September
27, 2005
Five
Great Undefined Goals
The
government that spent its first four years talking about
results based management is fumbling the ball when it comes
to measuring whether it is making progress on its goals.
It has chosen measurements that look at input and process
rather than outcomes.
The
new legislative session began with the routine of budget
and Throne Speech debates. Six
sitting days are allowed for each debate during which
MLAs pontificate on any topic of their choosing. Many of
the Speeches from the government side mentioned the "five
great goals" that the Campbell government campaigned
on. It was evident that the government had no concrete idea
of what the goals entailed when the Throne Speech invited
"…the Official Opposition, the B.C. Progress Board,
First Nations, and others to help identify the most appropriate
targets, benchmarks, and indicators for measuring progress
on each goal." Unfortunately, while government members
frequently cited their goals, none took the opportunity
to define them by way of measurable indicators. The Budget
Transparency and Accountability Act requires that
the government specify measurable results for its goals
by the time it presents its next budget,on February 26,
2006.
It is
not a trivial task to incorporate five campaign slogans
into a legislatively mandated Strategic Plan. It is worthwhile
to look at what performance measurements the Campbell government
provided for each of its five goals over the past four years.
This column looks at the goals "To build the best system
of support in Canada for person with disabilities, special
needs, children at risk and seniors." Future columns
will look at the other goals.
One
would expect to find performance measurements for a system
of support in the ministries of Income Assistance, Children
and Family Development and Health. The Ministry
of Employment and Income Assistance has a service plan
update on its website which attempts to relate ministry
performance measures to two of the Golden Decade Goals.
The performance measures it claims relate to the best system
of support are:
-
Percentage
of BC's population aged 19-64 receiving temporary assistance
with employment-related objectives
-
Average
percentage of clients with employment related objectives
who leave the caseload each month
-
Percentage
of BC's population receiving income assistance
-
Percentage
of total caseload receiving disability assistance
-
Percentage
of persons receiving disability assistance who declare
income from working or receive volunteer supplements
-
Average
number of working days required for the adjudication of
short-term nutritional supplement requests
-
Percentage
of reconsideration decisions that are made within 10 days
-
Percentage
of appeals commenced within the 15 day statutory time
limit
Many
of the measures focus on getting people off assistance.
It is true that a job is better than welfare, but it remains
debatable whether people are moving to jobs or to homelessness
and begging. BC should consider the type of performance
measurements that are included in the Oregon progress board's
report:
-
Percent
of Oregonians with incomes below 100% of the Federal poverty
level: overall, a. children 0-17, b. adults 18-64, c.
seniors 65 and over
-
Number
of Oregonians that are homeless on any given night (per
10,000)
-
Oregon's
national rank for percent of households that are food
insecure with hunger
-
The
ratio of Oregonians receiving food stamp assistance to
the number of Oregonians living in poverty
You
might not think of the US as being more socially progressive
than Canada, but a glance at the performance measures used
by Oregon compared to those used by BC should put the Campbell
government to shame.
The
Ministry
of Children and Family Development, mired in controversy,
has also updated its service plan to relate to the "great
goals" . It says that the following performance measurements
relate to having the best system of support:
-
Number
of children placed in extended family or in community
as an alternative to coming into care
-
Number
of families referred to family support services
-
Number
of adoptions of children in care of the ministry
-
Per
cent of Aboriginal children in care who are served by
dedicated Aboriginal agencies
-
Per
cent of Aboriginal children in care of the ministry who
are care for by Aboriginal families
-
Rate
of youth in custody based on a proportion of all 12-17
year olds (per 10,000)
-
Number
of Child and Youth serviced by Child and Youth Mental
Health Services
-
Number
of Aboriginal initiatives that enhance early childhood
development services for young Aboriginal children and
their families
-
Per
cent of children who enter kindergarten "ready to
learn"
-
Number
of funded licensed childcare spaces available
-
Number
of children whose families receive a childcare subsidy
-
Per
cent of children under six with special needs and their
families who receive supported child development services
within three months of service request
-
Percent
of children under six with special needs receiving an
early intervention therapy within three months of service
request
-
An
authority established under legislation assumes responsibility
for some or all of community living services
-
Number
of authorities established under legislation that assume
responsibility for delivery of child and family services
The
Ministry of Children and Family Development doesn't get
it. Its measures look at child welfare services not at the
welfare of children. Consider one simple indicator used
by the state of Florida
that is excluded from the BC list: "How many children
served by the program were reabused or reneglected?"
Isn't it a shocking idea to look at whether the abuse is
stopping or not! The Oregon Progress board looks at the
following indicators, which seem to be more relevant to
child protection than those considered by BC:
-
Substantiated
number of child abuse vicitims per 1,000 under 18, total,
a. abused/neglected, b. in threat of harm
-
Incidence
rate of child maltreatment for children, aged 0 - 2 years,
participating in Healthy Start compared to non-served
families in the same counties
-
Percentage
of abused/neglected children who were re-abused within
6 months of prior victimization.
The
Ministry
of Health has updated its service plan in an attempt
to relate the "five great goals" to previously
stated ministry goals and measurements. It says that three
ministry objectives relate to the goal of "the best
system of support": 1) Timely access to appropriate
health services by the appropriate provider in the appropriate
setting; 2) Patient-centred care to meet the specific health
needs of patients and patient sub-populations; and 3) Improved
integration of health care providers, processes and systems
to allow patients to move more seamlessly through the system.
Ordinary folks might look at simple things like whether
spouses can remain together when they are placed in residential
care, what type of care is available for special needs children,
or whether people with disabilities have access to the supports
needed to live independently. The jargon used by the Ministry
of Health is translated into measurable outcomes for its
three objectives as follows:
-
Proportion
of clients admitted to a residential care facility within
30 days of approval
-
Waiting
times for key services
-
Proportion
of patients admitted from an emergency department to an
inpatient bed within 10 hours of the decision to admit
-
%
of patients suffering from congestive heart failure who
are prescribed a) ACE (or ARB) inhibitors or b) Beta blockers
-
%
of patients with diabetes who undergo at least two A1C
tests per year
-
Decrease
in % of natural deaths occurring in hospital
-
%
of persons hospitalized for a mental health or addictions
diagnosis that receive community or physician follow-up
within 30 days of discharge
-
Years
of life lost before age 70 (rate per 1,000)
-
Percentage
of women subjected to domestic violence in the past year
-
Percentage
of seniors and adults with disabilities who are re-abused
within 12 months of first substantiated abuse.
-
Percentage
of abuse complaints that are referred appropriately
-
Average
initial response time to abuse complaints
-
Infant
mortality rate per 1,000
-
Number
of fatal crashes per one hundred million miles traveled
on rural state and interstate highways
-
Percent
of adults whose self-perceived health status is very good
or excellent
It
is not good enough for the Campbell government to cut and
paste its five campaign goals into its old service plans
and call them updates. A change that looks at outcomes that
matter to those in need of support is necessary. BC needn't
reinvent the wheel; much can be learned by looking at measurements
used in other jurisdictions.
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