Lawrence L. Schkade School of Business, Department of Systems Analysis The University of Texas at Arlington Arlington, Texas 76019

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1 Dick Schoech Graduate School of Social Work Lawrence L. Schkade School of Business, Department of Systems Analysis The University of Texas at Arlington Arlington, Texas HUMAN SERVICE WORKERS AS THE PRIMARY INFORMATION SYSTEM USER INTRODUCTION ABSTRACT. A mature information system is a model of the communication transactions of an organization. If the information system is to model the functions and processes of the organization, user needs, decisions which must be supported, and the characteristics of the data system must be understood. This analysis of the information requirements of human service organizations views the worker as the primary information system user. Deficiencies in present systems, practices and policies are discussed and developmental, technological and organizational recommendations for alleviating these discrepancies are suggested. A mature information system tends to mirror the operations and serve as a communication model of an organization (1). In order to move a manual or automated information system toward maturation, it is necessary to understand who uses information, peculiar information characteristics, and the type of decisions that the information must support. An information system which operates counter to the functions and processes of the organization can only be successful in the short term. Eventually, the information system must be aligned to become a communication model that mirrors organization operations. Information systems gradually change to model the organization rather than vice versa. Problems which some information systems exhibit are due to their lack of congruence with the basic operations of an organization. Thus, an understanding of organizational functions and processes is a prerequisite to successful information system development and operation. This paper examines the basic information requirements of a human service organization. Human service organizations facilitate daily living by enabling individuals, families and other primary groups to cope, to function, and to contribute (2). After analyzing the information requirements of humn service agencies, this paper examines existing human service information systems, current practices for using these systems, and the poliies and procedures related to their operations. This examination reveals inconsistencies between basic functions and processes and existing

2 information structures, practices and policies. Implications and recommendations are discussed to assist in developing systems that are more congruent with basic organizational operations. STRUCTURE OF INFORMATION IN HUMAN SERVICE ORGANIZATIONS The differences between the information requirements of a human service agency and those of a busines organization are discussed in the following analyses of the human service information users, the characteristics of the information used, and the decision making that Information must support. The.user of information Identifying where the primary information transactions occur in the process of achieving organizational goals (worker level), managing goal achievement (middle management level), and adapting the organization to its environment (top management level) is a prerequisite for the development of a communication model of an organization. This paper takes the perspective that most information transactions, i.e., information encoding, processing, and/or decision output, occur at the bottom of the human service organization in worker/client interactions. The worker is viewed as the primary information user because information generated at the worker/client interface is the primary information input that activates organization functioning. Ideally, client information would be captured, stored, and detailed summaries reported back to the worker. Less detailed summaries would be reported to middle management for planning, controlling and budgeting purposes. Even less detailed summaries, combined with information on the organization's environment, would be reported to top management for use in seeking funding, making strategic decisions, and guiding the organization in a changing environment. The information needs of clients further supports the focus on the lowest level of the organization as the location of primary information transactions. The client is a major user of human service information because most human service agencies exist to support and improve client decision making. If clients are to be capable of assuming more responsibility for their services needs, human service agencies must provide clients with information adequate for selecting the most suitable service alternatives. Human service professionals should make decisions for clients only in situations where the decisions are highly technical or where the client or the client's guardian is judged incompetent or irresponsible. An agency's information system should support the client/worker interaction whenever possible. Characteristics of information needed Gorry and Morton, in their classic article on a framework for management information systems and a more recent update by Keen and Morton have pointed to the characteristics of information required by organizations (see Table 1) (3; 4). This framework

3 aids in contrasting the information needs of human service workers, middle managers, and top managers. TABLE 1 INFORMATION REQUIREMENTS BY ORGANIZATIONAL LEVEL Organizational Development Continuum Characteristics Operational Management Strategic of Information Control Control Planning Source Largely internal < > External Scope Well defined, narrow < > Very wide Level of detail Detailed > Aggregate Time horizon Present < > Future Currency Highly current < > Quite old Required accuracy High < > Low Frequency of use Very frequent <- > Infrequent Age of information Current < > Old Type of information Quantitative < > Qualitative Type of decisions information must support The complexity and risk in decision making at the top management level in human service agencies is mediated somewhat by the policy guidelines inherent in legislation, regulations, grant guidelines and citizen boards and advisory committees. It can also be argued that this layer of guidance makes top management decision making in human service organizations more complex. This argument is true only if top management sees its primary role as making policy rather than implementing policy. At the middle management level, decision making becomes less risky, more quantitative and routine, i.e., repetitious and guided by procedures. The organizational activities with which planners, accountants and supervisors must contend are less complex and unpredictable than those which either top management or the workers contend. The worker level involves the most complex decision making as workers interact with people in trouble or crises. At the worker level quantification of processes and outcomes are the most

4 difficult* The dual organizational structure in which workers must make their decisions adds to the complexity of decision making* On one hand there are demands for compliance with professional ethics and on the other demands for compliance with organizational mandates* An example of this dual- structure exists in some mental health agencies where the psychiatrist and administrative staff vie for control over the day to day operations of the agency* Workers often have little guidance and must at times mediate between the needs of the client, their profession, the agency, and the agency's environment*.for example, in a recent child welfare case in El Paso, Texas several caseworkers were arrested for acting in accord with agency policy, and they were not legally defended by the agency. The workers had performed according to what they felt were agency, professional, and client (abused child/parent) needs, yet they ran afoul of an environmental factor the judicial system. Although the case was eventually dismissed by the court, this case illustrates that worker decisions can become the focus of multiple conflicting interests. The information requirements of a human service agency can be viewed as being substantially inverse to those of a traditional business production organization. This difference is illustrated in Table 2 which summarizes features of decision making in the two types of organizations. TABLE 2 COMPARISON OF DECISION MAKING IN BUSINESS AND HUMAN SERVICE ORGANIZATIONS Decision Making Characteristics Complexity Organizational Routine- Quantifi- of Level ness Quantity Risk cation Environment Worker Level Business High High Low High Low Human service Low High High Low High Mid-Management Business Med Med Med Med Med Human service Med Med Med Med Med Top Management Business Low High High Low High Human service Low Med Med Low -High

5 In the past, human service organizations have implemented information systems patterned after those in business rather than being designed to meet the peculiar nature of human service delivery, as illustrated by the following analysis of human service information systems, practices, and procedures* PRESENT SYSTEMS, PRACTICES, AND POLICIES Most human service agencies are in the initial stages of automating information processing. Agencies currently use a variety of information systems ranging from oral to written to automated in structure. In general, human service information systems are not as sophisticated as those in local and state government or in business. An examination of present practices illustrates the problems inherent in these information systems. Present policies are often Inadequate to address such key issues as user involvement, security and privacy. In this review of the present status of human service information automation, the worker's perspective is illustrated with quotes from lower level managers and line workers in typical human service agencies. Systems Many large human service agencies currently have centralized automated information systems which primarily process management oriented information in the areas of accounting, services, or client data. Medium size agencies typically process management oriented data via an outside computer service bureau. In smaller agencies, data is frequently processed remotely by a main office, a United Way office, or another computer time sharing arrangement. The results of a 1979 survey of the 241 community mental health centers with some form of automation, shown in Table 3, supports the view that most human service information systems are management rather than worker oriented (5). In areas where human service agencies are relatively standardized, e.g., Community Mental Health Centers and Title XX agencies, sophisticated information systems have been developed by vendors funded by government contracts. The systems resulting from these initial development efforts often are refined and marketed by vendors. For example, seven software vendors exhibited information systems at the 1981 National Conference of Community Mental Health Centers. Agencies, such as family services, which vary widely from city to city, are beginning to buy prepackaged data base management systems for small business computers. In the case of services that are hospital based, a variety of hospital systems are available. Most prepackaged systems, however, require some modification, since they do not address the agency's needs completely. These modifications can be extensive and expensive. Microcomputers are beginning to be used in small agencies, departments and local offices of large agencies. The acquisition

6 TABLE 3 MENTAL HEALTH CENTER COMPUTER SUPPORTED APPLICATIONS Adminis t rat ive % Clinical % Applications Using Applications Using Patient census/demographics 81% Direct service data 74% Staff activity data 77% Indirect service data 60% Payroll 66% Intake data 55% Third-party billing 57% Diagnostic data 49% Direct patient billing 57% Medication treatment data 21% Financial/accounting 55% Utilization review 17% Inventory system for Symptom/problem scales 13% property 32% Cost outcome data 13% Follow-up data 9% Screening (MMPI) 9% Individual treatment plan 8% Mental status examination 8% Goal achievement data 8% Development and social history 4% Clinical progress notes 2% Computerized predictions 2% of a microcomputer by a human service agency often results from the initiative of an employee who is knowledgeable of the computer and its potential. Microcomputers are being used primarily to perform functions such as processing client data or word processing and are rarely connected with a larger information system. These applications often discontinue when the person initiating the effort leaves the agency. In other instances,

7 management has forced the removal of personally owned microcomputers from agencies. Applications of microcomputers as integrated elements of a larger system, or as a total system for a small agency are rare. Practices In actual practice, human service information systems have rarely fulfilled initial expectations. System development often involves problems such as frustrations with development and installation, untimely and inaccurate data, duplication of effort, vendor unreliability and user resistance. Informal systems often evolve to circumvent the problems of an inadequate information system or because of a lack of trust in an existing system. The following quotes present views of some typical situations. "Currently within the agency there exists a vast array of management information systems of various types, shapes, and sizes." (Child Placement Supervisor) "We are now faced with a three year history of unsuccessful interfacing of old hardware that is already obsolete to new hardware. The lack of compatibility of these systems has created a backlog of data that must be processed manually, thereby negating the original purpose of automation." (Supervisor) "Inordinate amounts of my time and that of my direct service staff was spent on the routine collection, maintenance, and collation of data. A time study was done showing that 40% of each staff person's time could be released for more appropriate activities by automating this process." (Supervisor) "Different units performing similar functions not only classify data differently, but duplicate submission of input data to the Regional and State offices. There is a distinct lack of trust in the validity of the reports issued from these inputs." (Supervisor) "Social workers are quick to claim the sanctity of the client/worker relationship and decry the replacement of any human functions by machines. The agency management, wanting to avoid the heartless bureaucrat label, repeat this anti-machine argument like an article of faith. An example of this phenomena occurred in a program review in which the Deputy Commissioner stated that any testing of programmable calculators had been rejected on the grounds that it was too % dehumanizing' to have a worker punching a machine during the interview. Food stamp workers and supervisors have a diametrically opposing reaction and see the calculators as a method of saving hours and hours of calculation time, as well as giving the client the desirable immediate feedback." (Program Director)

8 "The system must not be responsive to management's inquiries because the field staff are deluged for specific data requests, and more frustrating, we receive requests for information that the automated system routinely receives monthly." (Supervisor) "No attempt has ever been made to ask field midmanagement staff what information would be useful to them." (Supervisor) Management and worker opinions of information systems in community mental health centers are summarized in Table 4 (5). The sharp contrast in Table 4 of the opinions of clinical staff compared to those of management/clerical personnel illustrate that computer based systems currently do not support information needs at the worker level. TABLE 4 ATTITUDES ON USEFULNESS OF COMPUTER-SUPPORTED APPLICATIONS Definitely Useful Creates More Problems Than Worth Evaluators 70% 2% Administrator 68% 2% Researchers 62% 4% Program managers/ supervisors 38% 4% Clerical support staff 30% 15% Clinical staff 8% 15% Policies Too often policies and procedures concerning human service information system are not written and formalized, and have evolved in response to problems rather than as a result of planning. Consequently, policies and procedures do not always reward use of and cooperation with the information system, as indicated by the following statement. "As long as managers continue to allow hand counts and manual records, there is no incentive for supervisors to require that the units report (data) promptly and

9 correctly to the MIS. Currently, it is not uniformly true that using the MIS is more rewarding and rewarded than not using the system." (Program Director) Another area where policies and procedures are often inadequate is in the protection of physical security and data privacy. Security and privacy are crucial if workers are to trust that sensitive data they supply will be used for the client's benefit. Client identifiable information which becomes part of statewide databanks is especially vulnerable. Because of the multitude of users, security can become inadequate due to Inadequate policies and procedures. Since the typical human service client is disadvantaged and powerless In safeguarding the information that must be provided, safeguards against privacy violations must be built in the system and in agency practices. IMPLICATIONS AND RECOMMENDATIONS It is apparent that little congruence exists between the basic human service operations and present systems, practices and policies. The following implications and recommendations are designed to help bring about a closer correspondence of information systems with the functions and processes of human service organizations and eliminate some of the present problems and frustrations. Focus of human service information systems Human service information systems should be designed to support decision making needs of all levels of the organization. Management data should be a natural by-product of the data captured at the worker/client interface. Human service information systems could operate similarly to grocery store automated checking systems where the data which support management decisions is captured at the point of checkout, the worker/customer transaction. Top management may need additional data about the environment of the agency, e.g., census data and statistical analysis, but this data need not involve the worker. The developmental process The development process of human service information systems should reflect the worker as a primary user. Traditional systems analysis is more helpful in producing a management information system rather than a worker information system. Since determining worker information requirements is difficult, the temptation is to ignore worker needs and develop a system which will address management needs. A management oriented system should be seen as a secondary rather than the primary element of a total agency information system. In developing worker information requirements, it may be necessary to combine a bottom up approach along with the traditional top down approach. For example, initial top down

10 analysis could produce long range information system objectives and a sketch of worker information requirements. This analysis could be the basis of a bottom up implementation strategy using a flexible data base management system. This total process could be' repeated until worker requirements are finalized and the information system supports the operations of the organization. An example of this process can be seen in eight documents describing the feasibility of developing a prototype minicomputer management information system for community mental health centers (6). This pioneering in human service worker information requirements and concommitant software is difficult, frustrating and can possibly lead to an initial system plagued with problems. No agency should attempt it without board, staff, and funding source support, and the total process should be modular to avoid total disruption of agency services during the several years needed to develop the system. Worker involvement is a key component in this process as workers know their needs best. Compensation for time involved in the process, training and exposure to other systems will increase worker participation. Technological implications The data base management system concept is useful especially in the initial stages of developing a worker oriented system due to the flexibility gained and the ease of changing the system. Data base structures which handle many to many relationships and variable length data items help insure this flexibility. Distributed data processing (DDP), especially in large organizations is desirable, because it allows the placement of computing power where it is needed most. The ideal would be to use a distributed data base management system which has proven flexible, easy to use and reliable (7). Other technologies which help reduce the data capture task of workers are also Important, e.g., word processing, optical recognition, and computer output microfilm. Equally important are computer graphics which enhance the comprehension and utility of reports. Organizations implications Traditional organizational structures may need to change with the introduction of a worker oriented information system. Worker information often flows across traditional boundaries as in a child welfare case management system which could involve information and referral data, financial and adult services data, and foster care and adoption data. Another organizational consideration is that the agency computer will frequently support multiple users in different departments, e.g., accounting, word processing, and management. Methods must be found to cross traditional boundaries and to

11 establish structures flexible enough to evolve as agency information systems evolve. Interdepartmental task forces and matrix oriented organizational structures are a step in this direction (8). CONCLUSION Convergence between the information structure of a human service organization and the automated information system is the ideal model for which to strive. Present management information systems are not based on the concept of the worker as the primary user of information in a human service agency. Congruence can be obtained if the system focus, the development process, and technological and organizational considerations reflect worker information requirements. Worker oriented systems will not solve all the problems associated with present human service information systems, but these systems can help to avoid some major problems and bring the agency closer to information system maturity In which the agency information system supports all agency decision making and becomes a more ideal communication model of the organization. REFERENCES (1) Nolan, Richard L. "Managing the Crisis in Data Processing," Harvard Business Review. 57: (1979). (2) Kahn, Alfred J. and Kamerman, Shell A. Social Services in International Perspective. Washington, D.C.: U.S. Government Printing Office, (3) Gorry, Anthony G., and Morton, Michael S. S. "A Framework for Management Information Systems," Sloan Management Review. 13: (1971). (4) Keen, Peter G. W., and Morton, Michael S. S. Decision Support Systems: An Organizational Perspective. Reading, Massachusetts: Addison Wesley, (5) Bellerby, Linda. Unpublished survey, Portland State University, Regional Research Institute for Human Services, MIS Curriculum Project, (6) Goodman, John, and Worster, Cecil. "NIMH Prototype Management Information System for Community Mental Health Centers." Presentation at the National Conference of Community Mental Health Centers, Dallas, Texas, April (Documents available through NTIS.) (7) Snyders, Jan. "Those Belated Distributed DBMSs," Computer Decisions. (February): (1981). (8) Homes, Fenwicke W. "IRM: Organizing for the Office of the Future," Journal of Systems Management. 30: (1979)

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