Systemic Change

An “Enabling Context” is a key factor in the formula for success.  Enabling Contexts purposefully support the use of effective implementation methods to assure the use of effective innovations in practice.  In the Active Implementation Frameworks, the context refers to the system in which organizations provide services to people.  For example, schools provide teaching and learning services to students in the context of district, state, and federal education systems.  The goal is to assure that the structures, roles, and functions within a system are more enabling than hindering in their impact on the services provided and the degree to which socially significant outcomes can be achieved.

It is a truism that all organizations and systems are perfectly designed to achieve exactly the results they obtain (“If you do what you’ve always done ….”). This statement does not impute intention to the design of human service systems (Barber & Fullan, 2005; Greenhalgh et al., 2009; Ulrich, 2002).  Quite the contrary.  Human service systems are legacy systems that are the product of "[d]ecades of quick fixes, functional enhancements, technology upgrades, and other maintenance activities [that] obscure application functionality to the point where no one can understand how a system functions" (Ulrich, 2002; p 41-42).  Legacy systems represent a layered history of well-intentioned but fragmented changes. 

The cumulative nature of current (legacy) systems means that no one can objectively analyze “how they work.”  Instead of trying to identify existing problems within a system, the strategy for establishing an Enabling Context is to develop a new system that reliably produces the desired outcomes.   Kurt Lewin described system change as unfreezing the existing system, changing it, and refreezing it in its new and more effective configuration.  Buckminster Fuller noted that meaningful change occurs when a new model is developed that makes the old model obsolete.  The leaders of Silicon Valley say if you want a better future, you have to create it.  As these leaders point out, tinkering with an existing legacy system (Tyack & Cuban, 1995) likely will not produce the Enabling Context needed to ensure socially significant outcomes.  Enabling Contexts don’t just happen, they are developed in a thoughtful and purposeful way.

As noted in the formula for success, Enabling Contexts are needed to achieve and sustain socially significant outcomes. As shown in Figure 1, when effective innovations and effective implementation are introduced into a system, they disturb the status quo and disrupt existing ways of work.  In the absence of an Enabling Context, legacy systems sustain the status quo and adapt key features of innovations to fit the usual ways of work in the system.  “Adapted innovations” that are missing functions essential to their success likely will not produce intended outcomes for systems (Westphal, Gulati, & Shortell, 1997).  Effective innovations that are not used as intended in practice have no chance to produce the intended outcomes.

As shown in Figure 1, if new (and improved) results are to be realized the current context needs to change to facilitate the work of innovation practitioners and implementation teams.  The task is to align changes so they support one another in coherent and purposeful ways that produce improved system performance and improved outcomes year after year.  Thus, Enabling Contexts are the product of purposefully making changes in systems so that innovations are used as intended and their effectiveness is sustained over time.

Figure 1.  The status quo is powerful and the existing system typically changes (adapts) key features of effective innovations to fit the existing system. Enabling Contexts are created when the existing system is changed to support high fidelity and sustained use of effective innovations.

Systemic Change to Create Enabling Contexts: Systemic Change in the Active Implementation Frameworks is based on best practices and the best available evidence.  Examples of data and documented experience related to systemic change are provided by Fixsen, Blase, Metz, and Van Dyke (2013); Glennan Jr., Bodilly, Galegher, and Kerr (2004); Khatri and Frieden (2002); Klein (2004); Kotter (1996); Morgan and Ramirez (1983); Nord and Tucker (1987); Prochaska, Prochaska, and Levesque (2001); Schofield (2004); and Vernez, Karam, Mariano, and DeMartini (2006). 

The approach to Systemic Change is illustrated in Figure 2.  Executive Management Teams (federal, state, regional) establish policies and regulations intended to improve practices and improve outcomes for recipients of human services.  The task of accomplishing change is delegated to an Implementation Team that has the expertise to make full and effective use of the Active Implementation Frameworks to support practitioners learning, using, and sustaining an innovation with fidelity that results in good outcomes for recipients. 

Figure 2.  The approach to Systemic Change.

The development of expert Implementation Teams and the full and effective use of the Active Implementation Frameworks and innovations in practice disturb the status quo.  When engaged in Systemic Change, reactions from individuals and groups who are impacted by the change process are to be expected.  To cope with these reactions, the Implementation Team has frequent communication with the Executive Management Team so the leaders can constructively intervene, clear barriers, and strengthen facilitators.  In this way, legacy systems are changed in functional ways and innovations are not crushed by the already established routines that sustain the status quo (Nord & Tucker, 1987). 

Marzano, Waters, and McNulty (2005) noted that systemic change is “emergent, unbounded, complex, nonlinear, [and] a disturbance of every element of a system.”  Disturbing the status quo creates a chaotic context (Snowden & Boone, 2007) that demands rapid responses to issues as they arise.  The Executive Management Team must be prepared for frequent (weekly, monthly) communication from the front line and be prepared to engage in constructive problem solving with constituents within and outside the system.  As roles, functions, and structures are strengthened and barriers are eliminated, coherence is created as system components and resources are aligned with achieved system goals and intended outcomes.  The Practice-Policy Communication Cycle is the timely communication from the practice level to the policy level to inform policymakers of the intended and unintended consequences of policies and guidelines.  The “cycle” is completed as the policy makers create and improve polices that enable the full and effective use of innovations.  The cycle continues as those changes are further evaluated for impact and improvement, or are deemed functional enough to be embedded in policies and guidelines.

An intended outcome of disturbing the system is to provide leaders with opportunities to design new system roles, functions, and structures – in essence, develop a new system on purpose.  A system developed on purpose can be changed on purpose in the future.  Using the Systemic Change processes, the resulting roles and functions of units are known and the relationships among units are known.  With the Practice-Policy Communication feedback loop in place and Implementation Teams functioning as sensors of alignment and misalignment at the practice level, the Executive Management Team has the ability to continually “monitor and question the context in which it is operating and to question the rules that underlie its own operation” (Morgan & Ramirez, 1983, p. 15). 

The purpose of the “External” System Change Support shown in Figure 2 is to facilitate the use of the Systemic Change proccesses.  “External” is in quotes because there are ways to have individuals already within an organization perform the external facilitation role (Klein, 2004).  External facilitation has been recognized as an essential feature of system change for many decades (Berta et al., 2015; Blase, Fixsen, & Phillips, 1984; Fairweather, Sanders, & Tornatzky, 1974; Klingner, Boardman, & McMaster, 2013; Nord & Tucker, 1987; Stetler et al., 2006).  As Ashby (1956) cautions, “[t]he fault cannot be in the part responsible for the repair,” so the external facilitation role is essential for establishing an Enabling Context.

Brown and Flynn (2002) state that interpersonal facilitation strategies are dramatically more effective than other strategies in achieving the individual and organizational behavior change needed to produce systemic change.  External facilitation of system change is an interactive and time consuming process that requires expertise to help insiders view their own system differently. For more information see OSEP SISEP Evaluation Report: 2013-2015.

Transformation Zone

In human service systems, services cannot be shut down, reconfigured, re-skilled, and restarted in some new and hopefully more effective mode.  The requirement to develop an Enabling Context in the midst of an operating legacy system adds yet another degree of complexity to attempts to purposefully change systems.

To prevent change leaders and external facilitators from being overwhelmed by systemic issues that need to be resolved, systems change is initiated in a Transformation Zone (Fixsen, Blase, & Van Dyke, 2012).  A Transformation Zone is a vertical slice of the entire system from the practice level to the policy level and includes all major levels within the system.  The slice is big enough to encounter nearly all the issues that likely will arise in system change, and small enough to keep issues at a manageable level until the beginnings of the “new system” are established and functioning well. 

A Transformation Zone is the place to develop the features of a “high reliability system” (Weick, 1987).  According to Weick, high reliability systems start with a centralized structure where a set of core values, decision premises, and assumptions are developed and operationalized so that people can understand, buy into, and engage in new ways of work.  Doing system change work in a Transformation Zone has the advantages noted for “continuous delivery” (Humble & Farley, 2011) where enabling system components are developed and tested in real time allowing effective functions, roles, and structures to be established and errors to be quickly detected and corrected in daily practice.

As work progresses in the Transformation Zone, a coherent system is established as the improvement cycles are used to develop supports for effective implementation of effective innovations.  A coherent system reduces reliance on managerial authority, formal rules and procedures, and narrow divisions of work.  A purposefully designed system, once established, creates a coherent and aligned set of working assumptions and decision premises that produce high levels of fidelity that rely on practical and reliable data systems to generate data for improvement and sustainability.  By developing teams that assure the availability of effective implementation supports in a system, Executive Management Teams can delegate responsibility and accountability far down the hierarchy in a task-driven, process-sensitive, outcome-oriented organization  (Beer, Eisenstat, & Spector, 1990).   Implementation Teams help fulfill the promise made by Elmore (2002): "For every increment of performance I demand from you, I have an equal responsibility to provide you with the capacity to meet that expectation" (p 5).

Aspects of an Enabling Context

An Enabling Context specifically includes implementation science and best practices in its day to day operations.  The system itself consists of new ways of work that produce good outcomes and engages in regular communications with constituents to improve those outcomes each year. 

To begin to establish an Enabling Context in a regional, state, or federal system, leaders can assure that:

  1. Funding is allocated for initiatives and for implementation supports.  Requests for Proposals (RFPs) specifically require implementation supports and set aside 20% of the funding for those supports from competent Implementation Teams.
  2. Review Committees for RFPs and compliance reviews have at least 50% of the members who are implementation experts who can provide implementation-informed reviews of proposals and practices.
  3. Regular reporting of progress by recipients of funds includes data regarding the fidelity of the use of the interventions and fidelity of the use of implementation best practices (e.g. the Active Implementation Frameworks).  Fidelity data are linked with outcome data and are reviewed by relevant management teams at least two times each year.
  4. Quarterly meetings are held among key participants from the funding agency, the Implementation Teams, and those using funded interventions.  The meeting agendas prompt reviews of expectations, facilitators and barriers, and innovation and implementation data.  At each meeting the participants agree on improvements each of them will attempt to make and evaluate during the next quarter.
  5. The results of the quarterly meetings produce action plans that lead to functional changes in funding, regulations, system functions, and so on.  Data are collected to monitor the results of making these changes (e.g. fidelity improves, desired outcomes improve, efficiency improves, errors decline).
  6. A federal or state agency that creates an Enabling Context for achieving ever improving outcomes has the opportunity to learn from each of the many initiatives funded each year.  By using implementation-informed RFP and review methods and engaging in frequent communication with key participants, agencies can become learning organizations (Drucker, 2004; Sheaff & Pilgrim, 2006) and continually create more effective supports for those providing human services (Metz & Bartley, in press).

Case Example: U.S. Department of Education Office of Special Education Programs

In 2006 the U.S. Department of Education Officeof Special Education Programs (OSEP) was the first federal agency to recognize the potential benefits of implementation science for improving student outcomes.  In 2012 OSEP announced its approach to Results Driven Accountability that intends to change the relationship between a federal agency and state education systems.   The new relationship being initiated by OSEP is to turn compliance into support.

Read More: Case Example: U.S. Office of Special Education

Case Example: Northern European Public Sector

Northern European states, regarded as world leaders in social welfare, have for a long time viewed implementation as enactment of legislation that is communicated top-down to the public and stakeholders. This study reports on interviews with 30 public sector executives in Northern Europe about how to achieve successful implementation. They confirm the necessity of the “Making it Happen” strategy that corresponds with implementation science.

Read More: Case Example: New Approaches to Policy Implementation (EU)