Behavioral Healthcare Centers often find themselves frustrated by their lack of success in defining and meeting their key organizational objectives. This frustration is not the result of lack of skill or passion, but rather lack of clear organizational goals and concrete measurements. Leaders in these organizations often confuse “doing good” with being effective. This commentary will illustrate how behavioral healthcare managers can learn from their for-profit counterparts and translate their organization’s mission into clear performance measures across the company.
The first thing any organization needs to do when it comes to goal-setting and measurement is to understand their “big picture”. Executives must answer the question as to why their organization exists in the first place. What is the mission that will drive all other decisions in the organization? This mission should not be so generic that it could fit every other organization in your industry. Rather, it should help everyone in the agency understand what makes it unique.
Once the mission is defined, quantifiable goals that, if accomplished, will allow the mission to be realized, must be articulated. This is where behavioral healthcare organizations tend to struggle. A goal should not be confused with an activity. For example, while you may wish to “provide more counseling services for school-aged children”, that is not a measurable goal. How is “more” defined? How will you know if you are on-track to meet your goal? A quantifiable goal could be “Increase the number of high school mental health presentation to 24 during the 2018-19 academic year”. By using a measurable and specific goal, results can be tracked throughout the year, the organization can determine if the project is on target to achieve the goal, and they can define the required resources. Simply stated, every goal that is defined, should be measurable. Measurability, however, is necessary, but not sufficient. In the scenario above, my organization may conduct 24 presentations in the year, and conclude that its goal was met. However, the bigger question is whether meeting that goal got us closer to achieving our mission. How do we know that the presentations had an impact on the mental health of teens? We need goal measurements as well as outcome measurements. As an example, let’s say you work at a company that wants to improve sales of a key product. The marketing department is charged with increasing the market exposure through advertising, social media, etc. They are given the resources required in terms of the marketing budget. They measure key metrics of clicks on their advertisements, viewers for their ads, recognition of the product in surveys, etc. and conclude that they met all their objectives. They did everything they were asked to do in marketing the product. However, the true test of the company’s success is not in whether people liked the ads, it is whether they bought the product. The final measurement has to be sales of the product.
Robert Kaplan of Harvard Business School conducted research into how companies can translate their strategy into actionable performance measurements, which resulted in an approach known as The Balanced Scorecard. Kaplan discussed how an organization can translate their overall vision into key performance measures in four areas that apply to any organization - for profit and nonprofit alike. These four areas are: Financial, Customer, Internal Business Processes, and Learning and Growth. For nonprofit managers, the fact that nonfinancial measures receive just as much attention as financial usually helps achieve willingness to consider the approach, as so many other “business” methodologies seem to focus more on financial measures only. While Kaplan’s approach is one of many, the basic philosophy of measuring the important indicators that help the organization achieve its mission applies.
Once goals and their performance measures are well-defined, the next step is assigning accountability. This is one area where nonprofit organizations need improvement. When so many people within the organization are sacrificing so much to do good in the world, it can seem crude to hold them accountable to measures and numbers; after all, they are doing admirable work. However, accountability can focus that goodwill and passion, and help these same employees be more able to achieve their personal goals as well as the organization’s mission thereby increasing job satisfaction, improving efficacy, and enhancing service delivery to patients. The accountability for performance measurement must be singular. While it is true that typically no one person controls the ability to execute a goal, one person must be charged with making sure that it is executed. Putting a team in charge of anything means that individual members do not feel the same accountability. Nothing focuses effort better than having your name on the report requiring an update to the supervisor on the status of key initiatives.
After the mission is defined, clear and measurable goals are developed and individuals are named accountable, the organization is in good shape to make progress. However, the most important part of the process is still forthcoming. The feedback loop is critical. If the organization met its goals, has it brought them closer to achieving the mission? If not, do goals need to be re-defined? Did achieving one goal result in another being missed (e.g. spending too much to achieve an outcome which results in financial health issues). Were there unintended consequences that must be addressed? The mission and goals must be constantly re-evaluated as the field evolves, regulations change, and available treatments improve. An organization cannot rest on past success; goal-setting is a continuous loop with new information used to inform decision-making on an ongoing basis.
While the process outlined above may seem daunting to many behavioral healthcare centers, it is important to remember that the process may be more important than the outcome. Having employees discuss the vision of the organization, work together to set and achieve goals, report out on outcomes, and evaluate results means that the whole organization is working together to improve. Even if they come up short, they will be far ahead of their counterparts who blindly try to “do good.” Moreover, given limited (and shrinking) resources within many of these organizations with people being tasked with doing more with less, it is critical that clear outcomes are developed and measured and results used to inform resource allocation. Simply stated, do not value what you measure, but measure what you value.
Citation: Steffan S and Klostermann K. Performance Measurement in Behavioral Healthcare Centers. SM Addict Res Ther. 2018; 2(1): 1003.