I.I.1

GROWTH OPTIONS FOR SAMARITAN CENTERS

The term “growth options” is used here to mean choices that leaders can exercise after the Center has achieved a basic level of development characterized by organizational viability, financial stability, and service capability. Basic development should not be seen as a growth option, but rather as the optimal starting point for further development.

Two growth strategies that naturally follow basic development are quantitative growth and qualitative growth. Quantitative growth, called expansion in this paper, means enlarging the size of the Center – more hours, more staff, a larger financial base, and so on. Qualitative growth has more to do with things like increasing staff productivity, upgrading information systems, offering differentiated services, and niche marketing. In many instances quantity and quality go together. For example, increasing the number of clinical hours to become more cost effective may make funds available for starting new programs.

Growth is never simple. For one thing, real growth is systemic rather than straight line (linear). For example, a significant increase in staff hours usually requires more administrative support, a more complex management style, and better marketing. The system itself changes when there is significant growth, because increases in size and quality necessitate changes in the way the Center runs internally and how it relates to its external environment. Growth is an interactive process that complicates straight line planning – i.e., logical, step-by-step progression to achieve predictable results.

Second, changes occur in organizations whether they are planned for or not. Even Centers that do not move beyond a basic level of organization and productivity find that, over time and in response to natural events in the life cycle of the Center, they must change their structures and procedures. For example, a Center that starts with a solo executive director who “does everything” will almost inevitably develop to the point where some type of shared leadership and of staff task differentiation become necessary, even when the Center remains small. The point is that expansion and qualitative growth interact with developmental patterns – sometimes slowing things down or speeding them up, and almost always modifying the intended growth objective.

For all of these reasons, two other growth options can be added to expansion and qualitative growth. Transitional growth, a third option, occurs when a Center moves effectively through a time of organizational development. Transitions can be a positive growth experience, particularly when the leadership of the Center recognizes the developmental situation and intentionally deals with it. When transitions are left to chance, opportunities for growth are wasted, and sometimes bad things happen.

Growth through restructuring is a fourth option that usually occurs when events or crises within the Center or in its environment force changes in the ways the Center organizes itself and conducts its business. For example, a Center may need to restructure if it finds that congregations, which used to be the main source of referrals and financial support, no longer relate to the Center in this manner.

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In this instance, the restructuring option is one of finding new sources of clients and funding, which can turn out to have positive growth potential.

The four growth options identified above -- expansion, qualitative change, transitions, and restructuring – are described in more detail below. The purpose is to help Center board and staff leaders assess growth needs and strategies for their own organizations. Keep in mind that, while each option is differentiated, there are overlapping features. More than one perspective may be relevant at any given time, although usually there is a predominant mode of growth activity. Also, change of any sort may be influenced by factors over which the leaders who undertake these changes have little control. The management of growth and change puts a premium on attitudes of openness, learning, creatively, and courage, and always there are technical and analytical factors that require knowledge and skill.

BASIC DEVELOPMENT

Two sources guide The Samaritan Institute in describing the basic development of a SamaritanCenter:

  • TheSamaritan Institute Accreditation Standards, and
  • Key Indicators For a Thriving SamaritanCenter.

These two documents contain the accumulated wisdom of the Samaritan Institute about developing strong Centers gained over the years in starting new Centers, in consulting with Center leaders about their own organizational needs and issues, and in applying to these tasks knowledge from outside sources.

Basic development means that the Center has gained enough resources to carry out its mission, has the capacity to adapt and contribute to its external environment, can weather organizational crises and transitions, and is positioned to develop further. Centers that do not attain this kind of foundation are often left with chronic weaknesses or deficiencies which make further development problematic.

Using the Key Indicators* as a guide, a Center has reached a level of basic development when it has:

  1. A clear identity as a SamaritanCenter
  2. A reputation for providing quality services at a reasonable cost
  3. A working board that leads through policy-making, fund raising, and advocacy
  4. Executive leadership that manages the Center and is accountable to the board
  5. A core staff of three or more full time licensed therapists
  6. Educational and consultative services
  7. The ability through its therapists to receive third-party reimbursement
  8. An evolving management system for executive, administrative, and clinical functions
  9. Viability as a small business that effectively manages its financial affairs

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  1. Optimal size to be cost effective and competitive in its market
  2. A planned growth strategy that is adaptive to market conditions and internal resources
  3. Sufficient contributions to pay for discounted services and new program development.

*The complete statement of the Key Indicators may be found at the start of the Management Section.

Several points about basic development should be emphasized:

  • Some Centers are relatively strong and stable without having achieved all of the key indicators. They succeed because of factors like dedicated board and staff leadership, unusual circumstances in their communities, and skilled management that maximizes organizational and financial resources. They pay a price for this, however.

For example, Centers that remain small typically have to raise more money, offer lower staff compensation, and see fewer below-cost clients compared with Samaritan averages. They may succeed in spite of these limitations; but they are also vulnerable to financial and staff reversals that larger and more fully developed Centers can take in stride.

  • It is not always the case that every element of basic development must be attained before moving on to expansion or quality improvements. Growth can take place even without optimal basic development provided Center strengths and limitations are fully understood, and opportunities and threats in the external environment are properly assessed. For example, a Center may have unusual funding opportunities that offset relatively low fee income. Or the Center may have educational programs and consultation contracts that compensate for reduced clinical hours. Board and staff leaders in Centers where optimal basic development has not yet been achieved have more than the usual responsibility to assess long range prospects when growth is contemplated.

The staff of the Samaritan Institute is committed to helping Centers achieve basic development through an active new center development process, accreditation site visits and reviews, ongoing consultation, and educational programs.

GROWTH OPTION I: EXPANSION

Expansion as a growth option may apply to any aspect of the Center’s life and function. Here are some examples:

  • Developing new service locations

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  • Developing diversified services
  • Upgrading administrative resources (e.g. computers)
  • Negotiating exchange covenants with new congregations
  • Adding clinical staff members
  • Enlarging the board and making it more active
  • Adding a marketing and development officer

What are the factors that should be considered in an expansion strategy? The list that follows may be used to assess a particular Center’s expansion ideas or needs. These lists, like the others in this document, are illustrative only. It is intended that users of this instrument expand it and tailor it to their own situations.

  1. Start with your mission.
  • Is what you want to do an authentic extension of your mission? Are there aspects of the planned expansion that are in tension with your current mission statement?
  • Is it time to rewrite your mission statement?
  • Who needs to be convinced that this project is relevant and needed?
  1. Know why you want to expand. Is it:
  • To provide more service hours to be more cost effective?
  • To position the Center more strategically in the community, e.g., service locations?
  • To decrease administrative costs relative to income production?
  • To capitalize on a Center strength or make an organizational weakness irrelevant?
  • To solve a problem, e.g., a new location because you have outgrown the old one?
  • Other
  1. Identify your objectives and their consequences

Name your objectives:

  • What do you hope to achieve through expansion?
  • How long will it take to get to where you are going?
  • Is this a cost-effective way to use resources and to plan for the future?
  • How will the Center be different as a result of expansion?
  • What current ways of operating will have to change because of expansion?
  1. Do your research (some examples)
  • If you are expanding services: Do you have a plan for surveying your market to determine the need for the new services or service locations?
  • If you are adding computer capability: Do you have a computer expert to help you assess your needs, costs, etc.

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  • If you are moving the central office: Have you studied how the new location will affect your clients and your staff? How will it be perceived by your sponsors?
  • What other kinds of research are needed? Name them:
  1. Decide on a strategy (some examples)
  • To add new service locations in area congregations. Is your strategy: a) to map out optimal service locations?; b) to respond to interested congregations wherever they are?; c) a mixture of both strategies?
  • To add staff counselors to increase clinical hours. Is your strategy: a) to go locally with part-time staff?; b) to find full-time people locally?; c) to search outside?
  • Your objective: (list)
  • Your strategy: (list)

5. Make plans to implement your strategy

  • Who are the key people in spearheading the expansion effort?
  • What tasks must be performed by what people on what time line?
  • What technical resources are needed?
  1. Determine costs and funding
  • What is the budget for the entire project?
  • Where is the money coming from? Regular revenue sources? Special funding?
  • How much money is needed to get started?
  • How will you manage cash flow in the critical start-up phase?
  • Have you factored in lost time expense, moving expense, etc.?
  • Other cost factors?

A word of caution: Expansion, especially if it is more than straightforward addition, not only puts a strain on Center resources, it usually requires a measure of restructuring. As the Center grows larger, it is important to anticipate and plan for the ways the whole system is likely to be affected by the changes brought about through expansion.

GROWTH OPTION II: QUALITATIVE CHANGES

Quality across the board -- services, organization, personnel – is the aim of every SamaritanCenter at every stage of development. Quality is not something that is added on after basic development. Without quality, it is hard to attract clients; boards lose their best members; talented staff persons leave for other positions; and community sponsors lose interest and respect.

Qualitative changes as a growth strategy means adding depth to the organization and to its human resources. It means improving what is already there, much like a successful

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sports franchise goes after quality players to back up and increase the effectiveness of the ones they already have.

Growth in quality may take the form of:

  • Building a more specialized staff
  • Increasing customer satisfaction through better service
  • Customizing services
  • More effective marketing
  • Improving staff benefits to retain talented staff members
  • Computerizing clinical, administrative, financial, and marketing operations

When should quality be the primary growth strategy? Use this checklist to assess the need for qualitative growth as the primary strategy.

1. Is your Center story being told effectively in the community?

  • To congregations?
  • To businesses?
  • Through your brochures and publicity materials?
  • Through an organized marketing plan?
  • To donors, foundations, civic clubs, etc.?

2. Are counseling staff developing new or repackaged services?

  • Does the staff system encourage innovation and diversification?
  • Are enough staff members trained to offer specialized services?
  • Is there enough organizational and financial flexibility to support new services?
  1. Do the Center’s financial reports give board and staff leaders the kind of information they need to make good decisions?
  • Are they accurate? Are they complete? Are they timely?
  • Is financial information linked to the decision-making process?
  1. Is the leadership and management system keeping pace with expanded services and the Center’s overall development?
  • Is the executive director burdened with too many roles and tasks?
  • Do staff members get the information they need to do their work?
  • Do staff members have a voice in decision-making?
  • Has there been sufficient differentiation of staff leadership roles?
  • Is there enough administrative support for services?
  • Do staff and board members complain about how the Center is being run, and do their complaints point to patterns of dysfunction in the management system?

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The questions above suggest the possibility of qualitative growth strategies. For example:

Question 1 is about marketing and communications. Qualitative improvements might take the form of a coordinated marketing plan, unified and attractive printed materials, and training in presentation skills.

Question 2 is about diversifying services and developing specialized staff resources. Qualitative changes might take the form of hiring staff that have specialized training, of committing to diversification, and of freeing up money to develop new programs.

Question 3 is about financial records and reporting. Qualitative growth might take the form of changing to better financial software programs, of hiring a more experienced business manager, and of more efficiency in reporting financial information to the board.

Question 4 is about the leadership and management system. Qualitative changes might take the form of changing from solo executive leadership to a management team model, of delegating tasks from the executive director to others, and of inviting staff input in the decision-making process.

Growth in quality requires these attitudes, commitments, and actions:

  • Top down, bottom up staff and board commitment to the value of excellence
  • Orientation to the customer’s needs and satisfaction – an external focus
  • Adding value to Center services through people more than things
  • Willingness to use available technologies
  • Openness to new information and new ways of doing things
GROWTH OPTION III: TRANSITIONS

Because Centers pass through developmental stages and must constantly adapt themselves to internal changes and to a changing environment, growth may focus on the process of transition itself. Transition, as the term is used here, is more than simply shifting the furniture – what some call “incremental” change. Rather, a transition is a “systemic” change that affects the Center’s culture -- the way people think about, value, and organize their work. Transitional growth is the process of moving to a new stage of development, often bringing with it a new culture.

Here are six examples of transitions Samaritan Centers frequently encounter:

  1. An executive director change
  2. Board reorganization, e.g., from a development board to a working board
  3. Incorporating managed care into the services mix
  4. Moving from a solo executive model of leadership to a management team model

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  1. A shift in services from predominantly long term counseling to short term counseling
  2. The loss of key staff service providers

These are examples of transitions rather than incremental changes because they bring the whole system into play. For example, changing the executive director inevitably means some change in leadership style, in management priorities, in staff-board relations – all things that affect the entire Center and not just the office of executive.

Some transitions are easy to identify – e.g., director changes or the sudden loss of key staff members – but others are more subtle. Many transitions, for instance, are characterized by a growing sense of crisis and dissatisfaction that cannot be pinned down. Is there a specific problem, or is it the result of unrecognized developmental changes? When specific problems are worked on without result, the chances are good that it is a systemic issue and that transitional rather than incremental change is needed.

What are the signs that a transition is needed? The following questions can be used to identify transitional growth issues:

Have there been significant changes and losses in the past year?

  • Has the Center lost something or someone that has been precious to it?
  • Has the Center moved to new space?
  • Has the Center come into a lot of money?
  • Has there been a major shift in office administration?
  • Have Center services branched out into new territory – e.g. mediation, contracts with
  • businesses, become much more tied in with managed care?
  • Are staff now paid differently than they used to be?
  • What significant change or loss has your Center experienced?
  • Transitions are marked by a sense of loss of something important, even when
  • decisions have been made to go to something different.

Is the Center “stuck” in particular patterns?