When Change Becomes Transformation

Abstract

This paper examines the implementation of large, transformative change in the Medicaid offices in New York City to improve efficiency and consumer-friendliness. A bottom-up process was engaged to design and implement the needed changes from those who were most affected by the change. Key informant interviews and observational site visits were conducted to assess the extent to which the change efforts were successful. We found that the changes impacted both quantitative measures of success (such as client processing times and number of clients served) as well as less tangible qualitative indicators of success such as staff attitudes and office climate.

Key words:

• Change
• human services

Notes

Note 1 The change under study here preceded the recent healthcare reform taking place in the United States (the Affordable Care Act, or ACA) at the national level. Regardless, the Medicaid programme is separate from the ACA and will co-exist with the new programmes under the Act. The ACA is market-based and captures those individuals who earn too much to qualify for Medicaid, but do not receive healthcare coverage through their employers or by other means.

Additional information

Notes on contributors

Kimberley R. Isett

This work was completed under contract to the Human Resources Administration in New York City