even more attention. This is actually consistent with Kelman's (2005) strategy of "activating the discontented". As Kelman found, in some cases, employees may be eager for change, not resistant to it. In such a case, participation in decision making empowers employees to engage with the proposed change. Connor and Thompson (2006) addressed this issue in commentary based on the Fernandez and Rainey article, accenting an alternative perspective that "argues that organizational change occurs most successfully when organization members are truly engaged", and their views are "in fact being taken into account and considered" (p. 29). In the same issue, Mihm (2006), summarized success factors in change at the GAO, noting that "employee involvement strengthens the transformation process by including frontline perspectives and experiences" (p. 34). Rainey and Fernandez, in a response to commentary reaction pieces (2006, 48), seem to agree with the importance of this.

Beyond the notion that participation may warrant its own proposition, the term "overcome resistance" in this proposition is different from all the others in the sense that it is not objectively observable to members of the organization or researchers, but is rather stated as an intermediate goal which can be pursued through observable tactics such as widespread participation. If this proposition were reworded to say "use widespread participation in the change process", its wording would be aligned with the other propositions, and it would also be easier to observe and measure. Eliminating here the rationales for participation (building support and reducing resistance) would also reinforce the notion that employee participation has value beyond these purposes: it can proactively enhance employee commitment and ownership over the process and outcomes and, perhaps more importantly, improve change outcomes by tapping the creativity and knowledge of a larger number of employees. For example, in their study of executives in two state agencies implementing the 1996 welfare reform law, Bruhn, Zajac, and Al-Kazemi (2001) found that the most commonly reported results of employee participation were enhanced "buy in", greater commitment and accountability regarding the success of the change, and the value of the employees' practical knowledge which aided in problem solving. Based on their findings, they recommend that "welfare agencies experiment with and evaluate the process and outcome of greater employee participation in organizational planning" (2001, 221), including the training of employees regarding effective participation.

As a final suggestion on this principle, replacing the phrase "and other means" with additional specific tactics would provide more specific guidance to both practitioners and researchers. These suggestions are reflected in Table 5, offered as a replacement for Fernandez and Rainey's third proposition. As noted above, the other propositions seemed to offer a solid framework for further study.

In terms of research methods, this study, which gathered data from over 250 respondents in seven agencies, can be seen as a transition step between earlier studies, which were often based upon single case studies or consultant experiences, and more systematic research such as that suggested by Fernandez and Rainey. As conceptual models are further refined, and success factors are more definitively identified, future research can be more precisely based upon this prior work, helping to unify this growing body of knowledge. Data from the seven cases presented above add to the knowledge base on organizational change and can help provide a foundation for more structured quantitative research to asses the presence and absence of key success factors by contrasting successful and unsuccessful organizational change initiatives.

Fernandez and Rainey suggest (2006, 18) that research should begin to address the effects of organizational change on actual organizational outcomes. The current study looked at agencies which were generally seen as having completed successful major change processes, but even within this sample some agencies were more successful in achieving change results than others (Patti, et al., 2003). Future research would be enhanced through longitudinal designs of change efforts in which pre-and post-data on performance can be gathered. Alternatively, and perhaps more logistically feasible, surveys of staff that have experienced successful and unsuccessful change processes can be used to contrast practices used and results obtained.

The success factors presented by Fernandez and Rainey provided the structure for presenting the findings here. These factors, including their sub-propositions, with any promising additions (such as the suggestion here that greater attention should be paid to the role of employee involvement), could be incorporated into a survey instrument which could be administered to staffs of large agencies that had experienced significant organizational change initiatives. Other variables, including specific change leader characteristics or behaviors, agency size, type of agency, culture, and the content of the change, could be included in such quantitative analysis. Until resources are available for large-scale research using the large-sample data sets and multivariate statistical techniques suggested by Fernandez and Rainey, smaller-scale survey research can make valuable contributions to knowledge development.

There is still a great deal to be learned about which factors are essential or valuable in creating successful organizational change, and what activities, in what sequences, contribute to success. The work of Ramirez and Rainey and others provides an excellent framework and foundation for continued work in this area.

APPENDIX: INTERVIEW GUIDES

For all interviews: Demographics: current and prior roles, time in current and former positions, position at the time of the integration, extent of involvement with the process

Acknowledgements: The research reported here was funded by the Southern Area Consortium of Human Services (SACHS), a county/university partnership of eight county human services directors in Southern California and the Schools of Social Work at San Diego State University and California State University, San Bernardino. The authors thank the SACHS directors for supporting this research, and also thank the staff from the seven county agencies which were part of the study.

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THOMAS PACKARD

RINO PATTI

DONNA DALY

JENNIFER TUCKER-TATLOW

San Diego State University
INTEGRATED COUNTIES:
QUESTIONS & RESPONDENTS

                                                       DIRECTORS,
                                                       DEPUTIES,
                                                        & OTHER
Q                                              CAO &   EXECUTIVE
                                               BOARD     STAFF

How would you describe the nature and extent     X
of you involvement in planning for the
reorganization of the integrated agency?

Were you (or your community organization)        X
generally in favor of, opposed to, or
neutral about the idea of integrating
several human service agencies when it was
first seriously proposed? (Follow-up
on why.)

Did your opinion about the idea of an            X
integrated agency change during the period
of planning leading up to the actual
reorganization? If so, what influenced this
change in your view?

What in your opinion were the key factors        X
(conditions, problems, interests, etc.) that
lead the Board of Supervisors to authorize
the creation of the super agency?

What would you say were the three or four        X
most important changes or goals for county
human services that the Board was attempting
to achieve when they authorized creation of
the integrated agency? (For CAO, were these
also the changes or goals you had for
reorganization?)

At the time of reorganization, how would         X
you describe your (Supervisor) assessment
of the likelihood of achieving the changes
or goals the Board was seeking? (For the
CAO, did you agree with this assessment?
If not, why?)

For each of the changes that the integrated      X
agency was supposed to bring about, what in
your judgment has been accomplished to this
point? Are you satisfied with what has been
achieved so far?

Where progress toward a goal has been slow       X
or unsatisfactory, why do you think this has
happened? What has contributed to the level
of progress you observe?

Where progress toward a goal has been            X
satisfactory or positive, why do you think
this has happened? What has contributed to
the level of progress you observe?

What in your opinion needs to be done now        X
and in the future to realize the full
potential of the integrated agency?

How would you describe the nature and                      X
extent of your involvement in the planning
and implementation of the reorganization
before it became "a fait accompli" (prompts:
on task force, chaired committees, worked
with external consultants, oversaw, etc)?

At the time the reorganization was                         X
completed and new agency established how
would you describe your assessment of
likelihood of achieving the goals that were
set for it?

Who would you say were the prime movers                    X
(i.e. leaders) in the effort to develop the
integrated agency? (Prompt: Get names and
positions)

Viewed from the perspective of the prime                   X
movers (i.e. decision makers and influential
advocates), what factors (conditions,
problems, interests, etc.) most contributed
to the county's decision to develop an
integrated human service agency?

In your opinions what factors (conditions,
problems, interests, etc.) most contributed
to the county's decision to develop an
integrated human services agency?

What would you say were the 3 or 4 most                    X
important changes (aspirations, goals,
visions, might also be words here), the
prime movers were seeking to bring about
through integration? (Prompt: were there
informal as well as formal goals being
sought?)

14) Other than those who proposed the                      X
reorganization, what groups and or
individuals were most in favor of the idea
of reorganizing? Which were most in
opposition? (Prompt: consulting with
groups, including representative on
committees, negotiating, making
concessions, etc).

How were the concerns of the groups who                    X
opposed integration addressed?

What strategies did the prime movers or
their assistants use to address your
concerns regarding the reorganization?

What strategies did the prime movers or                    X
their assistants use to address your ideas
and suggestions regarding the
reorganization?

What strategies did the prime movers or                    X
their assistants use to keep employees
informed of changes regarding the
reorganization?

What strategies did the prime movers or
their assistants use to keep community
groups informed of changes regarding the
reorganization?

How effective were these strategies in                     X
building commitment or agreement with the
idea of an integrated agency on the part of
those who opposed or questioned it at the
outset?

What major actions or strategies were used                 X
by the prime movers to arrive at the final
decisions regarding the structure and
functions of the reorganized agency? (E.g.
advisory committees, studies, consultants,
community meetings, etc)

When the reorganization was first being                    X
implemented (1-2 years), what were the
major barriers to building commitment to
the integrated agency and collaboration
among staff from different predecessor
agencies?

During this period, what were the principal                X
mechanisms or processes used to break
down barriers to and promote collaboration
and teamwork among staff of the previously
independent agencies? (Prompts: physical
relocation, staff training, reassignments of
staff, new leadership, combining,
community building exercises such as
retreats, advisory committees, others, etc)?

In general, were the strategies used during                X
the early period of reorganization
successful in effecting better collaboration
and teamwork between staff from the various
predecessor agencies?

To what extent did these strategies result                 X
in staff commitment to the new agency and
its mission?

Do most staff now feel they identify with                  X
the new agency or the one they were from?

In your opinion, has collaboration between                 X
staff in the agencies prior to
reorganization improved since
reorganization? (Prompt: ask for examples)

In your opinion, has information sharing                   X
(bridges between data bases, reducing the
constraints of confidentiality) improved
between program and departments since
reorganization?

Referring back to the changes sought by the                X
prime movers, to what extent have these
aspirations or goals been achieved at this
point?

Has the department been able to achieve                    X
efficiencies as a direct result of
reorganization?

Can you give examples of such efficiencies                 X
and how they were achieved (E.g. Through
economies of scale, elimination of
redundancies, better cooperation)?

Could you comment on whether the                           X
integrated agency has made it easier to
blend federal or state categorical and
discretionary funds (e.g. CalWORKS
incentive funds), or use them more flexibly
for cross program initiatives.

Could you comment on whether the                           X
integrated agency has made it easier to
blend federal or state categorical and
discretionary funds (e.g. CalWORKS
incentive funds), or use them more flexibly
for cross program initiatives.

Has structural reorganization made it easier               X
or more difficult to communicate with the
public and other important constituencies
about the goals, programs and
accomplishments of the departments?
(Examples of either, or both)

How are clients now served differently by                  X
the integrated agency than they were by
predecessor  organizations  before
reorganization? (Prompt: ask for specifics).

In your judgment would clients who were                    X
previously served by the independent
agencies believe they are receiving better
service from the integrated agency? (Probe
for specifics: better in some areas than
others?)

What changed for you when the
reorganization was implemented? Different
job, different duties? Different co-workers?
Different supervisor? Different program
head? Different location of work? Others?
Which of these changes were positive,
desirable, or beneficial for you
professionally? Which were negative,
undesirable, or not beneficial?

Please describe the nature of your
involvement with (name of integrated
agency).

If a member of a formal organization, please                       X
describe briefly the community organization
or interest group you represent. (Probe for
name, size, year founded, goal or mission,
etc).

If not employed by an organization, what is                        X
your profession or occupation? (e.g.
Lawyer, planner, housewife, etc.)

Ho4w4. did you initially become involved                           X
with the local agency?

At the time the reorganization was                                 X
completed and the new agency established
how would you describe your assessment of
likelihood of achieving the goals that were
set for it?

In your opinion do most significant                                X
community groups support the purposes of
the integrated agency? How would you
describe the current state of community
support for the new agency among
consumer  advocacy  organizations?
(Prompt: ask for examples)

In your opinion, is the interested community                       X
more informed about the integrated agency
than it was about its predecessor
organizations? More supportive of it?

Can you think of other positive outcomes                           X
that have resulted from the reorganization?
Any negative outcomes?

Any other comments, or observations              X         X       X
important to understanding the
implementation or performance of the
integrated agency?

                                                             CONSUMER
Q                                                            REPRESEN-
                                               SUPERVISORS    TATIVES

How would you describe the nature and extent
of you involvement in planning for the
reorganization of the integrated agency?

Were you (or your community organization)                        X
generally in favor of, opposed to, or
neutral about the idea of integrating
several human service agencies when it was
first seriously proposed? (Follow-up
on why.)

Did your opinion about the idea of an
integrated agency change during the period
of planning leading up to the actual
reorganization? If so, what influenced this
change in your view?

What in your opinion were the key factors
(conditions, problems, interests, etc.) that
lead the Board of Supervisors to authorize
the creation of the super agency?

What would you say were the three or four
most important changes or goals for county
human services that the Board was attempting
to achieve when they authorized creation of
the integrated agency? (For CAO, were these
also the changes or goals you had for
reorganization?)

At the time of reorganization, how would
you describe your (Supervisor) assessment
of the likelihood of achieving the changes
or goals the Board was seeking? (For the
CAO, did you agree with this assessment?
If not, why?)

For each of the changes that the integrated
agency was supposed to bring about, what in
your judgment has been accomplished to this
point? Are you satisfied with what has been
achieved so far?

Where progress toward a goal has been slow
or unsatisfactory, why do you think this has
happened? What has contributed to the level
of progress you observe?

Where progress toward a goal has been
satisfactory or positive, why do you think
this has happened? What has contributed to
the level of progress you observe?

What in your opinion needs to be done now
and in the future to realize the full
potential of the integrated agency?

How would you describe the nature and                            X
extent of your involvement in the planning
and implementation of the reorganization
before it became "a fait accompli" (prompts:
on task force, chaired committees, worked
with external consultants, oversaw, etc)?

At the time the reorganization was                               X
completed and new agency established how
would you describe your assessment of
likelihood of achieving the goals that were
set for it?

Who would you say were the prime movers             X            X
(i.e. leaders) in the effort to develop the
integrated agency? (Prompt: Get names and
positions)

Viewed from the perspective of the prime                         X
movers (i.e. decision makers and influential
advocates), what factors (conditions,
problems, interests, etc.) most contributed
to the county's decision to develop an
integrated human service agency?

In your opinions what factors (conditions,          X
problems, interests, etc.) most contributed
to the county's decision to develop an
integrated human services agency?

What would you say were the 3 or 4 most             X            X
important changes (aspirations, goals,
visions, might also be words here), the
prime movers were seeking to bring about
through integration? (Prompt: were there
informal as well as formal goals being
sought?)

14) Other than those who proposed the                            X
reorganization, what groups and or
individuals were most in favor of the idea
of reorganizing? Which were most in
opposition? (Prompt: consulting with
groups, including representative on
committees, negotiating, making
concessions, etc).

How were the concerns of the groups who
opposed integration addressed?

What strategies did the prime movers or             X            X
their assistants use to address your
concerns regarding the reorganization?

What strategies did the prime movers or             X
their assistants use to address your ideas
and suggestions regarding the
reorganization?

What strategies did the prime movers or             X
their assistants use to keep employees
informed of changes regarding the
reorganization?

What strategies did the prime movers or                          X
their assistants use to keep community
groups informed of changes regarding the
reorganization?

How effective were these strategies in              X            X
building commitment or agreement with the
idea of an integrated agency on the part of
those who opposed or questioned it at the
outset?

What major actions or strategies were used          X            X
by the prime movers to arrive at the final
decisions regarding the structure and
functions of the reorganized agency? (E.g.
advisory committees, studies, consultants,
community meetings, etc)

When the reorganization was first being             X            X
implemented (1-2 years), what were the
major barriers to building commitment to
the integrated agency and collaboration
among staff from different predecessor
agencies?

During this period, what were the principal         X            X
mechanisms or processes used to break
down barriers to and promote collaboration
and teamwork among staff of the previously
independent agencies? (Prompts: physical
relocation, staff training, reassignments of
staff, new leadership, combining,
community building exercises such as
retreats, advisory committees, others, etc)?

In general, were the strategies used during         X
the early period of reorganization
successful in effecting better collaboration
and teamwork between staff from the various
predecessor agencies?

To what extent did these strategies result          X
in staff commitment to the new agency and
its mission?

Do most staff now feel they identify with           X
the new agency or the one they were from?

In your opinion, has collaboration between          X            X
staff in the agencies prior to
reorganization improved since
reorganization? (Prompt: ask for examples)

In your opinion, has information sharing
(bridges between data bases, reducing the
constraints of confidentiality) improved
between program and departments since
reorganization?

Referring back to the changes sought by the         X            X
prime movers, to what extent have these
aspirations or goals been achieved at this
point?

Has the department been able to achieve             X
efficiencies as a direct result of
reorganization?

Can you give examples of such efficiencies          X
and how they were achieved (E.g. Through
economies of scale, elimination of
redundancies, better cooperation)?

Could you comment on whether the
integrated agency has made it easier to
blend federal or state categorical and
discretionary funds (e.g. CalWORKS
incentive funds), or use them more flexibly
for cross program initiatives.

Could you comment on whether the
integrated agency has made it easier to
blend federal or state categorical and
discretionary funds (e.g. CalWORKS
incentive funds), or use them more flexibly
for cross program initiatives.

Has structural reorganization made it easier        X
or more difficult to communicate with the
public and other important constituencies
about the goals, programs and
accomplishments of the departments?
(Examples of either, or both)

How are clients now served differently by                        X
the integrated agency than they were by
predecessor  organizations  before
reorganization? (Prompt: ask for specifics).

In your judgment would clients who were             X
previously served by the independent
agencies believe they are receiving better
service from the integrated agency? (Probe
for specifics: better in some areas than
others?)

What changed for you when the                       X
reorganization was implemented? Different
job, different duties? Different co-workers?
Different supervisor? Different program
head? Different location of work? Others?
Which of these changes were positive,
desirable, or beneficial for you
professionally? Which were negative,
undesirable, or not beneficial?

Please describe the nature of your                                X
involvement with (name of integrated
agency).

If a member of a formal organization, please                      X
describe briefly the community organization
or interest group you represent. (Probe for
name, size, year founded, goal or mission,
etc).

If not employed by an organization, what is                       X
your profession or occupation? (e.g.
Lawyer, planner, housewife, etc.)

Ho4w4. did you initially become involved                          X
with the local agency?

At the time the reorganization was                                X
completed and the new agency established
how would you describe your assessment of
likelihood of achieving the goals that were
set for it?

In your opinion do most significant                               X
community groups support the purposes of
the integrated agency? How would you
describe the current state of community
support for the new agency among
consumer  advocacy  organizations?
(Prompt: ask for examples)

In your opinion, is the interested community                      X
more informed about the integrated agency
than it was about its predecessor
organizations? More supportive of it?

Can you think of other positive outcomes                          X
that have resulted from the reorganization?
Any negative outcomes?

Any other comments, or observations                  X            X
important to understanding the
implementation or performance of the
integrated agency?

COLLABORATION COUNTIES:
QUESTIONS & RESPONDENTS

                                    CAO &   EXECUTIVE   SUPERVISORS
                                    BOARD     STAFF       & FRONT
                                                        LINE STAFF

What is occurring at the County                 X
Board level to encourage county
collaboration?

As a county supervisor (or CAO),                X
do you focus on, inquire about, or
otherwise expect human service
agency directors to report on
accomplishments in the area of
interagency collaboration. Will
the Board routinely say to (Name
DSS Director), "What are you doing
to work with (Name another HHSA
agency) (ex. Public Health) to
address a particular issue?

What would you say Board of                     X
Supervisors can/should do to
encourage public agency
collaboration?

Do you encounter provisions in        X
state or federal legislation that
constrain or impede the blending
of funds for collaborative program
efforts?

Please describe recent human          X         X
service interagency collaborations
(last 3-5 years) you consider most
important to your county.

As you think about these              X         X
collaborative efforts, please
comment on the barriers (issues,
constraints) that you and/or
others in your county have had to
deal with?

In your experience, what are the      X         X            X
key factors that contribute to
successfully initiating and
sustaining interagency
collaboration in your county?

What have been the outcomes of        X         X            X
these collaborations for: Ask for
examples of each and if there is
documentation. Better services to
clients? More efficiency or
improved used of resources?
Leveraging more funds?

If you were advising another          X         X
County Supervisor/new human
service agency executive on how to
build more interagency
collaboration in their county
collaborative with other county
what would you tell him/her about
what to do and not do?

On the whole, do think there is       X
room for improvement in
collaboration? In what areas?

Have you seen economies of scale      X
or other efficiencies that
resulted from the creation of
super-agencies or interagency
collaborations?

If you were able tomorrow to          X         X            X
mandate an integrated agency to
promote more interagency
collaboration or coordination by
bringing together (Name HHSA
agencies in the county/primary
public human service partners),
would you? If so why?

Please comment on conditions in                 X            X
the local, state, or federal
climate that encourage
(facilitate) or discourage
(hinder) interagency collaboration
among county human service
agencies?

If you had the power to create an               X
integrated agency with your
primary public human service
partners in this county, would
you? If not, why? If so, why?

Answer the following questions                               X
with reference to the most recent
attempts to improve service or
administrative coordination
between your agency and other
county human service agencies.

During the past 3-5 years, have
there been significant efforts to
improve: Interdepartmental
coordination of services to
clients served jointly by your
department and other county
departments? (Probe for examples)
Coordination of administrative
processes to increase efficiency,
reduce costs, etc.? Blended
funding (using funds from
different categorical sources) to
improve coordinated service
delivery?

Please indicate the 3-4 county                               X
human service agencies with which
your agency has the most common
clients.

For each of these agencies, please
list by name and title the
interagency collaborative programs
or projects (as defined
previously) with your agency.

Now, please describe the 1 or 2                              X
collaborations that you consider
the most important for your agency
as whole. (E.g. in terms of number
of clients served, the impacts on
clients, public perceptions of the
agency, etc. Note: the group is
free to use what ever criteria it
wants)

What factors contribute to                                   X
collaboration in your county?
(Prompts - director support/
leadership, Board directives,
funding necessities, county size
etc)

WISH LIST: What type of                                      X
collaboratives would you like to
see in your county? Between which
agencies? Why?

Do you think this collaboration is
likely to occur and/ or would
receive agency support? Why or
why not?

In your experience, what are the                             X
key factors that contribute to
successfully initiating and
sustaining interagency
collaboration in your county?

What strategies would you suggest                            X
to strengthen collaboration in
your county?

How would you suggest agencies                               X
build trust between one another in
order to increase collaboration?

Do confidentiality issues serve as                           X
barriers to effective
collaboration?

What are your agency policies re:                            X
sharing information with other
agencies?

Are there certain professionals                              X
that are more likely to share
information than others? Who? Why
do you feel this is the case?

How would you suggest resolving                              X
the confidentiality issue?

What types of leadership skills                              X
are effective in building
successful interagency
collaboration?


Table 1
Interview and Focus Group Respondents with Counties
Grouped as Structurally Integrated or Collaborative,
Ranked on the Extent of Implementation of Collaboration.

             Executives      Managers
             and Elected     and
             Officials       Community
                             Stake-
                             holders
INTEGRATED
(N=52)

County A     2 elected       3 Program
N=14         officials,      managers,
             CAO,            Consumer
             Director,       group
             3 executives    represen-
                             tative

County B     4 current and   2 Regional
N=13         1 former        Managers,
             executives      3 support
                             division
                             directors

County C     2 elected       5 Deputy
N=14         officials,      Directors,
             Director,       Fraud
             Assistant       Investi-
             Director        gator,
                             Community
                             Stakeholder

County D     CAO,            5
N=11         Director,       Department
             Assistant       Directors,
             Director        Project
                             coordinator
COLLABORA-
TIVE
(N=29)

County E     2 elected       3 Division
N=13         officials,      Directors,
             Director,       3 Section
             Deputy          Deputy
             Director        Directors

County F     1 elected       3 Deputy
N=8          official,       Directors
             Director

County G     Director,
N=8          5 executives

TOTALS       28              34

                            Collaborative
             Focus          Practices:
             Groups         Extent of
             (Managers,     Implementation
             Supervisors,   (5-point scale)
             Line Staff)    N=256
INTEGRATED
(N=52)

County A     3 groups       3.31
N=14

County B     3 groups       3.16
N=13

County C     3 groups       2.72
N=14

County D     2 groups       2.45
N=11

COLLABORA-
TIVE
(N=29)

County E     3 groups       3.69
N=13

County F     3 groups       3.52
N=8

County G     2 groups       3.44
N=8

TOTALS       19

Table 2
Organizational Change Propositions and Selected Findings

Propositions         Selected findings

Ensure and           * Emphasize the need for improved services
communicate the
need                 * Clearly state and prominently share the
                     vision and guiding principles

                     * Communicate regularly with employees
                     regarding benefits, costs, and progress

Provide a plan for   * Involve mid- and lower-level staffs in
implementation       planning

                     * Fully communicate plans to all employees

Build internal       * Involve key stakeholders in both planning
support and          and implementation throughout the process
overcome             through work groups and task forces
resistance
                     * Communicate concern for staff and an
                     understanding of their increased day-to-day
                     demands

                     * Provide support staff resources for change
                     processes

                     * Provide cross-program training and team
                     building

Ensure top           * Demonstrate top management commitment
management           through vision and championing the change
support and
commitment           * Build trust within teams and between
                     hierarchical levels of staff

                     * Build trust and mutual understanding among
                     executive team members

Build external       * Recognize and aggressively implement goals
support              and visions of elected officials

Provide adequate     * Manage change incrementally to prevent
resources            overloading staff while maintaining momentum

                     * Provide adequate training on change
                     management and implementation of new processes

Institutionalize     * Make formal changes in organization charts,
changes              policies, and procedures

                     * Address dynamics of culture change through
                     training and team building

                     * Monitor implementation through action plans
                     and review meetings

Pursue               * Recognize and address the interconnectedness
comprehensive        across organizational subsystems, both formal
change               (information systems) and informal (varying
                     professional cultures)

                     * Design and plan for comprehensive change

Table 3:
Strategies for Addressing Concerns / Building Support:
% of Respondents Mentioning the Factor N=52

                                                      Total
County:           A N=14   B N=13   C N=14   D N=11   Mean

Multi-level        71%      46%      36%      100%     62%
task forces,
committees,
workgroups to
get input,
plan, etc.

Information        36%      54%      43%      100%     56%
dissemination
(e.g.,
newsletters,
hotlines,
videos)

Team building,     21%      15%       7%      27%      17%
shared mission/
vision

Leaders             7%      15%       0%       9%      8%
emphasize
positives,
don't dwell on
problems

* Other            36%      46%      21%       9%      31%

Note: Percentages do not total 100% as respondents were asked to
check all that apply.

* Other responses include: Staff survey; Staff meetings; community
leaders involved in planning; evaluation of integration; position
above Regional Managers created; consultant; public hearing at Board
of Supervisors meetings; Town Hall meeting; director's commitment to
expansion of mental health services; one meeting w/ CAO & Directors;
tied reorganization to new classifications/ raises.

Table 4

Factors Contributing to Successful Collaboration:

% of Respondents Mentioning the Factor
N=29

                   County E   County F   County G   Total
                     N=13       N=8        N=8      Mean

Co-location          54%        75%        38%       55%

Cross-agency         54%        63%        50%       55%
training and
team building
activities

Strong agency        54%        75%        38%       55%
leadership

Regular meetings     31%        88%        50%       52%

Shared vision,       15%        50%        63%       38%
philosophy,
values and
culture across
agencies

Understanding        23%        38%        25%       28%
agency partners'
cultures and
limitations

Involve staff of     15%         0%        25%       14%
all levels in
planning and
problem solving

Shared               15%         0%         0%       7%
information
systems

* Other              23%        13%        13%       17%

Note: Percentages do not total 100% as respondents were asked to
check all that apply.

* Other responses include: Keep focus on community and best interests
of public; build trust, prevent blindsiding; economies of scale when
support functions centralized; measurable and concrete objectives to
show value of collaboration; clear procedures.

Table 5

Suggested Amended Proposition and Subpropositions

Proposition            Subpropositions

Use widespread         * Involve employees in change planning
participation in the   and implementation.
change process
                       * Provide ongoing opportunities for
                       extensive communication and
                       dialogue.

                       * Commit sufficient time, effort, and
                       resources to manage participation
                       effectively, particularly by supporting
                       employees.
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