Baseline Measures of a Systems Change Initiative for the Aging and Disabilities Communities: Measuring the Unmeasurable

Purpose: As public health initiatives become more systems-focused, researchers and policy makers recognize the need to assess systems and capture change in them over time. Yet, the dynamic nature of systems change makes its assessment difficult. The purpose of this study was to develop and test an effective methodology for assessing system change, as it may/may not be occurring in the South Carolina long-term care (SCLTC) system. Methods: Quantitative, on-line surveys and qualitative, in-depth interviews were used to assess several systems change constructs within the SCLTC system. Key stakeholders involved in/affected by change efforts (professionals and consumers) were asked to share their perceptions regarding (a) level of collaboration at the local/state levels, (b) strength of partnership ties, (c) degree of service coordination/integration, (d) effectiveness/efficiency of system administrative/organizational structure, and (e) benefits/barriers to systems change. Results: Baseline data suggest low levels of perceived intra- and inter-system coordination/integration. Stakeholders felt positive about the emerging collaborative relationships and the value of systems change. They agreed on the vision of a changed system but disagreed on how best to achieve it. Agency buy-in and long-term sustainability were identified as key barriers. Certain aspects of systems change were more relevant to consumers than to professionals. Discussion: Public health systems are multi-faceted and dynamic. Measurement of such systems is complicated; therefore, a mixed-methods approach works best. Getting the perspectives of stakeholders is important, as is capturing the interpersonal/organizational processes necessary to bring about systems change. These methods are useful across various public health settings.