NRCNA Business Acumen Learning Collaborative · 19/10/2016 · NRCNA Business Acumen Learning...

NRCNA Business AcumenLearning Collaborative

Organizational Culture Change – a View from the Field

2016 -2017 ClassOctober 19, 2016

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T. Lee Covington, MPA, Chief Operating OfficerKristen Perry, MPA, V.P. of Community Engagement

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Why Culture Change?

1. Customer is senior

2. Satisfaction = happiness with meals, etc.

3. Waitlists are common –“will get to it”.

4. Customer is “client”

5. One size fits all

6. Revenue streams = OAA, grants, fundraising

1. Customer is payer

2. Satisfaction = ROI, patient health outcomes, meeting contracted expectations

3. Product on the shelf for immediate delivery

4. Customer is the “Payer”

5. Boomers expect more and want choices; Payers want therapeutic meals

6. Revenue = diversified, private pay, contracts

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Organizational Culture

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Organizational Culture

Culture eats data for lunch! Steve MacLaughlin,

Data Driven Nonprofits

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Organizational Cultures – according to Steve

Culture of Champions: There is support from the organization’s leadership and motivational members of the staff that embrace being data driven.

Culture of Testing: There is a belief that measurable improvements can be made through iteration and testing throughout the organization.

Culture of Change: There is a natural curiosity to try new things and take calculated risks to adapt to changing conditions in the nonprofit sector.

Culture of Sharing: There is a willingness to share data and collaborate to achieve better results and a disdain for creating or maintaining data silos.

Culture of Growth: There is a focus on continuous improvement where success is measurable and visible across all levels of the organization.

Culture of Agile: There is empowerment of people to interact and collaborate that allows them to adapt and respond to a changing environment.

Culture of Data: There is a high value placed on data and it is a fundamental driving force to support and validate decisions at the nonprofit.

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Culture of Champions: There is support from the organization’s leadership and motivational members of the staff that embrace being data driven.

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Organizational Cultures – Champions

Leadership from many places, not just top down

New leadership from outside?People willing to help those outside

their own department – “it’s not my problem”

Unlikely champions to show importance of being data driven

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Organizational Cultures – Champions Create champions at all levels

Leadership team involved from beginning

Team member champions (cool new tablets)

Board (updates on impact of pilot)

Lee and Kristen both joined Senior Services within past 15 months – encourage new employees to share ideas for change

Had to get current CEO buy-in before proceeding – again, pilot was an easy way to “test” – bite sized chunks – not as threatening

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Culture of Change: There is a natural curiosity to try new things and take calculated risks to adapt to changing conditions in the nonprofit sector.

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Organizational Cultures – Change

Work of a few champions can be held back by those resistant to change

Need willingness to act on data and make decisions for change

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Here’s our BHAG (Big Hairy Audacious Goal)Aging with Purpose Pilot

Purpose

To identify successful activities and engagement opportunities that will help us address the loneliness, helplessness and boredom that have profound impacts on the health and well-being of many elders living in our community.

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Aging with Purpose Design

Starting with Meals on Wheels participants

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No Additional Activities

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Living History/Engagement Opportunities

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Question of the Week (QOTW)

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Living History/Engagement Opportunities + QOTW

(50 people)

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GROUP 1 This comparison group will continue to receive meals but will not have any additional activity beyond that. We will track outcomes/impact.

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GROUP 2 This comparison group will be

interviewed by Senior Services staff or trained volunteer, resulting in a one-page Living History which captures the moments, events and people most important and impactful in their life.

Based on what we learn, the elder will be connected to additional opportunities such as sewing, volunteering, dance, music, arts, community garden, doggie dates, etc.

Tracking outcomes/impact

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GROUP 3 This comparison group will participate in

Question of the Week – piloted on at least 10 MOW routes

Provides a common question weekly for conversation and reflection – question cards distributed by volunteers – answers collected through dedicated message line or card collection by volunteers

Responses shared between route participants each week

Samples… What’s the most important thing that you learned

in school? Who was the most influential person in your life

and why? Who did you go on your first date with and where

did you go?


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GROUP 4 This comparison group will participate in

both Living History and Question of the Week.


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Aging with Purpose Progress

We have completed 29 outcome/impact assessments in this comparison group

Completed 27 Living Histories and outcomes/impact assessments and have connected 10 elders to activities so far

Coming in July…

Coming in July…

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Culture of Testing: There is a belief that measurable improvements can be made through iteration and testing throughout the organization.

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Organizational Cultures – Testing People are naturally skeptical about change

Want to know if something will work or not? Test it!

May show it does not work

Can’t afford to “test”? - Can’t afford NOT to test!

Small tests over time build trust and body of knowledge

Success breeds more success as others across the organization get curious about what is happening

Allows organization to repeat “test, learn and trust” cycle

Leads to asking more informed questions – draws out natural curiosity of staff – looking for the right opportunities

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Our Experience with Testing

Natural curiosity has developed as we report to full staff on pilot Testing outcomes/impact assessment with home care and

Medicaid waiver

Fully implemented in our Money Follows the Person project

Exploring outcomes assessment at Adult Day Health Center

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Culture of Sharing: There is a willingness to share data and collaborate to achieve better results and a disdain for creating or maintaining data silos.

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Organizational Cultures – Sharing Many nonprofits share their processes and ideas with

others

“Best Practices” sessions at conference – excitement – then reality sets in!

Challenge is operationalizing best ideas locally Internally, an opportunity for common metrics and regular

reporting

Sharing of impact across organization – motivational

Things shared need to be about moving the needle in meaningful ways

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Pilot Participants

66% live alone

75% report having no “natural supports” from the community

55% report health to be poor or fair

68% take more than 6 medications daily, 10% take more than 16 daily

14% report one or more falls in the past month

Only 13% show NO signs of geriatric depression

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Culture of Growth: There is a focus on continuous improvement where success is measurable and visible across all levels of the organization.

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Organizational Cultures – Growth Growth mindset to leverage data to maximize results

Understanding that using data to drive decisions is a prerequisite for success

Adoption of benchmarking in nonprofits continues to grow

Creating culture of growth requires internal promotion of the good results that are happening

Use data to tell stories and engage organization to better understand what is happening – momentum is a powerful force for change

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IMPACT

Number of medications used daily down 19%

Geriatric Depression Scores down for every participant – 24% decrease on average

Average quality of life scores increased

DRAMATIC INCREASE in food security

Social isolation scores decreased 12% on average

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Meet Mrs. E

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• Gets Meals on Wheels

• Aging with Purpose pilot participant

• Used to show dogs• Loves “doggie

dates”

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Meet Mr. H

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• Gets Meals on Wheels

• Loves to garden• More than 90

seniors have benefitted

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Culture of Agile: There is empowerment of people to interact and collaborate that allows them to adapt and respond to a changing environment.

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Organizational Cultures – Agile Agile organizations value individuals and interactions over

process and tools, collaboration over negotiation, responding to change even when a plan is in place.

Agile = constantly trying to improve a process or end product through iteration Move quickly, make decisions as you go, shorten feedback loop,

repeat

Daily “stand-up” meetings to review progress, short-term (two weeks) projects, retrospective meetings at end to share lesson learned

Translate large spreadsheets into simple charts and graphs for sharing across organization

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Culture of Data: There is a high value placed on data and it is a fundamental driving force to support and validate decisions at the nonprofit.

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Organizational Cultures – Data Two types of nonprofits: data-driven from the

beginning; have evolved or are evolving to become data-driven

Evolving Different systems in different departments

Collect their own data, have their own metrics, reinforce culture that others should mind their own business

Duplication of cost, effort and data spirals out of control – data silos abound

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Changing what we measure: Satisfaction and Outputs Outcomes

and Impacts

Changing how we measure: Unified survey tool across all programs Using online data collection tool

Culture Change Around Capturing Data

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Why is Data Important?CHANGE! Managed Medicaid (NC plan proposes 3

statewide and up to 12 regional MCO/PLEs) Bundled Payment Initiatives Managed Long-term Services and Supports

Opportunities for Senior Services to develop new contracts/funding sources and expand our reach

Medicare Advantage Changes Accountable Care Organizations Funders/Donors/Foundations want to see

impact

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Aging Today – American Society on Aging

Front page quotes… “To meet older adults’ health needs and support their well-being,

the healthcare system, which encompasses hospitals and health plans, must address the critical social service needs that will ensure better health outcomes, including the need for adequate nutrition; transportation to medical appointments, the pharmacy and the grocery store; assistance with medications; personal care in the home; and caregiver support. To foster this integration in the new and fast-changing healthcare landscape, social service agencies must create business partnerships with the healthcare system to identify and integrate social services.”

“The social service sector, including area agencies on aging and other aging and disability organizations, must be prepared to demonstrate that they can deliver the quality, volume, confidentiality, geographic coverage, data and reporting needs of the healthcare system.”

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Aging Today – American Society on Aging Front page quotes…

“To be an attractive partner to the medical sector, the CBO must become an “outside-in” organization, adopting an external orientation in its thinking and actions. The outside-in approach is driven by the belief that creating value for the partner is key to its success.”

“The impact on community-based organizations will be pronounced. CBOs will need to adapt their approach to a value-based business model to maintain and/or improve their standing with healthcare payers and providers. New prototypes need to be developed, tested and rapidly replicated to meet this challenge.”

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From Healthy Aging Begins at HomeBipartisan Policy Center

Quotes… “By virtue of the rapid expansion of the senior population, more

and more Americans will be living with multiple chronic conditions and experiencing limitations in activities of daily living. Models and interventions that deliver health care and other services to seniors with these conditions in their own homes have the potential to improve health outcomes and reduce health care utilization and costs.”

“With health care transformation increasingly focused on paying for value, health care entities are beginning to think about patients beyond the four walls of the clinical setting.”

“In the years ahead, far greater integration of health care and supportive services with housing will be essential to improve health outcomes and will allow millions of seniors to age more successfully.”

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How do we fit in?

Some of the quality improvement and cost saving strategies align well with our services

But, we have to move from outputs to outcomes – data to prove our worth – what will be their return on investment

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More than a Pilot

Why Is This Important? Senior Services has always been on the “cutting edge”. Aging with Purpose is at the core of a larger movement across Senior Services programs to help promote well-being and purpose in the lives of elders by expanding opportunities to combat social isolation and support better engagement with the community.

It is not a new program or a time-limited initiative, but rather, an effort to learn which activities and engagements will be most impactful for participants across programs, building on our strong history of service to our community.

This work will ultimately establish a new standard for how the organization supports elders living in the community and how we capture and measure data related to the outcomes and impact of our work.

When successful, this pilot may be replicated across the country, meaning THOUSANDS of elders will be positively impacted and living lives of purpose!

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Data Schmada

Outcomes/Impact Assessment: Starting with pilot participants - The Senior Services representative will complete an outcomes/impact assessment for each participant at the following intervals during the first year of their participation:

Baseline survey assessment as they enter the pilot project.

Follow up survey assessment 6 months after entry to pilot project.

Year-end survey assessment 12 months after entry to pilot project.

After the initial year, participants will be surveyed once annually.

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Accessing/Administering the Survey

Online

Survey link to your email

Offline

Can save survey to tablet/phone/desktop and upload results when you are near wi-fi

Paper Copies

You will need to input data into SurveyGizmo

In-person during intake, re-certification process

Over the phone during intake, re-certification process

Email to participant/family member

By mail

Accessing the Survey Administering the Survey

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Data Schmada The survey is a compilation of validated

national scales that measure the following: older person’s quality of life geriatric depression social isolation hunger/food insecurity myriad of other heath utilization and well-

being questions. The survey assessments collect self-

reported data from pilot participants.

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What’s In The Survey Tool?Older Person’s Quality of Life-Brief

(OPQOL)

Further reading on the OPQOL questionnaire:

Bowling, A. (2009). Psychometric properties of the Older People’s Quality of Life Questionnaire Validity. Current Gerontology and Geriatrics Research. www.hindawi.com/journals/cggr/2009/298950.abs.html Bowling, A. Iliffe, S., Kessel, A., Higginson, I.

(2010). Fear of dying in an ethnically diverse society: cross-sectional studies of people aged 65+ in Britain. Postgraduate Medical Journal, 86: 197-202. www.pmj.bmj.com/content/86/1014/197.full

Bowling, A. and Stenner, P. (2010). Psychometric properties of the Older People’s Quality of Life Questionnaire: which measure performs best with older people. Journal of Epidemiology and Community Health. www.jech.bmj.com/content/early/2010/08/18/jech.2009.087668.short?rss=1 15

Bilotta, C., Bowling, A., Casè. A., Nicolini, P., Mauri, S., Castelli, M., & Vergani, C.(2010). Dimensions and correlates of quality of life according to frailty status: a cross-sectional study on community-dwelling older adults referred to an outpatient geriatric service in Italy. Health & Quality of Life Outcomes, 8, 56. www.hqlo.com/content/8/1/56

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What’s In The Survey Tool?

Geriatric Depression Scale

http://cph.uiowa.edu/icmha/outreach/documents/GeriatricDepressionScaleValidity.pdf

http://cph.uiowa.edu/icmha/outreach/documents/GeriatricDepressionScaleValidity.pdf

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U.S. Adult Food Security Survey Module

http://jn.nutrition.org/content/141/7/1362.long

http://jn.nutrition.org/content/141/7/1362.long

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Lubben Social Network Scale (LSNS-6)

http://www.bc.edu/schools/gssw/lubben/description_of_thelsns.html

http://www.bc.edu/schools/gssw/lubben/description_of_thelsns.html

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Demographics

Healthcare utilization

Falls and fear of falling

Medication use

Questions?

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