Performance Measures and COVID

 NY is in the media again for its failure to report COVID deaths in nursing homes. Although you might not think this story is about performance measures, it is. We know that Gov. Cuomo wanted to ensure there were enough hospital beds available. He publicized his solution was to admit new or returning COVID patients back to nursing homes. In the process, he seems to have had a problem with counting. Further, the actual numbers of nursing home deaths were, indeed, underreported, perhaps for political reasons according to the media.

NY shows us some important lessons about performance measurement. 

1.    If performance measures are to be helpful, neutrality can't be violated.  

2.    Create clearly defined definitions. You can't count what you haven't defined.  It raises the question of why it is so much of a concern that deaths be reported in two categories, nursing homes and hospitals. Perhaps, it is because we underfund our nursing homes through Medicaid, Medicare.

3.     Beware of double counting. Who should report deaths? When is it a nursing home death and when is it a hospital death?  What about those dying at home after release from a hospital, nursing home, or those who never were in a hospital or nursing home? 

4.    Determine the reporting chain: the state health dept should have been releasing the report. 

5.    Update data as new information comes in. Data are not static. You may be aware that unemployment figures are updated for a number of months after they are reported to the media.

What Gov Cuomo forgot is that the reason for reporting COVID hospitalizations or deaths or any other data on the pandemic is to learn. What can we do better? That's the goal of performance measurement.

https://www.nytimes.com/2021/03/04/nyregion/cuomo-nursing-home-deaths.html

Pragmatism and Reorganization

If you are in a state with a new governor, you may have already heard news about restructuring, reorganizing, consolidating, privatizing government.  Reorganization happens in large nonprofits and cities, too, but it is not quite as apparent.  The problem with reorganizing, no matter what word used is that there are few ways to measure success. Research doesn’t tell what the best way to reorganize is. 

Three reasons pop up for why your agency might be reorganizing 1) to improve efficiency, 2) to improve program effectiveness, 3) to serve a tactical or symbolic end.  Most reorganizations profess to improve efficiency.  We’d need to measure costs now and after the reorganization takes place to know whether that is true.  The same is true of program effectiveness.  Did the reorganization improve the ability of th agency to serve its clients?  You may remember that Homeland Security was created by merging agencies under this new umbrella.  Is it doing better at preventing or halting terrorism?  Prevention by its very nature is difficult to measure.  The last one is tactical.  Agencies might be reorganized to show that a new boss is taking an interest, wants work to be done differently than in the past.  This reason may get a bad rap, but it’s not very different than the others since the result is unlikely to be measured.

I’d say there is one more reason.  It’s purely pragmatic.  You’ve lost a crucial staff member; you’ve lost a space to work or added a space.  Two communities near me are sharing a police chief and calls. It occurred after one police chief left.  Yes, it may improve efficiency and effectiveness.  It may save money in the long run, but the time was right.  Here’s another purely pragmatic one, a urologist and an orthopedist sharing an office.  I bet that was pragmatic.  The schedules worked well enough that they could share an AA, and office space was right.

Listen to the Rocks

Did you listen to the rocks rolling? That's what it is like when you reorganize a government agency or a large nonprofit. Your employees come in with the tide and go out with tide, often griping and complaining.  Eventually, the rough edges smooth out.
In the public sector, it frequently happens after an election. A new administration wants to show that it is serious about change.  That change is top-down and with it, it brings complaints and griping that you can avoid.

The three most common reasons for a reorganization or even a merger of small nonprofits are.

1) Improve program or policy effectiveness.  We place together programs that have similar purposes.  Effectiveness is in the eye of the beholder unless you have a way to measure change.  That's what occurred after 9/11 when President Bush reorganized agencies into the Department of Homeland Security.  

2) Ideological or tactical ends. We restructure to symbolically convey the importance or loss of importance of a program.  Layoffs or hiring might occur.  Fundraising becomes a competition for nonprofits with similar goals, so we might even merge similar minded nonprofits.  Some might say that this is not reason for reorganizing.  That criticism may occur from within as well as from the public.  It may be time to change the mission if this is important to get a buy-in.

3) Improve efficiency. It’s the most common reason but the most difficult.  Costs occur from the very process of reorganizing.  Cost savings may be one-time savings. Administrative costs are not necessarily achieved by reducing redundancy such as closing offices.  Are the data available to measure performance before and after?  If you are working with publicly funded programs, the purpose of the programs can’t be changed.  

To be successful “listen to the rocks; ” get the input of employees at the front end as the waves of change are grabbing up the rocks.  You’ll grab even more as the waves roll out as the plans evolve with employee input.  Over time the rocks smooth out.

Locally Grown Organic Firewood Mission

Many a time we agonize over a mission statement. We have retreats to establish our mission, vision, and values.  I think the best are to the point.  Locally grown organic firewood. It’s funny isn’t it. That was the sign on the side of the road I passed by.  It could make a pretty good mission statement.  It’s easy to turn it into a mission statement.  TO provide locally grown organic firewood. Sometimes you need to narrow it down to a particular audience and can add the preposition FOR.  To provide locally grown organic firewood for Salem or for tourists.  Add BY and you are done.  To provide locally grown organic firewood for Salem tourists by using sustainable harvesting. 

If you know someone working in a hospital, he or she can probably recite the mission.  It’s on the back of the name tag.  It might read something similar to this: To provide the best health care in Salem Hospital by specializing in big toes.  Adding the BY helps us distinguish ourselves. 

You’ve seen, “To protect and serve” and “Community Policing on police cars.  It turns into a pretty good mission statement “To protect and serve (the for is implied) Salem by using community policing techniques.

That’s how to write a mission in a nutshell.  Start with to.  If you don’t need to add the prepositional statements beginning with for or by, all the better.  Don’t get bogged down in a long one.  No one will remember it and it becomes meaningless to your employees and your clients, participants or citizens.