Performance Management on the Front Line

By showing what's possible, a Tennessee child-services provider has built a national reputation.
April 22, 2016 AT 6:15 AM
By John M. Kamensky  |  Contributor
John M. Kamensky is a senior fellow with the IBM Center for the Business of Government.

There are plenty of theories and models and policies and scorecards for managing performance in government. Measuring the impact of social services is particularly difficult, but with pressure increasing to spend public dollars efficiently, some service providers are figuring out how to accomplish that effectively.

In a new research report for the IBM Center for the Business of Government, Patrick Lester, director of the Social Innovation Research Center, details how Youth Villages, a nonprofit providing child-welfare services in Tennessee, measures and manages frontline performance, and how this ties back to its success in meeting the state's performance-based contracting approach.

A little background: Mirroring national trends, Tennessee's caseloads for foster care soared in the 1990s, resulting in many children being placed in group homes or other institutional facilities. Child-welfare advocates sued, and the state agreed to develop a new approach, launching a performance-based contracting initiative in 2006 to encourage nonprofits to make foster-family placements a priority. Payment penalties and bonuses were based on the number of days children were in institutional care before being placed with a foster family and the number of children reentering institutional care after such placements.

The traditional payment method had relied on fee-for-service contracts with fixed payment rates, which provided no incentives. The new performance-based system created turbulence among the state's nonprofit providers, sorting the successful from the unsuccessful. This resulted in the overall number of providers shrinking from 89 to about 30. One of the most successful of the remaining providers was Youth Villages.

Youth Villages developed a principles-based operational model based on evidence of what works. But more importantly, Lester notes, was the leadership and organizational culture of the nonprofit itself. The head of Youth Villages, Pat Lawler, told state regulators: "I buy into this. It works. Let me tell you, it was hard for us to do. We had to reorient our staff. It was not easy, but I tell you, we would never go back." Lester writes that Lawler "invested his organization's limited funds in a performance system that will monitor and improve its results" and subject the nonprofit to external evaluations that could potentially expose it to risks to its reputation if results were not positive.

Lawler was willing to take those risks. The heart of Youth Village's performance-management system is a balanced scorecard of metrics that provides what Lester calls a "snapshot of actionable organizational performance data." Youth Villages' progress on performance is based on the concept of continuous quality improvement, which follows a "plan-do-check-act" cycle:

Plan: An assessment determines a child or family's safety, health and other needs. Frontline staff develop plans and enter them into Youth Villages' computer system within 72 hours. Frontline staff are generally on the road, so they are being equipped with tablet computers to enter data remotely.

Do: Youth Villages implements research-informed best practices outlined in the applicable-care model chosen for each individual case. Performance is scored on a zero-to-100 scale based on adherence to the chosen model.

Check: Supervisors oversee frontline staff's work on a daily or weekly basis. Frontline staff is organized into four- or five-person teams that review cases with their supervisors and mental-health practitioners.

Act: With frontline data being collected on a real-time basis, staff and supervisors can make quick adjustments and course corrections. If a child and family are not making progress toward identified treatment goals, alternatives are sought at an earlier stage than had been the case earlier. The data that team leaders are responsible for collecting are organized into nine core indicators. Upper-level management then uses these indicators to view overall progress.

While performance-management data help track children and families while they are in the care of Youth Villages, the more important element is tracking children and family outcomes after they leave care. Youth Villages conducts surveys -- at 6-, 12-, and 24-month intervals after discharge -- on such outcomes as the permanence of child placements, educational and employment status, and interactions with the legal system.

Of course, developing a performance-management system, conducting post-discharge surveys, and employing a performance-management and evaluation staff cost money. Youth Villages spends about $1 million of its $200 million annual budget on its system. It seeks separate funding for these efforts, getting direct support from both government and philanthropic sources. But the nonprofit also receives indirect support from increased efficiencies identified by performance data, reduced compliance and auditing costs, and increased organizational reputation.

Is it worth it? Youth Villages' success has allowed it to achieve a national reputation for its evidence- and performance-based approaches. While most of its efforts remain centered in Tennessee, it has expanded its operations to 13 states and the District of Columbia and now serves about 22,000 children. More broadly, its success can serve as an inspiration and model for other social-service providers, showing that performance management can make a difference both for the people who need services and the taxpayers who fund them.