06 Planning

One of the most consistent failures of human service planning concerns the failure to identify and articulate a clear and agreed upon goal. Generally human service goal delineation falls into two disparate parts; first, there is the goal to help individuals with problems in living improve their functioning so that they can improve their lives, and second, there is the goal of protection of society from those people who because of their problems in living are unlikable, poor, powerless, unclean and possibly dangerous. This is, to some extent, the traditional political debate in regard to individual rights and social justice. While any political debate in a democratic society must seek a balance between freedom and equality, it cannot become workable policy when the polarity rather than the stability is emphasized.

The failure of goal delineation happens in two ways: first, there is a tendency of bureaucrats to not define any goal in a manner in which one could be held responsible for failure to attain it, and second, there is often a dichotomy of interest which is left unaddressed. The result is frequently a goal or mission statement that means different things to different people and/or one which explicitly articulates a goal that is implicitly contrary to behavioral intentions. In human services, for example, the habitual actions toward control of people with problems in living substantiate the implicit intent to protect society, while most mission or policy statement emphasize the effort to help people with problems in living. The devil is in the details. Social planning and policy thus becomes an exercise in rhetoric, rather than a principled debate leading to an agreed upon plan of action to meet intended outcomes.

Ultimately, the process of planning includes participants with widely different frames of reference. Often the information about such decisions is unevenly dispersed and the critical concepts of the decision-making are incoherent to many of the participants. Incoherent, in this context, means that the people involved are unable to relate these concepts with their present belief system and therefore find them at best, metaphors [i.e., mental illness] for what they want to believe and at worst, reject them out of hand.

Reasonably simple concepts such as “community support” ranges in a participant’s understanding from a) being a service which is located in the community [meaning a highly medical, restrictive program become community-based if it is located within a non-traditional site], to b) being the development of natural supports in valued settings by nonprofessional lay people who happen to come into contact with the person with problems in living . Such widely disparate interpretations of the concept are debilitating to the planning process and tend to enable the status quo to be maintained.

Strategies

It is fundamental that 1) the objectives of such group planning decisions, 2) the purpose for which the decision is made, 3) the outcome which will satisfy that purpose, and 4) the indices with which to measure that outcome be agreed upon and articulated in a mission statement as the result of planning.

The mission must be coherent to all of the planners and stakeholders because it is intended to lead to the development of problem solving mechanisms [systems]. If the system is not coherent, it is unlikely to solve the problems that it has identified as needing to be solved. It is the failure of this initial agreement on mission that hinders proper outcome even in ideal decision-making situations. If a system is a problem solving mechanism, it first requirement is to frame the problem and to make a “solution” statement indicating what results will satisfy the need. Unless implicit agendas of all the stakeholders become explicit, there can be no plan that can be successfully implemented. Thus, good planning must, in some context, be confrontational. Each participant must challenge directly the ideas, beliefs and values of others to determine appropriateness to what is being discussed. In this sense, planning becomes an evaluation of what is possible. What will the system accept or at least tolerate in its transformation? Even “ideal” systems do not work without the commitment of the participants. Since the prophecies become self-fulfilling, the planners are in search of the “best” or most fitting results possible under the circumstance; not the “right” or “ideal” results.

Unfortunately, human service people tend to avoid confrontation and keep their opinions about what is right and good to themselves. There is little Socratic dialogue. The most important issue seems to be political correctness rather than a true confrontation of the significant issues regarding services to people with problems in living. Those that are exposed are articulated in terms of thymos [the desire for recognition], rather than reason. The issues become the prestige over which we battle. Reason must prevail.

Once the mission statement has been defined and accepted, the strategies and tactics for implementation may be developed. “There are many ways to skin a cat” and the selection of strategies should identify many alternative ways to achieve the mission outcomes. In selecting strategies, it is important to know what the key decision determinants are. Tregoe & Zimmerman [1980] suggest that there are nine basic strategic areas for making decisions regarding profit-making businesses. While all nine areas are critical for every company, one and only one should be the Driving Force for the entire organization.

1. services offered includes whatever an organization offers to the market it serves. Community mental health organizations enhanced their product line with the advent of services to the “chronically mentally ill” by adding social, vocational and residential programs to the traditional “therapeutic” services.
2. market needs: A market is a group of current or potential end users who share a common need [ e.g. mental health]. Recent court settlements have induced many traditionally adult services to turn their attention to the new market of children.
3. technology: is a learned body of knowledge that is reproducible and subject to frequent update and extension and includes the skills and knowledge possessed by those within the discipline. Psychodynamic techniques may be limited to “mental health” concerns, but learning technology could be useful in developmental as well as remedial arenas. Thus, emphasis on such technology could lead to a broadening market.
4. production capability includes the production know-how, processes, systems and equipment required to make specific products. In service organizations, the production capability includes those processes and skills required to provide the service(s) and any necessary support materials, procedures, programs, etc. Human service organizations that include a research and development component may have and increased production capability either through more efficient and effective practices or through internship.
5. method of sale is the primary way an organization convinces current or potential customers or users to buy [use] its services. Mental health and substance abuse programs are increasingly finding ways to market their services. Some school-based programs are seen more as a method of sale than as services in a valued setting.
6. method of distribution is the way the services reach the customer. In recent years human service organizations have expanded the shift from facility based distribution to where the client is distribution. This would also include time availability, as one organization is open evenings and weekends, while others continue on a nine to five basis. Again, the decentralization of distribution may be driven more by the method of sale. A true decentralization would of necessity require a different type of worker; one who is more independent and able to work away from the factory floor and the foreman.
7. natural resources are the actual and potential forms of wealth supplied by nature including coal, oil, metals, wood, water, etc. As such there is probably no legitimate human service comparison, although the concept of “creaming” is indicative of a human service organization’s attempt to capture “good raw materials” or improve inputs, as a means of improving outputs.
8. size/growth of an organization is defined as its overall size and/or rate of growth as measured by the most appropriate indexes. For some organizations, size is most important and rate of growth is how to get there. For other organizations, rate of growth is most important and size is only the result. Since size/growth is often an interim Driving Force, all organizations will occasionally choose it. On the other hand, the anomaly is that growth is, for many human services, connected to the increase in the number of services rendered. This may come about through increasing the number of clients OR though a failure to meet the individual client’s needs, since this also demands continued services.
9. profit or return is the financial result of an organization’s effort. Anyone who has ever worked with a not for profit agency on the brink of bankruptcy knows that this can be a major driving force. Such agencies are often seen as “going where the money is” rather than following a mission or strategy oriented to developing systems to solve human service problems.

These key determinants provide subtle clues as to how planning participants perceive the world and can be helpful in framing the mission statement and securing its validity. For example, if the overriding decision determinant is the market, [mental health clients], the question regarding use of medication, psychoanalytic therapy or cognitive/behavioral skill building is easier to debate. On the other hand, if any one of these technologies is the predominant concern, it is easier to discuss the full range of people with problems in living who may benefit from it. If participants are unwilling to discuss the make up of the market; perhaps the discussion should develop around the technology and vice versus.

All of the determinants are important decision tools, and the ones that are not predominant become secondary scanners. The decision about predominance, or the key determinant, along with the prioritization of other scanners, can help to shape the strategy decision regarding the best possible method of meeting the mission and carrying out social policy in the local arena. For example, if the decision is that the technology is predominant, the unifying of public agencies whose target populations can be effectively served by the technology becomes a possible strategy; on the other hand, if the market is the driving force, such a outcome is unlikely, if not impossible.

“[M]uch of an organization’s resources and capabilities, its plans and structure, its decision making and problem solving- in short, all of its important activities – are ultimately directed toward its [services] and markets. Thus, the most fundamental strategic decision is: What should the scope of our [services] and markets be” [Tregoe & Zimmerman – 1980]?

Not many human service organizations answer this question. Such organizations seem to go where the funding takes them without regard to the realization that awareness about the determinants and the decision that flow from them can open potentials for alternate funding.

“Top managers who do not consciously set strategy risk having their organization’s momentum or direction developed implicitly, haphazardly or by others inside or outside the organization” [Tregoe & Zimmerman – 1980].

There “are two facets which are critical to the survival of all organizations: what the organization wants to be and how it should get there. While both these facets are integral to long-range thinking, they must not be confused.”

 “Since what an organization wants to be sets direction, it must be formulated prior to long-range planning and the day-to-day decisions making that follow from such planning” [Tregoe & Zimmerman].

If the local governmental agency decides on a strategy of steering, not rowing, its organizational architecture is quite different than if it decides to implement direct services themselves. These are local decisions based on local needs.

The conscious awareness of the personal , professional and organizational aims and their integration into a conscious mission, goal, direction, are critical to the organization’s ability to perform and to measure that performance. It is not a question of what is right, for that is a value judgement that may never be identified. It is a question of an organization consciously choosing what it will do and then making every effort to develop strategies and tactics to accomplish that mission. Organizations without such awareness can be quite efficient, but this simply makes them arrive at the wrong intention more quickly. More usually, such situations result in an organization pulling itself in several different directions at once.

Tregoe and Zimmerman compare the strategy and operations relationship in the following illustration:

 

If an organization or system lacks direction, it’s functioning is likely to be incoherent. The sets of beliefs [organizational truisms] will merely be a combination of the personal truisms of each of its members. Such a collection is quite capable of functioning with the dichotomies of conflicting values as long as no one is willing to specify definitions and/or confront others on precisely what they intend. What result is an organization or system, which is capable of fulfilling unintended or hidden agendas without regard to the explicit statement of intention.

The use of the driving force concept is to insist that leadership stakeholders become aware of exactly what is their personal driving force; the key determinant which leads them to make decisions and to make these observations available to others. That each individual’s cutting edge decision key is likely to be incoherent to the other participant will merely indicate the state of the field. It is the sharing and confrontation of views that uses the creativity of the individual members to creatively shape a direction and goal.

Tactics

After the development and choice of mission and strategy, the process for the development of operations or implementation tactics must begin. Since public social policy has been quite incoherent over time; reaching for explicit goals without clear awareness of meaning, implementation has resulted in repeated failure. After forty years of chaos, with both professionals and clients alike in a limbo of progressive professional values and regressive professional implementation, change to services that can be effective in meeting positive client growth and development operational objectives will be difficult to articulate and define. One of the tactics that must be undertaken after reaching a clear and articulate mission and driving force, therefore is training. Failure to train direct service staff how to act in a right manner in regard to the mission and strategies, is to have people operating on their own personal truisms, which can lead to very incoherent service system indeed.

For our purposes, it is useful to recognize that change has both a technical and a social aspect. “The technical aspect of the change is the making of a measurable modification in the physical routines of the job. The social aspect of the change refers to the way those affected by the change think it will alter their established relationships with the organization” Lawrence – 1963]. The best results are delineated through the variable of social change. “…a real understanding, in depth and detail, of the specific social arrangement that will be sustained or threatened by the change or by the way it is introduced…” is vital to the planner. Defining the best way to do the job and getting the people involved to do the job that way are quite different things. The technical aspects are relatively easy. The social aspects require a true understanding of who gains and loses power…whose “ox is being gored”.

In the final analysis, however, resistance to change is seen as best overcome by getting the people involved in the change to participate in making it. However, participation, as Lawrence points out, is not just an activity. “Participation is a feeling on the part of people, not just the mechanical act of being called in to take part in discussion. Common sense would suggest that people are more likely to respond to the way they are customarily treated – say, as people whose opinions are respected because they themselves are respected for their own worth – rather than by the stratagem of being called to a meeting or being asked some carefully calculated questions.”

Change, then, involves the possible; and the possible is contingent upon the aspect of trust and respect between the participants. “Resistance” and “participation” are variable things that must be considered when change is entertained. Planners must understand and respect the social and psychological relationships that exist prior to the change effort if they are to effectively understand and cope with the individual stakeholder’s vested interest.

When there is an expectation of transformational change, the individuals in the system are likely to report such reactions as uncertainty, fear, disorientation, confusion, and loss of equilibrium. These feelings, which are expressions of inconsistency between what was expected and what is in fact perceived cause disruption in the group’s frame of reference; they no longer know what to expect from themselves [will I be able to do the job?] and others [what will they think of my attempts?] Crisis, then is the result of a breakdown in the established relationship between an individual and his/her expectations of the environment [Conner – 1978]. The whole system or institution can begin to express depression, paralysis of will, anxiety and fear. Such representations are often in terms of ideology: that is, the generalized representation of the institution does not allow for such transformation.

In attempting to get the institution or social system to change its mental representation of itself and therefore allow for the potential to absorb new evidence and take on new roles and functions, the return to molecular examination of the activities in which people engage, may hold some merit. As indicated by Vallacher [1993], as an activity becomes mastered people adjust their representations upward into more generalized representations or ideologies. A return to the molecular steps of that activity seems to allow for a revisions of such general representations. Deming, in his Total Quality Management approach has developed the constructs of flow-charting specific processes with the direct service or production staff. This appears to be a clear illustration of examining specifically the molecular steps of the activity process, and the effectiveness of allowing for organizational change which the Deming method has displayed, seems to support that the implications of Vallacher may be valid for institutions and systems as well as individuals. If this is so, the idea of causing people to examine closely the individual steps and building from this molecular activity a training development could lead to a potential method to transform a system despite personal mental schema reasons [dysphoric reactions, negative models, denial and avoidance] why it cannot happen.

Two things seem to happen for the individual and group mind in this process. First, the change is partialized into segments that are not so overwhelming to the individuals. The molecular level allows for specific observations, which if encountered on the macro level would be quite disorienting to a general representation. The molecular focus allows for control and predictability that might be absent in a larger order. Second, the molecular examination allows for evidence to be developed and rigorously analyzed. This would indicate that human services would do well to emulate industry and develop flowcharting groups of direct service staff which take each step from intake to discharge and examine each person’s perspective of that activity as well as making suggestions regarding improvement.

But what happens when we are talking about a life and death situation? How long can we ethically wait for human service stakeholders to come to terms with their own needs while clients’ lives are gravely affected? How do we deal with the lack of coherence caused by a paradigm shift of such magnitude that the people involved have their own blind spot and can not even understand what is being discussed? At what point do policy makers have a moral responsibility to seek better solutions without the support of stakeholders? The change sponsors and change agents have the authority to move change regardless of resistance, but only if they are willing to make the commitment.

Seeking systemic coherence is a process of helping the individuals whose participation and habitual behavior implement the “problem solving mechanisms” rigorously analyze their own belief system [personal truisms] through a process of seeking and identifying evidence of ability to predict and control outcome in better ways. Coherence in this context is to help individual stakeholders identify their own personal goals and make them coherent with the organization or system mission. This is a very time consuming process. While it certainly has validity for the participants; what is the validity for the recipients? Kuhn, in his History of Scientific Revolution implies that many scientist are never able to change their truisms, and the paradigm shift is not completed until such people die off. Since one might assume that scientists are by nature and training, rigorous in their thinking, what does this say about the generally “soft” thinkers within human services.

Business has also attempted a paradigm shift in management philosophy and terms of quality and consumer definition of quality, and has done so with a great deal more success to date than the human service component. Could it be that ownership is the ultimate convincer? One would suggest that in business the “fight, yield and grow” slogan of the functional school of social work is buttressed by the potential of separation from employment if the yielding and growing does not take place in a timely manner. Human services in general tend to care more about the employees than the clients, and this is escalated in an environment of government civil service where mediocre employees are able to foil good management change with impunity.

It is the reduction of uncertainty that is most important to decision makers. Helping reduce the unknowns in the making of the difficult decision can help speed the process of change or provide the impetus for finally getting things rolling.” Planning is the process of reducing uncertainty by making things known. Few if any participants can be expected to abandon their interests in light of new information, but they may well abandon their positions if given clear, forced choice options. The “social’ interests of the stakeholders are concerned with levels of relationship, influence and power. These are personal goals; not professional goals. Can we expect that when professional and personal goals conflict; professional behavior will come to the fore?

One could suggest that the development of social policy and the articulation is not a democratic process and that the reduction of uncertainty through the clear articulation and specification of system expectations, using the authority of the office and the support of the local policy makers will offer less resistance in the long run. However, this can be true only if the local policy makers are firmly committed to such change. Local policy makers, like national policy makers are prone to political pressures and any systemic change of any magnitude has the results of threatening people and their livelihood; thus the expectation of major political upheaval is appropriate. Change sponsors and change agents, therefore, must consider this in their planning.

Planning for human services means coming to terms with often-conflicting goals and objectives. As the primary goal of quality services potentially conflicts with the secondary goal of cost containment, so also do other concepts compete: symptom focus with function or capacity focus; continuity of care with self determination; program funding & capitation with fee-for-service; governmental responsibility with provider independence; and the right of the individual to deny services and the need for the professional to supply service when needed. These represent only a handful of the places that values clash .

Modifying a system of care is a process of such exquisite complexity that, often, when it occurs, we do not seem to understand what made it happen. We typically experience great difficulty both in identifying the precise variables that led to the change and in explaining the ways in which those variables interacted” [Santiago – 1990].

“It is not surprising, therefore, that efforts to introduce reform often fall short of intended goals. Lacking an understanding of the complexity of the process of change, we are apt to view the most obvious, although not necessarily the most relevant, variables as the effective agents” [Santiago – 1990].

Or as Jay W. Forrester states so succinctly “A social system tends to draw our attention to the very points at which attempts to intervene will fail.”

Reality

Michael LeBoef begins his book The Greatest Management Principle in the World – [1985] with a quote by Edgar R. Murrow – “The obscure we eventually see. The completely obvious, it seems, takes longer.” The completely obvious to LeBoef is “That which gets rewarded gets done.” If we accept this principle, we must first identify what the present system rewards; and then re-engineer the system to reward those things that we feel are important. These are not simplistic tasks. Many of the rewards in the present system may be obscure, hidden in the social or informal context of the system; but if we believe Murrow, we will eventually come to see them. More difficult, perhaps, given our present state of affairs, is to be clear about what we want to happen. Our options seem to be to 1) create an “expert” social policy based on professional values and beliefs and attempt to make it work; 2) develop a “community consensus social policy which the “powers that be” can agree on; or 3) we may even need to consider the customers preferences.

Whatever the elements of change, human services are contained in some extremely complex systems that frustrate politicians, bureaucrats, managers and clinicians alike. Within this complexity there unfortunately exists the ability for all of us to blame our inadequacies on the others in the system [most often we seem to blame the people with problems in living], while being unable to come to terms with appropriate remedies. We cannot know if our decisions are the “right” ones and would be precocious to assume that there is a “right” decision. But we seek a better decision and a better system, which would be demonstrable through a rigorous examination of the outcome. The point of the decision is that it reduces uncertainty. The decision can always be modified in light of experience.

It is clear, however, that our decisions about management will take a position that raising expectations will improve performance and boost productivity. Douglas McGregor’s influential Theory X and Theory Y approach to management helped set the stage for the total quality management and Pygmalion approaches.

“Theory X assumptions are that people are naturally lazy, hate work, shirk responsibility, have to be controlled and coerced into exerting effort on behalf of organizational goals, and are concerned primarily with security. In contrast, Theory Y assumptions holds that work is as natural as play or rest, that people can learn to accept responsibility and to be resourceful, creative and imaginative at work, that workers exert great efforts to achieve goals to which they are committed, particularly when attaining those goals leads to a sense of ego fulfillment and self-actualization, and that current organizational arrangements engage only a small part of their members’ productive potential.” [Eden – 1990]

The Pygmalion approach makes both of these Theories coherent. If management chooses to approach people from the perspective that they are lazy and incompetent, they will be; and if management chooses to approach people from the perspective that they are competent and energized, they will be. In Rensis Likert’s [1961] management theory, managerial leadership is a major causal variable that determines the level of intervening variables.

“The intervening variables are social-psychological in nature and include such crucial determinants of organizational effectiveness as subordinates’ loyalty, identification, sense of responsibility, motivation, and production norms. These intervening variables in turn influence the end results that the manager obtains through his subordinates….” [Eden – 1990].

These concepts of high [positive] expectations are equally applicable to the way the manager relates to the subordinate staff and how the manager organizes the policy, protocol and procedures to influence the relationship to clients. Staff and clients both need to have 1) clear normative expectations [procedures indicating how they ought to behave] and 2) clear probability expectation [ positive belief about how they are likely to behave] in carrying out their duties of work and life.

Thus, two important mental constructs arise for the human service manager. They must articulate clearly and often a normative expectation and they must equally articulate and place a positive expectation of probable behavior. People must know what they ought to do and believe themselves capable of doing it. The failure of human services management to understand and implement these constructs has allowed the development of failed systems. The negativity of human service approaches has supported and maintained a society of victims, where feeling good is more important than achieving.

To orient the local staff, community and people with problems in living, local human service managers must spend inordinate energy on the development of a rigorously analyzed and coherent social policy which includes the concept of client self-determination as the predominant element of a new system. As will be seen, this is not only for pragmatic or utilitarian reasons that are supported by both economic and competency perspectives, but from an idealistic or theoretical framework as well. This idealism, supported through the perspective of organismic psychology, suggests the basic belief that people cannot be helped unless they sanction that help; and because of a belief that self appreciation, a critical element of mental wellness, is based, at least in part, upon the ability to feel and exercise power. We feel that these compelling arguments make it necessary that client self-determination be the fundamental assumption upon which a new system is built.