Matrix: Mental Health System Transformation

Programs and Activities

Mental Health Transformation State Incentive Grant Program

Transformation: A Strategy For Reform of Organizations and Systems

Key Elements in the Transformation Process

Vision

A clear and compelling vision is a key ingredient for successful transformation. Developing a vision requires defining a “perfect world” and clear principles to guide the transformation effort (Society for Technical Communication [STC] 2004). It should constitute a shared image for a desired future state – not a strategic plan, but the inspiration that will motivate people to create such a plan and willingly make the special effort to achieve it (Sugarman, 2000).

As Kotter (1996) explains, a successful vision encompasses a sense of urgency to overcome stakeholder complacency. A well-defined vision clarifies the general direction for change, motivates people to take action in the right direction, and helps coordinate people's actions. To assess the effectiveness of a vision, planners may want to ask: Is it imaginable, desirable, feasible, focused, flexible, and communicable?

Leadership

Transformation efforts require exceptional leadership abilities. Leaders must have both the capability to formulate a compelling vision and the skills to organize and manage the change processes. These skills may reside in more than one person. In addition to developing and communicating the vision, the leadership’s responsibilities involve developing a coherent transformation plan, maintaining a focus on key transformation goals, and managing external changes to complement internal ones (Kotter, 1996).

A transformative leader can “guide, direct, and influence others to bring about a fundamental change not only of the external world but also of internal processes” (Jahan, 2003).

In transformation, Cebrowski (2004) notes that leadership plays a fundamental role by creating a vision of the future as well as inspiring people regarding their place in that future. He states, “If the senior leaders do not own transformation, there is no sense in pursuing it.” These executives do not necessarily have to declare that they own transformation, but they should convey that transformation is part of the entire organizational strategy in which each employee is involved. Leadership must establish an incentive structure that will maximize good management, encourage exploratory jumps, and harness resources to empower “big jumps.” (See box below).

Bernard Bass (1990) describes “transformation leadership,” whereby a leader transforms, or changes, followers by increasing their awareness of the need to perform tasks well, making them aware of their needs for personal growth and accomplishment, and motivating them to work for the good of the organization instead of just their own personal gain. At least three stages of change management demand transformational leadership: motivating changes in behavior and overcoming resistance; managing the transition to ensure control; and shaping the political dynamics so that power centers develop that support change (Nadler, 1983).

Alignment

A system’s structures and processes must be aligned with the idealized vision in order for relevant persons, organizations, and systems to participate in the transformation process. (STC, 2004).

According to Crossing the Quality Chasm: A New Health System for the 21^st Century (National Academy Press, 2001), four strategies are required for large-scale alignment: finance reform; retraining of human resources; developing performance measures and information technology; and identification and implementation of evidence-based practices. Similarly, Durant (2004) recommends that administrative, responsibility, and accounting structures be aligned and that central administrative units do not undermine the change strategy. Kotter (1996) underscores the power of systemic structures working in concert with empowered employees, stating that:

Discouraged and disempowered employees never make enterprises winners in a globalizing economic environment. But with the right structure, training, systems, and supervisors to build on a well-communicated vision, increasing numbers of firms are finding that they can tap an enormous source of power to improve organizational performance. They can mobilize hundreds or thousands of people to help provide leadership to produce needed changes.

Culture

As defined by Kotter (1996), “Culture refers to norms of behavior and shared values among a group of people.” In large organizations, a variety of social forces affect everyone; these forces comprise the corporate culture. He states that corporate culture has a significant influence on human behavior, noting culture is difficult to change and essentially invisible. Kotter believes that organizational culture is powerful because:

(1) individuals are selected and indoctrinated so well;

(2) the culture exerts itself through the actions of hundreds or thousands of people;

(3) the effects happen without conscious intent and thus are difficult to challenge or even discuss. Despite the challenges, visionary leaders do spearhead cultural change within their systems. Cebrowski (2002) recommends that leaders of transformation efforts realize success hinges on creating a culture of innovation that encourages and rewards those who embrace innovative risks.

Continual Process

According to Durant (2004), it is important to understand that transformation is an ongoing and permanent campaign. Cebrowki (2003) adds that change processes, “whether or not they…have a preconceived end point, are intended to create or anticipate the future and to simultaneously deal with the co-evolution of concepts, processes, organizations, and technologies wherein change in any one of these necessitates change in all.”

Defense Transformation for the 21^st Century

Within the United States military, transformation required changing the form or structure of the military forces, the nature of the military culture, and doctrine supporting those forces. It also involved streamlining fighting functions to more effectively meet the complexities of the new threats challenging the Nation in the new millennium. (United States Joint Forces Command [USJFC], 2004).

Arthur Cebrowski, Director of Force Transformation, Office of the Secretary of Defense, Department of Defense (DoD), identifies a five-part strategy used in the DoD for a recent reform of military forces (Cebrowski, 2004). He depicts the process used in this effort as consisting of major thrusts rather than sequential “steps.” It consists of:

• Developing a top-down approach by having transformation an integral element of the DoD corporate strategy (beginning with the President) in order to foster effective management (efficiencies, cutting waste, recapitalization, and modernization);

• Targeting and creating cultural change by use of bottom-up tools such as experimentation; prototyping of a new idea for a process, organization, or technology; and education as life-changing experiences in the field where people are lauded for experimenting and using innovation;

• Creating a new underlying theory, such as harnessing the power of the information age, to instill network behavior;

• Aligning metrics and seeing that they are adopted via performance measures, outcome measures, and so forth; and

• Creating new capabilities.

In this process, transformation can occur through both exploratory jumps that “push out the boundaries and big jumps to change the fundamentals of what one is trying to do.” (Cebrowski, 2004) These jumps, if realized, transform the enterprise.