The Process of Care Implementation and the Managing of Complexity James Anglin University of Victoria, Canada Martha Holden Cornell University, USA Frank Kuhn Cornell University, USA EUSARF Conference, Copenhagen, September 3-4, 2014

Residential care is not rocket science, It’s far more complex than that!

“When life was flowing as slowly as a river, complexity existed but was not really perceived. Nowadays, everybody feels complexity like a second skin, since life is flowing at a fast pace and looks like a rushing stream.” (p.54) “Organizations are complex systems in complex environments.” (p.55) Alberto De Toni and Luca Comello (Journey into Complexity, 2010)

Managing complexity  The ability to manage complexity is essential in implementing CARE  A key task of managers is to create an extra-familial care environment that supports the therapeutic mission

Putting CARE into practice… … requires the ability to move beyond technical thinking (“if x, then y”);

Putting CARE into practice… … requires the ability to move beyond technical thinking (“if x, then y”); … requires adaptive thinking (“what is going on here, and how can I be helpful?”)

Changing a mindset… It’s not about simply adding new information or developing new skills. Using the analogy of a computer, it’s not about adding new files or programs, it’s about changing the entire operating system.

Self-transformation… Involves being ready, willing and able to put your beliefs, attitudes and assumptions to the test, and to form a new sense of your own identity and potential.

Robert Kegan and Lisa Lahey - Immunity to Change (2009). Identify the struggle that people in many walks of life have in adapting to the increasing complexity of the world in which they work, and Offer an explanation for how and why some agency staff members are able to embrace and act in accordance with the CARE model while others are not.

Socialized Mindset Self- authoring Mindset Self- transforming Mindset Increasing complexity Adapted from R. Kegan & L.L. Lahey, Immunity to Change (2009)

For work of a technical nature, a “socialized mindset” is often perfectly adequate to the task. However, to be able to implement CARE, one needs to be willing and able to begin developing a “self-authoring” mindset. Supervisors should function at this level in order to model and support others to progress in this direction. The most effective agency leaders demonstrated characteristics of a “self-transforming mindset”.

Journey into Complexity (DeToni & Comello, 2010) proposes seven principles of complexity management.  Self-Organization  Creative Disorganization  Sharing  Strategic Flexibility  Network Organization  Virtuous Circles  Learning Organization

Given the complex nature of residential organizations and the residential tasks, principles of complexity theory as applied to organizational development have proven to be quite congruent with our own findings on the management of quality residential care.

Based on… …hundreds of observations …over 80 formal interviews, and …analysis by a CEO and consultant review group, It is evident that these seven dynamics are reflected in agencies that have successfully introduced, implemented, and sustained the CARE program over three years or more. Some examples…

CREATIVE DISORGANIZATION In order to implement a principle-based program model, an organization has to introduce and sustain a certain amount of creative capacity within the organization.  The creativity comes from the workers’ ability and need to imagine new scenarios and responses, thus fuelling the “creative circle”.  Such creativity is evident across the successful CARE agencies, where many old solutions and reactions have been put aside, resulting in discontinuity and clearing the way for true creativity and responsiveness, rather than pre-determined reactivity.

SHARING A theme that occurs repeatedly in CARE agencies is the increase in communication, both within and across the various programs due to shared values and objectives.  In effect, a staff member could go through any door in the agency and find relevant and informed support.  The spirit of communication, collaboration and sharing is palpable, and these dynamics lead to a shared spirit and congruence; a state of operational excellence in line with the ultimate objective - the best interests of the children.

STRATEGIC FLEXIBILITY Organizations that manage complexity expect the unexpected and tune into weak signals and often respond in counterintuitive ways.  Adopting therapeutic principles requires staff members to move away from their “natural” intuitive impulses in order to develop a new repertoire of responses in line with the principles and values.  Residential care requires attentiveness to small details in the behavior of the residents and other staff members in order to make necessary adjustments.  Staff members need to seize the creative moment.

NETWORK ORGANIZATION When the CARE program model is implemented successfully, it resembles a village or a community with the presence of a highly interactive network of relationships.  In order for workers to implement CARE, they need both the guidance of clear principles and values, and the freedom and opportunity to interpret them in action.  Workers must let go of looking for formulae or technical solutions (“if A happens, do B”), and become more creative and adaptive in their thinking and actions.  This requires a shift from a hierarchical to a network or participatory approach. Workers share in supporting each other, but also in monitoring each other’s practice to achieve the objectives and excellence for which they strive.

LEARNING ORGANIZATION Agencies that implement the CARE program model adopt new mindsets, acknowledge and welcome errors or mistakes as important learning opportunities rather than occasions for blame.  CARE agencies find themselves having to let go of longstanding habits of mind in order to embrace a more therapeutic mindset.  After a period of two to three years, much of what CARE agencies are doing has now become the new implicit, rather than self-consciously explicit.