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Organizational Social Context: Assessment, Impact, and Intervention for
Change
MCWIC Regional Forum, “Improving Outcomes for Children, Youth and
Families through Sustainable systems Change” (April, 2009)
Anthony Hemmelgarn, Ph.D.Children’s Mental Health Services Research Center
College of Social WorkUniversity of Tennessee
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Presentation ObjectivesPresentation Objectives
Organizational Social Context and the Organizational Social Context and the Socio-technicalSocio-technical modelmodel
Organizational Social Context (OSC) Organizational Social Context (OSC) Measurement SystemMeasurement System
CMHSRC research findingsCMHSRC research findings
ARC organizational interventionARC organizational intervention
Parting ThoughtsParting Thoughts
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Quotable Quotes
“Have you hit him in the mouth? Here, take this paddle and whip him. If it doesn’t work on his rear end, hit him in the head. That’s what my daddy did with me.”
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Which of the following gets the most Which of the following gets the most support in this court system?support in this court system?
Training court officers to work with Boot Training court officers to work with Boot Camp InstructorsCamp Instructors
Training court officers to work with Multi-Training court officers to work with Multi-Systemic-Treatment TherapistsSystemic-Treatment Therapists
A redo of the Scopes Monkey TrialA redo of the Scopes Monkey Trial
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There is ample empirical There is ample empirical research that indicates: research that indicates:
Empirically-Based Practices and Empirically-Based Practices and treatments are rarely adopted treatments are rarely adopted
And if adopted, seldom implemented And if adopted, seldom implemented effectively or with fidelityeffectively or with fidelity
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The Socio-technical Model arguesThe Socio-technical Model argues
The adoption of best practices, fidelity to The adoption of best practices, fidelity to new protocols, adherence to training, etc… new protocols, adherence to training, etc…
Are as much Are as much socialsocial as technical processesas technical processes
Are embedded in an Are embedded in an organizational social organizational social contextcontext
Require changesRequire changes in the social context to occur in the social context to occur
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Culture and Climate are the Key Constructs Culture and Climate are the Key Constructs in Organizational Social Contextin Organizational Social Context
CultureCulture – property of the organization – property of the organization System norms and valuesSystem norms and values ““The way things are done”The way things are done” What is expected and rewardedWhat is expected and rewarded
ClimateClimate – property of the individual – property of the individual Perceptions of work environment’s psychological Perceptions of work environment’s psychological
impact on employeesimpact on employees Affective responseAffective response E.g., “psychological safety”E.g., “psychological safety”
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Rejection or adoption of new technologiesRejection or adoption of new technologies - - Innovative/flexible cultures try & test new thingsInnovative/flexible cultures try & test new things
Assimilation versus accommodation of new technologies Assimilation versus accommodation of new technologies e.g., child welfare assessmentse.g., child welfare assessments
Sustainability and fidelity of new programsSustainability and fidelity of new programs
Positive or negative attitudesPositive or negative attitudes - - Defensive (active/passive) cultures create turnover, low organizational Defensive (active/passive) cultures create turnover, low organizational
commitment, poor service quality, & poor client outcomescommitment, poor service quality, & poor client outcomes
Individual learning/persistence versus apathy/resistanceIndividual learning/persistence versus apathy/resistance - - Associates feeling autonomy, decision controlAssociates feeling autonomy, decision control demonstrate more energy, tenacity, and motivation for actiondemonstrate more energy, tenacity, and motivation for action
What Does Organizational Social What Does Organizational Social Context Create?Context Create?
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The Impact of Organizational Culture The Impact of Organizational Culture and Climate and Climate
Main EffectMain Effect
Mediation EffectMediation Effect
Moderation EffectModeration Effect Change effort Service Outcomes
Culture/Climate
Change effort Service Outcomes
Culture/Climate
Change effort CultureClimate
Service Outcomes
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NIMH Study of Climate - NIMH Study of Climate - (Glisson & Hemmelgarn, 1998)(Glisson & Hemmelgarn, 1998)
InterorganizationalServices
Coordination
ServiceQuality
CountyDemographics
OrganizationalClimate
Service Outcomes(problem levels)
-.12*
-.17* .02.11*
-.05
-.35*-.04
*p<.05
2 = 945.79 GFI = .91 AG&I = .89 CFI = .91 w/ 370 df’s
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NIMH Study of Culture/Climate of Emergency Rooms: NIMH Study of Culture/Climate of Emergency Rooms: Emotional Support NormsEmotional Support Norms
(Hemmelgarn, Glisson, & Dukes, 2001)(Hemmelgarn, Glisson, & Dukes, 2001)
Potential sources of variation in norms F Significant effect
ER experience 3.16 No
Gender .19 No
Profession .22 No
Hospital 10.68** Yes
Comparison 1-2 5.75* Yes
Comparison 3-4 .42 No
Comparison 1&2 vs. 3&4 17.68** Yes
**p < .01
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NIMH Study of Culture/Climate of Emergency Rooms: NIMH Study of Culture/Climate of Emergency Rooms: Emotional Impact PerceptionsEmotional Impact Perceptions
(Hemmelgarn, Glisson, & Dukes, 2001) (Hemmelgarn, Glisson, & Dukes, 2001)
Potential sources of variation in impact F Significant effect
ER experience 3.41 No
Gender 2.55 No
Profession .37 No
Hospital 2.30 No
Comparison 1-2 .26 No
Comparison 3-4 .01 No
Comparison 1&2 vs. 3&4 5.11** Yes
**p < .01
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Organizational Social Organizational Social Context measurement Context measurement
system (OSC)system (OSC)
• Developed by CMHSRCDeveloped by CMHSRC• Nationally NormedNationally Normed• Provides Organizational ProfileProvides Organizational Profile
• Early WarningEarly Warning• Monitoring for ImprovementMonitoring for Improvement
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Organizational Culture
1. Proficiency – expectation that service providers will be competent, have up-to-date knowledge, and place the well-being of clients first
2. Rigidity – expectation that service providers will have limited discretion and flexibility, and closely follow extensive bureaucratic rules and regulations
3. Resistance – expectation that service providers will show no interest in change or new ways of providing services
Organizational Social Context (OSC) Measurement System
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Example of Worst Culture Profile
(approximately 10% of clinics)
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Example of Best Culture Profile
(approximately 10% of clinics)
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19
50.0
45.0
40.0
35.0
30.0
25.0
20.0
worst average best
Culture Profiles
Mo
nth
s N
ew P
rog
ram
Su
stai
ned
New Program Sustainability as a Function of Culture
Research funded by MacArthur Foundation.
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Five Studies to date link Culture to:Five Studies to date link Culture to:
Individualized care Individualized care by 408 service providers in 30 by 408 service providers in 30 social service organizations (Glisson, 1978)social service organizations (Glisson, 1978)
Family-centered careFamily-centered care by 131 service providers in by 131 service providers in four emergency rooms (Hemmelgarn, Glisson & four emergency rooms (Hemmelgarn, Glisson & Dukes, 2001) Dukes, 2001)
Turnover, work attitudes,Turnover, work attitudes, and and service qualityservice quality among 283 caseworkers in 33 child welfare and among 283 caseworkers in 33 child welfare and juvenile justice case management teams (Glisson & juvenile justice case management teams (Glisson & James, 2002)James, 2002)
Service qualityService quality in 15 child welfare teams serving 21 in 15 child welfare teams serving 21 urban and rural counties (Glisson & Green, 2006)urban and rural counties (Glisson & Green, 2006)
New program sustainabilityNew program sustainability in nationwide sample in nationwide sample of 100 mental health clinics (Glisson, Schoenwald, of 100 mental health clinics (Glisson, Schoenwald, Kelleher et al., 2008)Kelleher et al., 2008)
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Organizational Social Context (OSC) Measurement System
Organizational Climate
1. Engagement – service provider perceptions of personal accomplishment, involvement and concern for clients
2. Functionality – service provider perceptions that they receive the needed cooperation and support to do their jobs
3. Stress – service provider perceptions that they are emotionally exhausted and overloaded in their work
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Example of Worst Climate Profile
(approximately 10% of clinics)
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Example of Best Climate Profile
(approximately 10% of clinics)
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18.00
15.00
12.00
9.00
worst average best
Climate Profiles
Pas
t Y
ear
Th
era
pis
t T
urn
ove
r R
ate
(%
)
21.00
Past Year Therapist Turnover Rate as a Function of Climate
Research funded by MacArthur Foundation.
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Raw CBCL Total Score
Months following Initial Investigation
0
25
30
35
40
45
4 12 20 28 36
children served by systems with worst climates (least engaged)
children served by systems withbest climates (most engaged)
Results of 3 level HLM
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Organizational Culture and/or ClimateOrganizational Culture and/or Climate
DifferDiffer in organizations providing same service in organizations providing same service
Predict staff Predict staff job satisfaction and commitmentjob satisfaction and commitment
Predict staff Predict staff turnoverturnover
Predict Predict service quality service quality
PredictPredict service outcomes service outcomes
Predict adoption, fidelity, and sustainability to new Predict adoption, fidelity, and sustainability to new treatmentstreatments
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A Need for Organizational InterventionsA Need for Organizational Interventions
Evidence-based organization interventions are Evidence-based organization interventions are needed to improve mental health and social servicesneeded to improve mental health and social services
Improve work environments and reduce service Improve work environments and reduce service provider turnover provider turnover
Support the implementation of evidence-based Support the implementation of evidence-based training, treatments, and other best practices training, treatments, and other best practices
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ARC Organizational ARC Organizational InterventionIntervention
AvailabilityAvailability ResponsivenessResponsiveness ContinuityContinuity
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ARC Guiding PrinciplesARC Guiding Principles
mission-drivenmission-driven vs rule driven – all staff and administrative actions and vs rule driven – all staff and administrative actions and decisions must contribute to children’s well-beingdecisions must contribute to children’s well-being
results-orientedresults-oriented vs process oriented – measure staff and program vs process oriented – measure staff and program performance by improvements in children’s well-beingperformance by improvements in children’s well-being
improvement-directedimprovement-directed vs status quo oriented – staff and vs status quo oriented – staff and administrators continually seek to be more effectiveadministrators continually seek to be more effective
relationship-centeredrelationship-centered vs individual centered – staff and administrators vs individual centered – staff and administrators focus on consumer and stakeholder relationshipsfocus on consumer and stakeholder relationships
participation-basedparticipation-based vs authority based – include line-level staff and vs authority based – include line-level staff and community stakeholders in key program decisions community stakeholders in key program decisions
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Uses Uses 12 “levers”12 “levers” or intervention components or intervention components
Involves Involves all organizational levelsall organizational levels and and community community stakeholdersstakeholders
Requires Requires change agentschange agents who work directly with who work directly with managers, treatment teams and community leaders managers, treatment teams and community leaders
ARC Organizational Intervention ModelARC Organizational Intervention Model
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Twelve ARC Intervention ComponentsTwelve ARC Intervention Components
Leadership Leadership developmentdevelopment
Personal relationshipsPersonal relationships Network developmentNetwork development Team buildingTeam building Information & trainingInformation & training FeedbackFeedback
Participatory decision-Participatory decision-makingmaking
Conflict resolutionConflict resolution Goal settingGoal setting Continuous improvementContinuous improvement Job redesignJob redesign Self-regulationSelf-regulation
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Stages, Components and Phases of the Stages, Components and Phases of the Arc Organizational Intervention ModelArc Organizational Intervention Model
Stages and ComponentsStages and Components PhasesPhasesII
ProblemProblem
identificationidentification
IIII
DirectionDirection
settingsetting
IIIIII
Implement-Implement-ationation
IVIV
StabilizatioStabilizationn
1. Leadership development1. Leadership development xxxxxxxxxx
2. Personal relationships2. Personal relationships xxxxxxxxxx
3. Network development3. Network development xxxxxxxxxx xxxxxxxxxx
4. Team building4. Team building xxxxxxxxxx xxxxxxxxxx
5. Information and training5. Information and training xxxxxxxxxx xxxxxxxxxx xxxxxxxxxx
6. Feedback6. Feedback xxxxxxxxxx xxxxxxxxxx xxxxxxxxxx xxxxxxxxxx
7. Participatory decision-making7. Participatory decision-making xxxxxxxxxx xxxxxxxxxx xxxxxxxxxx xxxxxxxxxx
8. Conflict management8. Conflict management xxxxxxxxxx xxxxxxxxxx xxxxxxxxxx xxxxxxxxxx
9. Goal setting9. Goal setting xxxxxxxxxx xxxxxxxxxx xxxxxxxxxx
10. Continuous improvement10. Continuous improvement xxxxxxxxxx xxxxxxxxxx
11. Job redesign11. Job redesign xxxxxxxxxx xxxxxxxxxx
12. Self-regulation12. Self-regulation xxxxxxxxxx
Par
ticip
atio
nIn
nova
tion
Col
labo
-ra
tion
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Results of ARC Intervention
• ARC reduced turnover (39%) vs control (69%)
• ARC improved climate in both urban and rural teams
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Proportion of Youth Entering Out of Home Placements in State Custody
ARC
No Yes
No 34%(52/152)
22%(31/139)
29% (83/291)
Yes 20%(34/169)
16%(22/136)
18% (56/305)
27%(86/321)
19%(53/275)
23% (139/596)
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HLM Analysis of MST x ARC Interaction Effect on Problem Behavior at 6 months
No Yes
MST
60
55
65
CB
CL
To
tal
Pro
ble
m T
Sco
re
(Clinical Cut Point = 60)
(60.98)(60.89)
(60.85)
(57.55)
Non-ARC counties
ARC counties
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Parting thoughtsParting thoughts
Organizational Social Context has Organizational Social Context has survival valuesurvival value
Social Context can make or break Social Context can make or break technological changestechnological changes
Organizational “Learning” contexts Organizational “Learning” contexts need to be developedneed to be developed
Technological change without Technological change without attention to social context isn’t wise attention to social context isn’t wise
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Contact InformationContact Information
Children’s Mental Health Service’s Children’s Mental Health Service’s Research Center. The University of Research Center. The University of Tennessee Tennessee
865 974 1707865 974 1707
Tony HemmelgarnTony Hemmelgarn [email protected]@utk.edu