Casey Stengel said, “Getting good players is easy. Getting ‘em to play together is the hard part”. In January of 2014, there were good, hardworking, and very well-intentioned people in the DA, but I wouldn’t necessarily call them a team, or even a collection of teams. As I transitioned in, I reviewed the organizational chart and met with everybody there, both individually and as teams, sometimes more formally, and sometimes with pizza just to get acquainted. I learned a lot in those conversations, both about the individual people and the organization itself. 

By February of 2018, the Division of Aging was functioning as a much more cohesive unit, with a shared sense of purpose and clear line of sight to organizational objectives, and capable of achieving high performance levels in service to those objectives. I’d love to reflect a bit on how we got there. I think it demonstrates the themes of operational/organizational effectiveness and accuracy/consistency/ efficiency (ACE) we talk about as Sage Squirrel.

There was a clear delineation between people who worked on HCBS and people who worked on things related to nursing facilities (Money Follows the Person was considered a nursing facility program!). Half the DA staff were identified as the “Assistant Director of …”. When asked what work they performed, almost all of these Assistant Directors said: “My job is special projects.” (I even think Debbie’s title at the time was Assistant Director of Special Projects!) There were professional staff stacked on top of each other in narrow reporting columns that were up to five people deep – and yes, individuals in those columns were all Assistant Directors of something. Most of the reporting columns and work groups had little connection to, or little knowledge of, work that was done in other parts of the agency. That was a LOT of fragmentation and organizational silos – within a division that consisted of only 35 people!  

The Indiana DA is one of the smallest state units on aging in the country and is responsible for a great deal relative to its size, compared to other states. In the face of growing waiver utilization and the demographics of the aging baby boomers, we knew the Division would need to increase capacity. A typical response to that need is simply to hire more workers, but that is not always the best or most feasible solution, especially in state government where you are faced with budget limitations, hiring freezes, and cumbersome hiring processes and limited recruiting support. We did not want to request additional funds for additional staff until we were confident that we had maximized the capability and capacity of the existing staff structure, so that’s where we focused.  

To make the most of the resources we had available, we focused on:

• Automating business processes wherever possible;
• Creating efficient, effective, valued added processes; 
• Ensuring there were well defined expectations – and accountability for meeting those; and 
• Getting the right people in the right roles. 

Some specific steps that we took included:

• Establishing the concept of “ACE” – accuracy, consistency, and efficiency – and making that our guiding principle in the review of business processes and measuring performance.  
• Improving software, tweaking business process, retraining internal staff, empowering staff, and retraining of case managers in the field, made a great difference in how we handled waiver care plan reviews and approvals. In three years, that team was handling almost 100% more participants, while staffing was only increased by half an FTE.  
• Creating flexible teams that could be deployed as needs and priorities waxed and waned through cross-training. This had the added benefit of creating job enrichment for people who may have been a little stale, bolstering learning and engagement.
• Updating job descriptions and ensuring that each job description emphasized the role and level of responsibility for a position, rather than the specific tasks or duties.  
• Identifying core competencies for each job and featuring those prominently in the recruiting and hiring process. Assessment of candidates was oriented around those competencies rather than specific previous experience or knowledge. We found the best candidates regardless of location and leveraged technology to allow them to work remotely.
• Standardizing comprehensive onboarding for new hires. 
• Ultimately restructuring the entire organizational chart and creating a much flatter and networked organizational structure with no one more than three levels from the Director.

An aphorism that has stuck with me from almost the beginning of my work in HR is that “culture eats strategy for lunch”. I don’t believe that it is possible to achieve strategic objectives without paying very close attention to organizational culture, and organizational culture is notoriously difficult to change. The strategies we used at the DA were effective because we didn’t neglect organizational culture. While there are models of culture change, I believe we achieved a large measure of by being very pragmatic about where we wanted to go and what it was going to take to get there, and then being very transparent about sharing all of this with the team. And then putting those things on repeat… and repeat… and repeat…  until they finally started to be absorbed and integrated.  

This was not a linear or chronological process – in fact, it was quite iterative as we learned and evolved and built on what we were learning and as changes occurred. Some of that flexibility was part of the point; too many people were wedded to always doing what they had always done. While stability and consistency have their place in any well-run organization, rigidity has no place in today’s world. We wanted to foster a culture of ongoing learning and continuous improvement rather than rigid compliance. We not only allowed people to ask “why?” we encouraged it, even expected it. 

To achieve transparency, we held weekly “stand-up” meetings which all staff were encouraged to participate in, used Yammer to promote informal intra-departmental communications, and held quarterly staff meetings with expanded in-depth subject presentations, and an annual retreat. We consulted with the team on updating job descriptions and the organizational chart, and the team drafted the division’s mission statement during one of our holiday retreats. Most importantly we were accessible and open and encouraged questions and dialogue at all levels.

We didn’t label it this way, but person centeredness was always central to our thoughts and actions. It started with our concern that consumers needed to be at the center of the programs and services they utilized. We knew programs and services could not be person centered if we didn’t start with our own team and embrace a person centered culture. It was a work in progress to be sure; we were all learning fast – with credit to our Case Management Director, Amy Rapp, for continually pushing person centered concepts into how we interacted with one another in the division. 

It was all about aligning our organizational structure, culture, and business operations to the larger outcomes we wanted to see in the programs we administered. Organizational alignment is about getting everyone to play together to achieve shared goals and objectives. That’s what we mean when we talk about aligning operations and policy objectives.

#BeyondCompliance, #LTSSTransformation, #OperationalEffectiveness, #SageSquirrel