This document discusses frameworks for organizational change and systems change in human services. It provides definitions of key elements of a human services system, including pathways (programs and services) and institutional structures (policies, regulations, funding, etc.). Positive systems change is defined as more effective pathways through increased capacity, quality, comprehensiveness and improved connections through linkage, alignment and cross-system coordination. Effective collaboratives that undertake systems change initiatives require member engagement, clear governance structures and processes, and accountability frameworks with defined goals, metrics and targets.

1. Organizational Change in Human
Services
A U T I L I T A R I A N A P P R O A C H T O S Y S T E M C H A N G E
F O R S O C I A L S E C T O R

2. Abstract
In the social sector we are moving towards a collective systems
perspective.
Systems change has migrated into becoming a common occurrence
for nonprofits and funders.
We will learn from this presentation:
◦ A concrete way to operationalize the concepts of systems.
◦ A way to think about the factors contributing to the effectiveness of the
collaboratives that undertake systems change initiatives.
◦ A set of tools to be tailored and used in evaluation of change.
◦ Guidance for how to bring together this approach with key aspects of a
developmental evaluation.

3. Framework for Change
The first step towards a utilitarian systems framework is to focus on the human service delivery
systems.
Improving human service delivery systems is a common focus on systems change initiatives.
Human services “have multiple programs, policies, agencies, or
institutions at the national, state, and local level with the
common goal of achieving better outcomes for [clients]”
(Coffman, 2007)

4. Elements of a System
Pathways:
Organizational and inter-organizational
arrangements set up to deliver programs and
services.
Comprise a set of programs and services
designed to move clients through a
progression of steps, supporting them to
achieve positive outcomes.
Institutional Structures:
Policies, laws, and regulations: funding flows and
resources allocations, culture, norms and
standard operating procedures. KNOWLEDGE
BASED.
Structures form the institutional context in which
pathways function.
The factors typically outside the control of actors.

5. Elements of Positive Systems Change
MORE EFFECTIVE PATHWAYS
Increased pathway capacity:
A set of programs and services that show
improvement in:
◦ Scale
◦ Quality
◦ Comprehensiveness
Improved pathway connections:
A set of programs and services that show
increase in:
◦ Linkage
◦ Alignment
◦ Cross-system coordination.

6. Positive Systems Change cont’d
MORE CONDUCIVE INSTITUTIONAL
STRUCTURES
Changes in institutional structures that create
new sets of incentives, constraints, and
opportunities which result in allowing and
encouraging actors to build more effective
pathways.
More conducive institutional structures can
mean reduced structure barriers.
◦ Barriers that hinder effective pathways.
◦ Creates new structural enablers.

7. System Change Efforts and the Influence on
System Change Results
SYSTEM CHANGE BY COLLABORATIVES
System change initiatives that are managed by
a collaborative effort creates intentional
system change.
System change agents work in collaboration;
this will affect the likelihood of a successful
systems change.
Three factors contribute to the collaborative
effectiveness:
◦ Member engagement
◦ Governance structure and process
◦ Accountability framework.

8. Systems Change
Framework
What are the elements of a
system?
◦ Institutional structures are the
outside the organization things
that shape the pathways that a
group or relationship has that
then will affect the individual
outcome for an client.

9. Systems Change
Framework Cont’d
Seeing systems change:
◦ How can initiatives build systems
that work better for individuals?
◦ What keeps systems from
well for individuals?
Barriers and ineffective pathways
which lead to limited individual
outcomes.
Sourced from: Lantham, N. (2014). “A Practical Guide to Evaluating System Change
in Human Services Systems Context. Center for Evaluation Innovation.

10. Systems Change
Framework Cont’d
How do systems change
initiatives contribute to systems
change results?
◦ Effective collaboration supports
effective systems change
initiatives; this then contributes
to conducive structures that
enables actors to build
improved pathways that lead to
improved individual outcomes!
Sourced from: Lantham, N. (2014). “A Practical Guide to Evaluating System Change
in Human Services Systems Context. Center for Evaluation Innovation.

11. Parts of the Pathway
PATHWAY CAPACITY
Scale: The supply of program slots for those who can potentially benefit
from programming, and the accessibility of these slots to intended clients
Quality: The ability of programs and services in the system to meet
quality standards, the adequacy of tailoring for the purpose of meeting
participant/client needs, and the extent to which program staff and
planners engage in ongoing quality improvement processes.
Comprehensiveness: The extent to which there is the right mix of
programs to meet the diverse needs of potential participants/clients, and
whether there are enough of these different types of programs so that
the systems has few or no service gaps.
PATHWAY CONNECTIONS
Linkages: The extent to which linking mechanisms between related
programs are present, allowing clients to successfully transitions from
one to another. Warm handoffs, common enrollment forms, joint
protocols for referrals, cross-organizational case management teams,
service bundling, shared data systems for tracking clients.
Alignment: The degree of alignment between intended outcomes for
different program sets up clients to transition easily to, and succeed in,
the next program.
Cross-system coordination: The extent and effectiveness of work done
by stakeholders in the focal system to pursue linkage and alignment with
complementary systems in a way that supports focal systems.

12. Shifts to More Effective Pathways: Increased
Pathway Capacity
INCREASED QUALITY
An increase in the quality of service delivery for
individual programs, and an increase in the number of
high-quality programs.
◦ More programs are systematically adhering to program
quality standards, and engaging in continuously quality
improvement efforts.
◦ More providers implementing, and improving their fidelity
to, evidence-based practices.
◦ More providers working to tailor programs to the needs of
their focal client population.
INCREASED SCALE
Increased program supply, improved accessibility, and
improved outreach/recruitment.
◦ Increased supply refers to growth in the number of program
slots, with the goal being that program slot SUPPLY matches
program NEED for particular client populations. Increases in
scale can result from additional providers in the system, from
providers offering additional slots, or both.
◦ Improved accessibility includes ensuring that programs are
within the geographical reach of clients.
◦ Improved outreach/recruitment means that providers are
doing a better job of spreading awareness about, and
attracting clients, to their programs.

13. Shifts to More Effective Pathways: Increased
Pathway Capacity Cont’d
INCREASE COMPREHENSIVENESS
Ensuring not only that there are enough
programs.
Systems has the right to mix programs.
Service gaps decrease as the gaps are
identified.
◦ Actors ensure that there is a sufficient supply of
program slots tailored to the needs of diverse
client populations.
A PATHWAY WILL NOT BE EFFECTIVE UNLESS
THE INDIVIDUAL STEPS ALONG THE PATHWAY
ARE EFFECTIVE.
POSITIVE SYSTEMS CHANGE ENTAILS
INCREASED QUALITY, INCREASED SCALE, AND
INCREASED COMPREHENSIVENESS.

14. Improved Pathway Connections
Connections within the pathway are also vital for overall pathway effectiveness. To progress
smoothly along a pathway, clients exiting one step must be set up for success to enter their next step.
To prevent a client from “dropping out” of the pathway, even after success with an individual
program, a pathway must have effective connections.
Positive systems change entails IMPROVED LINKAGE, IMPROVED ALIGNMENT, and IMPROVED CROSS-
SYSTEM COORDINATION. ‘

15. Improved Pathway Connections Cont’d
IMPROVED LINKAGE: Strengthening linkage among programs by ensuring that clients can transition easily into other programs.
Improving linkage may entail increased/improved coordination among pairs of providers or within a network of providers. WITH
IMPROVED LINKAGE, CLIENTS TRANSITION TO THE NEXT PROGRAM OR SERVICE AND DO NOT FALL THROUGH THE CRACKS.
IMPROVED ALIGNMENT: Establishing or increasing aligned outcomes to ensure that different programs in pathway are all
contributed toward the same ultimate goals. This enhances the programs’ ability to contribute to these aligned outcomes.
WITH IMPROVED ALIGNMENT THERE IS COORDINATION SO THAT THE PROGRAMS SERVING THE SAME CLIENT POPULATIONS
BASING THEIR CURRICULUM ON THE SAME FRAMEWORK AND REINFORCING THE PREVIOUS LEARNINGS.
IMPROVED CROSS-SYSTEM COORDINATION: Establishing or increasing the level of coordination between focal system and
complementary systems. WITH IMPROVED CROSS-SYSTEM COORDINATION SYSTEM LEADERS IDENTIFY SHARED GOALS, AND
WAYS THAT PROGRAMS AND SERVICES LINK AND ALIGN TO CONTRIBUTE JOINTLY TO SHARED GOALS.

16. Collaborative Efficacy
There are three factors that contribute to effective collaboration: 1) governance structure and
process, 2) accountability framework, and 3) member engagement.
Collaboration is necessary but can and will be deeply challenging to achieve and maintain; this is due
to:
◦ Governance in a collaboration is much harder than managing within a traditional hierarchy.
◦ Accountability frameworks are critical to success but difficult to adapt to the complex conditions of
collaboration.
◦ In a collaboration many different actors represent a range of organizational interests and much find consensus on performance targets and
indicators; this makes it difficult to find who is accountable on producing results.
◦ Full member engagement in collaboration is not a given.
◦ Members can have a strong moral commitment to the vision of a systems change initiative but have many competing priorities outside of the
organization.

17. Governance Structure and Process
Collaborative governance is the process and structures of public policy decision-making and
management that engage people constructively across the boundaries of public agencies, levels of
government, and/or public, private, and civic entities in order to carry out a public purpose that could
not otherwise be accomplished.
The success of systems change initiatives depends largely on the ability of the systems change agents
to effectively manage the collaborative itself.
◦ The more a collaborative maintains and recognizes hierarchy, the easier it is to manage.
◦ Clear and concise division labor leads to easier accountability as each role understands their part in the
initiative.
◦ Structural linking mechanisms: linking the collaborative to all committees supports knowledge sharing and
brainstorming sessions.

18. Accountability Framework
Collaborative systems change initiatives involve many moving parts and are without clear goals, which
create struggles with maintaining progress. Establishing clear goals is a key part of maintaining
successful changes and setting the collaboration in route for progress. Maintaining accountability for
each member of the collaboration ensures that progress is being made; this is noted as the
accountability framework.
Accountability framework: performance management systems that involve identifying performance
indicators and targets, measuring indicators and managing the targets.

19. Accountability Framework Cont’d
Establishing clear goals: Collaboratives face the task of navigating the heterogeneous and sometimes
the conflicting interests of all members. The large the size of the group, the more divergent interests
present and create tensions in a collaborative occurring. Setting clear and measurable goals that are
transparent is imperative for the success of the group and change.
Identifying Metrics and Targets Aligned with Goals: Metrics are more concrete than goals and are
keyed on organizations tracking specific and popular outcomes. Targets are likely to remain
contentious as an organization highlights specific targets for quarterly and annual reports; such as
meeting compliance with monitoring of client-based services.

20. Connection between Accountability
Framework and Collaborative Efficacy
THE UTILITY OF CLEAR GOALS FOR A SYSTEM CHANGE COLLABORATIVE IS UNDISPUTED.
Clearly articulated goals support the collaborative to hold the larger picture for moving forward, design strategies needed
needed to reach those goals and align the disparate moving parts of a complex initiatives.
Goals can be operationalized within an accountability framework: “direct attention and shape behavior.”
Accountability frameworks support collaboratives to translate goals into action by clarifying what needs to change and to
produce the data that the collaborative needs in order to evaluate and possible adjust the strategies.
The accountability framework can be used as a valuable tool for initiative management, and studies have shown that
“articulating and measuring performance help(s) to direct activities, motivate stakeholders, celebrate accomplishments,
and enhancing learning.”

21. Effectiveness of Accountability Framework and
Collaborative Efficacy on Systems Change
Committing to targets that push members to shift their current organizational practices beyond the
status quo still supports genuine systems change. Without ambitious targets, organizations can
simply continue with business as usual.
Strong accountability framework can play an important role in the ability of the collaborative to ask
the right questions about pathway improvements.
Conversations are raised regarding critical questions about pathway and the members reflect on
performance initiatives.

22. Engaging Members
Prioritizing the collaborative initiative entails
committing sufficient staff time to participate
fully in collaboration, reorganizing operations
to fulfill collaborative goals, funding programs
with the express purpose of aligning with
collaborative goals and allocating funding to
the initiative.
Committing to a shared path denotes the
determination to “cross organizational,
sectoral, and/or jurisdictional boundaries” in
order to understand other members’
organizational perspectives, interests, and
constraints. This creates a forum that
supports the negotiation of shared goals.

23. Collaboration in
Motion
Sourced from: Lantham, N. (2014). “A Practical Guide to Evaluating System Change
in Human Services Systems Context. Center for Evaluation Innovation.

24. Moving Forward for SAM Inc.
Noting the development of collaboration through effective team building, collaborative efforts and
recognizing accountability will develop a stronger collective team for case management services and
define a more conducive structure that results in effective pathways.
◦ Building effective pathways results in improved individual (client) outcomes.
◦ Stronger individual outcomes results in a stronger organization and relationship with stakeholders.
◦ Results in more referrals due to reputation as a strong case management organization.
◦ Word of mouth referrals
◦ Relationships built with hospitals, medical providers, insurance companies and county administrators.
◦ Will result in expanding our level of support.

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