The Value Curve in Action

On-ramps: Strategies for Ascending the Human Services Value Curve

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In 2014, the Georgia Division of Family and Children Services (DFCS)—an organization housed within the state’s Department of Human Services that investigates child abuse and supports troubled families—was in crisis. It had recently experienced a 36 percent staff turnover rate and needed 60 percent more personnel—a major reason the unit had a backlog of approximately 6,000 investigations. Over 12 years, DFCS had had nine leaders. Most disturbingly, Georgia had recently experienced six high-profile child deaths.

In 2011, Kansas’s health and human services programs faced similarly significant problems. Following multiple reshufflings over five years, health and human services initiatives were fragmented and siloed. The state’s system for determining eligibility for health and human services programs was more than 20 years old. Amid the aftershocks of the Great Recession and following the passage of the 2010 Affordable Care Act, many residents needed assistance that Kansas was neither organized nor equipped to provide.

Over the last two years, both states have made progress. DFCS created a “Blueprint for Change” to bolster its practice model, workforce development, and constituent engagement. Kansas has partially launched the Kansas Eligibility and Enforcement System, an online portal allowing residents to apply for health and human services. Both organizations are climbing the Human Services Value Curve by fostering collaboration, investing in staff and systems, and amplifying impact.

At the 2015 Human Services Summit, Bobby Cagle and Virginia Pryor, DFCS’s Director and Deputy Director, and Dr. Susan Mosier, the Secretary of Kansas’s Department of Health and Environment, identified the methods and approaches that have enabled them to move forward. They then engaged in a consultative dialogue with Summit attendees about how to accelerate their progress along the Human Services Value Curve. The exchange yielded “on-ramps”—methods and initiatives—for scaling the Human Services Value Curve. The most important approaches involve leadership, decision-making, and stakeholder engagement.

On-Ramp One – Passionate and Empowering Leadership

Moving up the Human Services Value Curve hinges heavily on senior leaders. They decide to pursue reform, motivate staff, and guide the organization’s transformation. Under the leadership umbrella, exhibiting passion, empowering staff, and recognizing areas for improvement are critical “on-ramps.”

Passion and Personal Experience

Climbing the Human Services Value Curve is grueling, so to an extent, an organization’s success hinges on a leader’s ability to sustain motivation. Cagle—who spent the first ten months of his life in an orphanage—is a case in point. He decided to take the position leading DFCS, a struggling organization, because he cared about the work. “If your heart’s not in it,” he said, “you’re not going to stay long [in the human services field].”

Mosier draws on her background as well. After an audience member asked her how she would measure the success of integration, she described how as an ophthalmologist, she had treated patients with severe mental health problems. This impressed upon her that care should not be segmented into different providers; she therefore considers integration the catalyst for and barometer of success. “We need to think more holistically about our patients so it’s not just their physical health,” she said. "So we want to break down…barriers.”

Empowerment

There are limits to what any single person can do. This is why a leader must empower his/her team. Dr. Mosier hinted at this by quoting Steve Jobs, who, according to the Kansas official, once said, “We hire smart people so they can tell us what to do.” Pryor echoed this sentiment. “We can’t get anything done at 2 Peach Street,” she said, referencing the location of the Department of Human Services. She and Cagle meet with staff throughout the state and, as Pryor added, act on their “immediate feedback.” The implication is that leaders must encourage their teams to propose and implement innovative solutions.

Improvement

Finally, leaders must recognize and address an organization’s areas for improvement. For example, Pryor and Mosier said they are trying to make more extensive use of predictive analytics and metrics, respectively. More specifically, DFCS is hoping to use predictive analytics to devise strategies to manage staff time; nonetheless, as Pryor explained, DFCS is “at the very beginning” of employing predictive analytics. Similarly, Mosier is calling for greater use of data but acknowledged that the metrics (and the methods for gathering them) are still “in gestation.”

This discussion prompted one audience member to press Cagle to identify DFCS’s biggest area for improvement. What, the attendee asked, is “giving you the greatest concern right now?” Cagle responded that sustaining funding for DFCS “keeps [him] awake at night” and has therefore impressed upon funders the importance of not letting the state become comfortable with “mediocrity.”

On-Ramp Two – Decision-Making

Traversing the Human Services Value Curve requires difficult decisions about resources, strategies, and personnel. Speakers highlighted several “on-ramps” that can strengthen decision-making.

Data

DFCS has introduced a business intelligence platform that classifies clients as low-, medium-, or high-risk—categories that help the agency determine which clients need attention. Similarly, Mosier has adopted the mantra, “metrics matter,” and is working with her team to identify key parameters and to equip the integrated eligibility system to capture them. Organizations that advance along the Human Services Value Curve make data-driven decisions.

Organizational Structure and Information Technology

Another “on-ramp” is having an organizational structure and information technology that facilitate coordination. Mosier’s work illustrates this vividly. In 2013, she recognized that teams in offices were operating in silos. She created a “unified leadership” team that brought together program directors; established an executive sponsorship team to handle the most-important decisions; and grouped CIOs in pods, which facilitated information sharing as well as IT integration.

One audience member raised the concern that increased dependence on technology and data may lead some staff to fear losing their jobs to automation. Mosier responded by describing how she has encouraged staff to view reform as an opportunity to reimagine roles and impact. “Look inside for your next job,” she tells anxious staff, “because there’s plenty of opportunities….”
When an organization has many people involved in decisions, and those leaders are sharing data, the agency’s decisions become more informed, and staff members have insights to innovate.

A Personal Touch (In Doses)

Decision-making also depends on staff carefully using their time. Kansas’s integrated eligibility system has a “no touch” approach, so citizens can submit service applications electronically and without a staff member touching the application. This frees up staff to focus on the highest-need cases. In Georgia, Cagle and his staff have discovered that making in-person visits to high-need clients leads to better treatment.

Human services professionals have finite time; managing that commodity is therefore critical to ensure efficient organizational decision-making.

On-Ramp Three – Stakeholder Engagement

A final “on-ramp” is skillful stakeholder engagement. Scaling the Human Services Value Curve is a collaborative process involving several key groups.

The Private Sector

One valuable partner is the private sector. As Pryor recalled, DFCS “took a page” from Zappos (an online shoe and clothing vendor) by creating a “culture book,” compiling staff insights about whether the organization was living up to its values. Similarly, Kansas is working with Accenture to develop its integrated eligibility system. Companies are laboratories for innovation, and collaborative experimentation facilitates progress along the Human Services Value Curve.

The Government

Public officials from other agencies are also critical stakeholders. At one level, engaging these officials is critical so that they do not feel threatened. One audience member asked Mosier whether she is engaging providers and local government officials, prompting her to say that she does and to cite the adage, “If you’re not at the table, you’re on the menu.” Cagle similarly travels across Georgia to engage with local law enforcement officials, judges, and district attorneys. These leaders have supported the reform initiative and shared fresh perspectives about how to accelerate it.

The Public

During his first 17 months in office, Cagle has done more than 100 interviews and met with the editorial boards of media outlets across the state. This is in part to generate awareness, but he is also doing proactive damage control. “I firmly believe,” he said, “that it’s better to go and talk to somebody, even if it’s just about the blueprint for change, than to have never talked to them and have to answer a question about why a child died.”

Cagle’s media strategy prompted substantial discussion at the Summit. One audience member had spent over a decade in marketing and branding at Kraft; that firm did extensive quantitative and qualitative analysis to inform its marketing campaigns. The attendee suggested that the human services sector should use similar approaches. Another seminar participant said to Cagle, “I want the positive press you’re getting…because so much [of this work] is perception….” The discussant added that it is important to manage expectations. “Just keep in mind, it takes a really long time [to effect reform].”

Reform is risky, and in the event something goes awry, it is imperative to acknowledge a mistake, learn, and eventually move on. Having a store of political capital, developed through an ongoing dialogue with the public, can facilitate that process.