Fw: United Way Evaluation

H. C. Covington @ I CAN! America (@)
Sun, 30 May 1999 11:35:23 -0500


----- Original Message -----
From: Jon Hardie <jhh@IME.NET>
To: <ARNOVA-L@WVNVM.WVNET.EDU>
Sent: Thursday, May 27, 1999 1:10 AM
Subject: Re: United Way Evaluation


Steve et al

> The (United Way) financial management and accountability system is
meticulous - not always helpful but meticulous. I am uncertain if there is a
reluctance or an inability to apply this same attention to the service side of
UW.

If we backup from the UW issue of fiscal management and quantitative
accountability vs NP driven, client-centered quality of life management
issues for a moment, lets look at the larger playing field.

- UW is responding to intense competition and donor pressure for funds
usage accountability - counting works.

- Congress is suffering the same knee-jerk reaction with their initial
successful cherry-picking reductions in welfare reform and wants to
recover the savings through devolution to the states.

- There is substantial measurable evidence (see CA) of decreasing
capitation driving HMO's and forcing dramatic reductions in amount and
quality of care (read time with the patient) to those most vulnerable
(read impatient capital / improvement in the 10K's to deliver quarterly
stockholder value in the private sector).

- This is also the flip side of HMO CFO's managing care based on short
term ROI or UW measuring $$$ per unit of service.

- At the states, there are billions in unspent TANF funds for children
and welfare mothers.

        How do we measure success? We are measuring short term success with $$$
saved, while converting untreated acute illness among children, mothers,
and the the elderly into the long term chronic medical and poverty costs
at a down stream multiples of 10X.

        We are being asked to write checks our bodies can't and won't be able
to cash.

        The number of homeless and children at the poverty level continues to
climb dramatically. The number of families now marginally off welfare
but outside the safety net are skyrocketing.

        I am reminded of the airline pilot who is lost and comes on the
intercom - "I have no idea where we are - but we're making terrific
time"

        We continue to be fly headlong into a culture of financial revenge, now
that culture of blaming THOSE PEOPLE on welfare are disappearing, now we
just need to recapture the savings - to wit intentionally unspent TANF
billions.

        Again, the failure to address the "quality of life" stuff raises its
head ... and I do not think that UW is the only reactive and well
intentioned player here. The UW donor base is aghast at $700,000
salaries. Congress drives Medicare / Medicaid investigations - where one
is more concerned about fraud than mortality, funds than feelings.

        NP's, who classically have positioned themselves as the sensitive,
responsive client centered caregivers, are being asked to measure up -
be more businesslike, more accountable ... (actually not an unreasonable
request - on the face of it - for many NP's) but funding will be based
on the quantitative stuff - not on client centered values!

        So, for the UW funded NP staffer, congressionally capitated and HMO
funded Physician and Nurse, Faust accurately describes the moment didn't
he. This is the solyent green solution.

        Intriguingly, the vulnerable homeless mental health dischargee, (who
remains on the street from the last de-institutionalizing cost saving
adventure), chronically at risk, malnourished and domestically abused
child and wife, who don't vote, or sit on boards, or allocation panels
because they smell and because they talk funny and because they are high
maintenance, (where they belong)... are no where to be seen in the
qualitative measurements are they.

        But then why should they be - Foust's character speaks to us,
rationalizing the approach... "After all it was their fault they got in
that situation in the first place, so lets not have it cost us an arm
and a leg getting them out ... anyway I don't have time to worry about
that, I've got to check my email, write that grant so we can process
more of THEM.

        Then I can enter all those great numbers on my spreadsheet ... and get
reimbursed.

        mmmmmmmmmmmmm If that's the way it is out there in the trenches ... and
direct experience tells me that it is, in spades. What are the strategic
and tactical choices we have to make now - to change it - in teaching
strategies, training strategies, NP advocacy, on NP and UW boards and
allocation committees.....

        Isn't the most obvious answer for the jury / the boards and the
allocation panels to say - Lets not rush headlong into this decision
simply because we have set this imaginary timetable where the campaign
drives the allocation - not the need - I can't make that funding
decision without real qualitative / quality of life information.

        Do we have the simple courage to do that - or have we sold out to
analysis paralysis?
--
Jon Hardie



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Jon Hardie / in2itv
Community-based NP Consulting & Circuit Riding
Appropriate Technology Systems & WWW presence
Values-based Org Development & Strategic planning
Portland, ME
(207) 774-0471 office w/vm

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