Recently the InnerChange Foundation posted its core beliefs (click here). Among these is the belief that British Columbia and Canada need access to more and newer addiction treatment and prevention strategies. And, related to this is a desire for addiction services to be more available and effective for a greater number of those who need it the most, including an expanded toolkit.
Everyone who currently seeks help in coping with an addiction either engages (or tries to engage) with some sort of system of treatment and care. Where this system is not fully reaching everyone who needs help, the next question becomes “So how do we change the system?”
As we all know, systems are complex. But a lot of people have had successes in shifting parts of the system. In this blog entry, I give examples of useful ideas for changing the system, and then talk about how InnerChange hopes to be part of this process.
What are Systems and How Do They Change?
Systems at their heart are made up of people. They also include organizations (clusters of people and resources) and supporting laws, policies, routines, and resource flows. Change one part of the system and you might change others—or not, if the change that you make isn’t supported by a key group in the system. In practice, people and organizations make daily choices about which policies, laws, routines and resource flows they will support (Feldman and Pentland, 2005; see also Vilches and Tate 2016). But sometimes these choices aren’t clear; or alternative choices seem really difficult. So where the system refuses to change, chances are that it’s not because people are stubborn, evil, or misguided. It’s because there are not enough incentives in the system to help them do something different in the face of significant barriers.
If systems change means removing barriers or doing something different when they can’t be removed, how do we incentivize this? For problematic substance use, which generates a need for human services, the concept of service pathways becomes helpful. Pathways are a collection of programs and services which help move clients through a series of steps designed to build positive outcomes (Latham, 2014). If the pathways are not working as well as they could, then this concept helps service providers break apart different aspects of them to make them more efficient and effective-essentially re-creating the incentives within the pathways to provide improved care. According to Latham, key types of pathway enhancements seek better capacity (scale, quality, and service comprehensiveness) and better linkages (alignment, connection, cross-system coordination).
This may be enough-or not. Sometimes the pathway itself is a good one, but isn’t resourced in the right way. And providing needed inputs in times of scarcity requires a shift from other parts of the system that also need those resources. To make these shifts requires huge political will – and even this alone may not be enough. A package of changes in companion pieces may be needed, such as budgets, policies, laws, and other routines outside of the service pathway being addressed. Resistance could come up as changes in any one of these items is considered.
Systems and Bold Experiments
For this reason, sometimes you need a big bold experiment which injects new resources and concurrently re-knits key relationships together, strand by strand. Where large players build a new system pathway for a particular client group, and bring new resources to the table which signal the seriousness of the desire for change, this can create more incentive for existing parts of the system to reconfigure themselves. Service providers and policy makers are human too, and care deeply about the work that they do. Powerful gestures can give them hope and reassurance that there is a strong will for new approaches, and more incentive to make needed adjustments.
So here is where the InnerChange Foundation – and its partners at the Graham Boeckh Foundation, St. Paul’s Hospital Foundation, Ministry of Health and Ministry of Children and Family Development- come in. As we have proclaimed proudly on our website, we are part of a great new venture to re-knit key relationships together in support of a significantly improved system pathway for vulnerable youth, including some who may be coping with substance use challenges, or at risk of these. A total of six centres throughout our province are forming the core of significant pathway improvements for British Columbia youth in need. You can read more about this new venture here http://innerchangefoundation.org/initiatives/#bciys .
Feldman, M. and B. Pentland (2005). Organizational routines and the macro-actor. In B. Czarniawska and T. Hernes (eds.), Actor Network Theory and Organizing. Copenhagen : Business School Press , pp. 91 – 111 .
Latham, N. (2014). A Practical Guide to Evaluating Systems Change in a Human Services System Context. Centre for Evaluation Innovation. Downloaded August 8, 2016 from website: http://www.evaluationinnovation.org/sites/default/files/Systems%20Change%20Evaluation%20Toolkit_FINAL.pdf
Vilches, S. and L. Tate (2016). Grants as significant objects in community engagement networks: Kelowna, British Columbia. In Rydin, Y. and L. Tate. (2016). Actor Networks of Planning. Exploring the Influence of Actor Network Theory. London: Routledge. pp. 62-78.