Putting Patient Engagement To Work, No. 4

I've had a few-decades-long fascination with management frameworks, comprehensive approaches, and attempts to codify what does or doesn't work in-and-for organizations. It keeps me continually wanting to keep up with what the ABCs (see previous post) have cookin'.

About a year ago, The Bridgespan Group, a leading consultancy serving nonprofits exclusively, came out with a report entitled From Input to Ownership: How Nonprofits Can Engage with the People They Serve to Carry Out Their Missions. I've since read and referred to it many times. What really interests me are the authors' attempts to (1.) categorize the different ways nonprofits are engaging their constituents, and (2.) locate those on a straight-line continuum based on the "depth of intensity" they represent.

Per their framework, less intensive forms of engagement are put on the far left. Those have to do with efforts to elicit and gather timely data, i.e., input, from constituents. Input such as? Basic demographic info. Answers to poll questions. Survey responses. The juicier stuff that focus groups and /or ethnographic research can often unearth. 

Remember the docs and clinicians at Boston Children's Hospital, the ones I intro'd in post No. 2? They want input. Third-party observations about their patients' health-states are highly valuable, so they're engaging teachers, family members, etc. to obtain them.

By comparison, staffers at PCORI envision additional roles for patients to play. All research projects, for example, go through planning phases. Why couldn't and shouldn't patient partners help to: identify the topics? develop the research questions? create the interventions? identify comparators? define the characteristics of the studies' participants? You end up with better plans when they chip in, believeth PCORI. Garbage in...garbage out.

Relating this back to the report -- 

PCORI is promoting and pushing for more intensive forms of engagement, what Bridgespan calls co-creation. "Some organizations have chosen to take constituent engagement further into what we call co-creation -- developing solutions with constituents." These the authors peg as middle-of-the-continuum activities.

Interesting, hunh? Both Boston Children's' and PCORI's conceptions of patient engagement seem more or less to fit Bridgespan's schema. No doubt you can see why I applaud the efforts. 

Is it entirely helpful, though? Is it logically consistent? 

Well...

I believe every patient-partner contribution counts. It all matters. I don't believe you're doing less, or lesser, work the farther right on some dreamed-up scale you go. Offering input in the form of answering "yes" or "no" to a poll question, for example, isn't inherently shallower than co-creating. If it helps further an organization's mission, it's valuable. No matter how much sweat, synapsing, or soul searching is required. 

So I guess I don't know what "intensity of engagement" really means. Can you reliably measure it? I don't believe so.

Drawing lines between constituent (patient) contributions that are valued as input vs. contributions used for developing solutions can get dicey, too. But I do believe categorizing different engagement activities by type could prove to be helpful. Maybe we can say what Bridgespan gives us in this regard is a start. I hope to return to it in future posts.

For now --

All the various things engaged patient partners do lead to checklists getting marked off, to dents being made in workloads, to getting things done. For a trained manager, different forms of engagement equal different forms of execution. For the untrained rest of us, it's just plain ol' work. And it's on to looking at patient engagement as work where I'll head next.

My Two Cents_11

Bridgespan posits that deeper connections with constituents can equate to greater organizational (nonprofit) value and impact. Makes sense to me.

I especially like the way it spells out in a 2013 article some of the more promising forms of constituent engagement and how they differ in intensity. On the weaker-shallower end of things, when an organization conducts a satisfaction survey, for example, it receives timely and useful input but doesn't generally learn much about the respondents, who don't reveal much about themselves in the process. Engage those same respondents in a focus group, by comparison, and the organization is likely to gain a deeper understanding of their aspirations, challenges, and strengths -- and the respondents themselves are likely feel more connected to the organization.

Moving to the other end of the spectrum...

Stronger-deeper forms of engagement are tied to cases where constituents are co-creating, doing high-value mission-driven work, and /or controlling organizational resources, i.e., where they're taking some ownership.

Whenever constituents (feel free to substitute inside-outsiders, or, better yet, parents and family members) respond to an organization’s engagement efforts they're essentially doing work for that organization. They're giving it something of value -- often just for the asking -- that it would otherwise have to spend resources to acquire.

Key takeaways for organization leaders? 

Constituents can help advance your missions in a number of ways, many of which you probably haven't given much thought to. And -- the other side of the coin -- there are also a number of ways to draw people in who may be both willing and able to help you carry out your mission.

My Two Cents_10

PURE INSIDERS WANTED

It's time for our nonprofits to stop seeing the millions of us inside-outsiders as walking wallets and free labor (at worst) or as passive consumers (at best). Stop. And start thinking, instead, about converting us into evangelists for your various causes.

One of the more influential books on nonprofit management of the past few years is Forces for Good. (Crutchfield and Grant, 2012) In it, the authors lay out six practices the high-performing organizations they've studied use to magnify their impact in the world. My favorite of the six suggests that -- in order to help create "an ever-expanding circle of impact" -- nonprofits should strive to turn outsiders into insiders, i.e., co-creators of organizational value. 

CO-PRODUCERS. CO-DEVELOPERS.  

What's their recipe for turning outsiders into insiders? Among other things, you have to "go beyond traditional notions of volunteerism, transcend mundane tactics, and create opportunities for people to actively participate." 

CO-WORKERS. 

When I put it that way, do you see the parallels between outsourcing work and the authors' idea of turning outsiders into co-creators? Outsourcing is an opportunity for inside-outsiders to contribute, to make a difference. It's engagement by another name.

I want to move on to Bridgespan Group's conceptions of constituent engagement, next, to help tie some of these things together.

My Two Cents_08

What’s your best “guesstimate” as to the amount of raw work it’s going to take for us to beat CP? Any idea how you’d even express it?

I think it’s going to take more work than most of us would imagine. Way more than our organizations as they’re currently construed could possibly handle on their own. So let’s do something about it. 

Let’s figure out how to get dramatically more work done.

Jerry Hauser and Alison Green, co-authors of Managing to Change the World, say “effective management” is about “getting work done through other people.” What work are they talking about? Ultimately, all the discrete tasks and projects organizations do (or would like to do) in trying to fulfill their missions.

Good managers are good at delegating tasks and projects. We, i.e., the leaders of our organizations whose work revolves around CP, can start here. We need to become master delegators.

“If you can delegate it, you should delegate it.” How many of us operate by that rule? How many of us know which projects or tasks we should delegate to create the greatest organizational benefits?

If we’re to have bigger impact, we’ll need to know these things. The good news is that delegation has the attention of the big-time consultancies I’ve been talking about. I recommend these brief intros to the subject: 

• this Bridgespan piece about Hauser and Green’s work (take special note of their free tools for making it easier to delegate well) 

• this roughly 3-minute video introducing some interesting work done by Julian Birkenshaw (London School of Economics) and Jordan Cohen (PA Consulting) about effectively addressing “the work that matters.”

Next: To whom should you hand your work off?

My Two Cents_05B

I have to credit United Cerebral Palsy (UCP) for always fueling my fire. I literally get upset every time I visit its site.

I thought it would be helpful all the way 'round to start this section by recommending its Mission Driven Business consulting services, which the national office offers its affiliates and other nonprofits (outside the network) in areas such as finance, strategy, and leadership. Two would-be advantages of engaging MDB vs. one of the previously mentioned consultancies? I'd expect a higher level of understanding of what it's like to operate within the CP sphere. And -- at a lower cost. Probably much lower.

In true UCP fashion, however, online references to this offering haven’t been updated in years. Crawl the web the way I just did and you’ll get...

Crickets. 

Pathetic.

*  *  *  *  *

Doing more with less and working smarter -- not than, but -- with the next guy will be dominant themes of this series. As I've written before, "Our CP community may very well be under-funded, under-appreciated, and under-other-things. But those of us in it don't have to be under-ambitious, under-clever, or under-hard-working." There are other, less-expensive ways to take advantage of the leading consultancies' stocks-in-trade. 

For examples, they write books and white papers. They host webinars. And I still like -- for tips and tools you can put into practice right away -- newsletters. (digital) I say you can't go too far wrong subscribing to these four (4) today: The Bridgespan Group's Knowledge Letter, TCC Group's E-News, FSG's eNewsletter, and The Management Fix by The Management Center.

*  *  *  *  *

Who are you gonna call, on the other hand, if you want to become a more effective special needs parent? Probably not the wise guys and gals I've been referencing. You could, however, get up to speed with David Allen and his Getting Things Done (GTD) methodology. Mr. Allen is a management consultant and coach, and, since the publication of his first book in 2001, a "personal productivity guru". I'll have a lot more to say later about the personal productivity of the millions of us. For now, you may want to explore his company's various offerings @ gtd.com.

My Two Cents_05A

There are so many avenues for learning what the best and brightest management thinkers may have to teach us. Let me start with consultants and what they offer.

BTW: I’m no consultant myself, nor do I play one on YouTube. However, I do keep fairly close tabs on 'em -- like a political junkie in some ways -- and believe some are doing compelling, interesting, and promising work.

What do consultants do? Generally speaking, they:

• study how individuals and organizations address key challenges and opportunities 

• look for and help bring about success stories  

• rub elbows with top managers and academics

• create frameworks, tools, and techniques for others to use (to get the favorable results they seek).

We'd be foolish not to avail ourselves of the good ones' know-how and know-what.

Ideally, I’d like to see rich, vibrant, and ongoing exchanges between the CP and consultancy worlds. We should be clamoring to build relationships and to make connections, specifically with big-time, reputable firms that specialize in nonprofit management. If we want to get better faster, we should engage the services of a Bridgespan Group, FSG, The Management Center, or TCC Group. Each has its own strengths and weaknesses. Any could swoop in and help our organizations or multi-stakeholder networks adopt "better ways of doing." 

What’s to hold us back? Well, the cost for one. 

Consultants’ services come with high price tags attached. They go where the money is. And none of us seem to have it, which may explain why we don’t seem to be on their radar and vice versa.  I haven’t done an exhaustive study, but I've never come across a consultant's case study or white paper to the contrary, and I see very few even casual associations. (The Bridgespan Group “likes” The New York Stem Cell Foundation on Facebook. There's one.) 

So, what do we do? Just throw up our hands and say, “Oh well, too rich for our blood?"

Nope.

We learn from them in other ways.

ROUND SEVEN: Follow The Bridgespan

Here's something a little different stemming from our Parents to Projects (P2P) program. An opportunity -- not for parents to help an organization that's working on their behalf, but -- for leaders of disability organizations to help another organization that's working on their behalf. 

Confusing? 

Follow me: 

The Bridgespan Group is a management consultancy that serves nonprofits. It regularly conducts polls and surveys. The reason being? Bridgespan believes the more insights it can gather about its constituents or customers, the better it should be able to increase its own impact. By "increase its impact" I mean help organizations (like the many nonprofits that make up our community) become more effective. 

Their unstated proposition: If you nonprofit leaders will tell us about yourselves and your organizations by voting in our polls -- if you'll go to work for us, in other words -- we'll do our best to repay you down the road. How? With tools and advice: better ways of doing things; better ways of running your operation; better ways of trying to fulfill your mission. That's the inducement.

I'll throw in two more -- one that's hypothetical-theoretical and another that's more immediately practical:

• I doubt if Bridgespan has a clue about our community. What if, however, it were suddenly deluged with survey and poll responses from us? Maybe it would then pay us some attention, keep us in mind, or make concerted efforts to serve us? 

• If you as an organization leader were to take a few minutes to share your opinions here, at Bridgespan's site, you might well learn something valuable about gathering constituent input. (which you could then conceivably apply within your organization)

Either way, in my opinion our nonprofits would do well -- very well -- to follow their lead.

ROUND THREE: What CP Parents Are For (Part D.2)

We left off talking about the possibility of breaking work -- even something like a writing assignment -- down into smaller bits and inviting other people to help chip away at it. This'd be an example of using collective intelligence: the pooling of small and incremental contributions into coherent, useful bodies of knowledge. Surely it's an execution approach CP-facing orgs could use to get more stuff done.

Ever hear of Amazon's Mechanical Turk? It enables, in the words of David Weinberger*, "vast numbers of people to work on small, distributed tasks" in exchange for small amounts of money. What kinds of tasks? Getting images labeled, finding duplications in yellow-pages listings, rating the relevancy of search engines' results...

We have tons of communicating to do. Could any of it be run through Mechanical Turk or something similar? What about researching? I think about UCP's close to 100 affiliates and all the data they must generate. Could it somehow be worked on in small increments and parsed?

I really don't know much about this "microwork" business, but it does seem to represent a relatively shallower form of worker engagement. Little or no training or expertise are required. The contributors probably aren't deeply commited or emotionally involved. Much of what they have, potentially, to offer never enters the equation.

It may actually be helpful to look at the use of collective intelligence in terms of how relatively engaged the worker is -- with "fully dis-engaged" at one end and "fully engaged" at the other of a spectrum -- and to ask: What are the next, more-engaged kinds of work (after microwork) on the continuum? More to the heart of our matter: What additional kinds of work could organizations pull from the collective of CP parents out there?

As The Bridgespan Group sees it, the next, slightly deeper form of engagement involves getting constituent -- think CP parent -- input. The more insights an organization has about its constituents or customers, the better it should be able to increase its impact. You accomplish something, in other words, when you're able to engage constituents in doing the work of telling you about themselves. (Who are you? What do you think?) Gathering demographic info. Taking surveys. Conducting focus groups. Employing human-centered design processes. Making real-time and comparative feedback systems available. These are all ways of seeking input, of eliciting constituent voice. 

How many of these approaches are any of our CP orgs taking? Not many, I'm willing to bet.  We could be doing a lot more. Outfits that may be able to help nonprofits in particular in their quests to elicit customer voice? Keystone Accountability. Great Nonprofits.

The quality and quantity of information an organization is able to draw out via surveys, focus groups, and the like depends on how it frames questions and otherwise manages its interactions with constituents. Those things set the limits as they relate to depth of engagement.

The next level of engagement is where the org actually gets its constituents thinking creatively, developing programs and solutions together with your organization. On the same page and fully partnering with you, in other words, in furthering your mission. This is the deepest level, really, because lots of fully engaged people give you: multiple perspectives; ongoing relationships; surprises /unexpected better ways of thinking and acting...

The Net makes this sort of co-creation possible. And it holds out this promise: The more smart people you can deeply engage, the bigger the dent you can make in whatever problem it is you're trying to solve. This is where collaborative communities coming together at forums, wikis, mindmaps, etc. come into play. And where we'll head next.

*author of Too Big To Know (2012)

ROUND TWO: Could You Please Be More Specific? (Part D)

While hundreds of thousands of social service organizations work incredibly hard to help structurally disadvantaged and socially marginalized individuals, families, and groups build better lives and life prospects for themselves and their children, few do so effectively—and indeed lack the organizational competencies and capacity to do so. This is a bitter truth. And though it is a collective failure—not only of these organizations, but also of their funders and consultants—it is also a correctable one.

*  *  *  *  *

What a declaration, eh? To say in no uncertain terms that most social service organizations are inept?

That's David Hunter essentially calling out nonprofit leaders -- including, I take him to mean, the ones in charge of our leading CP orgs. Known for holding nothing back, Dr. Hunter is known as well, if not better, for helping organizations make "the kinds of fundamental decisions and clarifications that, if implemented, will allow them to perform reliably, effectively, sustainably, efficiently, and at a high level of quality." 

The now-retired consultant exhorts nonprofits to use a comprehensive approach  to "manage to outcomes." (Interestingly, his approach and The Bridgespan Group's both center around what's known as a theory of change -- an organization's blueprint for success, or statement of how it intends to get results.) His  Working Hard & Working Well lays out said approach in its entirety and serves as a guide to help leaders: 

• clarify what they’re trying to achieve; 
• develop the capacity to know whether they’re on track to get there and the drive to keep improving over time.

The book is downloadable for free in multiple electronic formats via: http://www.vppartners.org/leapofreason/get-working-hard-and-working-well.

ROUND ONE: Could You Please Be More Specific? (Part C)

SO: 

Our side (think organizations combatting CP in one way or another) has these compelling missions and visions -- "Life Without Limits" to name but one. We're off to a great start.

Do our nonprofits in particular, however, have practical and workable ways of bringing those about, i.e., of realizing them? At finer-grained and closer-to-the-ground levels of detail, are they able to focus on the activities that are likely to have the greatest impact? Do they have the know-how and know-what to wisely allocate their time, talent, and dollars to them?

They say in business school it's just a matter of getting the right people doing the right things the right way. Sounds simple. Where the rubber meets the road, however -- where real people have to grapple with real problems -- it's anything but.

I've been looking for the past few years into COMPREHENSIVE APPROACHES to doing the above. ("getting the right people doing the right things...") There are several. One of the more interesting to me is Kaplan-Norton's Execution Premium Process (XPP). Proferred by The Palladium Group as system for achieving breakthrough results, it uses, notably, Balanced Scorecards for linking an organization's bigger goals with its day to day actions. And per Palladium's site it's "as effective for government and not‐for‐profit organizations as it is for corporations." 

(The Balanced Scorecard Hall of Fame Award honors organizations that have achieved dramatic performance outcomes through through the use of the Balanced Scorecard. 2012 honorees include two US nonprofits -- Blue Ridge Electric Membership Corporation and Catholic Charities Archdiocese of Boston, Inc. See below for more.*) 

XPP is powerful, complete, and highly engineered. A criticism of it may be that it's not the simplest thing to implement, that it may require "dozens of measures, a data system, and a complex set of processes to get going."

SO:

As an alternative...

The Bridgespan Group specializes in driving nonprofit performance and offers a comprehensive approach of its own for linking an organization's mission with its programmatic activities. Its (approach) may be more accessible/ less intimidating/ easier to implement. "What are one or two things you could look at in a more methodical way to know whether your programs are working and how they could get better?" is the kind of low-key question they'd ask for starters.

While I haven't studied it in depth, I know Bridgespan's approach is similar to Kaplan-Norton's in that it's fundamentally the SCIENTIFIC METHOD applied to performance management and improvement. It's classic, closed-loop, quality control thinking applied to the whole organization, a structured way to continually learn and zero in on an organization's key goals.

As they put it:

As an organization’s leaders get increasingly clear about the results they aspire to achieve, and about what they need to do to achieve those results [DEFINE], they are better able to figure out what information will tell them how they’re doing [MEASURE], understand what works and what doesn’t [LEARN], and explicitly apply what they’ve learned to better their results [IMPROVE]. 

I like their overriding emphasis on learning, and on thinking of performance management & measurement as a tool for improving an organization's ability to meet its mission. To read about their five lessons for hopping on the performance management "lifecycle," go here: Measurement as Learning. 

CLOSING

Bridgespan, Kaplan-Norton, and other consultancies make strong cases for embracing performance management. (Several case studies are available at their respective sites.) Without it, how do you really know if you're making a difference? How can you improve your offerings and be accountable if you don't measure?

*From Palladium's site: 

The social services arm of the Archdiocese of Boston works to improve the lives of the poor. In 2008 CCAB implemented a Balanced Scorecard program in response to declining donations. Employees now focus on activities that are most impactful on the lives of their customers. By 2012 they moved from a budget deficit to a surplus, the number of people receiving food grew by 34%, and they are perceived by parents as one of the best daycare providers in the area.