"I feel so miserable without you, it's almost like having you here."




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I feel so miserable without you, it's almost like having you here."

JOE MARRONE

INSTITUTE FOR COMMUNITY INCLUSION

MAIN OFFICE: BOSTON, MA

NW OFFICE:

4517 NE 39TH AVENUE

PORTLAND, OR 97211-8124

TEL: 503-331-0687

CELL: 503-490- 2072

FAX: 503-961-7714

EMAIL: joseph.marrone@gmail.com

WEB: WWW.COMMUNITY INCLUSION.ORG

RRTC: VR BEST PRACTICE

RTAC: VR MANAGEMENT

STRIVE FOR SERIOUSNESS OF PURPOSE

NOT SERIOUSNESS OF MANNER

AS PEOPLE DO VERY STUPID THINGS IN VERY SERIOUS WAYS CONSTANTLY

ALL CHANGE IS DIFFICULT –NO MATTER HOW LONG YOU PUT IT OFF. “

------ JOE MARRONE

  • QUALITY ASSURANCE?

  • QUALITY IMPROVEMENT?

  • PROGRAM EVALUATION?

HOW DO YOU CULTIVATE AND USE INFORMATION AS OPPOSED TO FACTS?

HOW DO YOU COMMUNICATE QUALITY THROUGH:

BEHAVIORS EXPECTED IN STAFF (AND MODELED) BY LEADERSHIP) ?

OUTCOMES EXPECTED ?

CHANGE IN BEHAVIOR MORE IMPORTANT THAN CHANGE IN ATTITUDE:

BEHAVIORS SHAPES ATTITUDE > ATTITUDE SHAPES BEHAVIOR

ALBERT EINSTEIN

DO YOU DISSMEINATE INFORMATION TO ALL STAKEHOLDERS

(INTERNAL AND EXTERNAL) ABOUT RESULTS OF PROGRAM EVAL?

IF NOT, WHY NOT?

SHOULD THERE BE WINNERS AND LOSERS AS A RESULT OF PROGRAM EVAL IN TERMS OF FUNDING? STAFFING? USAGE?

QUANTITY WITHOUT QUALITY IS UNETHICAL;

QUALITY WITHOUT QUANTITY IS SELF INDULGENCE

PETER DRUCKER

NOTHING IS LESS PRODUCTIVE THAN TO MAKE MORE EFFICIENT WHAT SHOULD NOT BE DONE AT ALL.

BEWARE THE CONTINUOUS IMPROVEMENT OF THINGS NOT WORTH IMPROVING “

POSSESSION OF

CONTROL

OVER

ANOTHER

GRANTING OF POWER

FOR A SPECIFIC PURPOSE

WITHIN SPECIFIC LIMITS

CAUSING AN

EFFECT

IN AN

INTANGIBLE WAY

COMMAND

AUTHORITY

OR

INFLUENCE

ALTER BY MANIPULATION

• HANDLE WITH SKILL

• MAKE OR KEEP SUBMISSIVE



PETER DRUCKER

"CULTURE

EATS

STRATEGY

FOR BREAKFAST."

John P. Kotter (1998).

Leading change: why transformation efforts fail.

In: Harvard Business Review on Change. Cambridge: Harvard Business School Press.

The nature of
passive resistance within a nonprofit setting
is at levels that could teach Gandhi lessons.”

Error #1: Not establishing a great enough sense of urgency.

  • In the eyes of stakeholders, how important and urgent is the adoption of any change in policy or practice?

  • Are people so comfortable with the status quo that they will not want to take the effort and risks associated with change?

  • Are a significant portion of the key “stakeholders” (i.e., people with authority or influence or ideally both) honestly convinced that “business as usual” is totally unacceptable?

Bottom line: Is there a system-wide perception of urgency?

Error #3: Lacking a vision

  • Is there a clearly articulated vision of what we are doing and why?

  • Does the vision easily translate into actions?

  • Is the vision concise and easily understandable (If you can’t explain easily within 3 – 5 mins, you don’t really know it)?

  • Is there a clear link between the vision and each specific system redesign activity?

Bottom line: Is there a clear theme and blueprint showing how any QA/QI initiatives relate to a vision, or is system redesign perceived as a collection of disparate activities with no central theme?

Error #5: Not removing obstacles to new vision.

  • Have we identified the obstacles?

  • Are we willing to make changes in the existing organizational structures if those structures do not support improvements?

  • How will the system handle administrators, supervisors, and/or managers that do not support change and make demands on their employees that undermine planned?

Bottom line: Are we willing and able to take the actions necessary to manage organizational and personnel obstacles?

ERROR #8: NOT ANCHORING CHANGES IN THE ORGANIZATION’S CULTURE.

  • How can we create a “culture” in VR for it to be seen as a provider and employer of choice within the local service system?

  • How can we develop a broad base of support so that QA/ QI improvement efforts are not restricted to a small circle of advocates?

Bottom line: How do we make any changes such an integral and enduring part of the VR system so that it is self-sustaining?

OLD YIDDISH PROVERB

If 1 person calls you a jackass, ignore him;

If a second person calls you a jackass, think about it;

If a third person calls you a jackass- get a saddle.


" There is nothing you can say in answer to a compliment. I have been
complimented myself a great many times, and they always
embarrass me

-- I always feel they have not
said enough. "



  • Leader must clearly define what quality is; communicate, recognize, reward “quality.”

  • BHAG – Bold, Hairy, Audacious Goal; what can public VR be the very best at delivering? (Public VR - world leader in facilitating employment & building careers for persons w. disabilities.) (Good to Great, Jim Collins)

  • Define Success both Quantitatively /Qualitatively

  • Quality Assurance systems must “embrace the externalities.” (Leadership in an Age of Transparency, Meyer and Kirby, Harvard Business Review, April 2010)

  • Client/consumer

  • Employer

  • USDOE/RSA

  • State policy makers

  • Agency staff

  • Staff’s Informal Networks

  • Community partners

  • Must establish a feedback loop with all seven groups

  • Leadership analyzes and synthesizes this information as a component of its QA system.

  • Strong QA System does not identify problems within the organization; identifies and provides opportunities to excel.

 Employment for Persons w. Significant Mental Illness

  • BHAG vs. continuous improvement

  • Data analyses w. feedback from consumers, providers, advocates

  • Partnership with Dartmouth, Johnson and Johnson Foundation and the MD MH Administration – EBP - Supported Employment

 Employment for Persons w. Significant Mental Illness

  • Consultative links with ICI at UMASS Boston to assist MH-DORS collaboration & developing braided funding model using MH & DORS funding upfront + Medicaid for longer term support

 Employment for Persons w. Significant Mental Illness

  • Throw out “linear” VR service model to J.I.T. (just in time) approach

  • Integrate MH eligibility & service planning w. VR eligibility/planning (VR resistance to “giving up authority”)

  • Specialized counselors; & establishment of an affinity group

 Employment for Persons w. Significant Mental Illness

  • Extensive professional development for both CRP and VR staff

  • Established QA system – fidelity evaluations (money attached)

  • Medicaid for longer term support

 Employment for Persons w. Acquired Brain Injuries

  • Significant input from advocates/ staff; anticipation injured veterans returning

  • Identify service components/ structure; establish new policies specific to population that supports this structure

  • Affinity group; VR, CRP, other ABI staff

  • Ongoing professional development

  • Quantitative & qualitative indicators; used outside evaluator (Univ. of MD)

Quality

What takes place between the customer & us

What do we have most influence over?

  • Our own behavior/actions

  • What will need to change the most for our customers to achieve employment?

  • Have a positive experience using VR?

  • Why should our program be the program of choice for customers?

Consistency of Intent –
Flexibility of method

  • The intent reflects the key values and norms of the program, organization and profession.

  • Intent should be clear to all customers.

  • Actions by the organization and its representatives should be based upon the intent.

  • Organizations tend to be too conservative and restrictive thus limiting their potential

Simplify - Simplify

  • Organizations that provide “quality” are easy to work with as a customer, a partner and as staff.

  • Quality is a thousand things done better every time.

  • Staff want to be outstanding and achieve at the highest levels.

Attitude flows down-
Innovation flows up

  • Move from “keepers of the book” to “creators of the future” { Dream Crushers to Visionaries}

  • Transparency at all levels – policies/practices/funding

  • Own our mistakes – fix them & learn

  • Risk taking – prudent and at our expense rather than customers.

  • Under promise – over deliver

The Employer of Choice

  • The place were the best want to work

  • High expectations

  • tough but fair”

  • Play to our strengths

  • Improve all our skills

  • Feed our successes

  • Work hard, smart and with focus

  • Take care of internal customers - each other


Increased self Confidence


  • Decisions at the levels they need to be at.

  • Increase resources – learning.

  • Create organizational commitment.

  • Address chronic / painful issues for the organization.

  • Limit the impact of internal & external non essential distractions

Lead by action

  • Indentify “quality” – examples of achieving the intent

  • Create access to resources

  • Address the hard issues – the ones we need to get better at

  • Use all the organizational skills

  • Increase the organizational skills

Enjoyment

  • Don’t take ourself to seriously – the purpose and work are serious but be humble.

  • The customer should feel that we want them to use our organization and that we enjoy providing them with services.

  • There should be lots of “BRS want a b’s”

  • have a soul” and let it show.

The rewards & practices support “quality”

  • What is measured? How is it measured?

  • What is rewarded? How is it rewarded?

  • Nudge

  • Release the potential

  • Where is the organizational energy going?

  • R & D

  • Learning

Know the business

  • Do we have the knowledge and experience?

  • Who are the best in our business? Why

  • Who do we admire? - Why

  • What is the “ state of the art” in our business?

  • What and where are the cutting edge approaches?

  • Who are the “positive deviants”


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