Accountability: Economics 101 for public health

An interesting article came across the desk this week-- on "Business Basics for Nonprofits." The article is a Harvard Business Review piece from February 2004 describing a talk by Jeff Bradach, a strategy consultant to non-profit groups. Here's the lead:
To transform aspirations into quantifiable impact, nonprofits [and public health agencies] need to become more familiar with traditional business tools such as business plans...
Why? Because
Today's... climate demands accountability.
Now, let me make a personal admission (blogging seems to encourage personal sharing). I've always been intimidated-- ok, scared-- of that term accountability. It sounds so judgmental and harsh! Somehow the term is connected in my brain with the notion of being punished for falling short in some area. Accounts will be settled! You will pay for your shortcomings!

Recently though I've started thinking about the word differently. When I hear it now I think:


The ability to count something.

It's nothing personal: just a data inquiry. What are the facts? What is actually happening?

The article lists four areas where non-profits (and I think public health agencies as well) sometimes have difficulty with their counting: the first three are impact, process, and cost. And like the folks in the article, I think that business planning is an approach that can help you count better.

Impact: The difficulty here is in being specific about goals: exactly WHO we are trying to help and exactly HOW they are going to benefit. Among the key questions is "how do we define success?"

Process: The difficulty here is being specific about the steps necessary to get to the goal. Face it: you are working in a very complicated system. Sometimes people create interventions that don't have the results they expected. How do we know? Bradach wants you to figure out
what comes between the grand, inspirational mission and the activities and programs of the organization. By letting this in-between area remain grey, organizations have no way to measure whether programs are working, or even know if they are on the right track.
Cost: In public health, it isn't uncommon for cost and budget information to flow exclusively to one "business manager" type person, bypassing program staff entirely, and reaching leadership only in summary form. Does this sound familiar? Does your organization count costs effectively?

Bradach's clients typically don't. When he helps them do it they "often see that their spending doesn't align with what they had identified as key points in their mission."

Note that public health business planning requires that you look at all three of these areas.

That brings us to the fourth area, which the article calls "difficulty making hard choices." Across a whole organization, this sort of "counting" of goals, processes and costs might very well lead to some discomfort. Why? Because some people (people like me) will initially get itchy and warm and start jouncing their feet in a classic "fight or flight" response to perceived danger. Someone might get hurt!

Clearly it would be better, in a potentially difficult and emotionally charged situation, to have some data to base a decision on. Without data, these decisions will get hijacked by our individual or organizational lizard brains.

With data-- we might find out that some of our programs... aren't helping very much. Or aren't helping the right people. Or aren't exactly what our customers and stakeholders really need. In other words, we might find out that some of our programs are actually preventing us from moving towards our mission-- because they are tying down people and space and time who could be doing more important work.

Final word: business plans can help in your quest to "transform aspirations into quantifiable impact."

Am I right? Drop a comment and say what you think...

--Steve O