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Making a shift in a system of human services from a medical model to a cognitive behavior model requires significant design changes within all factors of the system.A paradigm shift of significant proportions requires that the policy maker/manager understand that most people simply "won't get it". When such changes are attempted, managers often attempt to address only one part of the system at a time because they are convinced that such practices are pragmatic. However, such practices allow the old way of thinking to continually undermine the process of change. In making the shift from traditional models of serving people with problems in living to a transitional model dedicated to the use of cognitive behavioral management, one is required to look at the full range of organizational elements which have been identified by Robert B. Waterman, Jr., Thomas J. Peters and Julian Phillips in a 1990 article called STRUCTURE IS NOT ORGANIZATION. Organizational Model comparison table SUPERORDINATE GOAL: While the superordinate goal has a compatibility with a "mission statement", is must contain the fundamental assumption of the system. The fundamental assumption of traditional models is based upon "pathology & cure" while the fundamental assumption of the transitional system is cognition & learning. These fundamentals are mutually exclusive. The articulation of the superordinate goal is required so that all other system factors can be developed to address the outcomes required by the goal. STRATEGY: Strategy defines the unique value of the system. The unique value of the traditional system is "control". The system assures the society at large that people with problems in living will not intrude on their lives. The unique value of cognitive behavior is choice and personal responsibility. Again, incompatible with tradition. STAFF: The basic values of management are conveyed through the people they employ. The traditional manager values credentials and hierarchy. Transitional managers value outcome and personal responsibility. This is extremely threatening not only to traditional managers, but to the guilds who benefit by the idea that one needs to be a member of the in-club to be employed. If psychiatrists, for example were not required participants by most public mental health system regulations, it is hard to imagine who would employ them. SKILLS: The attributes, capabilities, capacity or competence of the staff comprise the skills. Traditional model employees display little skill, although some [not all]are capable of interpersonal relationships. There approach is based on biomedical or psychodynamic approaches, the first of which is intrusive and at best suppresses emotion and behavior, while the latter is clearly ineffective. The new paradigm will require both a different knowledge base and teaching skills. STYLE: The style of an organization or system can be described by the symbolic behavior and regular patterns of action. Traditional models rely or expert opinion, professional choices and preferences, restrictive practices, programs and medical jargon. The transitional model is based on an enable model [positive enabling; not negative], client choice and preferences, provision of services in valued settings [where the person would be if they did not have problems in living], provides supports with the intensity required, and speak in functional language. SYSTEMS: The formal and informal procedures used within the organization constitute its systems. Traditional models tend to be process and "command and control" oriented; while the transitional approach is outcome oriented and manages through continuous quality improvement [which requires the use of data]. STRUCTURE: The task division and coordination of the organization comprise its structure. Traditional models tend to use a "factory" model [clients are sent to the factory to be 'fixed'"]. This requires a quite centralized structure. The transition to the cognitive behavioral model provides a temporary service to people with problems in living [based on the expectation that they will learn new thoughts and behaviors and get on with their lives ], in valued settings. The result is a decentralized, horizontal organization with "temporary help" such as a "Kelly Girl" model. It should be obvious, even to the most naive reader, that a significant shift
in thinking and behavior is required to retool the system. |
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