length and lack of a standard format to be a barrier in clinic use. An evaluation of this program is currently under way. A CSAT knowledge exchange activity is the Treatment Improvement Exchange (TIE) program to promote information exchange between CSAT staff and state and local alcohol and drug abuse agencies. TIPS and CSAT by Fax are both available on the Treatment Improvement Exchange. TIE is accessible via the CSAT web site (http://www.samhsa.gov/csat/csat.htm) or directly (http://www.treatment.org). While workshop participants who use the Internet appreciated this availability, it was evident that a significant number of providers still do not have effective access to this resource.

ORGANIZATIONAL CHANGE MODELS

An obvious goal of any organization is to maintain its viability. Organizational survival depends on the ability to provide a service or product that someone will buy or support. Increasingly, organizations must anticipate market forces and be able to accommodate rapid changes in their environment. Health care organizations, particularly those that are not-for-profit, traditionally have been somewhat sheltered from severe environmental and market forces. However, recent rapid changes in the financing of health care, including behavioral health care, are affecting community-based drug treatment providers.

As organization size increases, jobs within the organization become more differentiated. The workforce tends to be more stable because larger organizations are more likely to offer full-time employment, benefits, and other employee incentives. Organizational operations become formalized and may include specific procedures for innovation and implementation of new programs. Larger organizations are more likely to have adequate technology and other resources to sustain the extra work efforts that go into the adoption and implementation of new programs.

Many health care organizations have been unable to accommodate to a rapidly changing health care environment and have failed. This is particularly true of small to medium-sized mental health and drug abuse services that are poorly financed compared with organizations that provide mainstream health services. As a consequence, managers of CBOs, especially those that are small in size, focus primarily on maintaining organizational viability. This focus calls for a conservative organizational culture, a trim work force, and the ability to deliver a competitive product. The focus also stimulates attention to health care financing and other environmental changes that affect the resource base of the organization. In this climate, investing in innovation makes organizational sense only if it promotes organizational survival.

Not all organizations can support the kind of innovation necessary to



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