Tag Archives: efficacy

What I’ve learned from working with mission-based organizations

Keep calm and be a unicorn

 

Here are a few lessons I’ve learned, in no particular order:

  1. You need to make sure that your mission, operations, and desired outcomes are aligned with each other.
  2. Movements for equity, inclusion, and belonging have the potential to revolutionize both mission-based organizations and philanthropy.
  3. Carefully tailored one-to-one desk-side coaching usually increases a worker’s effectiveness much more quickly than classroom training.
  4. The nonprofit/philanthropic sector in Massachusetts is different from the analogous sector in any other state in the U.S.A.
  5. Poverty is an insufficient reward for devoting one’s professional life to a nonprofit organization.
  6. In a mission-based organization, many problems that initially appear to be about information and communication technology are really about organizational culture, knowledge management, or a combination of organizational culture and knowledge management.
  7. Age discrimination is alive and well in mission-based organizations.
  8. It makes much more sense to aim to run a nonprofit organization like a highly effective organization, rather than to aim to run it like a business. There’s nothing inherently superior (or inferior) about businesses.
  9. Every human being is eligible to help others and to be helped by others; moreover, it’s a mistake to stigmatize being helped by others.
  10. Bringing token members of various demographic minorities into the building isn’t enough; real power means being at the table when crucial information is disseminated and crucial decisions are made.
  11. When you decide to solve a problem, you need help from the people who are deeply affected by the problem in order to determine:
  • the real nature of the problem
  • the possible solutions
  • a clear and specific idea of what success in solving the problem would look like

I invite you to leave comments about what lessons you’ve learned from working with mission-based organizations!

Or, if you prefer to send me a private message, you can do so by using the form shown below:

 

 

“We count our successes in lives”

Brent James

Brent James is one of my new heroes.  He’s a physician, a researcher, and the chief quality officer of Intermountain Healthcare’s Institute for Health Care Delivery Research.

We had a very inspiring telephone conversation this afternoon, about whether the lessons learned from evidence-based medicine could be applied to nonprofits that are seeking to manage their outcomes.  We also swapped some stories and jokes about the ongoing struggle to document a causal relationship between what a health care organization (or a social service agency, or an arts group, or an environmental coalition, for that matter) does and what the organization’s stated aims are.  In fact, documenting that an organization is doing more good than harm, and less harm than doing nothing at all, continues to be a perplexing problem.  The truth may be less than obvious – in fact, it may be completely counter-intuitive.

In this phone conversation, we also waded into deep epistemological waters, reflecting on how we know we have succeeded, and also on the disturbing gap between efficacy and effectiveness.

It’s not merely a philosophical challenge, but a political one, to understand where the power lies to define success and to set the standards of proof.

I doubt that this is what William James (no relation to Brent, as far as I know) had in mind when he referred to success as “the bitch-goddess,” but there’s no doubt that defining, measuring, and reporting on one’s programmatic success is a bitch for any nonprofit professional with intellectual and professional integrity.  It’s both difficult and urgent.

What particularly struck me during my conversation with Brent was his remark about Intermountain Healthcare:

“We count our successes in lives.”

On the surface, that approach to counting successes seems simple and dramatic.  The lives of patients are on the line.  They either live or die, with the help of Intermountain Healthcare.  But it’s really a very intricate question, once we start asking whether Intermountain’s contribution is a positive one, enabling the patients to live the lives and die the deaths that are congruent with their wishes and values.

These questions are very poignant for me, and not just because I’m cancer patient myself, and not just because yesterday I attended the funeral of a revered colleague and friend who died very unexpectedly.  These questions hit me where I live professionally as well, because earlier this week, I met with the staff of a fantastic nonprofit that is striving to do programmatic outcomes measurement, and is faced with questions about how to define success in a way that can be empirically confirmed or disconfirmed.  Their mission states that they will help their clients excel in a specific industry and in their personal lives.  They have a coherent theory of change, and virtually all of their criteria of professional and personal success are quantifiable.  Their goals are bold but not vague. (This is a dream organization for anyone interested in outcomes management, not to mention that the staff members are smart and charming.)  However, it’s not entirely clear yet whether the goals that add up to success for each client are determined solely by the staff or by the client or some combination thereof.  I see it as a huge issue, not just on an operational level, but on a philosophical one; it’s the difference between self-determination and paternalism.  I applaud this organization’s staff for their willingness to explore the question.

When Brent talked about counting successes in terms of lives, I thought about this nonprofit organization, which defines its mission in terms of professional and personal success for its clients.  The staff members of that organization, like so many nonprofit professionals, are ultimately counting their successes in lives, though perhaps not as obviously as health care providers do.  Surgeons receive high pay and prestige for keeping cancer patients alive and well – for the most part, they fully deserve it.  But let’s also count the successes of the organization that helps a substantial number of people win jobs that offer a living wage and health insurance, along with other benefits such as G.E.D.s, citizenship, proficiency in English, home ownership, paid vacations, and college educations for the workers’ children. Nonprofit professionals who can deliver that are also my heroes, right up there with Brent James.  While we’re holding them to high standards of proof of success, I hope that we can find a way to offer them the high pay and prestige that we already grant to the medical profession.

Harsh truths

Illustration from "Six Harsh Truths That Will Make You A Better Person" by David Wong    http://www.cracked.com/blog/6-harsh-truths-that-will-make-you-better-person/
Perhaps as a counter-balance to my previous blog post, I’ve been reflecting on an article by David Wong that appeared this month in Cracked.Com: “Six Harsh Truths That Will Make You A Better Person.”

While I don’t agree with all of Wong’s assertions, there are a few that I think we should take to heart in the nonprofit sector.  I present them here as bullet points:

  • “The World Only Cares About What It Can Get from You”

Wong points out two corollaries to this:  “…society is full of people who need things….”  and “(e)ither you will go about the task of seeing to those needs by learning a unique set of skills, or the world will reject you, no matter how kind, giving and polite you are.

He’s right, or at least he should be.

(We all know of high-profile nonprofit professionals whose main achievement is making people feel warm inside.  They don’t contribute to any lasting and positive change, but they get plenty of photo opportunities.  If this were an entirely fair universe, the world would be rejecting them, and instead it applauds them.  However, they are the exceptions.)

Most of us are plebs in the nonprofit sector, and we are obliged to solve problems in order to justify our continued employment.  That’s the way it should be.  At the end of the day, if our organization’s mission is to save whales, then we should be judged on how our efforts add up to success in saving whales.  That might involve sticking to methods that have stood the test of time, or to finding ways to save more whales with fewer resources, or to finding ways to ensure that once we save them they stay healthy for the long run.   We have to keep our eye on results, and not give free passes to people who are merely impassioned without being effective.

By this I don’t mean that personalities and processes should be completely discounted.  It’s important to be considerate, ethical, and fair.  It’s also important to value the processes enough to learn from both failures and successes.  But having a pure heart is not enough, either as a process or an outcome, when your self-proclaimed mission is to save the whales.

  • “What You Produce Does Not Have to Make Money, But It Does Have to Benefit People”
‘Nuff said, right?  This the nonprofit sector, right? It’s not just that people ask “what’s in it for me?” when they donate, it’s that we’re living in an WIIFM universe. If what’s in it for us, as nonprofit professionals, is the dubious glamor of altruism, I suppose that’s alright, but we still have an obligation to make our work more than a vanity project.  Again, if it were a fair world, then effective projects would get more love than vanity projects.  But even though it’s unfair, there’s still a principle involved that obligates us to be as effective as possible in benefiting the world, even when that’s less glamorous.
  • “Everything Inside You Will Fight Improvement”

Thank you, Mr. Wong.  This is true indeed – not just for individuals, but for nonprofit organizations.  This one of the most compelling reasons why outcomes management is such an uphill battle in our sector.  It’s not just that we don’t like being judged by our results; it’s that we don’t like having to change.

I’m not using the first person plural (e.g., “we”) here in a abstract, vague, editorial way.  I’m using it, because I’m talking about flaws in which I fully partake.  When Wong says, “(t)he human mind is a miracle, and you will never see it spring more beautifully into action than when it is fighting against evidence that it needs to change,” he’s certainly speaking to my condition.

Here is his list of the powerful defense mechanisms of which I am (and perhaps you are) capable of fielding when we are challenged or criticized:

              “Intentionally Interpreting Any Criticism as an Insult”

              “Focusing on the Messenger to Avoid Hearing the Message”

             Focusing on the Tone to Avoid Hearing the Content”

              Revising (My) Own History”

             “Pretending That Any Self-Improvement Would Somehow Be Selling Out (My) True Self”

Of course, my personal favorite is the last mentioned. When I start wallowing in it, I do my best to remember that there are more important (and perhaps more valid) ethical principles at stake than expressing what I take to be my essential nature.

In fact, it’s our obligation to submit to public scrutiny and criticism when we work in the nonprofit sector.  (At least, it is in the U.S.; I can’t say much about other countries.)  As George McCully points out in his book Philanthropy Reconsidered, we are engaged in private initiatives for the public good, and the public has a right to evidence that we deserve the trust that is vested in us.  They deserve to know that we are striving to serve them with both processes and results that are valid, and that we are quickly learning from processes and results that do not yield strong positive benefits over the long run.

Why we do what we do

Candles lit in memory of those who died in the Sandy Hook murders

The horrific murders in Sandy Hook, Connecticut are on my mind.

On a theological level, I’m deeply annoyed by people who try to comfort the families of victims by saying that it was God’s will.  I think that that’s both offensive to suffering mourners and untrue.  We don’t have satisfying answers to the general question of why suffering, death, and evil exist in this world, and we certainly don’t have satisfying answers about this particular incident.

This is how I summarize my take on this, as a religious person:

  1. There’s a lot that we don’t know.  Perhaps we’ll never know.  However, we can keep striving for understanding.
  2. God gave human beings free will.  We all abuse that free will at times. What happened in Sandy Hook looks a lot like an egregious abuse of free will.
  3. We can choose to turn away from wrongdoing and act as God’s partners in the project of tikkun olam.  That’s a Jewish concept:  the healing or restoration of the world.

I’ve been thinking about tikkun olam, and doing my best to participate in it, for years now.  I feel so fortunate, because I work in a sector where my colleagues strive to make the world a better place every day of their professional lives.

When I think of what happened in Connecticut on December 14th, I think of friends and colleagues who work with at-risk youth, of violence prevention specialists, of civic dialogue facilitators, of mental health care professionals, of advocates of access to health care, of teachers of young children, and of alternative dispute resolution practitioners. They are engaged in a long, difficult, complicated, sometimes discouraging, often under-resourced effort. They seek to prevent harm wherever possible, to mitigate harm when it can’t be prevented, and to create a world where there is positive good.

Most of my work, if it brings any good or prevents any evil, consists of indirect service.  By serving these people, I’m supporting initiatives that I hope will make a difference.  Some of the organizations that I’ve been proud to serve are International Physicians for the Prevention of Nuclear War, the Public Conversations Project, Family Service of Greater Boston, and Health Care for All.  Their missions make it so very fulfilling to spend my professional life this way.

More than ever, I worry about my friends and colleagues that work with such dedication for all sorts of mission-based organizations.  It’s not just that I worry about the safety of those who are on the front lines, such as violence prevention specialists.  It’s that I worry about professional burn-out in a world where there will have to be a significant change in the culture in order to achieve their goals.  And at the moment, I worry a great deal about whether all that heartfelt effort expended on behalf of mission-based organizations is really adding up to progress toward their goals.

In the nonprofit sector, we do what we do because we believe that real progress and real good are possible.  I do what I can because of a belief that I have something to contribute and because I find it satisfying to think in terms of engaging in tikkun olam.

In search of some wise and realistic words to sum up my motivation for sticking with the work, I turn first to Pirkei Avot:

And then to Martin Luther King, jr:

Outcomes measurement for nonprofits: Who does the analysis?

I invite you to participate in this survey, bearing in mind that it is for recreational purposes, and has no scientific value:

There are many reasons that this survey is of dubious value, for example:

  • No pilot testing has been done to ensure that the choices offered are both exhaustive and mutually exclusive.

The list could go on, but I’ll leave it at that.  Although most of my training is in qualitative social research, I have taken undergraduate and graduate level courses on quantitative research, and the points I made about what’s wrong with my survey are what I could pull out of memory without consulting a standard text on statistics.

In other words, when it comes to quantitative analysis, I know just enough to be dangerous.

Meanwhile, I worry about nonprofit organizations that are under pressure to collect, analyze, and report data on the outcomes of their programs.  There are a lot of fantastic executive directors, program managers, and database administrators out there – but it’s very rare for a nonprofit professional who falls into any of those three categories to also have solid skills in quantitative analysis and social research methods.  Nevertheless, I know of plenty of nonprofit organizations where programmatic outcomes measurement is done by an executive director, program manager, or database administrator whose skill set is very different from what the task demands.  In many cases, even if they come up with a report, the nonprofit staff members may not even be aware that what have done is presented a lot of data, without actually showing that there is any causal relationship between the organization’s activities and the social good that they are in business to deliver.

Let’s not be too hasty in deprecating the efforts of these nonprofit professionals.  They are under a lot of pressure, especially from grantmaking foundations, to report on programmatic outcomes.  In many cases, they do the best they can to respond, even if they have neither the internal capacity to meet the task nor the money to hire a professional evaluator.

By the way, I was delighted to attend gathering this fall, in which I heard a highly-regarded philanthropic professional ask a room full of foundation officers, “are you requiring $50,000 worth of outcomes measurement for a $10,000 grant?” It’s not the only question we need to ask, but it’s an extremely cogent one!

I’d love to see nonprofit professionals, philanthropists, and experts in quantitative analysis work together to address this challenge.

We should also be learning lessons from the online tools that have already been developed to match skilled individuals with nonprofit professionals who need help and advice from experts.  Examples of such tools include the “Research Matchmaker,” and NPO Connect.

We can do better.  It’s going to take time, effort, money, creativity, and collaboration – but we can do better.

%d bloggers like this: