2. What Interventions Cause Results - Reginald K. Carter

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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”



An example of outcome management:


the factors causing quality in nursing homes


Steps in creating your success story


Success measures for anti
-
poverty
programs:


the inter
-
generational mobility model


Why bother?


The Transparency Paradigm


Why you should be obsessed with outcomes

3

INTRINSIC GOODNESS


The staff of human service organizations
view their programs as inherently “good”


This is the justification for continued or
expanded funding.


Most staff see no need to collect or use
client outcomes after the case is “closed”


It is a way to learn about long term impact.


Outcome collection can be seen as a threat
to continued funding


Why share performance information ?


What can you 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.


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.

5

THE FACTORS


Small (under 50) rural homes.


Management system that consistency
followed practices to assure quality.


Longevity and commitment of senior
leadership (Director of Nursing,
administrator) to this nursing home.


Aggressive involvement with the
community to assure local oversight.


Health benefits for staff family to assure
their commitment to the nursing home.

6

THE 100% SATISFIED HOMES



20 homes


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 this status.


The Randy Jordan story.


Implications for other human service
agencies.

7

BOWLERS

8

THE IDEA OF BOWLING

9

FUN

10

BOWLING WITH A CURTAIN


It is no fun because you never know your
score.


It robs you of knowing how good you are.


It encourages drinking and low morale.


It prevents focusing on what works.


It limits you to continuing questionable
policy and reporting requirements.


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.


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.


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


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


Can this research help us to set a realistic
expectation level for anti
-
poverty programs?

13





PARENTS' VS CHILDRENS' MEDIAN INCOME
1967-2002
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
$160,000
TOP 20%
HIGH 20%
MIDDLE 20%
LOW 20%
BOTTOM 20%
MEDIAN INCOME IN 2006 DOLLARS
PARENTS (1967-71)
CHILDREN (1995-2002)
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.


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 this.


Create your story of what factors cause
success.


Collect outcome information.


Test your story often and refine it if
necessary.


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 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.

17

TRANSPARENCY PARADIGM



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 share outcomes with all
stakeholders including the public.



Outcomes are measurable, simple, realistic,
manageable and easily understood by the
public.



Outcomes are the basis for resource decisions.

18

TRANSPARENCY PARADIGM


Program managers maximize outcomes.



Program managers create outcome measures and
their acceptance by stakeholders.



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 become educated on the performance of
government and communicate directly with their
legislators about their “ask” of government.