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 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. 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 the end of its capacity to deliver positive outcomes beyond what it has currently managed. 

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 within the organization, at every level extending upward through the organizational hierarchy.  Compounding the problem of relying on incremental change processes is that bureaucracies are incredibly resistant to change. 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). 

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.

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.