(Emily Keller
is an editorial associate in the Corporate Philanthropy department at the
Foundation Center.)
Foundation leaders who want to increase
the accountability of their work should consider supporting efforts to solicit
feedback from beneficiaries, say three experts in the field of conducting
recipient assessments.
To succeed, the feedback must be
representative, actionable, systematic, and comparable, said Fay Twersky, Phil Buchanan,
and Valerie Threlfall in a webinar presented last month by the Stanford Social Innovation Review (SSIR). The
webinar was based on the article, "Listening to
Those Who Matter Most, the Beneficiaries," written by the webinar speakers and
published in the spring 2013 issue of SSIR.
Despite its inherent difficulties, beneficiary feedback is poised for growth as a method for measuring performance and accountability within the social sector movement toward "big data."
Twersky, who is the lead author of the
article and the director of the Effective Philanthropy Group at the William
and Flora Hewlett Foundation, said gaining knowledge from
beneficiaries, in addition to experts and crowdsourcing, is a moral issue and a
smart thing to do to achieve effective program results. "I think if this is
important to practitioners to listen systematically and to do it well, it will
be important to funders who are responsive to their grantees...I don't think we
have done a good job as funders of listening to those voices. I think we can do
a lot better," she said.
A 2011 survey of
CEOs
by the Center for
Effective Philanthropy (CEP) showed that just 19 percent of responding
foundations use beneficiary focus groups or convenings to assess the
effectiveness of their foundation's programmatic work, and 16 percent use
beneficiary surveys to do so. Those who collect this information reported
having "a better understanding of the progress their foundation is making
against its strategies" and "a more accurate understanding of the impact the
foundation is having on the communities and fields in which it works."
So why aren't more foundations supporting
programs to solicit beneficiary feedback? The webinar speakers examined the
issue by discussing benefits and success stories, challenges and criticisms, and
best practices for establishing a feedback system.
Benefits
and Success Stories
Twersky, Buchanan, and Threlfall drew on
their experiences as co-founders of YouthTruth, a nonprofit organization that
administers online surveys to high school students across the country, to
exhibit an effective system for gathering beneficiary feedback. YouthTruth was
created in 2008 by CEP, in collaboration with the Bill & Melinda Gates Foundation, to leverage
student opinions into schools' decision-making processes. The questions focus on
student engagement, school culture, student-teacher relationships, rigor of
classes and instruction, and preparedness for the future. Two hundred thousand
students from 275 schools have answered the survey, and 85 percent of participating
administrators say they have used the data to make policy or programmatic
decisions.
"In the case of YouthTruth, we have seen
real benefits courageous students and schools that have participated in the
process in that it has really opened up new areas for discourse and I think
changed both adults' and students' expectations about their involvement in
decision-making," said Threlfall, a senior advisor at YouthTruth.
In the healthcare sector, the push for using
beneficiary feedback to improve outcomes has focused around patient-centered
and accountable care, as measured through initiatives such as the Hospital Care Quality Information from
the Consumer Perspective (HCAHPS) survey. The publication of "Crossing the
Quality Chasm: A New Health System for the 21st Century" by the
Institute of Medicine in 2001 spurred an increase in the collection and use of
recipient feedback for this purpose, the authors explained. The Patient Protection and Affordable
Care Act
continues in this direction with goals for measuring patient experiences during
hospital stays and incorporating consumer assessments in determining insurance
reimbursements. "When patients have better communication with providers, and
when they understand treatment options and feel that they have some say in
their own care, they are more likely to follow a treatment regimen and improve
their health," the authors wrote in the SSIR article.
They pointed to work by the Cleveland Clinic to increase
nurse check-ins as a result of patient feedback, as part of a successful quest
for a 90 percent satisfaction rate using HCAHPS; and an initiative by the California
HealthCare Foundation
to gather feedback from patients outside the commercially insured population
that has been the traditional focus of data collection.
The education and healthcare sectors
provide unique opportunities for collecting feedback, as the service structure
enables providers to track recipient populations and compare information across
institutions, the speakers said.
Criticism
and Challenges
Despite positive outcomes, experts say
that beneficiary feedback is under-utilized by philanthropic organizations for
many reasons. According to the CEP study, 73 percent of the responding
foundations provided some funding to assist grantees in understanding the
effectiveness of their programs, but only 9 percent did so for all of their
grantees.
The speakers identified a range of
challenges that may explain why beneficiary data is not more commonly used. According
to Buchanan, who is president of CEP, soliciting feedback can be expensive and
difficult to gather, particularly for populations that are hard to reach, and
power dynamics between recipients and service providers can create a barrier to
candid information sharing with a high response rate. Twersky cited low
literacy rates, trust issues among vulnerable populations, and access to
technology as other potential barriers. Allocating funding for surveys may be
viewed negatively as an administrative cost that takes resources away from the direct
provision of services. Another criticism is that placing an increased focus on
outcome metrics can impede innovation and risk-taking. And although recipients may
be viewed as customers of a business, they are not the ones paying for the
services they receive, the speakers explained, which makes it easier for
service providers to overlook their opinions.
Best Practices for
Gathering and Incorporating Beneficiary Feedback
Twersky, Buchanan, and Threlfall offered
a series of recommendations for collecting and utilizing beneficiary feedback
effectively, including the following:
- Seek Feedback When it Matters
The speakers recommended initiating the survey
process before or during a program rather than only after it ends, enabling the
data to have the most impact. Twersky compared this to leading indicators used
in business.
- Design Surveys for Impact
The speakers recommended developing a
process to integrate feedback early on and to consider the use of focus groups
before or after administering surveys, as well as establishing requirements for
a high response rate. Buchanan stressed the importance of detailed survey
design and methodology and suggested working with consultants or providers if
necessary.
- Strive for Candid, Representative Responses
Threlfall made the recommendation:
"Check for non-responder bias to make sure certain populations aren't left out." This requires cultural awareness of the
population being surveyed. For example, with smallholder farmers, "Men tend to
have disproportionately more access to mobile phones than women, so whose
voices are we hearing?" Twersky noted.
- Prepare for Negative Results
In a YouthTruth video shown in the
webinar, Dr. Brennon Sapp, principal of Scott High School in Taylor Mill, KY,
described receiving difficult feedback. "One question that will haunt me to my
grave is the question that was ‘do your teachers care about you?' We rated
bottom 1% in the nation on that one specific question and it really hit hard.
It's hard to swallow, hard to take, hard for my teachers to take," he said in
the video. Following the survey, Sapp said he worked with staff to change
policies and shift the culture of the school, which led to a decline in the
failure rate and increased teacher intervention.
- Collaborate with Other Organizations
Working with other groups enables
providers to generate comparative data. In the CEP survey, 26 percent of
respondents said they were currently using coordinated measurement systems with
other funders in the same issue area, and 23 percent were considering doing so.
According to Twersky, developing benchmarks through collaboration will help
organizations to interpret the data.
Beneficiary
Assessments in the "Big Data" Movement
Despite its inherent difficulties,
beneficiary feedback is poised for growth as a method for measuring performance
and accountability within the social sector movement toward "big data." The
push for evidence-based social programs utilizing impact evaluations was echoed
in the Obama Administration's launch of the Social
Innovation Fund (SIF)
in 2009 to provide million-dollar matching funds to nonprofit organizations
chosen by grantmakers that are working in the areas of economic opportunity,
healthy futures, and youth development. The SIF's "key characteristics"
include: "Emphasis on rigorous evaluations of program results not only to improve
accountability but also to build a stronger marketplace of organizations with
evidence of impact."
While some challenges will remain
insurmountable as Twersky pointed out during the webinar, "When the intended
beneficiary is the earth, how do we listen to the earth?" there are more than
enough resources available to start speaking to more of its inhabitants today.
What are the biggest challenges your
organization has faced in collecting and incorporating beneficiary feedback
into decision-making? What role should recipient assessments play in the "big
data" movement? How can foundations and nonprofits use beneficiary feedback to enable
greater accountability and effectiveness? Please provide your comments below.
-- Emily Keller