1 WHAT INTERVENTIONS CAUSE RESULTS? REGINALD CARTER National Peer to Peer ROMA Training & Certification Philadelphia, PA September 23-24, 2008

2 PERSPECTIVE The culture of “intrinsic goodness” The culture of “intrinsic goodness” An example of outcome management: the factors causing quality in nursing homes An example of outcome management: the factors causing quality in nursing homes Steps in creating your success story Steps in creating your success story Success measures for anti-poverty programs: the inter-generational mobility model Success measures for anti-poverty programs: the inter-generational mobility model Why bother? Why bother? The Transparency Paradigm and why you should be obsessed with outcomes The Transparency Paradigm and why you should be obsessed with outcomes

3 INTRINSIC GOODNESS The staff of human service organizations view their programs as inherently “good” and need no other justification for their continued or expanded funding. The staff of human service organizations view their programs as inherently “good” and need no other justification for their continued or expanded funding. Most staff see no need to collect or use client outcomes after their case is “closed” as a way to learn about their long term impact. Most staff see no need to collect or use client outcomes after their case is “closed” as a way to learn about their long term impact. Many see outcome collection as a threat to continued funding and are highly suspect of any initiative to share such performance information let alone learn from it to improve programs. Many see outcome collection as a threat to continued funding and are highly suspect of any initiative to share such performance information let alone learn from it to improve programs.

4 WHAT FACTORS CAUSE NURSING HOME QUALITY? Two measures of quality: citations from annual inspection and family satisfaction with nursing home care. Two measures of quality: citations from annual inspection and family satisfaction with nursing home care. Measures are co-related: when you find high satisfaction you also find low number of deficiency citations. Measures are co-related: when you find high satisfaction you also find low number of deficiency citations. We examined the top 50 of 400 homes with both high satisfaction and low citations. We examined the top 50 of 400 homes with both high satisfaction and low citations.

5 THE FACTORS Small (under 50) rural homes. Small (under 50) rural homes. Management system that consistency followed practices to assure quality. Management system that consistency followed practices to assure quality. Longevity and commitment of senior leadership (Director of Nursing, administrator) to this nursing home. Longevity and commitment of senior leadership (Director of Nursing, administrator) to this nursing home. Aggressive involvement with the community to assure local oversight. Aggressive involvement with the community to assure local oversight. Health benefits for staff family to assure their commitment to the nursing home. Health benefits for staff family to assure their commitment to the nursing home.

6 THE 100% SATISFIED HOMES 20 homes 20 homes First Consumer Guide listed individual homes by family satisfaction level. First Consumer Guide listed individual homes by family satisfaction level. Leadership in highest satisfied homes were not aware of their status as exceptional because no one had ever told them. They also could not explain why? Leadership in highest satisfied homes were not aware of their status as exceptional because no one had ever told them. They also could not explain why? The Randy Jordan story. The Randy Jordan story. Implications for other human service agencies. Implications for other human service agencies.

7 BOWLERS

8 THE IDEA OF BOWLING

9 FUN

10 BOWLING WITH A CURTAIN It is no fun and you never to know your score. It is no fun and you never to know your score. It robs you of ever knowing how good you are. It robs you of ever knowing how good you are. It encourages drinking and low morale. It encourages drinking and low morale. It prevents focusing on what works. It prevents focusing on what works. It limits you to completing questionable policy and reporting requirements. It limits you to completing questionable policy and reporting requirements. It breeds cynicism of management and political leadership. It breeds cynicism of management and political leadership.

11 TAKE DOWN THE CURTAIN Connect the scoreboard and create a way to give individual staff feedback on their specific clients. Connect the scoreboard and create a way to give individual staff feedback on their specific clients. Follow-up with clients during and after their case is closed. Follow-up with clients during and after their case is closed. Be curious and develop your story about the factors that are most important for client success. Refine your story as you get more feedback. Be curious and develop your story about the factors that are most important for client success. Refine your story as you get more feedback. Celebrate your outcomes as a measure of your success as all baseball players celebrate an exceptional hitter who hits safely 1 out of 3 times at bat. Celebrate your outcomes as a measure of your success as all baseball players celebrate an exceptional hitter who hits safely 1 out of 3 times at bat.

12 INTER-GENERATIONAL MOBILITY MODEL Poverty rate moves within a relatively narrow range of 12%-18% of families and we are not able to define which programs move families out of poverty. We do know the co-relates of poverty: low education, teenage births, single parent families, low employment skills, drugs and crimes. Poverty rate moves within a relatively narrow range of 12%-18% of families and we are not able to define which programs move families out of poverty. We do know the co-relates of poverty: low education, teenage births, single parent families, low employment skills, drugs and crimes. Movement out of poverty is rare as movement between other class levels is rare. New research on inter-generational mobility describes such movement and can set a realistic expectation level for anti-poverty programs. Movement out of poverty is rare as movement between other class levels is rare. New research on inter-generational mobility describes such movement and can set a realistic expectation level for anti-poverty programs.

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14 NEW RULES Anyone seeking to move between class levels must learn the new rules in order to belong and be accepted into the new class. Ruby Payne’s book (A Framework for Understanding Poverty) is highly recommended for advocates motivating clients to move out of poverty. Anyone seeking to move between class levels must learn the new rules in order to belong and be accepted into the new class. Ruby Payne’s book (A Framework for Understanding Poverty) is highly recommended for advocates motivating clients to move out of poverty. The new rules cut across possessions, money, personality, social emphasis, food, clothing, time, education, destiny, language, family structure, world view, love, driving forces and humor. The new rules cut across possessions, money, personality, social emphasis, food, clothing, time, education, destiny, language, family structure, world view, love, driving forces and humor.

15 CONNECTING THE DOTS Start with your own program you have some control over. Start with your own program you have some control over. Create your story of what factors cause success. Create your story of what factors cause success. Collect outcome information. Collect outcome information. Test your story often and refine it if necessary. Test your story often and refine it if necessary. Value your curiosity and how you can improve your sense of accomplishment. Value your curiosity and how you can improve your sense of accomplishment.

16 WHY BOTHER? It provides focus and meaning to your commitment to improving society. It provides focus and meaning to your commitment to improving society. It is the same reason you bother to exercise, eat healthy and buy a Prius – because it is good for you and the planet. It is the same reason you bother to exercise, eat healthy and buy a Prius – because it is good for you and the planet. You are part of a much larger movement, The Transparency Paradigm, which encourages government and non-profit agencies to focus on outcomes, be transparent with your results and increase the public’s trust in government as a positive investment in enhancing the public good. You are part of a much larger movement, The Transparency Paradigm, which encourages government and non-profit agencies to focus on outcomes, be transparent with your results and increase the public’s trust in government as a positive investment in enhancing the public good.

17 TRANSPARENCY PARADIGM Taxpayers demand a positive relationship between taxes and tangible program success. Taxpayers demand a positive relationship between taxes and tangible program success. Government programs demonstrate a positive impact on citizens and communities they serve. Government programs demonstrate a positive impact on citizens and communities they serve. Government programs share outcomes with all stakeholders including the public. Government programs share outcomes with all stakeholders including the public. Outcomes are measurable, simple, realistic, manageable and easily understood by the public. Outcomes are measurable, simple, realistic, manageable and easily understood by the public. Outcomes are the basis for most resource decisions. Outcomes are the basis for most resource decisions.

18 TRANSPARENCY PARADIGM Program managers maximize outcomes. Program managers maximize outcomes. Program managers create outcome measures and their acceptance by stakeholders. Program managers create outcome measures and their acceptance by stakeholders. Elected officials hire program managers that improve outcomes and remove those who cannot. Elected officials hire program managers that improve outcomes and remove those who cannot. Voters elect politicians who demonstrate their commitment to this level of accountability. Voters elect politicians who demonstrate their commitment to this level of accountability. Voters become educated on the performance of government and communicate directly with their legislators about their “ask” of government. Voters become educated on the performance of government and communicate directly with their legislators about their “ask” of government.