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Although their core mission is to improve the trajectory of people’s lives, many health and human services (H/HS) programs have long been more transactional than transformational.
For most programs, the business day consists of programmed actions and reactions, inputs and outputs, moving back and forth among government workers, their data systems, and their clients. Success is defined primarily by the timeliness and accuracy of these transactions rather than their results. This has led to a model in which outcomes are in fact merely outputs: Did we issue food stamps in a timely fashion? Did we approve 98 percent of our Medicaid applications within 30 days? Did we respond to 95 percent of our hotline calls within 24 hours?
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What’s often missing, particularly in eligibility programs, is any consideration of the extent to which these quantitative transactions have anything to do with qualitative changes in people’s lives. If an agency responds to 98 percent of its child abuse hotline calls within 24 hours, what about the 2 percent the agency didn’t get to—were those children safe? And what percentage of calls to which the agency responded were eventually “screened out” because they were based on unfounded allegations?
Or, more simply: To what extent are H/HS agencies doing the right work for the right people at the right time, and thus achieving meaningful results?
This is not to say, of course, that output measures are irrelevant. They do matter, and H/HS agencies should continue to track them. There will always be a needy individual or family that depends on timely and accurate delivery of programs and services. And there is certainly no shortage of federal and state reporting requirements and guidelines dictating how agencies should capture and publish their results.
But transactional measures alone cannot support the kind of outcomes for which H/HS systems were created. And yet it’s easy to become fixated on transactional measures because they are exactly the requirements for which agencies are likely to be held publicly accountable. As a result, the people who work in internal data reporting are driven largely by the capture and reporting of performance indicators that may have little or no relation to real-world results for clients.
In this environment, it’s entirely possible for an agency to meet or exceed transactional performance metrics while experiencing breakdowns in the system—whether it’s food stamps ending up in the wrong hands, millions of Medicaid dollars channeled to one doctor at multiple addresses, or a child who is seriously injured despite multiple visits by a child welfare agency. And when H/HS systems experience their worst failures where it matters the most, it often becomes obvious that traditional performance indicators do not guarantee meaningful, mission-critical outcomes for the people who rely on these services.
But this all-too-common pattern is beginning to change, thanks to the rapid proliferation of new technologies (AI, for example), the increased adoption of new methods such as human-centered design and behavioral nudges, and the introduction of more sophisticated data analytics.
Taken together, these new capabilities open up new possibilities for redefining H/HS—for moving beyond a strictly transactional business model to one that is also transformational.
What if we could know more about the people served and how the H/HS workforce serves them—and therefore, more about the potential impact of an agency’s work on their lives and their future? What if we could know more about each child’s day-to-day risk for maltreatment? What if we could get real-time reports that prompt a second look at a particular case? What if we could see which doctors’ and clinics’ billing practices seem disproportionately higher than others similarly situated? What if we could see which kinds of food stamp cases are more prone to error, and had a chance to double-check the work on those cases?
What if we could predict which families are more likely to achieve financial independence if a single factor in their lives changes, and predict those factors based on something in a case file or external data about similarly situated families? And what if we could do all this while determining their eligibility, so we would know which services are most likely to help them move forward?
These kinds of insights, paired with thoughtfully developed and targeted interventions, could help elevate H/HS from the realm of transactional service delivery, allowing agencies to measure the actual impact human services have on the lives of those they serve.
This playbook canvases innovations from across the H/HS ecosystem with an eye toward moving beyond transactional service delivery. The articles in this playbook are intended to help—even inspire—thinking about how a transactional business model can become a transformational one, capable of achieving potentially life-changing outcomes for the individuals and families H/HS programs serve in an efficient and cost-effective way.