January 31, 2013 Improving Quality Care Through Data Management

Do you manage your data or does your data manage you? Does your data make sense to you and what your agency does? Does your data help you to manage your programs, operations, and finances? OR Do you spend your time gathering and sending data to others? Do you have little time to analyze what your data tells you about your agency, services, clients? Do you manage independent data sets that are difficult to relate to each other?

Importance of data for non-profit service organizations Data (program, operational, financial) is critical for non-profits in: o Meeting funding requirements o Advocating for new, continued, or increased funding o Evidence-based decision making: when the numbers don’t agree with your gut, follow the data o Improving service delivery: when the client is happy more clients find their way to you o Improving client outcomes: ultimately, we are in the business of improving clients’ lives and we need to prove it to our ourselves as well as our funders

Valuing Data Funders value data—so much that they can require we use their data systems to report to them o To monitor that you are doing what you said you would in receiving their funds o To document that this is improving the lives of those served with their funds Do you value data? o To monitor that your staff are doing the work o To assess the quality of your service to clients o To measure the effectiveness of your service in clients’ lives

Valuing Data Does your staff value data? o To monitor that they are meeting their expectations o To check that these are the services the clients need o To see that the work they do actually makes an impact on the lives of the clients If you do not look at data and discuss what the data mean to you with your staff, then your staff will not be concerned with the data and what it means If the data the staff are asked to report does not reflect the work they are really doing with clients (if it is just to tell the funders what they want but what really matters is something else), then staff will not be concerned with the data collected If staff don’t value data, then the quality and accuracy of the data that is collected will be suspect

Funding Driven Data Management Funders focus on data for monitoring and evaluation o Funders monitor that the funds are being used for activities for clients as defined by their program As a manager you also want to ensure you are meeting the program deliverables for the funder, regardless of other needs o Funders want to evaluate the impact that the funded activities are having on clients as defined by their priority outcome measure(s) As a manager you will want to make sure you are measuring the success of your services in terms of the funders’ outcome measures even though your agency measures may be differently defined

Funding Driven Data Management Because of onerous data requirements of funders, many agencies use only this data to assess their business— there aren’t resources to do more o The priority for non-profits is to give the funders the data they ask for o Successful organizations have multiple funders—thus, multiple data requests o As funders become more data and outcome focused, the data requirements for each funder are expanding AND more funders have developed systems (many web-based) that are required o Although new funder systems are capable of making data available back to agencies, this feature is often the last developed as funders find system development is more costly than originally budgeted

Funding Driven Data Management Data for funders is often handled as a separate task from managing services o Since the funders data is often not how managers and staff refer to the services they provide, this data is handled as a separate program task o Reports to funders are due a month or more after the activity has occurred—this is useless for managers who need data for daily operations o Managers are forced create their own data systems to manage programs and operations o The further away staff are from understanding the required funder data, the less accurate that data may be and many times it is left to grant staff to translate for the funders o If the agency data elements are less valued than the funder data elements then the agency data will be less useful—staff won’t care since what is reported to funders is different : sometimes you have staff working for the program, not for the agency

Funding Driven Data Management Unfortunately the data required by funders for their specific program does not always align with information needed by management to make internal program and service delivery decisions o The data itself is limited to a program and does not relate client activities across programs o Even data elements of client demographics can vary as some funders want more detail than others or slightly different variables—do you ask more data from every program just to get the information for one or two programs? o Often agency program success is due to synergy between agency programs which management needs to analyze—clients engaged in more than one service often do better across the board o Each agency has unique ways of doing things and unique combinations of services that create its identity—these need to be reported and assessed in the agency terms o Many agencies translate funder defined categories into their own terms/data elements

Quality Improvement Recognizing these limitations of funding driven data management, some funders are requiring an agency to participate in quality improvement activities o Quality Improvement is aimed at improvement -- measuring where you are, and figuring out ways to make things better. It specifically attempts to avoid attributing blame, and to create systems to prevent problems from happening. o There are 3 types of measures used in quality work: Structure : Physical equipment and facilities Process : How the system works Outcome : The final product, results Structure and process are easier to measure; outcome is more important o Outcomes need to be defined in measurable terms o Carefully define outcomes so that sensible data can be collected and used to measure appropriate progress towards the desired outcomes

Quality Improvement o Quality improvement is data driven and is focused on improving quality care within an agency against standards established in a service industry o There are several quality improvement methodologies, all focused on identifying problem areas, gathering prioritized data, and analyzing it to make needed change o Quality improvement moves the focus from the program to the agency as all factors impacting program performance must be looked at—how is the program implemented in the context of the agency o Some government agencies are now using quality improvement methodologies to drive system changes through agency collaboration—thus requiring more data from agencies beyond funding requirements and beyond even agency requirements

Quality Improvement Quality improvement does bring a culture of valuing data although it does it to address problem areas and often adds onto to data requirements o Quality improvement methods change agency infrastructure for identifying and acting on program, operational, and financial areas of concern o Data replaces experienced opinion as the basis for decision making o Data is required to be accurate and relevant o Often data beyond what is already available is required to assess and address concerns o Quality improvement is itself the process to shift from funding driven data management to agency driven data management

Agency Driven Data Management Agencies need data to manage their business and their services to clients that accounts for funded programs but which also incorporates the unique way an agency combines funding from many areas to provide services—and ultimately, it is outcome data for clients that shows the success of this agency approach To manage this, the data must be available in real time (not a month later when reported to funders) and must look at overall operations between services—not just within programs This data must be relevant to how the staff perform their work so that they can use it in providing services—using it will ensure that it is both accurate and timely The data must be consistent over time so as to reflect a historical record of a client’s activity that can be assessed for individual change and improvement

Steps to manage your data 5 steps to put you in control of managing your data: 1.Identify what you need to know to run your operations (remember you are the experts at what you do) 2.Define what data show that clients are improving as a result of your services (you know what is realistic and what is not) 3.Identify what data you are already collecting for funders that meets these needs and what data elements you are going to have to add 4.Prioritize the data—while all of the funder requirements will have to be a priority, maybe some of the other data can wait to be added later 5.Identify a system to help you manage your data to meet all your needs— it used to be tempting to build your own system but today there are flexible systems

Data Management Systems 7 factors to consider in selecting your data system: make sure that it 1. Is scalable—to add or subtract programs as well as to grow as you grow 2.Is client focused—funder data systems are program focused and data is captive to each program but agencies manage clients who get services in different programs as well as outside the agency 3.Is able to manage sharing of data within compliance standards—since this data will be used in the business (not just reported to funders), HIPAA and other privacy regulations require that rules be in place to protect who sees what 4.Is flexible—you will want to add data elements as the business changes, without losing client history

Data Management Systems Make sure that it: 5. Is able to report on all the data collected—you are collecting data because it is valuable to know, so you need to be able to have access to it; as quickly as possible [if staff can use data in delivering services then the data will be high quality] 6.Is able to analyze and report data—if you have the data you should be able to analyze it in any way that makes sense to understand it; again, quickly 7.Is able to interface with other systems—to the degree you can download data to (or from) a funders’ required reporting system, you can minimize any duplicate data entry (soon all systems will have some interoperability but now there are some limitations)

Summary: Managing Your Data Make improving quality care and service to your clients your priority for data management This defines the motivation for collecting accurate and relevant data for staff and management and reinforces a culture of evidence based decision making Monitoring data remains a tool to ensure programs are being delivered Evaluation data is critical for management as well as for current and future funders As your agency focuses on improving service to clients, clients will experience improved outcomes and the clients, you, and the funders will all benefit

Further information on data management systems for you Even if your agency does not require a bid process, it still makes sense to look at several systems (at least three) to ensure you are getting a picture of what is possible and what is best for you I recommend ClientTrack be one of the systems on your list to look at: centered on the client and designed by a non-profit service provider, ClientTrack is one of a few systems available now that can easily meet your non- profit data management needs For further information about this you can go to: or contact ClientTrack Sales: If you have questions or comments please contact me at