Strategic Operations in Complex Care Systems: Lessons from Working with CBOs

The primary objective of organizational change is to minimize disruption to teams that maintain effective and positive routines. Coordinating and managing care for the most vulnerable populations is a challenging responsibility. In today’s world, where the aging population is prominent, combined with high rates of chronic conditions and significant social determinants of care needs, this becomes even more complex.

When I work with CBO leaders on strategic operations—especially when difficult decisions like resource reallocation are on the table—my approach is grounded in two main principles. First, change is never without impact on the teams executing the work. Second, the integrity of care coordination depends on established routines, which are often strained by various complex internal and external factors. My role is to help leaders strengthen systems without disrupting what already works for the people most impacted by the change.

My experience with organizational change has been a blend of two insightful methods:

SWOT and ADKAR.   SWOT encourages leaders to step back and look at the bigger picture—examining structural strengths, emerging opportunities, operational challenges, and overall alignment at a systems level. Meanwhile, ADKAR focuses on ensuring that change is embraced thoughtfully, compassionately, and sustainably, supporting the people who will carry it forward with care and purpose. Together, they create a balanced approach that honors both organizational realities and the human experience of change.

The ADKAR framework effectively supports key aspects such as Awareness, Desire, Knowledge, Ability, and Reinforcement – offers a practical way to think about how change lands with the teams. Awareness helps us understand the reasons behind the change and who will benefit from it. Desire reflects whether we feel enthusiastic or simply subject to it. Therefore, not embraced by the change. Knowledge involves being well-informed and confident about how the change relates to our roles. Ability refers to our capacity to contribute effectively to change. Lastly, Reinforcement ensures we feel appreciated and valued throughout the process and afterward. This approach makes the journey of change more engaging and supportive for everyone involved. 

Questions for Leaders to Consider

When considering organizational change, I often encourage leaders to pause and reflect on a few key questions:

• How clearly can your teams articulate why this change is happening—and who it is meant to serve?

• What routines are currently holding your system together, and what would be at risk if they were disrupted?

• Where might resistance actually be - signaling a gap in clarity, capacity, or support?

• How are we reinforcing progress in ways that feel meaningful to the people doing the work?

• Are we designing change around organizational efficiency alone, or around the lived realities of the populations we serve?

A Colleague’s Perspective: Working Alongside Care Coordination Teams

While my work often focuses on strategic structure and readiness for change, I’ve learned that the best insights come from collaboration. I invited a colleague with extensive experience in directing care coordination teams to share how she supports staff through complexity and change.

Elizabeth, from your perspective, what helps care coordination teams stay grounded and effective when systems, priorities, or resources are shifting? What do leaders often underestimate about the day-to-day realities of this work?

What helps care coordination teams stay grounded and effective when systems, priorities, or resources are shifting is:

·       Trust, Respect, and Transparency

·       A willingness to roll up your sleeves and walk the walk alongside them

·       Input from the front line in the development of workflows from beginning to end

·       Consistent supervision and support

What leaders often underestimate about the day-to-day realities of this work are:

·       The emotional toll the work brings forth because of the countertransference that can and often will play out multiple times per day.

·       The role a solid infrastructure plays in guaranteeing that the teams feel seen, heard, valued, and supported.

·       The correlation between transparency and securing buy-in

·       The acknowledgement that the day-to-day is already time-consuming, hence adding more does not equate to better.

There is no single right answer. I hope that these reflections help deepen our collective understanding of how to support the people doing this critical work with intention, care, and respect. Feel free to comment directly on the PHC blog or the LinkedIn post.

In Closing

Strategic operations are about more than just growth or efficiency; they're about caring for and guiding others. When we approach change with understanding, kindness, and a shared sense of responsibility, we create a space where teams and communities can really thrive. I see these frameworks and reflections not as rigid rules but as friendly guides to thoughtful, cooperative change.

In the spirit of collaboration and shared learning, I’m opening these questions to anyone who works alongside or leads care coordination teams and would like to reflect or contribute.

Contributor:

Elizabeth Malavé, MPH, CASAC-M, is a bilingual care management and quality-focused leader with over 20 years of experience supporting high-risk populations and guiding both supervisory and direct care teams. She brings a results-oriented, highly organized approach to strengthening programs and enhancing outcomes across diverse communities.