SW N390R10: Introduction to Human Service Administration

2 July 1998

Understanding Human Service Delivery Systems


In today's environment, human service organizations must establish and maintain a complex array of different types of relationships with other organizations in their environment. Weiner called the process by which this is done "systemic management."

Although the methods and techniques of systemic management are very similar to those of institutional management, the way those methods are applied are quite distinct. For one thing, sysyemic management requires a strategic as well as a structural approach to management. Weiner also points out that a primary difference is in the concept of the management repertoire. That is, in the "assembling of a particular set of techniques that when used in concert can exploit heretofore untapped potential in the standard management technologies and can effectively manage transorganizational systems.


Analyzing and Designing Systems

Creative human service management is committed to improving human service delivery systems through innovation, redesign, and planned change. Systemic management starts with the ability to analyze and redesign human services systems that cross organizational boundaries. The effective manager must continually apply the rigor and technology of research to the task of improving human service organizations. Data collection and analysis is the means by which effective managers improve human service delivery systems. Systemic management is concerned with identifying the strategic options available to the organization and with maintaining more cost-effective, responsive human service delivery systems. By the application of analytic techniques to better understand complex systems, human service managers can develop new alternatives to improve effectiveness, as well as productivity, in human services.

There are many analytic techniques that can be used for systemic management. The table below identifies several types of analytic tools based on the level of analysis.

Type

Definition

Example

Management

An objective analysis of structures and procedures of an organization.

Methods and procedures, paperwork simplification, records management, work measurement

Operations

Using higher mathematics for solving operational problems and to provide management with a more logical basis for making predictions and choices.

Probability, waiting lists, sequencing, resource allocation, routing, location of facilities

Systems

Continuous cycle of designing alternative systems to achieve organizational objectives and evaluating alternatives in terms of effectiveness and cost.

Conceptualization, design, model simulation, development, testing, and implementation

Community

Comprehensive socioeconomic analysis of the geographic area, searching for interrelations among the multifaceted processes of society and its institutions.

Neighborhood profiles, demographic studies, needs assessment, input-output analysis

Policy

Complex, dynamic process oriented toward the utilization of scientific methods for solving social problems of public importance.

Econometrics, financial investment analysis, Delphi process, social indicators

Social

Identification and analysis of societal problems, exploring historical and structural relationships, with an orientation toward social justice and promoting responses to current social issues.

Neighborhood profiles, societal issues studies, reality constructions, hermeneutics


Transorganizational Systems

Systemic management implies managing across organizational boundaries. Transorganization systems can take many different forms. In fact, a single organization may be involved in a number of different types of collaborations, coordination initiatives, and joint ventures with other organizations. Taken in total, these different relationships comprise the fabric of the service delivery system in an community. Our author identifies three different types of transorganizational system.

Single Agency Client with Individualized Case Management. This is probably the most common form of transorganizational system in human service today. In this case, systems have been developed in which an interdisciplinary team performs client assessment and develops a unique service plan for that client. A case manager is assigned to work with the client, and to make arrangements with community agencies to provide services to the client. The team monitors service delivery and outcomes while the burden of spanning organizational boundaries is left with the case manager.

Multi-Agency Client with Managed Care. In this type of system, a team or task force ties the various agencies together. The task force conducts assessment and staffing of the case with case management initiated to facilitate and monitor client services. Central to this approach is the use of an integrated information management system for client tracking. The task force is responsible for addressing boundary spanning issues.

An example of this type of system in Austin is the Community Resource Coordination Group (CRCG). The CRCG is comprised of representatives of several agencies. The task force meets monthly to monitor and staff hard to serve multi-problem clients who might otherwise fall through the cracks. The members of the CRCG must be willing and able to commit their organization to meeting the specific needs of the clients in order for the CRCG to work effectively.

Integrated Community Human Service System with Client Self-Management. According to our author, this type of system does not exist because the technology for making it a reality is just being developed. That includes information technology, although the advanced information technology available today has gone a long way toward solving technological probelms. However, it also means the system technology needed to design and implement a fully integrated human service delivery system. This type of system requires the ability to overcome the political difficulties of integrating a system that has traditionally been fragmented, and where the individual organizations have been turf conscious and highly autonomous.

This type of system integrates the majority of human service agencies in the community--public, private, and commercial--into a comprehensive service delivery system to address a wide range of community problems. It is guided by a multidisciplinary team of professionals from the agencies that comprise the transorganizational system. The team undertakes comprehensive strategic planning, out of which develops a number of task forces, each one charged with developing integrated multi-agency systems that target specific areas of human need in the community. The goal is to make available to the residents in the community the widest possible range of options for service acquisition to deal with each client in a comprehensively and uniquely. Central to this type of system is the concept of client self-management. This means that the client is able to activate and manage the system directly using an integrated telecommunication system.

Probably the closest thing to this type of system in Austin is the Community Action Network (CAN). CAN has been active in Austin in one form or another for nearly 20 years, although it has only been called CAN since 1992. Prior to that it was known as the Social Policy Advisory Committee.

The CAN has defined two key roles in the community:

1. to provide a community forum for creative and collaborative problem solving, inclusive community participation and consensus building.

2. to provide tools that community organizations can use to most effectively leverage resources to meet evolving community requirements. These tools include: an annual community resource and needs assessment; a community master plan specifying community impacts, goals, strategies, and measurable outcome, to be used for leveraging resources to address identified needs; a review and evaluation process to determine the effectiveness of resource use; and a selection process to help community organizations choose programs, services, and organizations that can best leverage resources.

The CAN currently consists of twelve partner organizations. Each organization, depending on its mission and capabilities, brings a combination of many resources to the CAN process: volunteers, staff support, facilities, expertise, and other capacities unique to each individual partner. The partner organizations include:

The name change in 1992 signified as major reconceptualization and reorganization of CAN. That process was completed in the summer of 1995 with the establishment of three organizational units:

The CAN Resource Council is the policy setting, decision making body made up of senior leadership representatives from each partner organization plus three at-large members from the community.

The CAN Executive Team is the policy and decision implementation group made up of executive level managers from each partner organization.

The CAN Community Council is the community input and CAN oversight body composed of membership from community experts, service providers, and citizens, as well as Resource Council member from each of the CAN partner organizations.

The CAN planning process has established six major issue areas where planning bodies are meeting to (1) evaluate Community Assessment data, (2) update the Community Action Plan, and (3) assist in the Review and Selection Process. The six issue areas are:

The CAN Review and Selection Process establishes Review Teams in the six areas and review/evaluation tools to assist in determining the effectiveness of resource use in the community. The Review Teams assist in the process of resource allocation by reviewing, evaluating and recommending potential service providers which they believe are best able to meet identified community needs.

The CAN coordinating staff makes it possible for the CAN Community forum function to be as effective as possible and for CAN partners, community organizations, planners, evaluators and support personnel (both staff and volunteer) to work together to develop the best possible tools to bring the maximum amount of community resources to bear on the most pressing community problems.

While the primary focus of CAN is strategic planning and resource coordination, it does facilitate direct service delivery processes. One way it does this is through task forces that address specific areas of need in the community. For example, in December 1996 the Homeless Task Force completed its Comprehensive Plan for Addressing Homelessness in Austin/Travis County. The plan outlines a Continuum of Care that will both prevent and reduce homelessness in Austin.

Central to the Continuum of Care is the establishment of a homeless campus to integrate homeless services in Austin. This campus would give homeless persons access to a wide range of services and provide opportunities for self-management of the services available through the center. Implementation of all elements of this plan could help move the community toward establishing an integrated community system with client self-management.

Another system that has tried to design a client self-managed integrated service system is the Member Organized Resource Exchange (MORE) developed in 1982 by Grace Hill Neighborhood Services in St. Louis, Missouri (Graber, Haywood & Vosler, 1996). This system is a self-help volunteer network through which trained neighborhood residents help link their neighbors to needed services and resources. A fully computerized system that links neighbors together in 12 neighborhoods, MORE provides service linkages in the neighborhoods 24 hours a day, 7 days a week.

From its humble beginnings as a simple barter exchange system, the MORE program has evolved into a Time Dollar Exchange System, an alternative economy non-cash exchange system through which participants offer services to their neighbors, earning credit (an hour of credit for an hour of service provided). At a later date, participants can spend their credit on services they need. This program enables neighbors to convert their time and under-utilized skills directly into access to needed services, preserving cash income for other essential goods and services.


Common Elements of Transorganizational Systems

Weiner identifies several key elements in the design of transorganizational system.

Managed Care. Under the traditional system of service delivery the provider charged the client (or their insurance company) a fee-for-service for each service provided with payment being made directly to the provider after the service was provided. The provider decided what services were needed and controlled the decision, sometimes with input from the client, about what level of service would be provided. Under managed care, the system is designed to control the service delivery process and to take much of that decision making power from the provider. This system uses a number of utilization controls to manage the practices of the providers. Using detailed cost analysis, fees are set for specific sets of services. Incentives are built into the system to encourage service providers to perform only those services required to meet the needs of the client. Some have argued that managed care is a misnomer since the primary goal often seems to be cost containment.

Comprehensive, Unique Sets of Client Services. A commitment to packaging a unique set of services for each client. Most clients need a range of services to meet their needs. Transorganizational systems must be able the bridge traditional boundaries across service delivery systems in order to adequately address the unique service needs of individual clients.

Client Managed Systems. The primary person responsible for managing a complex service delivery system is the client who is trying the exploit the variety built into the system in order to meet their unique needs. Managers of transorganizational systems must strive to create and maintain a service delivery system that provides clients with a wide range of choices, and at the same time encourages and assists them to access those services in an independent fashion.

Adaptive Organizations. Transorganizational systems require one or more types of organizational arrangements that are called adaptive, synthetic, adhocracies, or temporary. Focused on interrelating different structures, these organizational forms include task forces, project teams, strategic networks, interjurisdictional bodies, and matrix organizations. In such organizations, the primary functions of the manager are (1) opportunistic surveillance of the environment, (2) create dynamic configurations of administrative techniques to respond to a complex and turbulent environment, and (3) design the maximum range of options to address the unique needs of clients.

Meta-System Management. The meta-system is a system that is over and above the basic system. It is a "higher order" system capable of changing components as needed. Its primary function is to monitor and test the stability and reliability of the operational system. It continually monitors the degree to which the system is meeting all design specifications and makes necessary design revisions when the system's results are below the outcome criteria.

Integrated Service-Delivery Technologies. Integrated service delivery technologies include such things as interdisciplinary assessment and diagnosis of needs, case management, performance based outcome criteria, and individualized service packaging. It can also include the option of uniform client pathways so that no mater where the client enters the system each provider follows a uniform process for meeting client's needs.

Integrated Computer-Telecommunications Information Systems. An integrated information management system is the glue that holds the transorganizational system together. Given the advanced information technology available today, this system can take any number of forms. In general, the integrated information system has at least three requirements:

1. A common and shared data set for each client's individualized service plan.

2. A dual reporting system that aggregates data for reporting needs for each employee or agency.

3. Data analysis feedback capabilities with both internal and external data bases.


Analyzing Transorganizational Systems

There are several underlying assumptions related to understanding transorganizational systems. The first is the notion of shared interrelated purpose. The community is comprised of hundreds of different organizations, institutions, and systems, each with their own unique disciplines, culture, service orientation, and evaluation criteria. However, they are unified in their interest in humans and their environment. Just as people and their environment cannot be segmented, neither can the various organizational units acting on their behalf operate independently of one another. Because all organizations work from a common base of human and societal need, it follows that organizational missions are highly interrelated.

Another assumption is that each organization and institution in the community has multiple organizational foci. They must carry out their stated mission and their stated legal purpose. However, they must also perform special, often temporary, missions that require multiprofessional talents and joint efforts. Furthermore, in today's changing and dynamic environment, they must have a cross-community focus. That is, a willingness to engage in serving clients whose needs are the mutual responsibility of many institutions in the community.

A third assumption is that service delivery systems represent networks of relationships. A network can be defined as any bounded set of connected social units (Streeter and Gillespie, 1992). This definition emphasized three important characteristics of network: (1) they have boundaries, (3) the members of the network are connected (either actually or potentially), and (3) they are comprised of social units and may include individuals, small groups, organizations, communities, or even states and nations.

Human service networks are comprised of sets of people, processes, programs, and organizational entities that are linked together through a set of formal and informal relationships for some type of common purpose. In analyzing systemsas networks, one needs to look at both the relational properties and the structural properties of the network.

Relational properties focus on the content of the transactions between organizations (such as money, information, influence, personnel) and to the nature of the relationships between organizations (for example voluntary, cooperation, formalization, standardization, frequency of contact, symmetry).

Structural properties describe the ways that members of the network fit together for form a comprehensive whole. Common indicators of structural properties include things such as network size, density, connectedness, centrality, and hierarchy.

Weiner also suggests that we need to look at mechanisms by which relationships are managed. These include such things as joint planning, co-location of staff, purchase of service agreements, and joint administration.

Transorganizational systems also cut across multiple levels. This can result in significant challenges for managers as they seek to create coordination and integration within the system. Vertical integration occurs when on organization seeks to coordinate a group of agencies that collectively offer many different levels of service. This type of integration is common when one looks at the influence of federal and state level agencies over local service delivery systems. Horizontal integration it when one organization work collaboratively with a number of agencies that provide the same level of services.


References

Drucker, P. F. (1992). Managing the Non-Profit Organization: Principles and Practices. New York: HarperBusiness.

Graber, H. V., Haywood, S. & Vosler, N. R. (1996). An Empowerment Model for Building Neighborhood Community: Grace Hill Neighborhood Services. Journal of Progressive Human Services. 7 (2), 63-76.

Streeter, C. L. & Gillespie, D. F. (1992). Social Network Analysis. Journal of Social Service Research, 16, 1/2, 201-222.

Weiner, M. E. (1990). Human Service Management: Analysis and Application, Second Edition. Belmont, CA: Wadsworth Publishing Company.


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