Background
Organizational improvement approaches in health and social care
Characteristics of the COIL capability building approach
Strategies for multilevel development and multilevel action strategies
A flexible loop to visualize development processes on all levels
An action-learning loop connecting several levels
Methods
2009 | 2010 | 2011 | 2012 | ||||
---|---|---|---|---|---|---|---|
Jan-June | July-Dec | Jan-June | July-Dec | Jan-June | July-Dec | ||
Focus on:
| Phase 1 | Phase 2–3 | Phase 2–4 | Phase 2–5 | Phase 3–5 | Phase 5 | |
Case 1 R&D unit | • First contact and meetings with several levels • Planning and writing an application for funding | • Initiation • Meetings and workshops • Coaching via Skype and telephone • R&D mapping own context + Municipality A and B | • Two-day training retreat • Meetings and workshops • Coaching | • Meetings and workshops • Coaching | • Meetings and workshops • Coaching | • Meetings and workshops • One day workshop presenting experiences with other regional actors invited | • Meetings on sustainability • Reporting |
Focus on:
| Phase 1 | Phase 2–3 | Phase 2–4 | Phase 3–5 | (….Phase 5) | ||
Case 2 Municipality A | • First contact, initiation, and planning | • Seminars and workshops | • Two-day training retreat • Meetings and workshops • Coaching | • Meetings and workshops • Coaching | • One day workshop presenting experiences with other regional actors invited | • Reporting | |
Focus on:
| Phase 1 | Phase 2–3 | Phase 2–4 | Phase 3–5 | (….Phase 5) | ||
Case 3 Municipality B | • First contact, initiation, and planning | • Seminars and workshops | • Two-day training retreat • Meetings and workshops • Coaching | • Meetings and workshops • Coaching | • One day workshop presenting experiences with other regional actors invited | • Reporting |
Interventions | Forms/Means | Rationale/Assumptions | Intermediate Outcomes Individual | Intermediate Outcomes Group/Unit | Long-term outcomes |
---|---|---|---|---|---|
R&D unit – regional development and change facilitators | |||||
Exemplify, test, and evaluate the usefulness of the SIDSSA development loop, the systems view and multi-level/multi strategy approach, and the regular use of reflective learning and action-learning loops
- On the R&D unit’s own improvement areas - On municipality cases A and B, involving participants from several hierarchical levels and phases in the development loop - Of specific work procedures and instruments on the R&D unit’s own improvement cases and municipality cases - On the participants’ own learning and change processes |
Researcher-led development:
- Workshops - Seminars - Group coaching - Individual coaching - Test on real cases - Visualization of process/structure - Joint collection of data/information - Joint analyses of learning process and reactions - Participation in adapting the approach to specific contexts and choices of arenas for testing |
- Action-learning loop for double-loop learning
- Shared mental models
- Systems view
- Multiple levels, multiple strategies
- Structured approach
- Flexible and contextualized
- Visualized development process
- Increase complexity gradually
|
Improved knowledge
- Of the regional system of partner organizations, its levels, and functions - On change and learning processes
Improved competence, ability
- To act systematically when supporting COIL (map, identify, analyze, plan, execute, evaluate, sustain) -To analyze and reflect - To support others trying to change their work approach -To choose and use various procedures and instruments to aid change processes - Insights, attitudes, and behavioral changes in line with the new approach
Behavioral strategies, work approach
- Changed, more systematic, and strategic approach to support COIL - Clarified task, mission, and map of target organization |
Group strategies, work approach
- Common, systematic work approach to support and facilitate COIL
Shared knowledge
- Common team mental model of what it takes to change behavior and potential approaches to do so in their function |
Capability
- Improved capability as a unit to facilitate and support the development of COIL in the regional partner organization |
Municipality A and B participants | |||||
Exemplify, test, and evaluate the usefulness of SIDSSA development loop, the systems view and multi-level/multi strategy approach, and the regular use of reflective learning and action-learning loops
- For unit managers with the participating unit’s own choices of improvement areas/projects - On participants’ own learning and change processes - For local support functions to test when supporting the participating units in their process - For division managers to support unit managers in their processes and to reflect on the usefulness of the learning for the whole division |
Researcher-led development:
- Workshops - Meetings - Follow-ups - Initial group coaching Development led by the R&D unit: - Meetings - Group coaching - Individual coaching - Follow-ups
Local test and development:
- Local development work and support within organization |
- Action-learning loop for double-loop learning
- Shared mental models
- Systems view
- Multiple levels, multiple strategies
- Structured approach
- Flexible and contextualized
- Visualized development process
- Increase complexity gradually
| Improved knowledge - Of the organizational system and on-going development initiatives (national, regional, local levels) - On change and learning processes Improved competence, ability - To work systematically to support COIL in division and unit (map, identify, analyze, plan, execute, evaluate, sustain) - To analyze and reflect - To support others’ change and learning processes - To choose and use various procedures and instruments to aid change processes - Insights, attitudes, and behavioral changes in line with the new approach Behavioral strategies, work approach - Changed, more systematic, and strategic approach to support COIL |
Division strategy/work approach
- Development towards a common, systematic work approach to facilitate COIL in the participating units
Shared knowledge
- Common team mental model of what it takes to change behavior and potential approaches to do so in their function and in the division |
Capability
- Improved capability as a division manager; local support function and unit manager to facilitate and support the development of COIL in their organization |
Empirical setting
The R&D unit – Regional support function
Municipality a and B – Local support functions, division and unit managers within the sectors of care for the elderly and people with functional impairments
Function | Years in this function | Unit | Number of staff supervised | No of care recipients |
---|---|---|---|---|
Case 2 - Care of elderly adults | ||||
Division manager | 2 years | Strategic management | 24 unit managers | |
Development support | 1 year | Strategic level support unit | 0 | 0 |
Unit manager | 9 years | Three short term housing units | 43 | 38 |
Unit manager | 12 years | Special housing unit (dementia care) | 22 | 24 |
Unit manager | > 10 years | Four special housing units | 58 | 56 |
Case 3 - Care of adults and children with functional impairments | ||||
Division manager | 9 years | Strategic management | 11 units | |
Development support | 8 years | Strategic level support unit | 1340 staff | |
Unit manager | 11 years | Three housing units for people with autism | 25 staff | 17 |
Unit manager | 20 years | Day-time occupation | 70 staff | 236 |
Unit manager | 1,5 years | Three short term housing units (children) | 30 staff | 44 |
Unit manager | 4 years | Home assistance and service | 34 staff | 8 |
Data collection
Interviews
Process diaries and documents
Data analysis
Results
The R&D unit – A regional support function
Initial needs and challenges
Change and development process
“You became very aware that it is so much easier to tell others to do certain things than to do it yourself. So when we had contact with others, this was when you started to think – what are we doing? Then it was easier to understand why they did not do things.”
“It has taken a lot of time and priority, but it has been positive - a huge potential. When we grew [in staff size] it was important to acquire a common way to work with our partner organizations.”
Output – Capability building and new approaches
“I think it has been smart and necessary. So much happened, new persons, changed assignments – it could have been anything, but since we worked systematically with this approach [SIDSSA] we could lead things differently and the R&D unit is really strong today.”
The elderly care division of municipality a – Local support functions and division and unit managers
Initial needs and challenges
Change and development process
“We have a network group of volunteers 80 to 85 years old that are great. […] Staff that were responsible for entertainment, bingo, and gymnastics saw many barriers, but I told them to send out an inquiry; we cannot be certain that our elderly residents want to listen to accordion music […] Our goal is to become a health promoting eldercare unit. How did we work? We work with it [SIDSSA] all the time, focusing on it at staff meetings, away on educational sessions, and study visits. The driving force has been the quality group.”
Output –capability building and new work approaches
“When I pose questions to the unit managers on what we should do and how to do it I get lots of ideas, other than saying this is what we shall do – an important lesson”
“Initially we imagined that we had not had much help from the SIDSSA project – of course we had, but we did not realize. In the beginning, we said that we can do this on our own. We do it our way, but it [SIDSSA] has fallen into place more and more.”
“The main lesson concerns the basic loop model, looking at different phases, where am I now and why am I there? Analyzing one’s own process, and not just results, is the biggest lesson learned.”
Outcomes – Effects on units, staff, and elder adults
“In one ward, with seven staff, each staff member has their own area of responsibility, areas they are interested in. One person will once a week play the piano for the old people; another is a painter and will paint and do ceramics with them. One leads singing, one provides massage therapy, and one is responsible for the library and will once a week borrow books and read to the residents. We have come a long way.”
Municipality B’s care of adults and children with functional impairments division – Local support functions and division and unit managers
Initial needs and challenges in the local context
Change and development process
“In this ICF project, I had the privilege and opportunity to discuss and receive coaching. This has been very beneficial and a great difference from before.”
“I prepared a slide with the different phases of the loop and showed my colleagues and boss. It was time for our unit to reflect, because we run too fast. I wanted us to try this approach.”
Output –capability building and new work approaches
“An awakening experience to view one’s work differently at the unit, understand more how to reach out and promote changes, or talk when something needs to be done. It is not easy, but when you have a systematic way of working during change processes, it has been very precious.”
“SIDSSA is in many ways a way of thinking that I have with me, but I often skip a few steps because everything happens so fast. So I had to reverse one or a few steps. […] By participating in the project, I recognized that I do this and I’ve been forced to think and try to reverse.”
Outcomes – Effects on units and staff that provide services
“There is so much material now for the care recipients. Before, staff worked towards the target group and knew that they should work with clarity and clarifying pedagogics. […]This was not visible and if I, as a manager, cannot see it – how will the care recipients? […] Just setting up a goal for a care recipient – and then talking about how we can reach this goal.”