Assimilation approach to measuring organizational change from pre- to post-intervention

Table 1 Assimilation of problematic experiences scale

0	Warded off/dissociated. Client seems unaware of the problem; the problematic voice is silent or dissociated. Affect may be minimal, reflecting successful avoidance. Alternatively, the problem appears as somatic symptoms, acting out, or state switches
1	Unwanted thoughts/active avoidance. Client prefers not to think about the experience. Problematic voices emerge in response to therapist interventions or external circumstances and are suppressed or actively avoided. Affect involves unfocused negative feelings; their connection with the content may be unclear
2	Vague awareness/emergence. Client is aware of the problem but cannot formulate it clearly-can express it but cannot reflect on it. Problematic voice emerges into sustained awareness. Affect includes intense psychological pain-fear, sadness, anger, disgust-associated with the problematic experience
3	Problem statement/clarification. Content includes a clear statement of a problem-something that can be worked on. Opposing voices are differentiated and can talk about each other. Affect is negative but manageable, not panicky
4	Understanding/insight. The problematic experience is formulated and understood in some way. Voices reach an understanding with each other (a meaning bridge). Affect may be mixed, with some unpleasant recognition but also some pleasant surprise
5	Application/working through. The understanding is used to work on a problem. Voices work together to address problems of living. Affective tone is positive, optimistic
6	Resourcefulness/problem solution. The formerly problematic experience has become a resource, used for solving problems. Voices can be used flexibly. Affect is positive, satisfied
7	Integration/mastery. Client automatically generalizes solutions; voices are fully integrated, serving as resources in new situations. Affect is positive or neutral (i.e., this is no longer something to get excited about)

Note 1: Assimilation is a continuum, with intermediate levels allowed; e.g., 2.5 assimilation level is half way between vague awareness/emergence (2.0) and problem statement/clarification (3.0). Note 2: This table, authored by Stiles, appears in several of his papers. The first version was printed in Stiles et al[22] (1991).

Table 2 Retrospective interview: Structured questions and domains of interest

Questions	Domains of interest
	Events	Climate	Actions	Outcomes
In retrospect, what do you think were the key issues at the VAMC at the time of the NCOD intervention in 2002	Events that lead to intervention	Overall feelings about environment at the facility	Management, union, employee, legal
In general, what do you feel the intervention accomplished		Changes in the overall feelings of employees	Policies, plans	Lasting impacts on the VAMC, qualitative judgments of individuals who participated at a high level in the intervention
What do you think were the most helpful practices	NCOD events, management events		Management, union, employee, NCOD
What do you think were the least helpful practices	NCOD events, management events		Management, union, employee, NCOD
How do you think things could have been handled differently	Number and types of events	Party responsible for intervention	Type of intervention, management response	Ideas for improved outcomes, responses to employee ideas
Do you feel there were overall improvements at the facility		Changes in overall employee attitudes and morale, community perception		Long term evaluation, immediate improvement, sustainability
What do you feel were the causes of improvements or the lack thereof	Management, NCOD, and community events	Willingness to change of management and employees	Management, union, employee, NCOD	Effects of success or lack of success

VAMC: Veterans Affairs Medical Center; NCOD: National Center for Organization Development.

Table 3 Main problematic experiences by informant type, and pre- to post-intervention changes

Type of informant	Problematic experience rated on the APES	APES level at pre	APES level at post
VAMC administrators (n = 2)	Admin 1: Employee perceptions of discriminatory practices (the allegations)	2	5, 6
	Admin 2: Personal experience of the allegations	2	5
	Admin 2: Existing practices at the VAMC	0, 1	6
	Admin 1: Management-union relationship	1.5	2.5
	Admin 2: Management-union relationship	1.5-2	3
Union representatives (n = 2)	Union 1: Lack of communication (management and unions)	2	2.5
	Union 1: Lack of employee empowerment	2	6
	Union 1: Resenting interventionists “interfering”	2	3
	Union 2: Management “doing as they please” (discriminatory hiring and promotions, lack of accountability, resulting employee disempowerment)	2	3
VAMC employees (n = 240)	Existing practices (racism, favoritism, unfairness), caused by uncaring or weak leadership, result in negative workplace climate, low morale, disempowerment of employees	1, 2, 3	5, 6
	Intolerant, adversarial attitudes by supervisors of certain areas cause no cohesion between staff	1, 2	4, 5
	VAMC-wide lack of communication, training, and support for job-related tasks	2, 3	3, 4, 5
	Understaffing creates many problems which are not addressed by leadership	2, 3	3
	Bad public image of the VAMC is unfair and depressing	0, 1, 2	3.5, 4

VAMC: Veterans Affairs Medical Center; APES: Assimilation of Problematic Experiences Scale.