Central to the understanding of organizational performance is the use of the program itself—rather than the organization—as the unit of analysis. Understanding how managers behave and react to program stimuli, which has their greatest level of attention, provides better knowledge of how to manage implementation processes. A more detailed analysis of this point will be developed in Chapter 3. Two types of analyses are provided in support of claims asserted within the study. An exploration into health outcomes achieved by the program implementation is first explored in order to quantify the degree and type of success. Quantitative methods such as regression analysis utilizing a retrospective matched cohort method are applied to health care program data. Administrative data from patient registries is aggregated and assessed along with medical-chart information in order to explain possible associations between the program’s implementation and changes to patients’ health care outcomes over time. To understand the relationship between management behavior and implementation program outcomes,hydroponic vertical farming the second analysis is presented in Chapter 3. An organizational development based framework is developed to help to understand administrative behavior. Interventions on management are subsequently performed in attempts to modify non-optimal behavior. Behavior that is not considered optimal to program performance is identified by surveying the management staff periodically on their levels of engagement to the program work.
The interventions utilized applied organization development practitioner techniques and had the goal of improving manager’s interactivity with the work for which they were responsible. Oftentimes managers are pulled in multiple directions and their attention diverted from core program implementation work. Interventions were designed to ensure better understanding of the work at hand. The types of interventions employed are explored in Chapter 3. In support of the health outcomes data provided by the program implementation, interviews were conducted with the managerial staff responsible for the work behind the chronic care model program. Using the program as the unit of analysis, these analyses will contribute to our understanding of well-directed administrative behavior’s effect on organizational performance, as described and discussed in Chapter 3.As acknowledged by the Uhrig review of the Australian government sector, there are benefits to be gained by studying the lessons learned in the private sector when considering appropriate operating frameworks for the public sector . Improving public-sector performance can have multiple objectives. Transparency may be an objective. The inner workings of a public agency’s decision-making process can expose inconsistent behavior that may need to be remedied. To remediate this behavior, performance-improvement techniques are likely to be employed using models such as the continuous improvement model first asserted by W. Edwards Deming . The techniques chosen by the private sector may differ from those chosen by the public sector due to their structural differences. As Uhrig showed, however, there may be important lessons available from the private sector that may be used by public entities. The purpose of the Uhrig review was to assist in improving the performance of public sector governance.
This paper has a similar purpose. The environment in which the private sector operates creates significant challenges for companies. The consequences of failure, combined with the threat of takeover and desire for profitability, provide incentives for the private sector to constantly strive to improve operational practices. The Uhrig review examined the experiences of the private sector, focusing on a range of governance arrangements and their corresponding impact on outcomes. In comparing and contrasting the private sector to statutory authorities, Uhrig found that the governance of the public entities was unclear and inadequate. As a result, Uhrig called for private-sector style changes to increase transparency and accountability within the public sector. Among the solutions offered were calls for a central regulatory body and transparent roles and responsibilities . Criticisms of the reforms included an opposing view that suggested that governance experience within the public sector is institutional in nature and, as such, many of the criteria applied in the private sector are unsuitable for adaptation by the public sector . Employing private-sector methods to engage in work is not a revolutionary concept. Operational tools such as SWOT analysis and collaborative work environments have been carried over from public to private and vice versa for decades . The adaptation of full private-sector programs for public-sector implementation is not often undertaken, nor is it well documented. Likely due to the complexities faced, operationalizing entire programs that have been initially incubated in the private environment is not an easy task. A counterexample is the public education system, which most recently attempted to adopt the private charter-school approach and proved successful in improving test scores within the private sector .
The results of attempts to mirror private-sector programs appear to be mixed . While it may be theoretically sound to adopt the core principles and methods surrounding a private-sector model to the public setting by employing experienced private-sector labor, the actual measures of program success differ greatly between the two environments . These differences in measurement may lead to difficulties in the implementation process. The private sector tends to employ a generalized cost-benefit analysis related to future gains to revenue. The public sector is more multifaceted in its review of the benefits and costs to the social sector it supports. Issues related to social equality and cost avoidance are taken into account . Further levels of complexity arise as administrators are often bound to the whims of lawmakers and policy-making bureaucrats, whose tenure and focus are tied more to voting cycles than to long-term progress and integrated success. As a result, administrators within the public sector face a different set of challenges when attempting to implement private-sector programs. The body of literature pertaining to the health care industry, and to the adoption of private-sector health care programs for use within public-sector agencies, is thin. There are only a scant few examples of successful adaptations of private-sector social models in correctional settings , through which researchers can gain an understanding of the foundational underpinnings that have made these undertakings work. Within the correctional literature on implementations, no examples were found of health-care-sector program adaptations. Most studies of program implementations are examples of failure. Pressman and Wildavsky wrote about the change efforts that the city of Oakland underwent as established and supported by the federal government. In this study, the authors reviewed projects aimed at granting or loaning monies to development efforts. A major goal of these attempts was to reduce systemic unemployment; however, this goal was never realized under the program that the researchers evaluated. Problems related to compliance with regulations, changes in leadership,vertical vegetable tower and many others stemming from lack of attention to the technical details of implementation led to ultimate program failure. While the implementation studied by these researchers was not the result of a required effort under which the federal government dictated the outcome of efforts, a direct connection to the implementation under study in this paper may be drawn. Pressman and Wildavsky note in their work that the technical details of implementation might be the most formidable barrier to implementing public policy. In this dissertation, the technical details of the program are reviewed to understand the process of successful implementation. Prior to turning to the technical details of this study’s implementation, it is useful to describe some peripheral knowledge about program implementation within the prison setting. The custodial setting is highly institutionalized in nature, as it has very strict and routinized behavior guiding most actions. As such, effecting change is a difficult, uphill battle . Linn provides an in-depth look at prison program failure and success, using information gathered from over 350 structured interviews with staff and inmate observations from five prison sites. Following Lin’s tradition, this dissertation also utilizes data from prison-program implementation and interviews. Her synopsis of those data argues that successful implementation requires attention to the details surrounding the attitudes and cultural context of both staff and inmates.
She frames the problem as an extension of Lipsky’s concept of the “street level bureaucrat.” Lipsky suggests that it is the line staff, rather than policymakers or agency directors, who actually make policy: “They exercise wide discretion in decisions about citizens with whom they interact. Then, when taken in concert, their individual actions add up to agency behavior” . Similarly, within the health care context of the custodial setting, it was found during this study that the workers carried much of the power. The success of administrator’s policies depended upon whether or not line staff decided to implement in a timely manner. It is beyond the scope of this study to research whether levels of adherence to administrative policy were functions of strong leadership skills on the part of managers. It is well noted, however, that power did reside in the non-management workers—and working within the confines of their subgroups’ cultural context was, as Lin suggests, a necessary condition for successful implementation. As introduced in the first chapter, the implementation of the chronic care model in the custodial setting of the CDCR environment faced numerous obstacles. Evidence from 34 empirical studies that looked at the differences between public agencies and private firms found that public entities were more bureaucratic and their managers had weaker organizational commitment than their private-sector counterparts . As a result it was concluded that due to these great differences, business practices or models developed in the private sector should not be transferred to the public sector. Private-sector companies appear to have greater success in adopting public-agency models, suggesting a unidirectional effect between sectors. For example, Khuri et al. concluded that the Veterans Affairs’ National Surgical Quality Improvement Program achieved positive health care outcomes when applied in private-sector hospitals, and the model was fully applicable to this sector. This suggests that the obstacles to change in the public sector may be more onerous than those faced by private-sector counterparts.Because private-sector organizations tend to face a set of challenges different from what confronts public-sector agencies, what are the characteristics of a program implementation that crosses these boundaries successfully? To understand how this can successfully occur, one must first understand how the public sector operates at the program level of analysis. Program-level analysis means focusing on how departmental units operate to achieve performance under a series of objectives that follow an overall goal—otherwise termed a program. The program level of analysis differs from the organizational unit of analysis in some significant ways. The former may take into consideration how the departments coordinate collaboratively with other departments both within and external to the organization. While not all programs require external collaboration, the program under review in this study did; therefore, attention was paid to how these external collaborations and interactions took place. In the setting under review in this study, the organizational sub-units were tightly coupled in that physical colocation existed, and the various organizations were concentrated under a common set of oversight bodies . The various correctional agencies brought together under the program had varying missions and organization-level goals, and they tended to have distinct objectives due to the differences in both mission and organizational need to interact with nonpublic entities. Analyzing this implementation at the program level of analysis provides insight into the operation of individual organizations and the differences in how they react to changes in program direction over time. Program-level analysis provides a better level of understanding of managerial behavior than would standard organizational-level analysis when analyzing the implementation of a program such as the chronic care model. Using the organization’s behavior as the unit of analysis to describe program performance eliminates discussion of the behavior that occurs at the organization’s departmental level because focus remains at the higher, overall enterprise level. Program-level analysis describes performance outcomes specific to program objectives, so it can improve the understanding of how administrative behavior was dictated by program-level requirements. This provides a more direct understanding of the linkage between managerial focus and outcomes in program focus. When studying at the program level of analysis, behaviors—or characteristics—of the program are evaluated. As a concept, critical success factors are defined as “the limited number of areas in which satisfactory results will ensure successful competitive performance for the individual, department” .