1. OUTCOME LESSONS REGINALD CARTER In-Service Continuing Education Program National Peer to Peer Training Baltimore Maryland, September 25, 2007

2. LESSONS I have learned seven lessons over the past thirty-three years of implementing a client outcome-oriented management approach to human service programs including nursing home care. I have learned seven lessons over the past thirty-three years of implementing a client outcome-oriented management approach to human service programs including nursing home care.

3. CARTER’S SEVEN QUESTIONS 1. How many clients are you serving? 2. Who are they? 3. What services do you give them? 4. What does it cost? 5. What does it cost per service delivered? 6. What happens to the client as a result of the services? 7. What does it cost per result?

4. These seven questions plus Fred Richmond’s two questions on ROI are the basis for the Results Oriented Management and Accountability system used in the national training program and for many of the HUD grants. These seven questions plus Fred Richmond’s two questions on ROI are the basis for the Results Oriented Management and Accountability system used in the national training program and for many of the HUD grants.

5. Question number six has always been my favorite because it is the hardest one to answer. Question number six has always been my favorite because it is the hardest one to answer.

6. LESSON 1 A client may be receiving your service for a short period of time but the impact of your service may only become obvious long after they have left your program. A client may be receiving your service for a short period of time but the impact of your service may only become obvious long after they have left your program. They are always your client. They are always your client.

7. LESSON 2 Program managers prefer not to articulate expected outcomes and they develop a number of reasons why it cannot or should not be done. Program managers prefer not to articulate expected outcomes and they develop a number of reasons why it cannot or should not be done. You need to be aware of these and be ready to convince them otherwise. You need to be aware of these and be ready to convince them otherwise. Resistance to leadership direction is common and requires constant clear messages regarding expected results. Resistance to leadership direction is common and requires constant clear messages regarding expected results.

8. The best book on overcoming resistance is Ferdinand Fournies Why Employees Don’t do What They are Suppose to Do and What to Do About it (McGraw- Hill, 1999). The best book on overcoming resistance is Ferdinand Fournies Why Employees Don’t do What They are Suppose to Do and What to Do About it (McGraw- Hill, 1999).

9. LESSON 3 It is much easier to implement outcome management if your boss also believes in outcomes. It is much easier to implement outcome management if your boss also believes in outcomes.

10. LESSON 4 Be skeptical of the accuracy and consistency of program information – including federal compliance requirements like reporting using the National Performance Indicators Be skeptical of the accuracy and consistency of program information – including federal compliance requirements like reporting using the National Performance Indicators

11. LESSON 5 Workers underestimate their positive impact on the lives of clients they serve. Workers underestimate their positive impact on the lives of clients they serve.

12. LESSON 6 The public is hungry for transparency and outcome information and expects agencies to tell the truth about a program’s success. The public is hungry for transparency and outcome information and expects agencies to tell the truth about a program’s success. The fear of sharing low program outcomes is largely unfounded. The fear of sharing low program outcomes is largely unfounded.

13. LESSON 7 The biggest untapped potential benefit from sharing worker specific outcome information is telling the worker how good they are. The biggest untapped potential benefit from sharing worker specific outcome information is telling the worker how good they are. Left to their own conclusions most human service workers underestimate their impact and suffer low morale. Left to their own conclusions most human service workers underestimate their impact and suffer low morale.