Toolkit: Moving through the Value Curve Stages

Overview and Introduction


Human services is experiencing many of the same challenges that all modern systems face, including rapidly changing economic forces, social structure, demographics, communications, and technology. Leaders from all sectors of our field must be able to adapt to this changing environment, and lead a culture change within their organization that supports a more collaborative, creative, and innovative way to deliver services in communities across the nation.

Indeed, it is impossible to deliver a truly holistic platform of solutions and supports to people, families, and communities in need of them without a highly collaborative partnership approach. This approach results in more efficient and effective intake and eligibility platforms, more effective casework and engagement practices that respond well to any and all root causes for the challenges faced by the people we serve, and more powerful, far-reaching advocacy and capacity-building efforts that are much larger than the needs of any individual or family case.

An Emerging Framework for Field Transformation

Developing stronger cultures and strategic partnerships is also how APHSA is approaching its own internal operations and partnerships. One such strategy is APHSA’s partnership with Harvard and Accenture since 2010, to jointly-sponsor Harvard’s Human Services Summit. This annual series has provided an opportunity for participants to learn from and network with the world’s foremost human services practitioners – both public and private, domestic and global, along with Harvard faculty and researchers and industry experts on ways to collectively address our most challenging issues. 

A key framework developed by Harvard’s Technology and Entrepreneurship Center’s Leadership for a Networked World is the Human Services Value Curve. This model, along with related tools APHSA has developed, is designed to provide a roadmap for improving human services outcomes, value, and legitimacy through the lens of four different business models: regulative, collaborative, integrative, and generative.

Figure 1 Human Services Value Curve Components

This progression in value can best be described from the point of view of the consumer: 

  • At the regulative level, consumers receive a specific product or service that is timely, accurate, efficient and easy to understand.
  • At the collaborative level, consumers “walk through a single door” and have access to a complete array of products and services that are available “on the shelf.”
  • At the integrative level, products and services are combined into packages, and designed and customized with input from the consumer themselves, delivered in the most convenient ways, with the objective of best meeting the consumer’s true needs and driving positive outcomes.
  • At the generative level, those providing products and services are joining forces to make the consumer’s overall environment better for them, resulting in value that is broader and more systemic than an individual or family might receive.

The path to moving up this “value curve” as an agency, community and entire system is transformative at each stage of transition and evolution: 

  • At the regulative level, agencies focus on program-specific compliance and effective delivery.
  • At the collaborative level, agencies with their partners focus on cross-programmatic effectiveness, oftentimes requiring transformative operational innovations.
  • At the integrative level, they focus on consultative consumer engagement and product and service flexibility, towards early intervention and preventing problems versus fixing them downstream.  In our field this requires transformative changes to casework practice, technology, data sharing and mining, and adaptive program design and funding mechanisms.
  • At the generative level, agencies with their partners focus on consumer advocacy, and co-creating capacity at a more systemic level as a means to meet consumer needs.   This requires efforts targeted at community-level infrastructure and societal beliefs and norms.

Improving the organizational effectiveness and Value Curve progression of public agencies results in increasing strategic partnerships with multi-service non-profits, and strengthened financial dynamics between the two sectors.  This is expressed by the following logic model: 

  • When public agencies progress from program compliance (regulative) and working more seamlessly across their own programs (collaborative), to a casework model where individuals and families are engaged and empowered to actively participate in customizing solutions and plans that address the root causes for their presenting issues (integrative), they must partner with MSOs and other jurisdictions to assess and deliver responsive services across the entire spectrum of possibilities that will arise.
  • When public agencies advance to a stage where they are advocating for culture change within their communities, and collaborating to reduce overall community risk factors and increase opportunities (generative), they must join forces with MSOs.
  • When public agencies become more effective organizations, they are more capable and motivated to align clear vision, strategy, management practices, cultural patterns, and quality staff- all of which increase readiness and ability to partner more strategically.
  • When strategic partnerships and the resource and financial dynamics between the public and MSO sectors in a given community improve, this results in more transformative approaches to practice and service, and mutual acceleration through the Value Curve stages.  This results in improved community capacity, and ultimately improved outcomes for individuals and families.
  • This degree of partnership and practice transformation is both enabled by and enables stronger sponsorship and support from the state and federal system levels, for regulations and funding streams that are conducive to this evolution.
We have developed this toolkit as a “way into” transformation and Value Curve application, and have determined what items to include through field testing with one state agency and three communities actively working through such transformative efforts: Vermont, Hampton, VA, Olmsted, MN, and Sonoma, CA.  We would like to thank them and also acknowledge that as we continue to use this toolkit to support more and more agencies, we will be continuously improving its design and content.  

The Toolkit Design

APHSA’s recent scan of state and local agency CEO self-assessment indicated that these leaders are by and large clear that they want to advance to the Integrative and Generative stages, yet at the same time mark very limited progress in doing so across most of the related fronts required.  The contents of this toolkit are intended to raise awareness for how agency leaders and their partners can actively and purposefully move through stages of the Value Curve together.   

The sections of the toolkit are organized as follows: 

  1. A brief summary of transformation themes stemming from our documenting of innovations taking place around the country and also from our three test sites: Sponsorship, Staff Engagement, Partnerships, and Resources.
  2. A brief discussion of readiness for change and links to the APHSA readiness assessment tool.
  3. A discussion of “big leadership” as a driving force for sustaining a transformation effort, as the most critical readiness and sustainability factor, and links to APHSA’s adaptive leadership tool.
  4. Specific sections with short narratives and  links to related tools and templates for:
    1. Defining the desired future state
    2. Opening up stakeholders and staff to the possibilities of transformation
    3. Establishing a mutual strategy and formal sponsorship structure for the work
    4. Establishing improvement teams and work teams to connect the strategy to effective and empowering planning and implementation activities
    5. Effective facilitation as a critical support function to teaming
    6. Communicating for impact throughout the transformation effort
    7. Building capacity in critical change and sustainability areas, including data and analysis, support functions, general workforce, through partnerships, and for procuring and allocating resources
    8. Topic-specific tools for common barriers and enablers to change and innovation
    9. Monitoring progress, impact, lessons and adjustments to form a continual learning cycle
  5. Summary and Acknowledgements
Some very high readiness agencies will be able to use the 25 attachments to this toolkit without additional support as they advance through the Value Curve stages.  But most will need some form of additional technical support to do so, and each agency and community context will present particular challenges that require much more than a “textbook or rote toolkit” set of strategies and methods. 

Transformation Themes

Transformation, whether it is in an organization or in a field, does not happen overnight.  This level of effort and change takes time, hard work, consistency, persistence and an understanding of what it takes and how to successfully implement change.  To increase the field’s knowledge of demonstrations, pilots, innovations and transformations, APHSA: 

  • Interviewed twenty-four state and local human service agencies and their stories not only provide the context in which the agency was innovating,  but also various strategies agencies used to improve outcomes and become more efficient as they work to transform their  system to a generative state on the Human Services Value Curve.
  • Conducted more in-depth technical assistance within one state and three counties to further test and confirm the importance of these general strategies.
Based on the field experiences and interviews to date, a range of contextual themes have been consistently pointed to by leaders and staff as drivers of their agency’s ability to innovate and transform. These themes include Sponsorship, Staff Engagement, Partnerships, and Resources:

Sponsorship: Agencies that are sustaining their transformative efforts have a strong level of sponsorship for the change, innovation or transformation they implemented. Through this work, we found that sponsorship or a high level support for projects came from the Governor of the State, from local community Boards of Supervisors and community partners, or from the agency leadership itself. This can be done by engaging internal and external stakeholders or identifying “change champions” to serve in a sponsorship role.

Staff Engagement: Agencies who succeed in launching and sustaining transformative efforts do so with and not to their staff. Agency staff possess the hands-on understanding of how the Value Curve stages “look” in operational contexts, and are essential contributors to both the tactical decisions and follow through for such change efforts over time. Peer-to-peer influence and collaboration are key to creating efficient and effective practice and service strategies, and support functions like HR, IT, and Finance can either be enablers or inhibitors of these efforts, in large part depending on how they are engaged in the cause.

Partnerships: As described above, to operate in the Integrative stage of the Value Curve, public sector entities and non-profit MSOs and private sector partners must all join together to engage consumers holistically and address the root causes of individual, family and community risk or limited opportunity. And as our systems move more into the Generative stage- involving building the public will for our efforts and recognizing the need for a level playing field and practical solutions that work, advocacy must be advanced through partnerships and collective action.
Resources: Agencies need to be savvy about the tangible and nontangible resources required to move them forward. Primary categories of resources include staff capacity, fiscal resources, and technology resources. Examples of staff resources include onboarding and training of staff to ensure consistency; changing and building a flexible and empowered culture; and improving and ensuring effective internal and external communication and collaboration. Examples of fiscal resources include the utilization of flexible funding strategies and creative new funding sources. Examples of technology resources include workload management systems, tablets for workers and office self-serve kiosks.

Readiness for Change

Key leaders will need to be prepared to take charge of the transformation effort.  Before beginning the transformation it is essential to reflect on the degree of organizational change required and the capacity of the workforce to take on the work that will be necessary to reach your desired future state.   Actions will need to be taken to address conditions within the organization that need to be in place prior to beginning the actual work of the transformation.     

Key readiness considerations include:

  • Is there an agreed upon definition and rationale for transformation across the organization?
  • Is there clarity about the desired outcome from the transformation effort?
  • How supportive are current leaders, staff and stakeholders to the idea of the transformation?
  • How big of a change from current organizational practice will be required for the transformation?
  • What actions must be taken to remedy preexisting conditions that pose a threat to successful implementation of the transformation?
  • How can existing initiatives/priorities already underway be aligned with the transformation?
  • Are there currently the capacity, expertise and resources within the organization to achieve the desired value curve advancements and desired outcomes?
  • How will the time and resources needed to make the desired changes be provided?

    a. Organizational Effectiveness Tools to support this stage:
    - Readiness Reflection Tool, quick guide and detailed guide
    Provides for the assessment of organizational, leadership, staff and general capacity readiness to take on new bodies of work involving systemic change.

Big Leadership

Throughout the conversations with agency leaders and their staff, it was clear that there was a certain level of leadership capacity that made it possible for agencies to think innovatively and move towards transformation. Leaders must determine how the workforce may need to be supported and enhanced to adapt to rapid change and meet the new demands of the transformation. Required leadership capacity can be described as adaptive leadership, and includes creating a vision for change, developing momentum and support for that change and understanding the current context in which the organization is operating in.

Transformation requires leadership to be clearly at the helm and serving as a beacon of light showing everyone the path for the changes that will be needed to transform the organization. Leaders must show their passion for the change, inspire and connect with the hearts and minds of their staff to build a wave of support for the new direction. Bold leadership actions that demonstrate their commitment to making change a reality can be extremely impactful in signaling the significance for the organization.

Leaders must anticipate and respond to resistance to the changes that are a part of the transformation, both enlisting the support of constructive resisters and marginalizing those who resist for non-constructive reasons. The development of a sound communication plan helps leaders message the changes in a clear and concise way. These messages should include the rationale for the changes and address the benefits to the organization, staff and stakeholders. Painting a clear picture of the expected outcome of the transformation effort is essential.

As the transformation progresses, leaders must authorize the organization to bring an end to the “old ways” and exchange them with new policies, processes and practices that will support the new way of doing business. Leaders need to identify, develop and support “change champions” who will plan, guide and implement the strategies to bring about the transformational organizational changes.

  1. Organizational Effectiveness Tools to support this stage:
Provides for assessment and reflection on how to practice adaptive leadership techniques such as empowering the organization and being agile to get to the goal. 

Tools and Templates 

This Toolkit section contains the key focus areas for the work in each area and the associated leadership actions that will move the work forward, with tools and templates that will support the work required to effectively implement the system transformation: 

  • Defining the desired future state
  • Opening stakeholders and staff to the possibilities of transformation
  • Establishing a formal sponsorship structure
  • Driving systematic change management
  • Facilitating the change and improvement process through implementation, monitoring and continuous learning
  • Communicating for impact throughout the transformation effort
  • Building capacity in critical change and sustainability areas
  • Addressing common organizational barriers and opportunities along the way
  • Monitoring progress, impact, lessons and adjustments for a continual learning cycle

I. Defining the Desired Future State

  1. What is the key focus of the work (action oriented) during this stage?  What actions must be taken by the implementers of the change?
    • Create the time and space for discovering possibilitiesUnderstand the current environment/contextIdentify the needReview best/research informed models/ innovationsAssess model fit with organizational/ community/consumer needs/valuesDefine the new change/model
  2. Organizational Effectiveness Tools to support this stage:
Strengthens understanding of the Value Curve Stages and the underlying factors for stage progression. 


II. Opening Stakeholders and Staff to the Possibilities of Transformation

  1. What is the key focus of the work (action oriented) during this stage?  What actions must be taken by the implementers of the change?
    • Communicate the Vision for Change, articulate the Desired Future State
    • Engage stakeholders to build support
    • Develop staff support for making the change
    • Formally adopt the model and move forward to demonstration
    • Communicate early learning /accomplishments
    • Demonstrate commitment to a supportive learning environment
  2. Organizational Effectiveness Tools to support this stage:
Provides guidance on development of overarching organizational or initiative purpose, desired future state and guiding principles.  Engages stakeholders and staff in the process of setting a future direction towards mutually developed and understood goals.


III. Establishing a Formal Sponsorship Structure

  1. What is the key focus of the work during this stage? What actions need to be taken by the implementers?
    • Garner leadership/sponsorship
    • Specify strategic goals, outcomes, benchmarks
    • Clarify relationships between this initiative and others
    • Define decision making pathways
    • Develop the implementation structure/teams
  2. What are the Organizational Effectiveness Tools to support this stage?
Provides purpose and key elements for the development of scope of work for leadership, work/ continuous improvement teams.  

IV. Driving Systematic Change Management
V. Facilitating the Process
VI. Ongoing Communication

  1. What is the key focus of the work during this stage?  What actions must be taken by the implementers of the change?
    • Develop implementation and change management plan
    • Define feedback mechanisms to support continuous quality improvement
    • Align organizational structures to support implementation ( HR, IT , Finance)
    • Align strategy to daily performance and operations: organization-wide, department, and individual level performance goals and objectives
    • Communicate early “wins”, prepare for the long haul
    • Develop timeline, resources
    • Reinforce Procedures/processes to make them routine
    • Highlight observable practice change as the “new” standard
    • Promote continuous improvement that are consistent with the model
    • Highlight and reinforce the organizational changes that support implementation
  2. What are the Organizational Effectiveness Tools to support this stage?
    • Continuous Improvement Plan Guide and Template - Provides a vehicle for the organization to plan and implement quick wins, midterm/longer-term improvements.
    • DAPIM - Provides a model for systemic approach to continuously improving organization’s performance, performance capacity and client outcomes.
    • Facilitation Markers - Provides markers of effective DAPIM facilitation for internal facilitators to use in their own improvement work.
    • Data Planning Template - Provides the organization with help in identifying data essential to tracking outcomes.

VII. Building Capacity
VIII. Addressing Common Barriers
IX. Monitoring and Adjusting

  1. What is the key focus of the work during this stage? What actions need to be taken by the implementers of the change?
    • Purposeful changes are made as a result of evaluation findings, feedback loops/continuous quality improvement findings, and new conditions/knowledge
    • Develop a sustainability plan, secure resources to support the plan
    • Promote visibility and successful outcomes
    • Ensure ongoing connection of stakeholders
    • Ensure ongoing mid management support  to keep the change in place
    • Monitor progress to maintain focus, schedule and momentum
    • Managers /Supervisors facilitate emerging model fidelity and help staff reach proficiency; the project (model) becomes organizational practice
    • Address barriers to implementation head on, both task-oriented and relational barriers
    • Use data to demonstrate outcomes.
  2. What are the Organizational Effectiveness Tools to support this stage?
    • Capacity Planning Guide - Provides systematic approach to examining and employing all major areas of capacity management.
    • Building Trust - Provides guidance on how to define, assess and build trust through understanding and improving its underlying drivers.
    • Following Through - Provides a means of assessing barriers and solutions to effective follow through by team members.
    • Difficult and Courageous Conversations - Provides guidance on moving teams to take on challenging and often underlying issues that are barriers to effectively working together.
    • Resistance and Power - Provides guidance on how to differentiate forms of resistance, and define, assess and use power dynamics.
    • Monitoring Guide - Provides systematic approach to ongoing monitoring efforts that maximize learning opportunities and opportunities for plan adjustment.

Summary and Acknowledgements

So what must occur to transform health and human services?  Our members’ and partners’ experiences and expertise have shown us that greater impact will be realized if we, in fact, accelerate moving through the Value Curve stages, supported by doing the following: 
  • Establish and align new and positive relationships and networks among all levels of government and the private non-profit sector toward a common purpose, integrated strategies and sustainable outcomes;
  • Move beyond traditional governance lines and advance a shared agenda with other public sector partners, the private non-profit sector, foundations and businesses;
  • Meet program participants where they are, doing so with modern marketplace tools, and actively engaging them in their own success;
  • Adopt a culture of creativity and innovation, seeing this as a necessary and central part of the transformation of health and human services rather than occasional and experimental exceptions; and
  • Build on the many known successes of leading states and community networks, first by identifying and sharing the trend and innovations, then by assuring their scope and application can be broadened to all parts of the field that can benefit from them.
Agencies, MSOs and communities around the country using the tools and language of this toolkit will further strengthen the impact resulting from like efforts such as the annual Harvard Summits.  Indeed, it is already evident in many ways that our field is speaking and working in a more unified manner around the precepts of the materials included here.   
As we continue distributing and sharing this toolkit, through future efforts like a peer-to-peer “learning by doing” institute or other means of technical support, this value will continue to grow.  And through our efforts to facilitate understanding and application of these tools, as well as through embedding management strategies to ensure continued improvement and innovation, we have by extension more communities aligning around common ideas, goals, frameworks, and strategies.  This “collective impact” will grow as we advance the use of these models, tools and facilitative techniques.  
We would like to take this opportunity to thank the agency leadership teams in the state of Vermont, Hampton Virginia, Sonoma California and Olmsted Minnesota for their support of the HHS Value Curve and their “big leadership” efforts to progress through its stages, using many of these tools to drive these efforts.  We would also like to thank the Kresge Foundation for both their financial support and wise counsel and technical advice as we developed this toolkit.  
If you and your leadership team would like to discuss receiving the technical assistance you need to move forward from here, please contact Emily Campbell, Director of Organizational Effectiveness at APHSA at [email protected].