Organizational Change: Changes in HIV/AIDS Nonprofit Structures

Change is constant; an ongoing process. New and innovative strategies are needed to stay current in organizational change. Operational efficiency is lost when organizations fail to change with the times. According to Newton, acceleration is defined as rate of change of velocity. Our bodies change as we grow older, our thought process changes as we are exposed to new ideas. Change is part of human behavior. Much like humans grow and change, so do organizations.

A local HIV/AIDS organization is a service oriented health care and resource center serving those who may be at risk of or living with HIV/AIDS. For twenty one years, The Philadelphia Center located in Shreveport Louisiana, has served all of northwest Louisiana as the only HIV testing and resource center in the region. Funding is through the Ryan White federal grant with matching funds from the state. The Ryan White HIV/AIDS Program provides HIV related services in the United States for those who have no health insurance, are under insured, or are indigent.  As with many social service programs on the national level, cuts and freezes are being implemented, therefore forcing cut backs in the staff and services.

            In the early days of the AIDS epidemic, there wasn’t any funding available that specifically addressed the medical needs of this demographic. There was limited research surrounding its transmission, how to treat the disease, and a stigma so fearful that the Reagan administration refused to acknowledge AIDS as a problem. Activists fought to bring forth legislation and funding to combat what became the AIDS Pandemic.

            In the Clinton administration, a HIV/AIDS pandemic was overwhelming the United States health system. It was clear an aggressive approach was needed. Under this administration, the Ryan White ACT was introduced. Ryan White programs are "payer of last resort," which subsidize treatment when no other resources are available. This means when someone who is HIV infected has basic needs are not being met, and there are no other funding sources available, then the program will pay for medication, transportation, food, and doctor appointments. The Act is under reconsideration at this point because of the changes in President Obama’s Health Care Act. Those who are HIV infected will go into the Medicaid Program in 2014. Until then the present Act will continue to be in effect as an active piece of legislation.

            The problem for those that disperse HIV/AIDS services are; these funds are being cut back, frozen, or the same amount of funding is being divided between more people who are newly infected. Service providers for nearly fifteen years did not need to go out and look for additional funding, until now.

            One example of this need is the AIDS Drugs Assistance Programs. Here in Louisiana, these programs are funded if the state is willing to match federal dollars. With the present governor in office, Bobby Jindal refuses to use state funds to match the dollars the federal government has allotted for this state. Thousands of people that once enjoyed healthy productive lives are now put on HIV drug assistance program waiting lists for life sustaining medications. In 2011, Texas lawmakers voted no to a request for millions of dollars to assist with keeping people on the drug assistant programs that have historically been free to those living with AIDS. “The Resource Center of Dallas, like the Philadelphia Center in northwest Louisiana, assist HIV/AIDS apply for medications that will keep them healthy and alive. “ They are medicines that would cost thousands of dollars, per prescription, without government aid”. (cbsdfw.com, 2011). In order to fill this need, community based organizations have been hit with the dilemma of restructuring funding sources and are seeking new financial entities to ensure patient medication adherence. To receive “last resort” funding, community based organizations must prove they have approached other community based programs for assistance before being able to utilize federal funds. Contracts in prevention dollars have been cut by 50 percent. Because of the lack of prevention education dollars, new HIV infection rates are soaring.

            The key element for successful change in organizational structuring is to get support from key stake holders. “Organizations have to take bold action, and business leaders must be courageous in betting on the long term future that will benefit their organizations the most, by betting on the future they want. (Kinicki and Kreitner, 2009).  A mistake often made by leaders when implementing a new vision, is they fail to translate a broad analytical vision into something that the key stakeholders can understand and execute.  “A project can only exist with the informed consent of its stakeholder community. This community comprises individuals and groups, each with a different potential to influence the project's outcome.”(Bourne, 2009).

            Nonprofit organization stake holders are diverse. They include the public at large, staff members, government entities, volunteers, politicians, and board members. “Major organizational changes involve organizational policy, strategy, leadership, culture, work processes, and organizational structure. The cues that signal need for change are found by monitoring various external and internal sources of forces for change encountered by organization” (Kinicki & Kreitner, 2010, p. 400). Restructuring organizational funding outlets have become necessary to survive in this economy.

            Internal stake holders are those who are passionate about carrying out the organization’s mission statement. These people consist of board members, volunteers and donors, and staff members. In some cases, former internal stake holders are still active promoting the nonprofit in external ways.  With the impact of loss of revenue and funding sources on stake holders, organizations must become creative in filling the gaps in funding. It would be the responsibility of board members, executive directors, and CEO’s to create new strategies to strengthen underfunded organizations. There are key characteristics that must be addressed. A strategic planning model would need implementing to address changes experienced by internal stake holders. (exinfm.com, 2009). Once faced with needed changes, affected board members and CEO’s would identify gaps in five areas:

·         A strong mission statement- The mission statement must be clearly articulated.

·         Cohesive leadership team- Defining roles and being accountable for decisions.

·          Decision making and structure- they must support objectives.

·         Work processes and systems- Superior execution of programmatic work processes.

·         People- Bringing people onto the board that will fill clear roles needed for all aspects of the organizational needs to meet the mission and

·         Culture- High performance values, behaviors and the capacity to change.

The three “G’s” of a nonprofit board of directors are give, get, or get out. Many boards expect their members either contribute financially themselves creating or participating in fundraising events, or recruiting their peers to get involved. The role of a board of directors is recruitment, fiduciary responsibility, fund development, volunteerism, ambassador, accountability, and reporting guides. According to the Harvard Governance Model, “In a well-functioning nonprofit organization, the executive will take responsibility for assuring that the governance function is properly organized and maintained.” (Drucker, 1990). The impact of change on internal stake holders has driven them out of a comfort zone into one that can be challenging. Not all nonprofits will sustain enough funding to keep their doors open. Depending on a government backed grants has become a thing of the past. Many times, board members are unfamiliar with these duties and must be trained in grant writing and taught “The Ask.”

“The Ask” is the act of asking donors to write the check or pledge to make a donation to the organization once you have articulated your needs. With private donations being the number one demographic of donors, each and every board member should be able to articulate what your organization does in 30 seconds and be able make “the ask’ to their peers in the community. Nonprofit boards have become more dependent on volunteers, grant writers, fundraising, and corporate assistance.  They have filled the gap where federal funding has stopped short. With the unemployment rate much higher, nonprofits are seeing more unemployed professionals willing to volunteer, lending their professional skills to the needs of their community. Likewise, trend in opportunities are being used by free and non-traditional forms of communications such as Facebook, twitter, and blogging.  Internet donations increased efficiency and reduce administrative costs. Nonprofits have started to create profiles on online social networking sites to raise money and attract supporters, staff, and volunteers.  “Development, and use of technological advancements, will be one of the biggest forces for change.” (Kinicki & Kreitner, 2009, p. 401).

            External stake holders are individuals and families served by the nonprofit organization. In an HIV/AIDS resource center, the external stakeholders are specifically people who are HIV infected, those affected by HIV (family members of infected parents) or those at risk of contracting HIV. These stake holders may also carry dual diagnosis such as mental disease, substance abusers, and indigent or homeless people.

            The impact of change on external stake holders can be deadly. As stated, thousands of external stake holders are so affected by funding cuts that their lives are at risk. Without life sustaining HIV medications, consumers could die on ADAP (AIDS Drug Assistance Programs) waiting lists. Community based organizations that serve HIV infected consumers are writing grants or requesting pharmaceutical companies to donate medications to fill the gap of federal program cuts. The majority of people on waiting lists are receiving donated medication, but it a quick fix which isn’t a guarantee. The average cost for HIV antiviral medications costs patients $1500 a month if they self pay. With the rising new infection rates, pharmaceutical companies cannot supply the need for free or donated medications, therefore alternative funding sources are needed. Other impacts on external stake holders would be lack of food, transportation, and housing.

            With housing dollars cut, and local housing authorities with waiting lists for up to five years, consumers or the external stake holders, are being under housed. The lack of affordable housing leaves those living with HIV at risk in all areas of their lives.  They are more likely to be underfed and less likely to be consistent in medication adherence if they do not have stable housing. When there are other factors involved, such as drug use, then the spread of HIV is more common. Housing those who are living with AIDS, not only increases healthy living but is cost effective. The economic costs of new HIV transmissions, among the homeless are extremely high. The cost to house people is much cheaper on the economy that the estimated lifetime medical treatment cost of each new infection.

            The Prosci’s Change of Management Maturity Model addresses the adverse impact on nonprofit organizations and their key stake holders. There are five levels of the maturity model that range from no change management to organizational proficiency. “Research shows that a ‘one-size-fits-all’ approach does not work when managing change, since each change and each impacted group is different.” (change-management.com, 2004).              
          Prosci’s ADKAR is an acronym for Awareness, Desire, Knowledge, Ability and Reinforcement.  For the individual to make needed change, an awareness of the need for change is needed. Once the need is acknowledged, employees need to be motivated with the desire to support the change. Knowledge of how to make the change will then be sought out. Ability to implement the required skills and behaviors will be followed by reinforcement to sustain the change.

      With funding cuts to nonprofits, individuals are impacted and aware of the needed changes in seeking alternate funding sources. These people may be internal or external stake holders.  The desire to sustain healthy lives for those living with AIDS will motivate stake holders to educate themselves (knowledge) restructure funding sources and continue to run organizational programs that meet the mission statement’s criteria (Ability and Reinforcement).

      In conclusion, organizational change is the backbone of competitive organizations and key stakeholders. Implementing a continuous planning model, budgets and business plans reviewed throughout the year, help determine how an organization is faring in budget cycles and what adjustments need to be made. While waiting for an economic turnaround, nonprofits will continue to deal with decreased federal and state funding and finding solutions to help them remain operational. Prosci's change management model addresses changes needed by the individual first, then the organization as a whole. Effective change management is successful when there is an understanding how one person makes a change successfully. Without individual change, organizational change cannot happen.

References:

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Cbs.com. (2011). State Budget Cuts Potentially Deadly For Some    

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Drucker, P. F. (1990), Lessons for successful nonprofit governance. Nonprofit Management and Leadership, 1: 7–14. doi: 10.1002/nml.4130010103

Evans. M.(2009). Strategic Planning. Retrieved November 5, 2011, from http://www.exinfm.com/workshop_files/strategic_planning_model.ppt

Gordi, C. (June, 2011). HIV Budget Cuts: A Life-or-Death Matter. Retrieved 

November 5, 2011, from: http://www.theroot.com/views/life-or-death-budget-cut

Kinicki, A., & Kreitner, R. (2009) Organizational behavior: Key concepts, skills and best practices (International 4th Ed.). New York, NY: McGraw-Hill Irwin. ISBN: 9780071285582

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