1. Learning to Lead System and Organizational Transformation Arthur C. Evans Jr., Ph.D Philadelphia Department of Behavioral Health and Mental Retardation Services Mental Retardation Services 2008 PCPA Conference October 7, 2008 Seven Springs Resort, Champion, PA

2. GOALS OF PRESENTATION Present a Leadership Framework for Guiding System and Organizational Transformation Present Examples that illustrate how this framework can be applied Provide an opportunity for discussion of effective transformation efforts

3. BACKGROUND While consensus is emerging around what “transformed systems of care” should look like, the “how” of moving large systems and organizations still remains a challenge frameworkHaving a framework for approaching this work can be useful for initiating and sustaining transformation initiatives Philadelphia is undergoing a major transformation initiative and has some early lessons learned. 10 Domains are presented that can be helpful in organizing the work and evaluating success

4. OUTCOMES

6. AREAS FOR TRANSFORMATION Transformation involves activities in a variety of areas. Below are examples of key areas that systems and organizations are working on: Evidence Based Practices Reducing Health Disparities Co-Occurring Treatment Approach Trauma Informed Care Integration with Primary Care Cross-Systems Collaboration

7. TEN CRITICAL DOMAINS FOR SYSTEM TRANSFORMATION Leadership and Political Philosophy Financing Language and Communication Organizational and Program Development Education and Training Research and Evaluation Community / Environmental Consumer and Family Change Management Technology

8. LEADERSHIP AND POLITICAL PHILOSOPHY TRADITIONAL Politically Reactive Focused (if any) vision –acceptance of status quo Critique is limited and controlled (Closed Systems) TRANSFORMATIVE Politics managed to achieve goals Broad vision – willingness to push boundaries Critique is used to identify opportunities for improvement (Open Systems)

9. LEADERSHIP AND POLITICAL PHILOSOPHY (Continued) TRADITIONAL Organizing principles are not made clear or explicit Policy and philosophical framework are an afterthought TRANSFORMATIVE Considerable effort made in making organizing principles explicit Developing and articulating a policy and philosophical framework are key activities. Move beyond operational focus

10. FINANCING TRADITIONAL Focus on protecting and managing limited resources (Defensive stance ) TRANSFORMATIVE Focus on leveraging and pooling resources, e.g. funds, staff, purchasing, etc. (Offensive stance)

11. LANGUAGE AND COMMUNICATION TRADITIONAL Unidirectional – top down Narrow scope, task oriented, at times coercive Dissent is discouraged and punished TRANSFORMATIVE Multidirectional – network Broad scope, visionary, appeal to ideals Openness and multiple perspectives encouraged

12. ORGANIZATIONAL AND PROGRAM DEVELOPMENT TRADITIONAL Premium placed on established standards and protocols Focus on maintaining existing programs and systems TRANSFORMATIVE Premium placed on data driven and empirically supported approaches Focus on evolving organizations to support the goals of transformation

13. ORGANIZATIONAL AND PROGRAM DEVELOPMENT (Continued) TRADITIONAL Management directed decision making Treatment focused Specialty focus TRANSFORMATIVE Inclusive decision making, consensus building Treatment is a part of a continuum that begins with prevention and ends with support in the community Cross-systems focus

14. EDUCATION AND TRAINING TRADITIONAL Education and training is directed to “the professionals” Emphasis on “treatment compliance” TRANSFORMATIVE Consumers and community members are also the focus of Education and Training activities Emphasis on health literacy and empowerment

15. EDUCATION AND TRAINING (Continued) TRADITIONAL Behavioral Health focus Focus on theory and “art” of practice Training is focused on clinical practice TRANSFORMATIVE Cross-system focus Focus on evidence- based treatment Training in a variety of skill areas including advocacy, program evaluation, etc

16. RESEARCH AND EVALUATION TRADITIONAL Management by anecdote and history Infrastructure focused on mandated reporting TRANSFORMATIVE Insistence on data to manage Infrastructure developed to make management decisions

17. COMMUNITY / ENVIRONMENTAL TRADITIONAL Community relevant only as to where services are provided/located Community is viewed as a passive recipient of services TRANSFORMATIVE Community context drives service design and delivery Community viewed as an active partner in strategy for health care improvement

18. CONSUMER / FAMILY PARTICIPATION TRADITIONAL Consumer/family input sought to meet requirements Input is limited to specific tasks TRANSFORMATIVE Consumer/family input viewed as essential Consumer/family perspective is sought out and integrated throughout all decision making

19. CHANGE MANAGEMENT TRADITIONAL Transformation viewed as another project to be managed Emphasis is on stability and creating certainty Transformation activities viewed as separate initiatives (Compartmentalized) TRANSFORMATIVE Transformation understood as fundamentally a complex change management process Leaders understand and can tolerate uncertainty. Help others through the process Transformation activities viewed as parts of a complex whole. Emphasis on an integrated change process

20. TECHNOLOGY TRADITIONAL Opportunities for paradigmatic shifts are often missed (i.e., new technology, same processes) Technology drives processes and policy Used to increase efficiency of existing processes TRANSFORMATIVE Shifts in thinking and processes are capitalized and spurred on by new technologies (e.g. geo- mapping) Technology is rigorously viewed as a means to an end Used to increase efficiency and develop new processes

21. LEADERSHIP EXAMPLE Considerations Politically Savvy vs. Politically Driven That “vision thing” Motivating the Masses Transparency Consensus Building Control vs. Influence Distributed Leadership

22. LEADERSHIP EXAMPLE Managing a Recovery Initiative Issues that Arise The Push Back: “My clients are too sick to recover” “We don’t have the money to do this” “Regulations prevent us from being recovery oriented” Consumers: “You are co-opting our movement” “We need to support the Core services first” Politicians: “Why are you taking X provider’s funding” Etc...

23. LEADERSHIP EXAMPLE Key Questions How do you lead transformation in a complex environment with so many competing agendas? How are you able to move forward without simply retreating to a defensive posture? What strategies can you employ to create a climate that allows progress What “traditional” style leadership strategies should be avoided

24. Managing Politics Proactive Management Anticipate “the crisis” (e.g., argue with the referee) Data, Data, Data Strategic Relationship Building Conceptual Integration Pick Your (some) Fights Lead! STARTEGIES THAT ALLOW FOR TRANSFORMATIVE LEADERSHIP

25. Exercise Choose a challenge that you currently face in trying to transform your system or organization. Describe how you believe these 10 domains would be applied to your situation Describe how you might address your challenge through the application of principles and strategies discussed here What do you hope to accomplish (ie how would you define success)

26. arthur.c.evans@phila.gov arthur.c.evans@phila.gov Philadelphia Department of Behavioral Health and Mental Retardation Services arthur.c.evans@phila.gov