By David Barnes and Barney Savage
For years I have felt that the human services field is desperately in need of new models of service and organizational integration. On a recent trip to Hamilton, Ontario, I saw a model in action that offers some hope of fresh thinking and action.
Let’s start with the problem: across government of different political stripes, I have seen government and non-profit organizations approach integration from radically different perspectives. In sectors such as child welfare, mental health and developmental services, governments have explicitly linked both system coherence and organizational viability to the need for larger organizations. With a range of assertiveness, governments have sought to amalgamate organizations, particularly within sectors (such as reducing the number of Children’s Aid Societies (CAS’s). They have argued that public funds are wasted on duplicative administrative structures.
Non-profit organizations have tended to disagree. They speak of the founding story of their organizations, their local responsiveness and nimbleness, and community-based governance. They point out the savings of amalgamation are negligible, and that wage harmonization and other factors often results in increased costs. They can require a level of organizational effort that distracts from service and mission.
Can the disagreement be resolved by citing the evidence? Well, there are undoubtedly large organizations that are more viable because of their size. But there have also been mergers that have failed entirely, or where the purported savings failed to materialize, often due to wage harmonization.
The election of the current Ontario provincial government, with the funding cuts identified in social services, has significantly accelerated action on organizational mergers. Some organizations have moved ahead quickly to amalgamate with other agencies. In mental health, the province is quickly identifying the Ontario Health Teams that might operate – at full implementation – with one, integrated funding envelope. The impact of this on organizations is unclear.
In Hamilton, some health-funded organizations have conducted a fascinating experiment, and one that is worthy of examination – and possibly replication. Four organizations have voluntarily come together to create a single shared services corporation. This would appear to satisfy the government’s demand for back-office scale and savings. Information technology, human resources, labour relations, finance, and property management have been centralized. These services are delivered professionally, and can even be purchased by other organizations.
Yet the organizations themselves remain in place as legal entities. To the service user, there is no rebranding or lofty promise of integrated care. The organizations may seek opportunities over time to solve problems collaboratively, seek joint funding, or choose areas of particular focus as a collective. But for now, they remain as separate organizations – although their websites now look remarkably similar!
Perhaps the craftiest compromise is governance. Each organization – as well as the collaborative entity itself – has its own board of directors. But the board members themselves are the same for each of the five legal entities. At the senior staff level, the leaders of each of the organizations comprises the management team.
I was impressed. Perhaps the greatest achievement is that it delivers professional, integrated, larger-scale administrative processes in the short to medium term. And it makes no implausible promise of service integration in the short term. Integrations often fail to deliver a transformed client experience of integration because such change needs longer time horizons and sustained change management. And if we want service users to be actively engaged in service change, we need to accept that it will take time, effort, and a sustained commitment.
Finally, it is worth noting that this model is not mandated, but consists of organizations voluntarily deciding to enter into the formal collaboration. This means that communities themselves determine the scope of the integration effort. Sometimes governments decide that there is one recipe for organizational integration to be replicated in every community. This might work if we were planning whole service systems from scratch. But when we are dealing with existing organizations, existing relationships and particular local histories of service delivery, it is unwise to assume that one model will work everywhere.
For more information please contact David Barnes at BMG. firstname.lastname@example.org
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