A Great Leap Forward: Ending the Reliance on Incrementalism

A  NOIRE Editorial

April 2026

Owning a home, an office or apartment building, a storefront, or a vacation cabin in the woods requires constant maintenance. At some point, a remodel may be in order. When engaged in a remodel, one may do it room by room- or focus area by focus area. Kitchen one month. Bathrooms next. Maybe the windows need to be replaced, and next tax season, the central air will be upgraded. Another time, maybe all the appliances, a new deck, or a new roof. A piece-by-piece or incremental process is put in place to accomplish the goals, a new look, or maybe a new feel and function. But if there is structural damage to the home or building in question, the incremental approach will not work. It doesn't make sense to upgrade the HVAC system or the windows, the roof, or new tile in the kitchen if the building is at risk of collapse. An entire rebuild or replacement is in order. In fact, the safest option available is to completely rebuild the structure from the bottom up, from the inside out. The HCBS service system and its related organizational structures are failing. They are at risk of collapse. An incremental piecemeal approach will not create the substantive changes needed to meet the purpose of human services in this new and evolving environment that is the 21st century. Traditional approaches to course correction for the current state of the HCBS system and human service organizations supporting people who experience intellectual and developmental distinctions have failed repeatedly over the years to achieve true lasting human flourishing because the root of the problem is structural. The foundation upon which the human service delivery system was built was meant for a different time, a different environment, and a different purpose, and is out of alignment with the stated goals of supporting human flourishing. Bureaucracies are self-reinforcing structures that are highly resistant to substantive change and need to be replaced with organizational structures that are adaptive, flexible, and in alignment with affirming human dignity and encouraging human flourishing of both those within the organization and those the organization supports.

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The understanding that bureaucratic organizations are flawed and out of alignment with human flourishing is not a new concept. Researchers as far back as Wolf Wolfensberger asserted that bureaucracies like state-run institutions and organizations that are built upon the bureaucratic foundation are dehumanizing and resistant to change. Downs (1967) asserts that bureaucracies adopt rigidity cycles that become more inflexible the longer they last and are extremely resistant to innovation. Osborne and Gaebler (1992) state that bureaucracies have long worn out their usefulness and go on to say that this idea is not new; systems thinkers like Peter Drucker, Edward Deming, and Russell Ackoff have long challenged the usefulness of bureaucratic organizational structures in relation to genuine problem solving and human flourishing. Russell Ackoff emphasizes the destructive nature of bureaucracies and asserts that bureaucracies are the most obstructive systems to human needs development and progress. Yet the entirety of the human service delivery system is built upon a century of bureaucratic systems, organizations, and mindsets.  This is not to suggest that positive outcomes have not been experienced by both internal and external stakeholders of various bureaucratically structured human service systems and organizations over the decades. Many gains have been made, and the lives of millions of people have, in fact, improved.  What is true, however, is also that the system, as it is currently functioning, has reached its capacity to deliver positive outcomes beyond what it has currently managed. The question is why? The primary answer is found in two areas: demographics and the theories of change and how organizations respond or adapt to changing environments.

The key areas impacting the HCBS system and its organizational infrastructure include an aging population, increased reliance on home-based supports, the closing of remaining institutional settings throughout the country, rising levels of complexity of need, including chronic medical conditions, mental and behavioral health issues, the rising prevalence of developmental delays, and, of course, the increasing levels of preventable disparities in the key determinants of health. A review of the literature, both gray literature such as company reports and industry assessments, and peer-reviewed academic research, is in consensus on one major component: human service organizations in the current structural iteration are failing. A second point of agreement is that incrementalism, which has been at the heart of the change process in human services for decades, is ineffective for HSOs that are structurally incompatible with the provision of human services aimed at human flourishing.

 The Problem:

The problem NOIRE is confronting, and bringing to the global public square, is the organizational and human cost of relying on incremental change to address deeply rooted incompatibility. Structural misalignment produces measurable, documented harm at every level of the organization.  For direct support professionals, bureaucratic demands create chronic moral distress. As documented by Davis (2018), support coordinators consistently describe the experience of being caught between what the person they serve actually needs and what the organizational system requires them to do. The conflict between structure and purpose creates conflict for staff between what they know to do and what they are expected to do. This moral injury manifests in high turnover burnout rates and higher incidences of abuse, neglect, and exploitation. The harm extends upward through the organizational hierarchy. Middle managers are placed in contradictions they cannot resolve: enforcing policies they recognize as counterproductive, held accountable for outcomes they cannot control, caught between the legitimate needs of staff and people served on one side and organizational imperatives for efficiency and compliance on the other.  

Compounding the problem of relying on incremental change processes is that bureaucracies are incredibly resistant to change. Having relied on “muddling through,” a theory of decision-making that favors small, incremental changes over sweeping, comprehensive change, introduced by Charles Lindblom, human service organizations have remained self-reinforcing bureaucracies, and those incremental changes get swallowed up in the bureaucratic feedback loops. Incrementalism doesn't work for deep structural problems. Incrementalism as change strategy when coupled with catastrophic levels of burnout and stress among the direct support workforce and frontline supervisor work force, strained resources, rapidly changing demographics, and structural resistance to transformational change HSO’s have demonstrated a degree of resiliency that has led to “scores of people being abused and mistreated by many systems, organizations, and bureaucracies” (Ackoff and Rovin 2003). Weber, the father of rational-authoritative theories and bureaucratic structures, himself stated that bureaucracies, once established, are almost impossible to destroy as a result of their self-reinforcing structures, hierarchies, and mechanisms of control. So, in spite of many successes in the lived experiences of people across the 50- 60-year lifespan of these human service organizations that are fundamentally misaligned with their purpose, a plateau has been reached where transformational change is no longer an option. The system has evolved to a point where incremental change is completely ineffective. Organizations that were never designed to meet human need and, in fact, in their design structure and purpose were quite antithetical to human growth and development, have come to the abyss where a simple remodel can no longer be expected to yield positive results in the lives of both staff and those with whom they are supporting to live a full life. A complete structural overhaul must take shape.

Legacy human service organizations, specifically those in the business of supporting people who experience intellectual and developmental distinctions, must undergo transformative entrepreneurial structural change. Peter Senge’s systems-thinking framework (1990), foundational to NOIRE’s intellectual architecture, provides the analytical explanation for why incremental reform consistently fails to produce meaningful organizational transformation in human services.  Senge’s framework asserts that bureaucracy is not a collection of problematic policies. It is a self-reinforcing system. Feedback loops, delay structures, and systemic archetypes ensure that surface-level interventions are absorbed and neutralized by the organization’s underlying logic. The system has a structural immune response to change that does not alter its fundamental architecture. Organizations that invest significant energy and resources in incremental reform often discover that their efforts have stabilized, rather than transformed, the very structures that need to be replaced.

Three Epochs

NOIRE’s Three Epochs Framework positions this dynamic within its historical context. The current moment represents a critical and unfinished transition from the Machine Age to the Systems Age. Organizations still structured according to Machine-Age principles are not merely inefficient in contemporary terms — they are historically misplaced. They are applying a paradigm developed for the nineteenth century to the challenges of the twenty-first. Incremental reform sustains their operation into an era their design cannot serve. As NOIRE’s research explicitly states, incremental improvement of bureaucratic systems is structurally insufficient. The organizational form itself must be replaced.

Service providers who are now actively engaged in the human service delivery systems, especially those engaged in supporting people who experience intellectual and developmental distinctions must engage in the difficult work of carefully evaluating their mission and vision in relation to their design and structure. Misalignment between the two is one of the root causes of the erosion of institutional learning, the weakening of staff capacity, and reductions in overall program effectiveness.

Power and Messaging in Organizational Design

The implications of clinging to incremental change and holding fast to organizational paradigms meant for the production line, the manufacturing sector, and the industrial age are a system that continues to work for a few but fails the many. Incrementalism is a slow, linear process. Societal change and changes in the breadth, depth, and complexity of human need move rapidly in a non-linear fashion. The two are out of sync. What then is the answer? How do we move forward? We start with new providers; this is the path of least resistance. Existing organizations carry the implicit defense of legacy — not all…but most were built before the field had developed the evidence base now available. Many of the larger providers are headed by families that were at the forefront of the deinstitutionalization movement and built organizations based on the models that were set before them in government and so forth. New entrepreneurs, however, do not have that excuse or that history and need to be held to a different standard. The organizational design and frameworks brought to the system by entrepreneurs wishing to become qualified providers in the HCBS system should be evaluated against the well-established body of research and data. The evidence establishing the structural incompatibility between bureaucratic organizational design and effective human service delivery is documented, peer-reviewed, and practically available. The field has decades of accumulated cost data in staff turnover, service failure, regulatory crisis, and human harm. The alternative organizational models grounded in learning organization principles, distributed leadership, person-centered design, and human flourishing as the primary accountability metric are no longer experimental hypotheses; they are field-tested frameworks. There are some jurisdictions where systems are pivoting in the direction of the changes needed. Performance-based outcomes and value-based reimbursement structures, like in Pennsylvania and Missouri, are a fair start. However, the most important first step remains at the level of paradigm. Evaluating the paradigms that the human service delivery system has about organizations. Gareth Morgan and the work of Donella Meadows and the late great Russel Ackoff inform the discussion. Our images of organizations must change. Organizational structures carry power and communicate messages. Structure and culture are not separate; they are interrelated. How we think about organizations must be aligned with how we understand human beings, human flourishing, and the quality of life.

The First Criteria for New Providers

Structural alignment as a precondition of entry into human services should be the first criterion to be implemented to usher in the transition of the human service delivery system from the machine age to the systems age. This is not bureaucratic gatekeeping. It is a quality assurance argument grounded in evidence. Wolfensberger’s social role valorization framework establishes the theoretical baseline: organizations that serve people with IDD are implicitly making a claim about human dignity and social value. That claim cannot be honored by an organization whose structure systematically contradicts it. New entrants who build bureaucratic organizations and then overlay person-centered language are not making a startup error to be corrected at scale. Private equity is not a viable alternative. They are both ethical errors that will be paid for, as it always is, by the people the organization purports to serve. The field has an obligation to say so plainly.

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AUTHOR ATTRIBUTION

Dr. Stephen T. Davis, PhD., is the Executive Director and Founder of the National Organization for Interdisciplinary Research and Evaluation (NOIRE). His research centers on support coordination as a marginalized profession, Gentle Teaching frameworks, and the transformation of IDD service systems through social justice principles and systems thinking. The views expressed in this editorial represent NOIRE's institutional position.

DISCLOSURE & INSTITUTIONAL POSITION

This editorial represents the institutional perspective of NOIRE. Positions expressed herein are grounded in NOIRE's interdisciplinary research program and social justice framework. Readers are encouraged to examine cited evidence independently. NOIRE discloses any relevant funding, partnership, or affiliation relationships in footnotes where applicable.