Using Behavioral Systems Analysis to Improve the Clinical, Administrative, and Supervision Functions in ABA Service Organizations KYABA 2016 Heather M. McGee, Ph.D.

Two Approaches to Organizational Change Make the Change* and Then Identify and Implement Required System Supports Identify and Implement Required System Supports and Then Make the Change* Add new clients Hire more staff Start billing insurance Provide BCBA supervision Unit name

Choose Your Own Adventure Add new clients Hire more staff Start billing insurance Provide BCBA supervision Unit name

Considerations Approach #1 Approach #2 Very fast implementation of change Gives appearance of being an adaptive organization Can get in over your head Requires retrofitting the organization to meet demands placed on system by the change Slower implementation of change in the beginning Will become faster once system variables have been initially mapped and org has gone through the process once or twice Creates an adaptive and proactive organization Unit name

Considerations Approach #1 Approach #2 Very fast implementation of change Gives appearance of being an adaptive organization Can get in over your head Requires retrofitting the organization to meet demands placed on system by the change Slower implementation of change in the beginning Will become faster once system variables have been initially mapped and org has gone through the process once or twice Creates an adaptive and proactive organization Unit name

Behavioral Systems Analysis (BSA) Recognizing an organization as an adaptive system Understanding that a change in one part of a system affects other parts of the system Use BSA Tools to assess impact of change on organizational system We’ll go through one tool (Organizational System Mapping) during this presentation and I will make suggestions at the end for other tools and how to use them Unit name

Define the Change Our starting point, this is the change in the system that we are considering Need to identify HOW this change impacts the parts of the system Note that we are saying HOW and not WHETHER BSA assumes a change in one part of system affects other parts of system Unit name

Define the Change Hire more staff: We would like to add __ BCBAs, __ BCABAs, and __ RBTs over __ amount of time Unit name

Analyze Impact on System Once we have defined the change, we can begin analyzing how the change will impact the system This allows us to determine whether the current system supports the change Shows us where system changes need to occur in order to support the change Unit name

1. Clients Would quality of service be impacted by new hires while they in training? Would quality of service be impacted by current staff who need to train new staff? Unit name

What is our mission? Why do we exist? Do we have a strategic plan and has it been updated in the last 3-5 years? Is internal growth part of our strategic plan? Unit name

3. Products/Services How would recruitment, hiring, placement, onboarding, and training new staff affect our product and service provision? Can we afford the temporary decrease in productivity and quality of care that comes with pulling experienced staff away from the client to handle new staff requirements? Unit name

3. Products/Services Would new staff mean offering new products/services? Can we afford the resources it would take to develop those new products/services? Unit name

4. Internal Standards & External Feedback Would adding new staff have a positive or negative impact on new or current clients’ experience in the short term (during onboarding and training)? In the long term? Do we have the resources to get new staff performance levels to internal standards of excellence within a reasonable timeframe? Are we ok with a temporary decrease in quality of service and/or consumer feedback? Unit name

4. Internal Standards & External Feedback Would adding new staff negatively impact morale/satisfaction of current staff in the short term? Long term? Unit name

5. Resources/Suppliers Do we have the resources to add more staff right now? Training Coaching Ongoing Performance Support Payroll/Benefits Financial Resources to pay them Can we reasonably expect (afford) to increase resources in order to increase capacity for these things? Unit name

5. Resources/Suppliers Can our suppliers support this? Can we get more qualified staff? Where would they come from? Would we need to utilize new technologies (behavior analytic or otherwise) in the hiring, onboarding, training, and/or performance support processes? Do we have or can we get that technology? Will current staff be able to effectively utilize the technology? Would it require training? Unit name

5. Resources/Suppliers Can our suppliers support this? Can we afford to procure more materials and/or equipment? Is more funding available? How would we secure it? Unit name

6. Organizational Functions What would be the effect on the various functions of the organization? Leadership/Supervision Product/Service Provision Support Functions Administration Functions Unit name

6. Organizational Functions – Leadership/Supervision Are organizational leaders prepared to make required systems changes? Will strategy, policies, or procedures be affected? How will leaders communicate changes? Unit name

6. Organizational Functions – Leadership/Supervision Will hiring more staff require changes to how we manage performance or provide BACB-based supervision services? Are supervisors able to increase supervision and/or training load? Will quality of supervision, training, and/or service suffer? Unit name

6. Organizational Functions – Product/Service Provision Will new staff mean increased workload for existing staff? What is the optimal staff to client ratio? Can we meet these numbers while the new staff are getting trained? Will quality of service provision suffer? Unit name

6. Organizational Functions – Support Functions Will it be possible to provide instructionally sound, performance-based training? Who will train? How will the allocation of resources during hiring, onboarding, and training impact client service? How will it impact existing staff? Unit name

6. Organizational Functions – Support Functions Will employee satisfaction and/or workplace morale be impacted? Could employee retention be impacted? Is the selection and placement process sound? Unit name

6. Organizational Functions – Administration Functions If adding new staff means adding new clients, do intake, billing, and records keeping have the human and technology capacity to handle new/more client records? Do we have the administrative staff and expertise to handle more employees? Unit name

7. Environmental Factors How will external factors impact the organization if we increase the number of staff? Regional Economy Funding Opportunities Regulations ACA/Insurance Licensure Certification Unit name

8. Competitive Advantages Considering the impact on all other components of the system, would this change increase or decrease our competitive advantages? Unit name

What if we’ve ALREADY made a big change? Unit name

Are You Experiencing Negative Impact in One or More of These Areas? Clients Mission Products/Services Internal Standards/External Feedback Resources/Suppliers Organizational Functions Leadership/Supervision Product/Service Provision Support Functions Administration Functions Environmental Factors Competitive Advantage Unit name

1. Clients Would increasing or decreasing the number of clients we’re serving right now or over time help? Can we do that? Can we (right now or over time) take on different types of clients to better match our system? Unit name

2. Mission Does our mission need to be adjusted to match our current and future trajectory? Unit name

3. Products/Services Can we add, eliminate, or alter services to reduce strain on the system? Unit name

4. Internal Standards & External Feedback Do we need to adjust our internal standards? Are we ok with doing this? Are there things we can do to bump consumer satisfaction that won’t put additional strain on the system? Unit name

5. Resources/Suppliers Can we bring in more resources? Labor Technology Equipment & Materials Financial Can we reallocate current resources to ease strain on the system? Unit name

6. Organizational Functions – Leadership/Supervision What are our leaders doing to address the situation? Should we bring in outside help (OBMers)? What are we learning from this experience that we can apply in the future so we don’t keep making decisions that put undue strain on our system? Unit name

6. Organizational Functions – Product/Service Provision Have we analyzed our processes? Can we make our processes better? More efficient? Can we improve cross-functional relationships to improve service provision? What alterations to service provision, training, and supervision can we make to ease the strain? Can we reassess job roles and responsibilities? Unit name

6. Organizational Functions – Support Functions Are there changes we can make to our training and other support systems, using the resources we have? Can we afford to bring in more support staff to help ease the strain? Can we send our current staff to training, if we are experiencing a skills deficit issue? Unit name

6. Organizational Functions – Administration Functions Are there changes we can make to our administrative systems, using the resources we have? Can we afford to bring in more administrative staff to help ease the strain? Can we send our current staff to training, if we are experiencing a skills deficit issue? Unit name

7. Environmental Factors How can we better use environmental factors to our benefit? Regional Economy Funding Opportunities Regulations Can we put someone in charge on monitoring these variables and designing system responses to them? ACA/Insurance Licensure Certification Unit name

8. Competitive Advantages What can we learn from our competitors? What are they doing better than us? Do we still have competitive advantages? How do we leverage them? Unit name

The Big Take-Away Chaotic Growth Controlled Growth Bring in new staff now, figure it out later Capacity concerns Potential negative impact on quality of service Potential negative impact on employee training and satisfaction Turnover, client dissatisfaction, bad word of mouth, loss of clients Understand the impact Identify needed changes in advance You don’t exist without your clients and employees, so the impact on these two groups is of critical importance Unit name

Questions or Comments? For more information: heather.mcgee@wmich.edu