Using Behavioral Systems Analysis to Improve Large Scale Change Initiatives in Autism Service Organizations

Abstract

Large scale organizational change initiatives are certainly difficult endeavors. But when we implement large scale change initiatives without properly assessing the impact the changes will have throughout the organization, we make the changes harder than they need be. Organizations tend to take one of two paths when implementing large scale change initiatives. The first path is to implement the change initiative (e.g., grow your client base, hire more staff, add a new service, begin serving a new market) and then identify and implement any system changes and supports required to support that initiative. The second path begins with identifying and implementing required system changes and supports and then implementing the change initiative. While the second path requires a slower implementation of the change, change initiatives in general will become faster once system variables have been initially mapped out and the organization has gone through the process once or twice. Additionally, rather than creating the appearance of being an adaptive and proactive organization, the second path actually produces an adaptive and proactive organization. Therefore, it is the second path that will be the focus of this paper, and this path relies on behavioral systems analysis.

Large-scale organizational change initiatives are difficult endeavors that require significant time and resources and can often fail. However, when we implement large-scale change initiatives without properly assessing the impact the changes will have throughout the organization, we make the changes harder than they need be (Laffoley, 2013). Organizations tend to take one of two paths when implementing large-scale change initiatives. The first path is to implement the change initiative (e.g., grow your client base, hire more staff, add a new service, begin serving a new market) and then identify and implement any system changes and supports required to support that initiative, either through deliberate analysis of the effects on the system or through a more informal assessment of system impacts (make changes as necessary, or as problems arise). The second path begins with identifying and implementing required system changes and supports and then implementing the change initiative. The first path allows for fast implementation of change and gives the appearance of being an adaptive organization. Unfortunately, this path can also require significant retrofitting of the organization to meet the demands placed on the system by the change. In other words, change in one part of the system affects other parts of the system (Brethower, 1982, 2000, 2001; Rummler, 2001). Adding a significant number of new clients, for example, is likely to result in increased demand for human resources (clinicians, administrators), which increases demand for onboarding and training. It could also result in a need for more materials, physical space, and even services.

The second path requires a slower implementation of the change, especially in the beginning of the initiative when the system is analyzed and requires changes and supports are identified and implemented. However, change initiatives in general will become faster once system variables have been initially mapped out and the organization has gone through the process once or twice. In addition, rather than creating the appearance of being an adaptive and proactive organization, the second path actually produces an adaptive and proactive organization. Therefore, it is the second path that will be the focus of this article. However, we understand that it is not always possible to complete a comprehensive, proactive analysis; therefore we will also provide strategies for conducting a post-hoc systems analysis.

Behavioral Systems Analysis

Behavioral systems analysis is a methodology for improving performance that blends applied behavior analysis (ABA) and general systems theory. Whereas the focus of ABA is on the analysis and improvement of socially important behaviors (Bailey & Burch, 2018), the focus of applied general systems theory is on the analysis and improvement of the relationships among the parts of a system (including organizational systems), as well as the relationships between the system and the external environment (Kast & Rosenzweig, 1972). Therefore, BSA is a performance improvement approach that relies on analysis of both the organizational system and the behaviors of the individuals who work within that system. A core tenet of BSA is that organizations must be adaptive systems in order to survive (Rummler & Brache, 2013). In other words, organizations must function as open, not closed, systems (Bertalanffy, 1950). Another core tenet of BSA (and general systems theory) is that changes in one part of a system affect other parts of the system. Therefore, any planned systems changes should consider the impact of the change on all parts of the system.

The BSA approach requires following an analysis and improvement process across multiple levels of performance. Following a process ensures that systems changes are made only after understanding the impact of those changes on the system, and that interventions are based on an assessment of the variables maintaining problem performance or suppressing optimal organizational performance (Austin, Carr, & Agnew, 1999). Several analysis processes are available, including Malott’s (1974) ASDIER (analyze, specify, design, implement, evaluate, and recycle) process and Rummler’s (2004) results improvement process (desired results determined and project defined; barriers determined and changes specified; changes designed, developed, and implemented; and results evaluated and maintained or improved). It should be noted that analysis and improvement processes are not exclusive to BSA. In six sigma and lean six sigma methodologies, the DMAIC (define, measure, analyze, improve, control) process is standard (Borror, 2009), whereas in instructional design the ADDIE (analyze, design, develop, implement, evaluate) is considered best practice (Beckschi & Doti, 2000). Each model includes the fundamental requirements for effectively improving performance; that is, (a) analyze the problem, (b) identify and implement solutions, and (c) determine whether the changes made affected performance.

Organizations are complex systems operating across multiple levels. Though BSA frameworks analyzing four to six different performance levels exist (Addison & Haig, 2013; Gilbert, 1978; Malott, 2003; Rummler, 2004), the most commonly used multilevel framework in BSA is the three-levels approach (Rummler & Brache, 2013). This framework is used to analyze and improve performance across the organization, process, and performer levels of the organizational system. At the organization level, we analyze the environment in which the organization operates, strategies that organizational leaders will employ to adapt to changes in that environment, and whether the organization is structured in a way to support the strategies employed. At the process level, we analyze how work gets done, which includes the steps taken and decisions made, sometimes across multiple functions or departments of the organization, to convert inputs into outputs. Finally, at the performer level, we analyze the job design characteristics and antecedents, behaviors, and consequences of the individuals who work within the system.

Conducting BSA for a Large Scale Change Initiative

In order to follow the second path for implementing a large-scale change initiative, we must (a) follow the BSA process to analyze and specify the changes required throughout the system—the A and S phases of Malott’s (1974) ASDIER process, and then design, implement, evaluate, and recycle (the D, I, E, and R phases)—appropriate changes across each of the three levels of the organization. For illustration purposes, we will follow a common ABA organization large-scale change example: increasing the number of clients served. We will use a hypothetical organization to describe the second path—the BSA path for organizational change efforts. For the sake of space, we will be focus on the “analyze” and “specify” phases of Malott’s (1974) ASDIER process, and will cover the organization level of analysis in detail. We will provide a brief description of how the rest of the process, along with the other two levels of analysis (process and performer) might be applied in our example. The process starts by defining the large-scale change initiative so it can then be analyzed.

Define the Change

Before we can begin analyzing the system impacts of growing the client base, we must first operationally define the change. When a change is organization-wide, it is helpful to frame it as a SMART strategic goal (Doran, 1981). Several variations exist (Haughey, n.d.), but one version of a SMART goal is that it is specific, measurable, accountable, realistic, and time-bound. Specific (S) goals explicitly state the direction of change (e.g., increase) and the specific accomplishment sought (e.g., number of clients receiving ABA services). Measurable (M) goals state the exact amount of the change (e.g., by 50%) sought. Accountable (A) goals ensure that the initiative has an owner at the leadership level (e.g., Heather). Realistic (R) goals ensure that amount of change and the timeline (T) for achieving the change are reasonable (e.g., 50% within 5 years). Table 1 shows the initiative of increasing the number of clients served rewritten as a SMART strategic goal.

Table 1.

SMART strategic goal

	Direction of change (S)	Accomplishment (S/M)	Amount (M/R)	By When (R/T)	Owner (A)
Strategic Goal Example:	Increase	number of clients receiving ABA services	by 50%	within 5 years	Heather

Analyze the Impact

Once we have defined the change, we can begin analyzing how the change will affect the system across the three levels of performance. This will allow us to determine whether the current system supports the change and where system changes need to occur. We can use a common BSA tool, organizational system mapping (also referred to as total performance system or supersystem), to conduct the analysis (Brethower, 1982; Diener, McGee, & Miguel, 2009; Rummler & Brache, 2013) (Fig. 1).

Fig. 1.

Organizational system map

Mission. First we need to determine whether the change is aligned with our mission and strategy. Sometimes organizations are faced with opportunities that seem enticing, but that are not really well aligned with what the organization says it is and why it exists. Over time, taking advantage of these opportunities could potentially lead to considerable “mission drift,” or an unintentional shift away from the stated mission of the organization (Jones, 2007). Table 2 presents specific mission/strategy-focused questions along with our organization’s answers to those questions.

Table 2.

Mission and strategy impact questions

	Mission	Strategy	Changes required
Questions	What is our mission? Does this initiative align with our mission?	Do we have an up-to-date strategic plan? Is this initiative part of our strategic plan?	Would changes need to be made to our mission or strategic plan? Is this something we are ok with?
Answers	Our mission is to provide gold standard applied behavior analysis services for individuals with autism and other developmental disabilities to help them and their families achieve their goals. This mission holds regardless of the number of clients served, provided we can increase our capacity to truly provide “gold standard” ABA.	Yes, our most recent strategic plan was drafted at the end of last year and targeted client growth as one of three strategic focus areas for the next 5 years.	This would not require a mission or strategy change, nor would we be comfortable with either. We are committed to our stated purpose and goals.

Clients and Client Feedback. Because organizations exist to provide products and/or services to clients or customers, the next step should be to identify the impact of the change on those clients. Because the initiative itself is to add new clients, we must analyze the system impacts on both the current and new clients. Table 3 presents specific client-focused questions along with our organization’s answers to those questions.

Table 3.

Client impact questions

	Client market	New and existing client impact	Changes required
Questions	New customer market? Existing customer market? New geographical region?	How does the initiative impact current client service provision? New client service provision?	What changes will need to be made to secure new customers? What changes will need to be made to continue to meet the needs of our existing customers?
Answers	Our market analysis indicates that we can increase the number of clients served by reaching out to our current client market (do not need to target a new market or geographical region)	Existing clients might see temporary decline in service quality as we will need to bring in new staff to serve new clients. This will pull existing staff from their duties as they train the new staff. New clients will also see this temporary decline in service quality. New clients will also require new materials and perhaps new physical space.	Will need to increase marketing to reach new clients. Will need to increase human resources in onboarding, training, clinical service, and billing. In order to continue meeting the needs of existing customers, we will need to bring in new staff and clients in stages, so as not to overtax the current system.

Products and/or Services. Next, we need to determine how the change affects our product/service offerings. Sometimes large-scale changes affect current product/service offerings and sometimes the changes require adding new products/services and/or removing products/services. For example, serving new clients might involve providing new assessment services or it might mean focusing more on core service provision and stop providing other services, such as professional workshops. Table 4 presents specific product/service-focused questions along with our organization’s answers to those questions.

Table 4.

Product/service impact questions

	Products/Services	Product/Service impact	Changes required
Questions	Which products and/or services are most directly involved in the initiative? Which products or services will affect or be affected by the initiative?	How are the products/services affected by the initiative?	What changes will need to be made to the products/services themselves? What changes will need to be made to how we produce and deliver the products/services?
Answers	Increasing clients served will impact: 1. ABA service delivery 2. Professional workshops	The services will be affected as follows: 1. Increased capacity required 2. Eliminated	Depending on the clients we add, we may need to provide more severe behavior reduction programming, more daily living skill training, or more academic programming. We will need to determine whether changes in any or all of these programming types is currently feasible (may dictate the specific clients we take). We will need to move to electronic data collection because paper will no longer be practical. Need to reallocate resources from workshops to ABA service delivery, which means eliminating workshops.

Internal Standards and External Feedback. Once we have identified the impact on product/service offerings, we need to determine how the initiative affects our product/service feedback loops. Organizations should seek feedback from their customers/clients, but should also assess performance internally (Rummler & Brache, 2013). Client feedback should be formally solicited on a regular basis. This can be done through paper or electronic surveys, though organizations should not overwhelm families with surveys or they may see response rates decrease dramatically over time. In addition, organizations can take advantage of interactions with families to solicit more informal feedback. Organizations should set internal standards around each product or service. Measures and standards at the organization level typically involve some combination of quality, quantity, timeliness, and/or cost. Table 5 presents specific standards and feedback questions along with our organization’s answers to those questions.

Table 5.

Standards and feedback impact questions

	Internal standards	External feedback	Changes required
Questions	How do we currently measure performance related to the relevant services? What are our current internal standards for the services? How would these be affected?	How satisfied are our current consumers and their families? Would the initiative have a positive or negative impact on new or current clients’/families’ satisfaction?	What changes will need to be made to how we assess performance?
Answers	Quality Measures/Standards: Tx integrity, IOA on service provision, and client progress toward goals/goal attainment, but do not have explicit individual (employee/client) or aggregate standards in place for these measures Impact: Need to begin measuring and collect data before making further determinations Quantity Measures/Standards: Number of clients served and authorized hours vs actual hours, but do not have explicit standards for these measures Impact: Need to analyze data, set standards, and determine resources required to reach standards Timeliness Measures/Standards: Milestones: 1. Preauthorization (< 3 days) 2. Initial assessment/screening (< 3 days) 3. Service recommendation report (< 5 days) 4. Authorization/Reauthorization (< 5 days) 5. Client program/Update (< 5 days) Impact: Need to run analysis to determine whether we will still be able to meet all standards with additional clients in system. Cost Measures/Standards: Authorized/Actual Hours; Billed/Reimbursed Hours; Labor costs Impact: Determine how each of these will change and have finance run analysis to determine financial impact.	Current satisfaction ratings on our biannual satisfaction survey averaged 4.3 out of 5 (range 4.1–4.6) on our “Big 5” questions. This is up from the previous implementation results (average 4.0; range 3.8–4.2). 1. How satisfied are you with your child’s progress? 2. Are we consistently meeting your needs and the needs of your child? 3. If a friend or family asked you whether you would strongly recommend our services, how likely would you be to say “yes, without hesitation”? 4. How well do you understand your child’s program and outcome goals? 5. How strongly do you agree with your child’s program and outcome goals?	Improve internal data collection and analysis. Will need to hire additional 1 FTE into OBM position to design and track measurement systems.

Resources and Suppliers. Organizations use four main types of resources to create their products and services and serve their customers: (a) labor resources (people); (b) financial resources (money); (c) physical resources (materials, equipment, tools, space [METS]), and technology resources (the actual know-how required to provide science-based services, as well as the computer technology to provide the services more effectively and efficiently; Brethower, 2000). Strategic goals typically are written around products and services, competitive advantages, and/or new markets (Rummler & Brache, 2013). Changes in each of these areas require corresponding changes to resources, either in the specific resources required, or how those resources are allocated and/or used. Therefore, any major initiative should involve first analyzing the impact of the initiative on current resources and suppliers.

Continuing our organizational example, serving new clients requires staff. Before growing our client base, we need to determine whether our current staffing levels are sufficient. This means looking at capacity and determining what our ideal staff to client ratios are for the (a) leadership and supervision (e.g., BCBA, BCaBA, clinical director), (b) service provision (e.g., RBT, behavior tech), (c) support (e.g. training, selection), and (d) administrative (billing, scheduling, intake) functions. In other words, we would want to determine the optimum proportion of management and supervisory staff to direct-care workers, direct-care workers to clients, trainers and other support staff to clinical staff, and schedulers and other administrators to clients and staff in order to ensure the successful design and delivery of, along with reimbursement for, services to our new and existing clients. Almost invariably, and unless you are currently operating below capacity across the board, an increase in clients will require an increase in staff.

An increase in staff necessitates an increase in financial resources and opportunities (you must be able to pay the staff you hire). Increasing the number of clients will also result in additional need for METS.. Materials and tools that facilitate service provision and other critical business functions (e.g., curricula, reinforcers), as well as physical space and equipment requirements (e.g., phones, computers, play equipment) will have to be assessed. Adding METS resources will require financial resources (again, you must be able to pay for them). Serving new clients might also require additional technology. If the new clients will receive new services, individuals with expertise in those services (technology of the science) will have to be hired or trained (making this both a technology and labor requirement). More clients might also require adding computer technology (e.g., moving to electronic data collection). Of course, all of this would again require money (adding anything in an organization is likely to cost money). Given the expenses involved (especially on the front end) in any large initiative, including adding new clients, a detailed financial assessment should be conducted in advance of implementation.

All resources (financial, human, METS, technology) come from somewhere. It is not enough to analyze what we have and determine what we need; we also need to determine whether we can get the required resources from our current suppliers of those resources. For example, if we determine that we need to hire additional BCBAs, we need to determine whether our current BCBA suppliers (e.g., job sites, university job fairs) will be able to meet our increased demands. If not, we might need to find new suppliers to either supplement or replace existing suppliers. Table 6 presents specific resource and supplier questions along with our organization’s answers to those questions.

Table 6.

Resources and suppliers impact questions

	Resources	Suppliers	Changes Required
Questions	Financial:Do we have sufficient financial resources to support the initiative? Human:Do we have the necessary staff to meet all staff related initiative requirements? METS:Do we have the necessary METS resources to support the initiative? If the initiative will require new space, do we have the necessary materials/furniture to properly set up/arrange that space? Technology:Do we have the know-how and computer technology to support the initiative?	Financial:Is more funding available? Can we negotiate new reimbursement rates? Can we add new funding sources? Human:Can we get more qualified staff? From where? METS:Can we secure additional materials and space/furniture, if necessary? Technology:Can we build, hire, or buy the know-how and computer technology resources (expertise, software)?	What changes, if any, need to be made to secure additionalFinancial/Human/METS/Technologyresources? Will existing resources need to be reallocated? How?
Answers	Financial: Need to analyze the rest of the system components before making this determination. UPDATE: Need financial resources to support new building/furnishings (lease or take out loan) and hiring additional 9 staff up front (use existing financial resources). Eliminate workshop services to free up more financial resources. Human: Need to hire an additional 9 FTEs up front (1 BCBA, 1 BCaBA, 3 RBT, 1 OBM-PM, 1 OBM-T&D, billing, scheduling) with more added as we continue to add clients. METS: Will need new building, furniture/equipment, curriculum materials, reinforcers. Technology: Will need to switch from paper to electronic data collection. Need to bring in billing specialist with expertise in billing codes. Need to begin using scheduling software and improve scheduling process.	Financial: Can secure an appropriate loan from our bank if necessary Human: Will need to expand where we advertise for clinical staff (will likely need to hire from outside of our geographical area). Will recruit through job fairs at universities with behavior analysis programs and national ABA conferences. Will recruit for OBM staff through known OBM professors. Will recruit billing and scheduling through online job finder sites. METS: At least 3 potential buildings available right now in desired area. Technology: Need to research available options in terms of reviews, costs, and ongoing help/service available.	Financial: Reallocate workshop financial resources to service provision Human: Begin aggressively recruiting new staff; reallocate caseloads during transition; offer employee incentives (TBD) to offset negative impact of increased workload. No new clients assigned to A.S., C.B., or T.M. during training. METS: Analyze physical layout and space/materials utilization at L.S. and B.R. sites—identify furniture/materials that can be reallocated to new site Technology: Will need to switch from paper to electronic data collection. Need to bring in billing specialist with expertise in billing codes. Need to begin using scheduling software and improve scheduling process. Will require organization-wide trainings and communications.

Organizational Functions. Organizations use resources to design, develop, and deliver their products and services to clients/customers. To convert those resources (inputs) into products/services (outputs) effectively requires the work conducted throughout the various functions of the organization. Therefore, we must assess the impact of any initiative involving resources, products/services, or clients on the relevant organizational functions, including leadership and supervision, product and service provision, support functions, and administrative functions. Table 7 presents specific organizational function questions along with our organization’s answers to those questions.

Table 7.

Organizational functions impact questions

	Organizational function impact	Changes required
Questions	Leadership/Supervision:Are organization leaders prepared to make required systems changes? Will strategy, policies, or procedures be affected? How will leaders communicate changes? Will the initiative require more supervision of staff? Are supervisors able to increase supervision load? Will quality of supervision suffer? Product/Service Provision:Will the initiative mean increased workload for staff? What is the optimal staff to client ratio? Will quality suffer? Support Functions:If initiative requires hiring new staff, can we provide instructionally sound, performance-based training? Who will train? What will client impact be during training? Will client/employee retention be affected? Do we have HR systems in place to support more staff (selection, onboarding, compensation/benefits, legal compliance, employee relations, staff development/succession planning)? IT systems in place? Administrative Functions:Do intake, billing, scheduling, and records keeping have the human and technology capacity to handle increased demand?	Leadership/Supervision:What changes must occur within leadership to ensure smooth transition from where we are to where we want to be? Product/Service Provision:What changes must be made to avoid/ameliorate decreases in service provision quality? To avoid increasing current staff’s workload beyond capacity? Support Functions:What changes must be made to ensure new staff are properly trained and potential for negative client/employee impact during staff training is minimized? Administrative Functions:What changes must be made to build capacity in the intake, billing, scheduling, and records keeping functions? If these functions are currently external (contracted with vendor), should they be brought in-house? If they are in-house, should they be outsourced?
Answers	Leadership/Supervision:Leadership is 100% committed to supporting the initiative if the final determination based on this analysis is that it should move forward. Strategy and policy should not be affected, but procedures around scheduling will be. In addition, new staff will require supervision beyond our current capacity, which means we will need to hire. Will have period of working over capacity, which will require careful management and messaging. Product/Service Provision:Changes will result in temporary increases in workload for most employees. Expect temporary decrease in quality of service. Support Functions:Do not have appropriate training and performance management systems in place to support increased staff. Administrative Functions:Do not have sufficient billing and scheduling resources in place to support change.	Leadership/Supervision:Communications will be drafted and tested in advance and all changes will be announced in advance and feedback/questions will be solicited and addressed in town hall meetings BEFORE implementation. Product/Service Provision:Task force (clinical, finance, scheduling, training) will be put together to determine optimal staff/client ratios. Analysis will be conducted and results analyzed prior to implementation of change. Will work with HR and marketing to create messaging. Support Functions:Hire OBM-T&D and OBM-PM experts to work with clinical to design and develop scalable training and performance management systems. Administrative Functions:Hire additional billing and scheduling employees.

Leadership and Supervision. Large-scale change will always require extensive time and effort from leadership. Failure at the leadership level has the greatest potential to destroy not only the current change initiative, but any future initiatives as well (Laffoley, 2013). Therefore, the actions of leadership are critical. One of the most critical leadership actions will be the effective communication of (a) the goals themselves, (b) the system changes required to achieve those goals, and (c) the rationale behind the goals and changes, including how the employees and clients benefit, both directly and indirectly (McGee, 2017). The last piece might be the most critical—without it, we are unlikely to get the organizational members “on board” with the initiative. This is not surprising given that large-scale change is likely to require more and/or new work, at least in the short term, for the majority of the organization’s employees. Most of us do not look forward to doing more work, especially when the value (both for the organization and for us personally) of doing that work hasn’t been made clear. Leadership should assess and understand the best way to communicate with its employees and ensure that the members of the organization are receiving and hearing the correct messages regarding the potential changes. Another element leadership must address is how the change will affect the already established strategy, policies, or procedures of the organization. Implementation of the change must be accompanied with clear messaging across the board. If policies will change as part of the initiative, this should be decided in advance, and the impact of those changes understood.

In addition to leadership impact, we also must assess how the change affects day-to-day management and supervision. Continuing our example, if new clients will require new clinical staff, and the new staff will require supervision for certification purposes, we must now factor those time requirements into our staff to client ratio calculations (see Resources and Suppliers, above).

Product and Service Provision. Next, we need to assess the impact the change will have on our product and service provision. It would be ideal if the organization is already measuring service provision quality through customer feedback, internal observations/reviews, and outcome measures. Not only do these indicators tell us a lot about the success of our products/services, but they also provide us with key information regarding optimal supervisor/employee/client ratios. This is especially true if we also purposefully and methodically adjust these ratios and measure their effect on organizational metrics over time. However, this can be a difficult to impossible feat to accomplish in an environment where confounding changes, such as client absences, are occurring regularly.

In our current example, increasing the number of clients served will increase the workload of current staff (even if we hire new staff). If the current staff are already working at capacity, this will have a negative impact on some aspect(s) of performance. In addition, if our change requires hiring new staff, this will likely have a direct, though one hopes temporary, negative impact on clinical service quality. This is because the new staff will have to be trained, which typically involves existing staff to some extent. In addition, if new clients are brought on before new staff are completely independent, existing staff will have to assume additional responsibilities to ensure the clients receive adequate services.

This might be the area of strategy impact that can have the largest and longest lasting effect on the organization. Burnout in ABA service organizations is a real problem that has both obvious and hidden repercussions (Plantiveau, Dounavi, & Virués-Ortega, 2018). The most obvious repercussion is high turnover, which increases costs for the hiring process (selection, placement, and training) and affects service provision to current clients. Boushey and Glynn (2012) estimated the cost of employee turnover as 21% of an employee’s salary. The hidden costs are decreased productivity (because now the organization has to do more with less) and decreased reputation with current and potential clients and the potential pool of applicants from which the organization can draw. Failure to understand the impact of large-scale change on employees and take action to support them during times of change can create a negative reputation that stays with the organization for years to come.

Administrative and Support Functions. Administrative and support functions will also be affected by large scale change efforts. Once we understand the impact on service provision, we should be able to identify which administrative and support functions will need to be involved in the change effort, how they will need to be involved, and what resources they will require to ensure success. For example, serving new clients (assuming this will also require hiring new staff) will affect the selection function (recruitment, hiring, onboarding), the training function, scheduling, HR functions (payroll and benefits, legal, discipline/termination), intake, billing, and records keeping. Further assessment of, for example, intake, might show that we do not currently have the capacity to intake the increased number of clients efficiently and with the same level of personalized care that we have taken to this point. If this is important to us, we must determine if we can afford to increase resources to intake to ensure quality does not suffer.

Environmental Factors. One of the final areas of analysis is environmental factors. These factors are external to the organization, but affect organizational performance nonetheless. When analyzing environmental factors relevant to ABA service organizations, we might look at how the regional economy, funding opportunities, insurance, licensure, and certification would affect our ability to achieve our strategic goal. For example, if insurance requires that services be provided by individuals who are licensed and/or certified, this will affect our staffing around serving new clients. If we will require BCBAs and BCaBAs, we will need to ensure that the applicant pool for these roles (our resources and suppliers) can support our planned increase (i.e., that we can find enough BCBAs and BCaBAs to hire). Table 8 presents specific environmental factors questions along with our organization’s answers to those questions.

Table 8.

Environmental factors impact questions

	Environmental factors impact	Changes required
Questions	How do the following environmental factors affect whether, when, or how we undertake this initiative? What is the current state of each of these factors? What trends do we see in the near and long term? How will those anticipated trends impact our initiative? • Regional Economy • Market • Funding Sources/Insurance • Licensure • Certification	What system changes will need to be made to appropriately and proactively respond to the demands placed on our organization by these external/environmental factors?
Answers	Regional Economy: Regional economy is improving; trend expected to continue. Market: Client market is growing and trend anticipated to continue over next several years. Employee market is growing, but much more slowly than client market. More competitive environment. Must match/exceed competitors on employee expectations around compensation/benefits, reputation, hours, performance requirements. Funding Sources/Insurance: Current relationship with funding sources is not strong enough to negotiate better reimbursement rates. Only working with Medicaid and 2 insurance providers. Need to expand. Insurance service coverage changes are difficult to anticipate in current climate Licensure: No anticipated licensure changes in next 3–5 years Certification: Will be moving to 5th Edition Task List. Will require supervision changes.	Regional Economy: Continue to monitor Market: Aggressively recruit employees from broader area. Conduct competitor analysis to determine where we stand re: compensation/benefits, reputation, hours, performance requirements. Funding Sources/Insurance: Add new billing specialist to work on relationship building with funding sources to both expand network and negotiate better reimbursement rates. Continue to monitor insurance coverage changes. Licensure: No anticipated licensure changes in next 3–5 years Certification: Add OBM-T&D and OBM-PM experts to build out training and performance management systems to map 5th Edition Task List

Competitive Advantages. Finally, after we have analyzed each of the preceding areas of the organization to determine the system requirements for achieving the strategic goal, we must make a final determination as to whether this change would either create or expand an organizational competitive advantage or reduce or eliminate a competitive disadvantage (Rummler & Brache, 2013). If it would not either create/expand an advantage or reduce/eliminate a disadvantage, it is not in the organization’s best interest to follow through on this particular strategy. Continuing our example, leadership must review the results of our analysis and come to consensus on whether this strategy is worth pursuing. Let us assume that our leadership team has decided to move forward with the strategic goal of adding new clients. Based on our analysis, the next steps would be to conduct the additional, more in-depth analyses indicated, begin the process of purchasing or leasing a new site, and build and begin recruiting for the new job positions.

Post-Hoc Analysis and Improvement

Many organizations find themselves in the position of having already implemented a large-scale change effort without having first completed a BSA to determine the system requirements. This is understandable given the amount of work involved in such an assessment and the desire to help individuals in need of services as much and as quickly as possible. Unfortunately, failure to analyze the system requirements beforehand can result in either failed or struggling initiatives. If an analysis is not conducted and improvements made at this point, the organization could find its reputation with both clients and employees damaged beyond repair.

Let us imagine our organizational example is the same, only now we are approaching it from a post-hoc rather than a prechange analysis perspective. In other words, let us imagine that we increased the number of clients we serve, but did not conduct a systems analysis or make systems changes in advance of bringing on new clients. It should not be surprising to find that our organization is experiencing negative impacts around the change. We may be experiencing an increased level of employee turnover, decreased family and employee satisfaction, and dramatically reduced cash reserves. Rather than accept these impacts as inevitable and permanent, or cross our fingers and hope that the issues resolve themselves, we decide to conduct a post-hoc analysis to determine what, if anything we can do to improve performance and avoid future problems.

Soon after our initial change is implemented, our organization will begin to experience the direct effects of the change. The detriments to the change are often the most conspicuous and can have large impacts. It is important to keep track of the issues as they arise, as some may be immediate whereas others may be delayed (e.g., billing cycles). Documenting and tracking the repercussions of change has the benefit of categorizing the issues to determine root causes, guiding resources to solve issues, and being a reference guide for future changes.

These “pain points” can and should be analyzed using the same system categories as above to determine the root cause and potential viable solutions. Below are examples of common problems, and potential solutions, which may result in going forward with a large organizational change without doing a thorough assessment. In this example, as above, the organization increased its client base by 50%.

Mission

When any large organizational change is completed, it is helpful to take a step back and review our strategy and mission statements to check for alignment. Often, the work within an organization can evolve over time based on changes in the community, the client base, health and insurance policies, and new and emerging research and tactics, to name a few. Assessing and modifying our mission and vision statements helps to provide guiding direction to our organization and should match the work that is currently being completed as well as the vision for our organization for the future (Pearce & David, 1987). See Table 9 for examples of how we might assess and change the vision based on the effects of an increase in clients.

Table 9.

Post-hoc mission and strategy impact questions

	Mission	Changes required
Questions	How has the increase in clients affected our mission and strategy?	Would changes need to be made to our mission or strategic plan? Is this something we are ok with?
Answers	Depends on our mission and strategy. If the mission is to provide best care possible and we are seeing client care and provision slip then it may be necessary to temporarily alter our mission or strategy to align with your current organizations performance	A temporary change may be necessary. The organization may need to cut back on services it provides until changes can be made that are aligned with the original mission. For example, the organization could temporarily halt its assessment services and only take on clients who have been assessed and have established treatment plans.

Clients and Client Feedback

The impact on our existing and new clients is a logical place to start considering this was the main organizational change and clients are a critical part of autism service organizations. An increase in clients will necessarily have consequences on the service provision for existing clients as well as how new clients are introduced, assessed, and onboarded. See Table 10 for specific examples of consequences of increased client base.

Table 10.

Post-hoc client impact questions

	New and existing client impact	Changes required
Questions	How has the initiative affected current client service provision? New client service provision?	What changes will need to be made to continue to meet the needs of our existing customers and prevent negative impact to service provision
Answers	The increase in client base has had an adverse effect on client service provision. Feedback from parents of current clients has shown a decrease in skill acquisition as well as an increase in undesired behavior since the change.	Will need to hire additional staff to ensure that clients are receiving adequate and quality instruction. May need to temporarily halt the increase in clients until quality of provision stabilizes. Communication to new and existing clients and staff regarding the change will also help with buy-in and can help parents of clients note any recent changes in behavior.

Products and/or Services

A substantial increase in clients will have an impact on our products and services. In general, these should be continuously monitored to ensure that quality service and products are still being delivered given the increase. A cost-benefit analysis should be conducted on all of our current services and products to determine the resources needed to provide those services well, as well as the benefit to the client and our organization (Hyten, 2009). After this analysis is complete, we can determine if resources need to be shifted or products temporarily halted because of the influx of clients. In general terms, our organization should focus on its core functions while assessing the worth and return on investment of secondary or tertiary products/services. See Table 11 for examples of impacts on products and services and suggested changes.

Table 11.

Post-hoc product/service impact questions

	Product/Service impact	Changes required
Questions	How are the products/services affected by initiative?	What changes will need to be made to the products/services themselves? What changes will need to be made to how we produce and deliver the products/services?
Answers	As mentioned above the service quality has been affected by the increase in clients as observed by parents and tracked data.	An assessment will need to be made to determine which products or services to eliminate or decrease. This may follow from the change(s) made to the mission or strategy. Analyzing what services our workforce excels or what your organization is known for would be a good start. There may be some ancillary services that are easier to stop than others (education, home services).

Internal Standards and Feedback

Another business function that will be affected by an increase in clients is internal standards and feedback. The post-hoc analysis is an ideal opportunity to assess whether the standards have changed and whether feedback from your clients or customers is changing in a negative or unplanned way. Gather feedback more frequently during this time so that the effects of the change can be captured sooner, either through formal methods like surveys, or informal conversations with parents and/or guardians. If standards and feedback suffer greatly we will hear feedback from our customers but should also be noticing different trends during standard data reviews. The standards of care and feedback should be measured along the four dimensions of measurement (quality, quantity, timeliness, and cost) so that parameters of quality care can monitored and adjusted. See Table 12 for some examples of impacts on internal standards and feedback.

Table 12.

Post-hoc standards and feedback impact questions

	Internal standards & external feedback	Changes required
Questions	Are our internal standards being affected by the client increase? What is the external feedback we are receiving from clients after the change? What are the data telling us?	What changes will need to be based on data from post-hoc analysis?
Answers	Quality Measures/Standards: Tx integrity and IOA scores have dropped since influx of new clients. Anecdotal feedback from parents/guardians reflects more problem behavior and lack of transfer to home and school contexts. Quantity Measures/Standards: Our client to provider ratio has increased. This will likely have undesired side effects such as reduction in provision quality Timeliness Measures/Standards: results post-client increase 1. Preauthorization (< 5 days) 2. Initial assessment/screening (< 5 days) 3. Service recommendation report (< 7 days) 4. Authorization/Reauthorization (< 7 days) 5. Client program/Update (< 7 days) Results show an increase in 2 days on average for each milestone.	Because quality and timeliness have dropped it may be necessary to bring in additional resources (permanent, or temporary) to ensure quality returns to prechange levels. In addition, process analyses may be necessary to understand any bottlenecks that were created by the influx in clients.

Resources and Suppliers

Our post-hoc analysis will highlight strains put on resources and any supplier concerns. The most immediate and apparent strain will be on our labor force, especially if we took on more clients without increasing essential staff. Increasing staff is a good solution to reach the desired ratio of staff to clients, but the market for suitable employees will need to be assessed. Financial resources should not be an issue considering we are taking in more clients and therefore generating more revenue. METS may be an issue if we are low on space to provide quality services to clients without interfering with concurrent clients or treatments. In addition, we should ensure that our staff are not short on tools and materials that are required to deliver quality care. Finally, technology resources need to be analyzed to understand if additional software and/or licenses are required. See Table 13 for impacts on resources and suppliers and suggested solutions.

Table 13.

Post-hoc resources and suppliers impact questions

	Resources & suppliers	Changes required
Questions	Financial:Do we have sufficient financial resources to continue to support the initiative? Human:Have we hired enough staff to compensate for the increase in clients? METS:Do we have the necessary METS resources to support the initiative? Are there physical space concerns? Technology:Are we running into issues with software or technology, including know-how?	What changes, if any, need to be made to secure additionalFinancial/Human/METS/Technologyresources? Will existing resources need to be reallocated? How?
Answers	Financial: The increase in clients has yielded an increase in income Human: Our post-hoc analysis reveals that we need additional BCBA’s and RBTs METS: The increase in clients has created space demands that currently cannot be met. Technology: Know-how is not an issue due to adequate supply of high-caliber applicants. Assessment has determined that additional licenses for software can be covered by increase in revenue. Implementing new billing software could eventually make billing process easier.	Human: Begin recruiting additional necessary staff. Assess current staff morale and consider increase in pay to help through the transition. METS: If finances allow, consider renting space in adjacent buildings or repurposing current space to fit needs. Technology: Hold off on new billing software, too many changes are taking place to adequately deploy new software while not interrupting accounting timeliness.

Organizational Functions

Next we must assess the effect of the change on the organizational functions. Leadership is one of the most critical functions of an organization during a large (or any size) change. In addition to their daily responsibilities of managing the business and staff, additional effort and time should be spent on behaviors that are critical to stewarding change. It is critical at this point that leadership is still providing essential work direction and feedback so that service provision does not falter. Communication to staff and clients is critical during all parts of the change process to ensure a lack of surprises, including what to expect, when to expect it, and the strategy and reasons behind the changes. Leaders should also make efforts to assess and, when possible, remove potential barriers to performance (e.g., time, resources, autonomy). Supervision of staff is another element that will be affected by an increase in clients and staff and should be assessed accordingly. Product and service provision should also be considered as well as support and administrative functions that will be affected by the increase in clients, reports, paperwork, billing, etc. See Table 14 for impacts on organizational functions and suggested solutions.

Table 14.

Post-hoc organizational functions impact questions

	Organizational function impact	Changes required
Questions	Leadership/Supervision:Are organization leaders prepared to make required systems changes? Have strategy, policies, or procedures been affected? How did leaders communicate the change? Is more communication needed? Does the change require more supervision of staff? Product/Service Provision:Has quality of service provision suffered? Are our supervision ratios where we want them to be? Support Functions: Are our support functions working appropriately with the increase in clients (staffing, L&D, and IT?)What have been the effects on these systems due to increase in clients? Administrative Functions:Have intake, billing, scheduling, and records keeping been negatively affected by the change?	Leadership/Supervision:Do we need more or different leadership engagement to help us through this change? Product/Service Provision:What changes must be made to avoid/ameliorate decreases in service provision quality? To avoid decrease in employee morale? Support Functions:What changes must be made to ensure new staff are properly trained and potential for negative client/employee impact during staff training is minimized? Administrative Functions:What changes must be made to build capacity in the intake, billing, scheduling, and records keeping functions?
Answers	Leadership/Supervision:Leadership has been engaged in the change and have done well communicating the reasons and the expected outcomes of the increase in clients. Supervision is an issue due to having to hire new BT’s and BCBA’s Product/Service Provision:Reduction in service quality has been identified as a repercussion of the change. Support Functions:Training material needs to be updated and has been identified as a barrier to onboarding new hires Administrative Functions:Currently there are delays with client intake due to increase in clients. Billing and other administrative functions are functioning nominally.	Leadership/Supervision:Suggest hiring new supervisors or leveraging supervision skills of current leadership in the meantime so there are no gaps in supervision. Suggest that leadership continue to check pulse of organization to understand any unintended side effects of change as well as how the organization will approach solutions. Product/Service Provision:Increase in staff should rectify issues with service quality. Support Functions:Suggest contracting additional training resources to update training materials for new hires. Administrative Functions:Adjust scheduling to handle intake delays. Determine process improvements or bottlenecks to intake process. Watch billing issues as they may be delayed.

Environmental Factors and Competitive Advantage

The last factors to assess in the post-hoc analysis are environmental factors and competitive advantage(s). Considering that the change has already occurred, leadership should assess upcoming environment and any possible changes in the realm of insurance, licensing, population growth/decline, and availability of potential applicant pool. Leadership should also understand how the increase in clients has affected our competitive advantage.

Additional Tools and Analyses

Once we have identified the necessary changes to be made within the system, we might find that additional analyses are warranted. This is common, because we are making large-scale changes that affect multiple jobs, processes, and departments/functions of the organization. Understanding the extent of the effect of those changes will help us ensure the transition from current to future state is as smooth as possible. For the sake of space, we will only briefly present possible additional analyses that organizations can use in change efforts.

Functional Relationships Analysis

If our changes will affect multiple departments or functions of the organization, we should consider examining the effects of the changes on the input/output relationships between functions. We can use a functional relationships mapping tool (also referred to as relationship mapping) to conduct the analysis (Diener et al., 2009; Rummler & Brache, 2013). In functional relationship mapping, we first identify the functions/departments affected by the change. Then we identify the functional inputs (what comes into the functions) and outputs (what comes out of the functions) that will be affected by the change. Finally, we analyze the functional goals and performance requirements to ensure they are aligned across all of the affected functions.

For example, in our prechange analysis we identified that we do not currently have the appropriate training and performance management systems in place to support increased staff numbers. Our recommended changes involved hiring OBM experts in training and performance management into a support function to work with the clinical function to design and develop scalable training and performance management systems. This will require the clinical function to provide the OBM function with information regarding performance requirements. This information is an output of the clinical function and an input to the OBM function. The OBM function will then use that information to produce training and performance management designs (outputs) that will go to the clinical function (inputs) for review. Once the clinical function is satisfied with the designs, the OBM function will build the systems and work with the clinical function to get them implemented.

At all points where inputs/outputs move from one function to the other, performance requirements and expectations must be clear and agreed upon by the parties involved. If the OBM function does not align its designs and systems based on the clinical function’s stated needs (or if the clinical function fails to communicate their needs effectively), the OBM function runs the risk of meeting its own goals, but utterly failing to provide something useful for the clinical function, which could potentially have a negative impact on the organization as a whole. If clinical is provided with ineffective training and performance management systems, we should expect clinical performance to suffer as a result. If clinical performance suffers, client progress suffers.

An example of functional relationship alignment can be seen in Robertson and Pelaez (2016). The authors discuss an initiative in a large university to increase the retention and graduation rate of the university’s undergraduates. The author’s used a vertical and horizontal approach to analyzing and solving this problem. The vertical approach started with the analysis of critical behaviors of students that were indicators of on time graduation. The authors then analyzed the staff that made up the student’s environment and identified target behaviors and consequences to support student behaviors at all levels—from academic advisors through board trustees. This vertical approach ensured that each level’s behavior and consequences were aligned to achieve the target behavior of the undergraduate student. The horizontal approach assessed the different student life cycle functions that affected student successes. These functions included the admission system, advising system, and instructional systems to ensure that their mission and functions were aligned with the target behavior for undergraduate retention and on time graduation. This systemic approach and alignment across functions was responsible for a substantial increase in the on-time graduation rate of undergraduates.

Process Analysis

If we find that our change has affected one or more work processes, a process analysis may be necessary. Process analyses can contain many steps but the critical few are: (1) identify the objective or goal of the process (scope, performers) including the inputs and outputs of the process, (2) gather information (who, what, when, where, how) from documentation or employees, (3) convert this information into a map starting with the input and ending with the output, (4) analyze the process for inefficiencies, (5) adjust the process based on your analysis to eradicate unnecessary or nonvalue-added activities, and (6) implement and monitor the new process (Diener et al., 2009; Rummler & Brache, 2013).

As an example, our post-hoc analysis identified that we have received staff feedback indicating that the intake process has become less consistent in terms of timeliness and accuracy of information. A process analysis could be used to determine the cause of the inconsistencies. Our goal for the client intake process might be “administrators enter critical client information into our database and prepare client for initial assessment within X amount of time.” Our inputs for this process are the client and their information (e.g., demographics, background, insurance, family profile, history of treatment) and the output is the client is ready for their initial assessment with clinical staff.

Our next step would be to gather information from those staff engaged in this process to understand how this process currently works. Asking staff who, what, when, where, and how questions can help fill in the picture of how the work is actually completed as well as reviewing critical documents related to the process. After information gathering is completed, there should be enough information to draw a map from start to finish. These maps can look different—from horizontal cross-functional swim lanes to vertical flow charts. As long as we display the critical information in terms of who, what, when, where, and how the process is completed, we can assess process effectiveness and efficiency. This is our “IS” map, a detailed explanation of how work currently gets done.

The next step is to analyze the map to determine where inefficiencies occur. Steps that involve an “re” word, such as “recycle,” “rework,” “retouch,” “reword,” or “review,” are typical indications of nonvalue-added work. Repeated or unnecessary steps should be identified and marked for change. By reviewing the process holistically, we should be able to identify areas for improvement—these can be process steps, supporting documents, and additional roles or resources. By analyzing the process, we might uncover that there is no “standard process” and that each administrator has his or her own way of completing the intake process.

The final step is to adjust the process based on our assessment by creating a “SHOULD” map. This map should be a redesign of the process (minor or major, depending on our findings) with suggestions for changes in how work gets done, who does it, and what they use to complete the work. Making the changes and implementing a new process should result in a more efficient and effective process, which can be measured by using our baseline measures for the “IS” process. Finally, we would need to continue to monitor the process after implementation with input from staff to determine whether additional changes are necessary.

Kelley and Gravina (2018) used a process analysis as part of an assessment and intervention design to decrease the amount of time patients spent in emergency departments. The authors analyzed the current process for patient intake and found that bottlenecks existed at the point where diagnostic tests had to be ordered for emergency patients. Physicians were the only staff who could approve diagnostic tests, but were few in number at any given time and were usually the busiest staff. The solution was to identify the top 10 most common symptoms and their related tests and to have these preordered and approved by nursing staff, thereby removing the bottleneck for a majority of the most common cases. After implementing the process change and providing performance feedback to nurses on the correct use of the new procedure the times to receive diagnostic tests and the total duration of visits decreased. This decrease in time was also correlated to an increase in patient satisfaction scores.

Job Analysis

If our changes will affect a particular job position within the organization, we should consider examining that job in detail. We can use a job mapping tool to conduct the analysis (Diener et al., 2009). In job mapping, we first identify the outputs or accomplishments associated with the job role. Next, we determine the critical tasks that produce those outputs, along with the resources required to complete the tasks (time, tools/equipment/materials, foundational skills and knowledge, training, and information). We then identify measures and goals around outputs and tasks, along with how performers receive feedback on their performance. If necessary, we can also conduct an ABC analysis (also known as behavior mapping) to determine whether current contingencies do or would support the completion of the tasks required (Diener et al., 2009; Rummler & Brache, 2013).

For example, in our prechange analysis, we identified that we need to hire two new positions: OBM-PM and OBM-Training. Because neither of these jobs currently exists, we should use job mapping as a design tool. We should identify the accomplishments/outputs that will be associated with each position, along with the tasks that produce those outputs, the resources the jobs will require if the individuals in those positions are going to be successful, and how we will measure performance, define success, and provide the position holders with ongoing, informative feedback on their performance.

An example of analysis and intervention at this level can be seen in Pampino, Heering, Wilder, Barton, and Burson (2004). The researchers used the performance diagnostic checklist (PDC; Austin, 2000) to assess the job and task responsibilities of baristas at a small independently owned coffee shop. Feedback from the owner of the coffee shop indicated that improvement could be made for nonroutine tasks. The results of the PDC showed a lack of adequate antecedents and consequences for the performance of closing and maintenance tasks. Given the results of the assessment, the researchers designed a package intervention that consisted of a task clarification (performance checklist) and consequences in the form of a lottery with the opportunity to win $20 every month. A multiple baseline design across task groups showed the package intervention was successful at increasing maintenance tasks. A social validity assessment was also conducted and results showed the employees found the procedures were acceptable, the coffee shop was cleaner, and customer satisfaction had improved.

Summary

In this article, we have discussed two possible ways to implement large-scale change in a health and human services organization: the quick but ultimately chaotic change method and the slower but controlled method. The chaotic growth method involves a decision to make a change and then dealing with the consequences, both intended and unintended, after the organizational change has been implemented. Although we do not recommend this approach (unless the organization thrives in chaos), it can be a viable or necessary option if a change needs to occur quickly. For example, if our organization is aware that a competitor is closing, or there are major changes regarding insurance and covered services and those changes will go into effect soon, it may be advantageous to change quickly so that opportunities are not missed and threats do not go unanswered. In addition, if our organization is small and change resilient, chaotic growth may a suitable option because the organization is small enough to be aware of the organization elements that we must address in order to regain stability after a change is implemented.

On the other hand, chaotic growth creates many challenges to organizations. The larger the organization and the more staff that are affected, the more chaotic and disruptive the change will be. Depending on how large the change is, the consequences could be catastrophic, including a reduction in quality of care, parent and guardian complaints leading to decrease in reputation, an increase in employee turnover, and revenue and billing complications, to name a few. Another negative side effect of chaotic growth is the dearth in communication to the organization regarding the reason for change, the possible disruptions the change may cause, and how daily activities and client interaction may be affected. Because of the chaotic nature of this method and the need to fix the unintended consequences that stem from the unplanned change, the organization can take a long time to stabilize, which can create “change fatigue” within the workplace.

It is not surprising that we recommend taking the planned approach to organizational change. This approach has many benefits if done correctly. Some, but not all, of the potential benefits ensure the right amount of communication within the organization regarding the reasons, benefits, and expected complications of the change; assessing and adjusting the organization to prepare for the change; communicating and preparing clients for possible disruptions; and a smoother change implementation. As the old saying goes, sometimes you “have to go slow to go fast.” In other words, the more preparation and planning leadership can do, the easier, more effective, and more efficient the change implementation is likely to be. It is, however, rare to be able to foresee and address all the elements of organizational change. Therefore, when possible, we recommend pilot testing your change. This involves developing a test group/department/site where the elements of the change can be implemented and tested on a small scale. This small quasi-experiment can help leadership understand the implications and results of the change—from communication and planning through unintended consequences of implementation—and then retool their change strategy for the large-scale effort. Regardless of the change path chosen, BSA includes several tools and methods that are helpful for planning, understanding, and diagnosing elements of change within and outside of your organization.