In the Spring of 2005, five students enrolled in UC Berkeley’s Undergraduate Business Administration 105 course conducted research into the organizational behavior of the Suitcase Clinic, authoring an 18-page document reporting their conclusions. This study, titled “Strong Weak Culture – A Study of the Suitcase Clinic” provides an interesting look at an outsider’s perspective on the structure of our community.
Portions of the study can be read below in a search engine-friendly format:
Strong Weak Culture
A Study of the Suitcase Clinic
UGBA 105
Professor Ding
May 10, 2005
Ilene Chau
Patty Chiang
Carolyn Cobb
Jennifer Loo
Elisa Pan
TABLE OF CONTENTS
Acknowledgments
Introduction to the Suitcase Clinic 1
Challenges 3
Hypothesis 5
Methods 5
Data and Results 7
Discussion and Recommendations 11
Appendix A
Survey I: Planning Committee (administered April 5, 2005) 16
Survey I Results: Planning Committee 17
Appendix B
Survey II: Volunteer Survey, HMS 98/198 (administered April 28, 2005) 18
Survey II Results: Volunteer Survey, HMS 98/198 19
Appendix C
C.1 Caseworker Interviews –March 21, 2005 20
C.2 Caseworker Interviews – April 21, 2005 22
Appendix D
D.1 Coordinator Interview – April 19, 2005 23
D.2 Coordinator Interview – April 24, 2005 25
D.3 Coordinator Interview – April 25, 2005 26
Appendix E
Faculty Advisor Interview – April 25, 2005 29
Appendix F
F.1 Planning Committee Meeting Observations – March 15, 2005 36
F.2 GSI Planning Meeting Observations – April 27, 2005 37
Appendix G
Organizational Chart 40
Survey Responses 41
ACKNOWLEDGMENTS
We would like to thank the Suitcase Clinic for graciously allowing us to study their organization. In particular, we extend our gratitude to Dr. Steinbach, the Planning Committee, and the volunteers and coordinators that took the time to interview with us and answer our surveys.
We would also like to thank Professor Waverly Ding for her support and guidance throughout this project. We have all learned a tremendous amount this semester.
INTRODUCTION TO THE SUITCASE CLINIC
The Suitcase Clinic was founded on a vision formulated by students participating in the UCB-UCSF Joint Medical Program to provide services that were otherwise inaccessible to Berkeley’s homeless population. The Suitcase Clinic began as a mobile clinic that traveled directly to clients, offering services from suitcases full of medical supplies. In 1990, organizers collaborated with the First Presbyterian Church to hold clinic sessions every Tuesday night.
Today, the Suitcase Clinic continues to follow the mission set by its founders:
To promote the health and overall well being of homeless and low-income individuals through service provision, cooperative learning, and collective action among community and professional volunteers, students, and participants. (Policy Book)
The non-profit agency offers a multidisciplinary general clinic that provides a range of free services such as medical care, haircutting, and chiropractic and optometry services to Bay Area homeless and low-income communities. It has expanded to include a Women’s Clinic and Youth Clinic that offer specialized services to those client bases.
The organization is comprised of student volunteers from the UC Berkeley campus and other professionals from the community. Undergraduates coordinate the recruiting and training of new volunteers each semester through a service-learning course sponsored by the Health and Medical Sciences Department. The course is supervised by faculty advisor Dr. Alan Steinbach.
The success of the clinic in expanding its programs and attracting volunteers is a result of the clear, defined goal set by its founders. The vision attracts philanthropists – people who passionately seek to bridge the divide between students and the homeless population. Volunteers play an integral role in supporting the operation and development of the Suitcase Clinic. Their time and commitment keep the organization running from day to day. Volunteers go above and beyond providing general services to their clients; they create an environment for social interaction. Sometimes clients are more grateful for this social outlet than for the physical services. The implicit satisfaction that volunteers gain from working for such a unique organization has been the driving factor behind its historical success.
The structure of the Suitcase Clinic has several hierarchical levels, according to Dr. Steinbach (Appendix G). At the top is the Planning Committee, which consists of three administrative coordinators, a secretary, class coordinators, clinic coordinators and a handful of divisional coordinators. The Planning Committee’s responsibilities include maintaining the clinics, creating and implementing projects, and approving expenditures. The General, Women’s, and Youth clinics have their own leadership hierarchy, consisting of two clinic coordinators and other various division coordinators such as class, health education and medical. All other volunteers that are not officers are caseworkers that attend any of the three clinics. While the Suitcase Clinic Policy Book formally outlines this hierarchical structure, the actual existing structure is comparatively loose and flat.
A key component of the organization’s philosophy is that “the Clinic should maintain an informal environment that fosters teamwork and community building” (Policy Book). It is designed to have a relaxed and social environment, in order to not seem bureaucratic to the clients. The lenient structure also effectively accommodates the high turnover rate of its volunteers. However, a negative aspect of this adherence to informality is that it compromises order.
While a hierarchy of command exists according to the Policy Book, in reality, the power structure is comprised of “a handful of extremely charismatic and dedicated people” who commit the most time and effort to the organization (Appendix D.1). Leadership positions are based on high personal involvement and titles are often not relevant. The result is a “family structure” where volunteers share lateral command.
CHALLENGES
An organization’s culture encapsulates its core values and is instrumental in shaping and defining an organization’s path. It has the informal potential to energize members and coordinate behavior. The spirit of volunteerism reaches beyond the Suitcase Clinic’s mission statement to affect its members, structure, and developmental trajectory. The Suitcase Clinic has a very “strong weak culture.” That is, its tradition of a loose structure and lenient requirements is widely shared and deeply embraced by its members. This culture is at once the organization’s greatest asset and an inhibiting weakness. Success of a service-oriented organization is highly dependent on its informal culture, but formal rules are crucial for standardizing performance. The Suitcase Clinic has the advantage of a member base that rallies behind shared values and ideals: to contribute to the community by improving the lives of the homeless. Oftentimes, volunteers and coordinators are passionately committed to the cause and enthusiastically contribute their time and effort. However, survey results and interviews reveal that enthusiasm alone is not a substitute for a strong formal structure to ensure the efficient functioning of the organization. Despite its pervasiveness, certain aspects of the culture itself result in a number of issues that hamper the growth and development of the organization.
One of the most pertinent issues is that of accountability. Volunteer requirements are fairly lenient; the organization relies on the idea “you get as much as you put in.” This is an effective system for some volunteers, but the spectrum of commitment ranges from whole-hearted dedication to marginal interest. Some volunteers, and even some coordinators, do not make the organization a high priority in their schedule. This results in commitment and accountability problems: absence at meetings and clinic sessions, shortage of volunteers, difficulty in making decisions, and work left undone.
The lack of role definition is a primary cause leading to this issue of accountability. According to Dr. Steinbach, the organization “has a family structure, rather than a military or purely business model” (Appendix E). As such, the flat leadership structure is conducive to fostering camaraderie, but it also results in blurred boundaries and confused roles. Because individuals—and the organization at large—are often unclear about the extent of their duties, they may leave tasks unfinished or issues unresolved.
When these responsibilities are unmet, it often falls upon leaders to pick up organizational slack. Volunteers and coordinators alike commented that members of the planning committee face a higher level of expectation and are consequently inclined to spend more hours and effort on the Suitcase Clinic. This greater time commitment and responsibility is often a deterrent for people to pursue officer positions. According to one interview respondent, there is a scramble every semester to find and persuade volunteers to run for open positions (Appendix D.1). This sometimes compromises the spirit of volunteerism, giving rise to such feelings as: “I didn’t want to take this position anyway.” Therefore some individuals are less committed to, or even disinterested in, their roles. This weakens leadership development.
Furthermore, because leaders face so many responsibilities, they tend to be bogged down in the day-to-day operations of the clinics and are unable to focus on other managerial duties. These duties, as defined by French engineer Henri Fayol, can be divided into four primary buckets: planning, organizing, leading and controlling. Suitcase Clinic administrators do an excellent job of organizing and controlling, determining the necessary tasks and ensuring volunteer sign-ups. However, they are not always successful in planning and leading, as they have not been able to develop long-term strategies to progress the organization or ensure a smooth transition from one generation of officers to the next. As a result, important functions such as motivating volunteers, resolving conflicts, and ensuring clear communication channels have been neglected. The Suitcase Clinic’s flat structure and somewhat ambiguous leadership body makes it difficult to know whom to turn to in case of emergencies or conflicts. This fragmented leadership leads to an unstable organization because operations hinge on the abilities of transient leaders. Such a structure also results in difficulties in decision making. The Suitcase Clinic fits the so-called “garbage can” model of decision making, where preferences, criteria, alternatives and decisions are “dumped” out. While the concerns are put forth, there is no one to lead the change, resulting in a stagnant organization.
Another consequence of the organization’s loose culture and structure is problems with communication and knowledge transfer. Knowledge—meaningful, contextual information, processed and passed on for future use—can be relayed in two ways: explicitly through some form of hard data, or tacitly through personal interactions and informal mechanisms. The Suitcase Clinic relies on the latter – there is no formalized method of documentation. This leaves the organization vulnerable to a mass exit of knowledge capital. It also makes long-term planning difficult because the ideas of one year’s administration may not be implemented the next, subjecting the Suitcase Clinic to the negative aspects of organizational inertia.
HYPOTHESIS
The Suitcase Clinic has a fairly flat, loose structure and organization; a culture that is widely accepted and largely adhered to by its members. While such a culture is common among volunteer organizations, neglect of formal structure can compromise efficient functioning of the organization, resulting in issues of accountability, role definition, leadership development, communication and knowledge sharing.
METHODS
The primary data collection methods used in the study of the Suitcase Clinic consisted of surveys, interviews, and on-site observations of planning meetings.
The surveys were designed to determine general attitudes and recognize possible problems within the organization. Each survey consisted of a series of demographic questions, quantitative “rank” questions, and open-ended qualitative questions. A preliminary survey was distributed to officers in the Planning Committee in order to determine the degree of individual motivation and goal alignment within the Suitcase Clinic (Appendix A). Twenty surveys were administered, and 19 were returned. A second survey was given to students in the HMS 98/198 class, the requisite course to volunteer at clinic, which addressed the general attitudes, commitments, and motivations of the caseworker volunteers (Appendix B). All 29 of these surveys were returned.
The interview sequence was intended to be a sample viewpoints from members at different levels in the organization and to further evaluate possible organizational issues. Initial interviews were given to caseworker volunteers so as to better understand the Suitcase Clinic’s structure from the perspective of students in the class, and to determine the students’ degrees of commitment to the organization (Appendix C). A second set of interviews was administered to two of the coordinators in order to gain insight into the organization’s structure and policies from a “middle-manager’s” perspective (Appendix D). The final interview conducted with the Suitcase Clinic’s faculty advisor was aimed at gaining an overview of the organization and its history (Appendix E). The advisor has been involved with the organization for over 12 years and acts as a preceptor.
Two on-site observation studies were conducted: the first one at a Planning Committee meeting on March 15, 2005, and the second at a GSI Class Planning Meeting on April 27, 2005 (Appendix F). These studies enabled the assessment of the structure of group meetings and the decision-making process of the Suitcase Clinic. They also provided insight regarding the interactions between various members of the organization.
There was a slight selection bias in the administration of the surveys; students that did not attend the two meetings could not be surveyed. The students that were present at the Planning Committee meeting or HMS 98/198 class were presumably more committed to the organization than those who failed to attend. The interview process was also subject to selection bias because the interview pool was limited to individuals who gave permission to be interviewed. Students willing to participate are likely to be more passionate or committed to the organization.
Another constraint we faced during data collection was that surveys and interviews could only be administered to current, active members of the Suitcase Clinic. The inability to contact and interview former volunteers concerning their reasons for leaving the organization limited the scope of our analysis.
DATA & RESULTS
In the initial stages of data collection, Survey I queried a sample of Suitcase Clinic members at a Planning Committee meeting for possible issues in the organization. Results from Survey I are summarized in Appendix A. Of the 19 respondents, 15 were administrative coordinators or executive committee members. The surveys provide a good sample group for representing views and opinions at the coordinator level. The coordinators are a mixture of graduate and undergraduate students, experienced and newer members, and students in various health-related disciplines such as environmental studies, molecular cell biology, and public health. Several coordinators are pursuing double majors in non-healthcare related concentrations: economics, religious studies, history, and comparative literature. Notably missing from this list of studies are the fields of engineering, legal studies, business administration, mathematics, and other more quantitative fields.
The survey’s open-ended questions, which were designed to explore goal alignment among members of the Suitcase Clinic, indicate a high degree of agreement regarding the organizational goals. This is evident from responses to Question 2 of Survey I (Appendix A). Coordinators share two main goals for the organization. First, the Clinic serves as a “place for [the] homeless and low-income to come and receive services and social support” (Survey I, Respondent 1). Secondly, the Clinic promotes a better understanding of the homeless community for the student volunteers. These responses are closely aligned with the official mission statement found in the Policy Book.
Likewise, students’ reasons for joining the organization are also closely related to the mission of the Suitcase Clinic. The survey shows that students find meaning in volunteering in an organization that provides services to its community.
The level of commitment to the organization varies depending upon the position of the individual. Students who serve as part of the executive committee are much more committed than general caseworker volunteers or volunteers from the HMS 98/198 class. This was established by comparing the results of the quantitative “rank” questions in Survey I and Survey II. Survey I shows that coordinators believe themselves to hold the Suitcase Clinic at a higher priority than fellow members by 4.3% (Survey I, Questions B and C). In contrast, volunteers who filled out Survey II felt that the Suitcase Clinic was less of a priority for themselves than others by 5.6% (Survey II, Questions B and C). These results reveal a general perception that the Suitcase Clinic ranks higher in priority for coordinators than volunteers.
Results from Survey II provide insight into the retention patterns of the organization. With a homogeneous makeup of students studying healthcare-related majors, volunteers in the HMS 98/198 class tend to be younger, averaging 2.1 years in school, as opposed to 2.5 years for coordinators. This result was expected, since coordinators must have at least one semester of training through the HMS class before taking on a coordinator position. Survey II results also indicate a surprisingly high rate of retention. Twenty-four out of 29 respondents affirmed their return to the Suitcase Clinic next semester, yielding an 82.8% retention rate. However, the stated intent to return does not necessarily translate into actual retention; one coordinator estimates that 10-15 volunteers return each semester (Appendix D.1). Further studies must be conducted in order to compare intended versus actual retention rates. Of the 24 respondents that intend to return next semester, only eight indicated they would run for an officer position. Many cited lack of time as a reason for not pursuing a higher position. These results suggest that even though volunteers are interested in continuing their involvement with the Suitcase Clinic, the intensity of commitment is fairly low. In contrast, according to Survey I, ten of 15 coordinators intend to return next semester. Adjusted for two coordinators who are graduating and one who plans to travel abroad, the retention rate is 83.3% for coordinators. It is evident that coordinators stay more involved than volunteers. The results of the two surveys reveal a disparity between the efforts put forth by coordinators and volunteers.
The organization’s loose structure does little to encourage higher levels of commitment from volunteers. As one volunteer puts it, “I do feel that the members match up to the Suitcase Clinic’s expectations, but only because they don’t seem to expect much in the first place.” Indeed, the HMS 98/198 class is designed so that students are only required to attend six events: three clinics, one planning committee meeting, one share group, and one shadow.
The organizational culture is very pervasive, as evidenced through observational studies of the clinics, class meetings, and interactions between individual coordinators and volunteers. For example, when the Planning Committee meeting on March 15, 2005 was called to order at 6:10 PM, only 17 members were present. Eleven more people flowed in during the next half hour (Appendix F.1). A loose agenda was drawn out for the meeting, and an administrative coordinator led the group through each item. Individuals raised their hands to bring up new points and anyone could discuss issues during the meeting, despite the agenda. Attendance was only monitored for volunteers who were taking the class for credit; all other volunteers “come and go sporadically” (Appendix D.1). The meeting was adjourned at 6:30pm, and the group used the remaining time to prepare the facility for clinic. Most of the volunteers immediately began setting up various stations and equipment, but others hung back and dawdled. According to responses collected in Survey II and individual interviews, volunteers often feel lost. One candid account relates, “Everyone’s there, but they don’t know what they’re supposed to do” (Appendix F.2).
Given the flexible nature of the organization, additional problems limit the organization’s efficiency and potential for growth. In an interview, one coordinator mentioned that the issue of communication was a major problem area for the group (Appendix D.1). For example, one of the class GSI’s did not know Sunshine was a mandatory meeting until three days before it. Often, miscommunication is coupled with an unclear decision-making process at Planning Committee meetings. When a decision is finally made after much discussion, there is no formal channel for disseminating that new information. Outside of meetings, communication media were not used effectively. Coordinators fail to check their personal e-mails, and the class website is not updated regularly. Without telephone numbers, some members are nearly impossible to reach. Lack of accountability also limits the effectiveness of the communication channels available to the organization. As the coordinators graduate and leave the Suitcase Clinic, they carry their institutional knowledge away with them. Without a system to retain institutional memory, the organization continues to make the same mistakes over the years and fails to address recurring problems.
An interview with Dr. Steinbach offered valuable insight into how the informal culture of the Suitcase Clinic promotes the emergence of charismatic leaders and inhibits the development of a long-term strategic plan (Appendix E). The high agreement over an informal culture breeds strong organizational inertia such that clinics remain relatively unchanged throughout the years. New ideas meet resistance from inadequate funding, inconsistent support from other coordinators, and a simple lack in the time and energy needed to take the next step. While Dr. Steinbach acknowledges that organizational inertia keeps charismatic leaders from overstepping their boundaries, he also notes that the “humble worker” style of the clinic leads to failure in the development of a strategic plan that would result from a “brilliant executive” style. From the results gathered in this interview and other surveys and observational studies, it is evident that the informal culture of the organization creates challenges to the efficient functioning of the Suitcase Clinic.
DISCUSSION AND RECOMMENDATIONS
The Suitcase Clinic’s strong weak culture promotes a high retention rate amongst its members, but it lacks formality. The following proposals in accountability, communication, and leadership facilitate the processes of the Suitcase Clinic and ensure a strong organization.
Accountability can be improved by monitoring the successes and failures of the clinic inside and outside the classroom. Sign-in sheets for everyone at clinic – not just for volunteers from the class – would be an easily implemented improvement that should not meet with much resistance. This would provide an official record of volunteer involvement, as well as a record of attendance from which to predict future attendance. It also allows for a system of formal recognition. For example, awards could be given out at the end of each semester as positive reinforcement for regular attendance.
Performance evaluations, administered mid-semester, collect valuable information about involvement. Paying attention to individuals creates a Hawthorne Effect and holds volunteers accountable for their contributions. These evaluations also provide systematic feedback for the Planning Committee and allow volunteers to voice concerns. If issues are addressed before the end of the semesters, volunteers will feel empowered by the ability to induce change in the organization. Furthermore, evaluations create a performance standard, enabling the Planning Committee to see how well they have accomplished their goals and determine where further improvements are needed. For ease of implementation and confidentiality, mid-semester evaluations should be completed in the classrooms.
Another way to improve accountability is through volunteer empowerment. In addition to the current class curriculum that introduces volunteers to the rich history of the Suitcase Clinic, GSIs should challenge volunteers to think of new ways to improve the organization. It is important to keep volunteers updated on changes to the organization, as well as current issues in affecting long-term planning such as concerns about funding. As volunteers learn more about the organizations, they will become more embedded into the organization and also gain more out of the experience.
As a functionally flat organization, the Suitcase Clinic can overcome its communication issues through a few simple measures. For day-to-day operations, the Planning Committee should establish a standard medium of communication. While the current standard is e-mail, the Planning Committee should enforce rules for its members to check their messages regularly. If e-mail is not the medium of choice, another regular mode of contact should be made known.
One of the impediments to efficient information dissemination within the organization is unclear chains of command. A caseworker volunteer concurrently reports to her HMS 98/198 GSI’s, the volunteer coordinator who records attendance, the coordinator in charge of the individual clinic, as well as other administrative coordinators. This can be straightened out with an information dissemination tree. In order to reach all volunteers, a separate e-mail list should be created that includes all members of the Planning Committee, the HMS 98/198 class, and general caseworkers. A weekly newsletter will keep all volunteers updated on relevant issues or policy changes.
For the retention of institutional knowledge, it is important to retain a history of the organization. Codifying information, maintaining a database, or simply keeping old records are simple examples of information storage that allow an organization to continue to be effective in the future. The existing Policy Book is one valuable source of information, and the Clinic should insist that volunteers are familiar with its contents. Another way to codify the collective experience of its volunteers is to implement an exit interview at the end of each semester. Relevant questions include performance evaluations similar to the mid-semester review, suggestions for improvement, and reasons for leaving the organization. These responses should be collected, reviewed, and shared with the upcoming Planning Committee at the end of the semester. A “change-of-powers” meeting could facilitate the transfer of both codified and experiential knowledge.
To extend the administrative coordinators beyond organizing and controlling, the Clinic should emphasize the planning and leading aspects of leadership. The first step to focusing on long-term planning is to eliminate the encumbrance of day-to-day management. It will help to better define officer positions explicitly so that boundaries and responsibilities between the positions are clear. Coordinators will maintain a more balanced work load if the responsibilities of the volunteers are more explicitly defined. That is, volunteers and coordinators should have the same understanding of what the various positions entail, so coordinators will not be forced to perform duties that volunteers should be doing.
Next, the Planning Committee should empower middle-managers, such as the clinic coordinators, to make more decisions. For example, volunteers can be given specific tasks or responsibilities during set-up. This would leave the administrative coordinators and other members of the executive committee available for more strategic planning. In particular, the issue of financial planning for the next five years should be carefully addressed in terms of availability of sources, timing, and forecasting for future program expansions. The creation of a new task force could help implement plans and bring ideas to reality. This would allow the executive committee to focus their energies on planning. However, one disadvantage of this proposal is that such a task force further fragments the chain of command by separating the planning component of leadership from the actual leading part.
Finally, while recruitment has been strong in the traditional health-related majors such as molecular and cell biology and public health, it would be advantageous to recruit a more diverse volunteer base to help with the planning and development of the organization. Inasmuch as the Suitcase Clinic is in need of volunteers to work the clinics, it needs strong organizational planning, financial forecasting, and management skills.
These recommendations can be quickly implemented, but it will require planning and full commitment from the coordinators. Such changes may face resistance as a result of organizational inertia because the Suitcase Clinic has a strongly-accepted weak culture. Members may feel that a stricter, more formal structure will impede the realization of the organization’s fundamental mission. Furthermore, agreement about the necessity for change by this semester’s administration may not translate into implementation by next semester’s new administration because of the current deficiencies in organizational memory. It is therefore necessary that a consensus for change be reached by the new officers and that the administrative coordinators take the initiative to institutionalize the recommendations. The coordinators need to develop a plan of action and a realistic timeline for implementation. Information regarding possible changes should be disseminated clearly to coordinators and volunteers alike, and most importantly, coordinators must demonstrate their personal commitment to these changes so as to show the volunteers that the administration is dedicated to the improvement of the organization.
The Suitcase Clinic possesses a strong, highly shared culture of volunteerism that moves and motivates its members. The organization has been phenomenally successful in realizing its mission of bringing together students and professionals to serve the community. However, it is impossible to avoid the disadvantages of possessing such a “strong weak culture.” The organization has been afflicted by issues of accountability, leadership development, communication, and knowledge transfer. Measures need to be taken toward improving the Suitcase Clinic’s infrastructure in order to maintain its strong mission statement and culture, and to transform the Suitcase Clinic into a more forward-looking organization equipped with the faculties to develop, progress, and expand.