Organisational Silos Research Articles

A multi-dimensional study of organisational boundaries and silos in the healthcare sector.

Purpose: The aim of this study is to understand how healthcare practitioners experience organisational boundaries and silos in day-to-day operations. Based on a multi-dimensional scale of organisational boundaries, the study examines how organisational demarcation lines enable and constrain daily work tasks in the healthcare sector.Research design: The study is based on a quantitative and qualitative analysis of survey responses from 895 healthcare practitioners in Denmark.Results: The results indicate that tendencies toward organisational silos relate to systems and hierarchies (management-staff) rather than professions and departments. Moreover, the study identifies resource scarcity as an important undercurrent in the understanding of the respondents' perceptions of boundaries and silos.Conclusion: The study contributes to existing research by documenting the coordination and collaboration challenges linked to the multitude of demarcation lines in complex health organisations.

Policy interventions for scaling up agroforestry in Fiji

ABSTRACT Agroforestry is recognised as a land management system balancing goals of environmental conservation with the socioeconomic needs of communities. In Fiji while traditional agroforestry is rapidly eroding due to modernisation and commercialisation of food systems, institutional agroforestry has failed to reintroduce trees in farming systems. This paper is a discussion on the challenges, opportunities, and policy interventions affecting agroforestry. Weak extension activities, lack of an institutional champion, organisational silos, lack of awareness and poor understanding of agroforestry, low focus on native trees, poor land and resource rights of women, and lack of economic incentives are among the major constraints to agroforestry adoption. An agroforestry policy should create enabling conditions for institutional support and coordination between diverse sectors, raising awareness and dissemination of success stories, harmonising traditional and modern agroforestry, mainstreaming gender in agroforestry decision making, strengthening agroforestry extension, generating short-term and long-term economic incentives, and agroforestry research and curricula development.

Reconsidering silos

While organisational silos are often viewed as an obstacle to overcome, this paper argues that they are a necessary feature of the workplace environment and should instead be approached in a manner that maximises their potential. This case study describes an approach used by three specialised areas at an academic library — cataloguing and metadata services, digital collections and digital preservation — to retrospectively manage the technical debt incurred during the COVID-19 pandemic. In response to the sudden shift to remote work, library workers developed an action plan to continue an in-process migration with minimal disruption; however, this necessary action significantly exacerbated an already complex file storage system. Although retrospective management of technical debt can be complicated by the management needs of multiple stakeholders, staff members in several areas of specialisation approached the project by identifying needs related to the subcategories of a digital object entity — the intellectual entity, representation entity, file entity and bitstream entity — and developed high-level solutions to meet these needs. This approach exposed three types of silos (context, schemas and processes) and related communication challenges, which can complicate cross-team collaboration. Yet by reconsidering organisational silos as interconnected units of specialisation, staff members successfully applied specialised knowledge, advocated for their management needs and collaborated to resolve the technical debt.

Real-life resilience: Exploring the organisational environment of international water utilities

The water sector has signalled the need to advance organisational and social resilience efforts. There is a lack of understanding of whether the organisational environment in water utilities is conducive to organisational resilience. Themes from interviews showcased challenges related to cognitive and contextual organisational properties. We identified a need to broaden the cognitive frame of utilities to account for flexible concepts of enhanced sense-making. We propose categories of organisational silos and a set of cultural attributes that contribute to organisational resilience. Interventions are needed to develop the cognitive, behavioural, and contextual properties of utilities that support organisational resilience.

Digital Heritage and Contingent Labour in the Museum

Museums have responded to calls for accountability and reconciliation by establishing cultural recuperation programming, which commonly involves community members travelling to museums to visit and research object collections. Community groups identify the ability to be physically present with their belongings and bear witness to the stories and relations they embody as one of the most valuable outcomes of these initiatives. These visits are often prohibitively expensive and time consuming; therefore, museums are increasingly exploring digital solutions to expand access to collections and other resources. However, North American museums in particular are increasingly reliant on contingent labour to fill roles previously occupied by salaried staff. This is especially true for digital initiatives that frequently operate on a limited-term, grant-funded basis. Existing literature in museum studies offers little critical analysis of the nature of digital museum labour and its impact on workers, outcomes and community partners, focusing instead on standards, protocols and best practices. I argue that this shift towards contingent digital labour in museums challenges the robust, locally specific ‘logic of care’ that scholars suggest undergirds satisfactory cultural recuperation work. The impacts of this shift are compounded by the institutional tendency towards organisational silos and the reliance on technical specialists and specialised knowledges to ensure the success of digital projects. In this paper I attend to the experiences, perspectives and everyday practices of those people ‘doing’ digital work in the museum as a method to uncover the nature of that labour behind the scenes. Furthermore, I demonstrate that reliance on contingent labour perpetuates harm against community groups that have already been and continue to be harmed by institutions. To do so, I bring together extant data on employment precarity in digital museum work with literature on decolonial museology and the use of digital technologies for cultural recuperation to analyse the way that the precarious, technically specialised and temporally limited nature of digital museum labour articulates established museological praxis.

Transcending the silos through project management office: Knowledge transactions, brokerage roles, and enabling factors

Organisations often suffer from knowledge flow gaps between operational and strategic management levels, leaving much knowledge trapped within operations’ boundaries. Prior studies viewed the project management office (PMO) as a knowledge broker that can enhance the interaction between these levels. However, they take a single-faceted knowledge brokering perspective that fails to define the specific knowledge brokering roles of the PMO and offer highly fragmentary evidence on the associated enabling factors. To fill this void, we draw on the brokerage theory to develop a comprehensive theoretical framework in which we define specific knowledge brokering roles of the PMO and delineate their enabling factors for facilitating multidirectional knowledge transactions. We elaborate on three sets of knowledge brokering roles, each of which corresponds to one of three categories of knowledge transactions. Our model shows how PMOs can broker knowledge trapped in organisational silos by balancing bottom-up experiential learning with top-down deliberate learning while maintaining horizontal knowledge synchronisation.

Breaking down silos: A journey from functional distance to collaborative accountability

Silos or behaviours that disconnect people from others within their organisation can play a key role in the overall performance of companies, especially large businesses. This paper explains how to review current silos, address or minimise challenges within them, and create employee engagement and collaborative accountability. There are many types, but three significant silos to avoid and address include physical, organisational and experiential silos. Once silos are identified, ‘broken down’, or minimised, leaders often declare victory and are surprised to see them return. By aligning goals and establishing a culture of collaborative accountability, engaged leaders can maintain better communication and connections across teams and functions to ensure the broader organisation continues moving forward together in pursuing broader business strategy. All these pieces together help create optimal performance and deliver top results.

A framework for conceptualising the organisational communications of a project management office

The project management office (PMO) plays a key role in linking the strategic and operational levels of a project-based enterprise. Fulfilling this mission requires effective collaboration with stakeholders since PMOs can no longer operate in organisational silos. This research aims to tackle the knowledge gap regarding the conceptualisation of the content of PMO communications in project-based organisations. A critical literature review and qualitative synthesis were conducted to draw conclusions concerning the existing theoretical discussions on the topic. The results are presented in the form of a framework explaining 11 categories of stakeholders and respective potential communications with them in four directions: horizontal, vertical upward, vertical downward and external. This study extends the literature by introducing a new theoretical framework of PMO communications and providing an insight into the main constituents required for maintaining effective relationships with stakeholders in practice.

Collapsing organisational silos in health system operations

‘Coordinated care’ is a growing concept in healthcare, with practices like electronic health records (EHR) helping disparate providers and specialists break out of silos to complement each other’s care for a given patient. But de-siloing is also beneficial — and sorely needed — in the way health systems organise their management teams, both in clinical and business operations. Virginia Mason Institute has helped medical centres minimise errors, reduce workloads and improve morale at all levels, from front-line staff to directors, through a series of reforms focused on cross-functional collaboration. These reforms may serve as a template for other systems to follow as they seek to conserve costs, engage staff and instil a culture of teamwork and shared goals. This paper describes how Virginia Mason applied VMPS in two scenarios. These scenarios showcase how combining two broad strategies and five specific tactics can diminish silos and improve efficiency, morale and financial performance.

ФУНКЦІОНУВАННЯ ІНТЕГРОВАНОГО ПОРТАЛУ ЕЛЕКТРОННИХ АДМІНІСТРАТИВНИХ ПОСЛУГ: ПРАВОВІ АСПЕКТИ

The article is devoted to the legal principles of implementation of electronic administrative services in Ukraine. eGovernment supports administrative processes, improves the quality of the services and increases internal public sector efficiency. Digital public services reduce administrative burden on businesses and citizens by making their interactions with public administrations faster and efficient, more convenient and transparent, and less costly. In addition, using digital technologies as an integrated part of governments’ modernisation strategies can unlock further economic and social benefits for society as a whole. The digital transformation of government is a key element to the success of the Single Market. One of the factors that significantly reduce the effectiveness of digital public services is their distribution between different levels of government. Public administrations and public institutions should be open, efficient and inclusive, providing borderless, personalised, user-friendly, end-to-end digital public services to all citizens and businesses. Innovative approaches are used to design and deliver better services in line with the needs and demands of citizens and businesses. Public administrations use the opportunities offered by the new digital environment to facilitate their interactions with stakeholders and with each other.To overcome this obstacle, a single state web portal for electronic services was created. The creation and functioning of the Unified State Web Portal of Electronic Services is analyzed. The factors that may adversely affect his work are identified. In particular, the relevance of information on administrative services, lack of legal regulation, lack of interoperability of public digital resources and platforms. Interoperability mean that public services should be designed to work seamlessly across the Single Market and across organisational silos, relying on the free movement of data and digital services in Ukraine. The functioning of the service and its convenience for users of electronic administrative services are analyzed. These are: integration of existing public digital services on a single platform, identification that will provide data protection, user-friendliness and clarity of the interface. Electronic identification means the process of using person identification data in electronic form uniquely representing either a natural or legal person, or a natural person representing a legal person. The formation of digital administrative services based on the criterion of life situations. Confidence in and convenience of online services are essential for users to fully benefit and consciously rely on electronic services.

Organisational Silos and Decoupling in Sustainability

The decoupling between policies, practices and outcomes have been extensively studied in sustainability. As our comprehension of the phenomenon expands, new explanations for such disconnections emerge. In this article, we introduce the relationship between decoupling and organisational silos, a situation when communication and alignment between parties is minimal. We draw on a qualitative case based on 480 hours of ethnography and 73 semi-structured interviews to understand the implementation of sustainability in a highly siloed organisation. Our findings reveal a vicious cycle between silos and decoupling that makes it very hard for sustainability to be implemented. The more the sustainability department is isolated in the company, the more disconnected their activities become from their intended outcomes. With widespread decoupling, the reinforcement of departmental walls to keep resources and projects is needed. Thus, even with the recognition of the problem, the organisation trapped in this cycle indefinitely. We contribute to sustainability implementation studies by moving away from instrumental approaches; we show complex reasons for failures that are beyond mere organisational design choices. We contribute to decoupling studies by unpacking the silo-decoupling relationship, proposing an explanation for its emergence and persistence.

From silos to solutions: How one district is building a culture of collaboration and learning between school principals and central office leaders

AbstractLarge urban school districts often struggle with hierarchy, fragmented processes and cultures whereby organisational silos between school and central office staff serve as a major barrier for reaching the desired strategic goals of improving student achievement. In addition, school district staff are undergoing change requiring leaders and staff in these organisations to adapt and build their capacity to support changing demands. However, little attention is paid to how to build the necessary systems and learning environments to support capacity building and leader development. This article reports on an action research study using mixed methods that reveal how central office leaders and school principals break down organisational silos to build a culture of learning using learning organisation principles. Using the Dimensions of the Learning Organization Questionnaire (DLOQ) short form, participants completed questions related to the school district's capacity for learning. Data from the survey and interviews outline key findings that illustrate how the learning organisation framework served as a model to create the organisational conditions and culture to enable support and cooperation for learning, capacity, change and improvement to occur. This action research case study is a look at one organisation's approach to addressing a gap in learning organisation research in the area of learning organisation interventions. In addition, it extends current research on schools as learning organisations with an example of data‐informed change in one large school district in the southern United States.

Description and Observations of the Transition from LHINs to Ontario Health Agency

Until recently (and is still a work in progress as reforms are implemented), the Ontario health care system’s main coordinator group was the 14 regional Local Health Integration Networks (LHINs). However in 2019, the newly elected provincial government choose to abolish LHINs in favor of a single agency called Ontario Health. As stated by the provincial government, the main reasons put forward were achieving financial efficiencies, avoiding duplicative structures and eliminating organisational silos: “To achieve true integrated and coordinated care, Ontario is proposing to streamline the important work of these health agencies so it can be performed more effectively and collaboratively, provide more value for tax dollars and enable people to work together instead of in silos” (Ministry of Health, 2019b, p.1). The purpose of this research note is to provide an overview of the new Ontario Health agency and to discuss some observations resulting from this transition. This note is part of a sequence of three research notes. The first note (#PARG 2020-06RN) provides a typology and list of the organisations within Ontario’s health care system. The note represents the system as it has existed before implementation of 2019 reforms. This second note (#PARG 2020-07RN) provides an overview of the transition to a single Ontario Health agency. The third note (#PARG 2020-08RN) examines the organisational transition to Ontario Health Teams.

Information Evolution and Organisations

In a changing digital world, organisations need to be effective information processing entities, in which people, processes, and technology together gather, process, and deliver the information that the organisation needs. However, like other information processing entities, organisations are subject to the limitations of information evolution. These limitations are caused by the combinatorial challenges associated with information processing, and by the trade-offs and shortcuts driven by selection pressures. This paper applies the principles of information evolution to organisations and uses them to derive principles about organisation design and organisation change. This analysis shows that information evolution can illuminate some of the seemingly intractable difficulties of organisations, including the effects of organisational silos and the difficulty of organisational change. The derived principles align with and connect different strands of current organisational thinking. In addition, they provide a framework for creating analytical tools to create more detailed organisational insights.

De los silos a la colaboración interprofesional: un estudio de caso de métodos mixtos que utiliza investigación-acción participativa para fomentar equipos multidisciplinarios en un departamento de cirugía de un centro de dí

This single case study reports on the establishment of a multidisciplinary day care surgery at a Norwegian University Hospital utilising participating action research design principles drawn from sociotechnical theory. Data was collected through mixed methods including stakeholder analysis, document studies, observations of meetings, semi-structured interviews and participating group methods. The senior management at the hospital had decided to implement a department that diverged from organising around professional disciplines, and this decision evoked strong resistance among several professional groups in the first phases of this project. This case follows the implications of the decision to establish a multidisciplinary day care surgery through re-organising location, staff and management structures. The findings suggest that the hospital achieved the vision of creating an efficient multidisciplinary work environment, reducing the culture of tribalism between professions, and creating a work environment with a high degree of knowledge transfer. This case describes how action research can be used to reduce organisational silos and to improve multidisciplinary co-operation.

Risk factors and causes of interpersonal conflict in nursing workplaces: Understandings from neuroscience

Aims and objectivesThe purpose of this literature review is to explore the risk factors and causes of interpersonal conflict in healthcare nursing workplaces and test the applicability of the SCARF model (Status, Certainty, Autonomy, Relatedness and Fairness) in explaining, predicting and mitigating interpersonal conflict. BackgroundThe SCARF model seeks to explain how a person’s neurological responses to social stimuli influence workplace engagement, management and leadership behaviour. Interpersonal conflict in nursing workplaces is a complex and multi-faceted phenomenon. A nuanced understanding of conflict causes and risk factors will support the design of effective healthcare systems and the development of nursing-specific conflict interventions. MethodThis paper reviews existing research findings into the causes of interpersonal conflict in nursing workplaces, and the application of the SCARF model to professional settings. Themes from the healthcare conflict studies are extracted and mapped to the SCARF domains of status, certainty, autonomy, relatedness and fairness. ResultsThis paper identified twenty-nine studies reporting on the causes and risk factors of conflict in healthcare workplaces. Twenty-two conflict-causing themes were identified. Twenty of the themes could be mapped to one or more of the SCARF domains. ConclusionThe notion that the SCARF model is applicable in the explanation, prediction and mitigation of nursing workplace conflict is supported. The domain of ‘status’ is reflected in conflicts between physicians and nurses over the rights to perform specialist treatments, between physicians and other professions over control of ward rounds, and in the conflict dynamics between members of multidisciplinary team. The domain of ‘certainty’ is reflected in conflicts which arise due to the complexity, fragmentation and organisational silos of healthcare systems. The domain of ‘autonomy’ is reflected in conflicts which arise from leadership style, management practices, and decision-making processes. The domain of ‘relatedness’ is reflected in the different characteristics and outcomes of intra versus inter-professional conflict. The domain of ‘fairness’ is reflected in conflict arising from bioethical disputes, tension between personal, professional and organisational ethics, and perceived conflicting values of other professional groups. Limitations and potential directions for future research are identified.

The feasibilities and practicalities of the integrated working journey: exploring the development and implementation of a whole population approach to delivering person-centred care within the United Kingdom

Introduction: The demographic shift of an ageing population increases demand on health and social care services, in a time of limited resources. Services are currently faced with the challenge of providing high quality, patient-centred care to a population who are increasingly living with multiple complex long-term conditions. This often results in care from multiple providers, subsequently increasing the risk of duplication, inefficiency, poor coordination and experience. Services therefore urgently need to work in partnership in order to deliver person-centred care. Methods: A qualitative study utilising in-depth semi-structured interviews with representatives from strategic roles was undertaken to explore perspectives of developing and implementing integrated services across organisations. The strategy includes a shift from working in organisational silos to delivering integrated care to the whole population. Primary data were collected in a rural setting within the United Kingdom. Data were transcribed and analysed using a thematic analysis approach. Results: Data were grouped into six themes including: focus and purpose of the integrated concept, multidisciplinary team working and engagement, professional roles and responsibilities, contextual factors and challenges of integration, expectations and the reality of integration, and aspirations and future goals for care delivery. Transferable key enablers for progression included a clear shared vision, organisational commitment, cultural change, individual behaviours and personalities, and period of stability in workforce and leadership. The systemic, organisational, and professional challenges experienced are likely to be represented across initiatives aiming to integrate care. Discussions: Despite extensive research and policy changes, initiatives continue to experience similar barriers in progression with integration and population health management. Robust case study designs and in-depth qualitative explorations into the experiences of those developing approaches to improve care delivery, add essential value to understanding associated barriers and facilitators. These findings are therefore highly relevant to those developing integrated care initiatives across international contexts. Conclusions: While a combination of relational and technical aspects are necessary for progression, the success of the initiative was largely perceived to be dependent upon the workforce, and individual behaviours and personalities rather than processes and structures. In light of the often underestimated lengthy process of large-scale system transformation and organisational change, it was apparent that the initiative remained in its infancy. As health services run on people and not processes, relational aspects and increased workforce investment may therefore hold the potential for success and sustainability of integrated approaches to care delivery. Lessons learned: The need to start small and scale up, invest time in building relationships and peer support, and focus on proactively supporting people, before expanding models, were highlighted. Limitations: Whilst the appreciation of the contribution of contextual factors to the challenges of integration are transferable, the case study nature may limit the applicability of some aspects. A further potential limitation includes the inferred organisationally representative nature of the participants in their perspectives of strategy development. Suggestions for future research: There is the need to develop approaches to measuring outcomes which account for impacts at the individual patient and professional level. Explorations into integrated workforce development is also advocated.

Transforming Pittsburgh International Airport: Building an employee culture of innovation to fuel a dramatic turnaround in a post-hub era

Unfortunately, too many airports are afraid to take risks and change their stale, business-as-usual approach. Too often, airport leaders choose to err on the side of caution and simply maintain the status quo. It is safe, easy, and it damages employees’ morale. In just a few short years, Pittsburgh International Airport has become an organisation built on employee engagement, collaboration and innovation. This paper considers how this culture change put employees in the cockpit and Pittsburgh International Airport back on the radar as a leading origin and destination (O&D) airport. Among other things, the paper will discuss the following: •Employee engagement and communication are critical to creating an innovative culture. •How to generate ideas from all levels that are heard by leaders who can facilitate them. •How to create a culture that encourages brainstorming where all ideas — even outlandish ones — are welcome. •How to build high-performing teams across all levels and break down vertical organisational silos to encourage collaboration. •How to accept that calculated risks should not be punished and that innovation victories be celebrated to create a lasting culture of innovation.

Enacting a model of integrated care for people with complex health needs

Introduction : Improving health care through integrated care has been a goal for governments and policymakers internationally for three decades. However, it is still unclear how integrated care can be achieved in practice. This doctoral study examined how a model of integrated care evolved as an approach to caring for people with complex health needs. The case is HealthOne, a NSW government initiative, located in primary health care. Theory / Methods : Drawing on resources from actor-network theory, practice theory and integrated care literatures, this study explored how a model of integrated care was enacted in practice. The multi-sited, mobile ethnographic fieldwork extended from 2011 to 2013. Data was collected from shadowing HealthOne liaison nurses, observing meetings, semi-structured interviews and documents. The focus was on work practices associated with care of HealthOne clients carried out by a range of health and social care professionals. Results : The enactment of integrated care emerged as a relatively unstructured form of integration, understood as linkage. While embedded practices such as working in silos and protecting client confidentiality reacted uneasily to the model of care, practices including engaging clients and working with general practitioners fostered change. This enactment of integrated care was an approach to new ways of working reliant on relational practices encouraging engagement with the model of care. HealthOne liaison nurses and case conferences held together shifting relations and emerging practices. Care was individualised and attuned to the client’s immediate needs and the realities of the local context. Discussion : Policy positioned HealthOne as a new model of care that would encompass primary care and community-based services, with integrated patient-centred care provided by multidisciplinary teams. The absence of adequate structural arrangements for shared care and lack of supportive technologies were matters of concern. Practice change evolved in uneasy tension with stability, rather than as a straightforward replacement of old with new. The policy did not work in practice entirely as envisaged, however, a form of integrated care was accomplished in practice as an ongoing, fluid process of negotiation and adaptation. Conclusions : Since there were no funding incentives, formal agreements or shared care arrangements organising practice, enacting integrated care relied on creating flexible informal partnerships across professional and organisational silos with individual clinicians and services. The HealthOne approach to integrated care became cooperative care management facilitated through liaison nurses and case conferences acting as mechanisms of integration. Lessons learned : Engagement of practitioners and clients are key dependencies. Future initiatives should establish partnership agreements with private practitioners and social care services involved in integrated care. Clinical integration should be supported by systems and structures to facilitate multidisciplinary care management and care planning. Limitations : The data and findings may not be representative of all HealthOne sites, or of a different timepoint in HealthOne’s evolution. Suggestions for future research : Future studies are recommended that foreground the clients' experiences and outcomes from integrated care initiatives. Investigation of how the HealthOne model of integrated care has been embedded in practice and further evolved would produce valuable and complementary findings to this study.

Goodbye comand & control – Hello circles!

Introduction : While most organisations in the health and social services strive to reduce fragmentation in care delivery, especially Primary Health Networks in Australia, they themselves suffer the side effects of a command and control bureaucratic organisational design and work in siloed departments. It is generally agreed that the current ‘department’ or ‘stream’ based organisational designs have many drawbacks including, causing silos and fragmentation, turf protection mentality, stymied collaboration and integration, inability to use the full capability of staff and grow and develop staff. Change : So is there an alternative? Moving away from the historical command and control bureaucratic organisational design, reducing fragmentation between and within organisations, requires a new way of working and organising. To achieve this, structures and processes that enable and facilitate collaboration and coordination, rather than those that block and impede it, are needed. North Coast Primary Health Network (NCPHN) over the past two years has moved to a new way of organising itself and working. We simply call it CIRCLES. Innovation : A CIRCLE is a formal organisational structure designed to carry out business functions or projects. Importantly, the CIRCLE transcends organisational departments and silos. There are clear structures, processes and elements that we have developed through trial and error and experimentation. When the need for a CIRCLE is determined, the process of establishment includes first and foremost identifying the capabilities required to achieve the project outcomes. The capabilities are then matched to staff using the NCPHN ‘capability repository’. Staff whose capabilities are a match, from across the organisation, are invited to join the CIRCLE. This is the tactical CIRCLE responsible for the 'doing'. CIRCLEs operate in three monthly cycles, each cycle beginning with a Strategy meeting (participants are; tactical CIRCLE members, experts and management) wherein the plan for the ensuing three months, including measures, are set out. The tactical CIRCLE meets on a weekly basis in an hour long (maximum) sharp & purposeful meeting to ensure progress in achieving the program metrics and remove any obstacles. The tactical CIRCLE members have defined roles including the CIRCLE Lead and CIRCLE Facilitator. The CIRCLE has a technology application where all the CIRCLE’s information is stored and is accessible to all. The CIRCLE methodology ensures that the regular progress is being made in a cyclic and consistent manner in achieving the organisational objectives and strategies. We have developed this model that shifts power from management hierarchy to functional roles - moving the power to the collective rather than individual managers. CIRCLES exercise autonomy and creativity. Once the scope and purpose of the CIRCLE has been developed and confirmed, the CIRCLE is free to organise itself within the basic building blocks provided in the CIRCLE manual. This has been a major change management process.This is an essential internal change required in health care organisations to facilitate integration. The method is applicable for working between organisations as well. We have published our CIRCLE methodology in a handbook, suited to human services organisations. The model is transferable to all human service organisations.