First Nations & Inuit Home & Community Care
PRINCIPLE: Results-Based Organizations
For more than 15 years, the lack of home care services relevant for First Nations and Inuit communities has been identified as a significant health and social issue.
In response to this need, a Joint Health Canada / Department of Indian and Northern Affairs (DIAND) / First Nations / Inuit working group was formed to develop a framework for a comprehensive home care program. Based on community consultations, the First Nations and Inuit Home and Community Care (FNI HCC) program was established in June 1999. What separates this program from others is the commitment to ensuring that the program is continually moving towards its founding vision.
The Principle in Action
The results-based model used in this program has three core fundamentals: 1) measurement, 2) evaluation, and 3) accountability. Through these three elements of performance management, it is possible to continually assess the program to determine what is working, what is not and then apply the learning to improve program design which will enhance results achievement.
Results-based management focuses on the demonstrated needs and expectations of stakeholders and target populations, enhancing responsiveness and accountability through a number of key features including:
Good Planning: Deciding how to achieve the best outcomes with the resources available. This involves identifying and focusing on expected outcomes, selecting performance indicators, setting specific targets and examining alternative and/or complementary ways to achieve the expected outcomes.
Continuous Learning and Improvement: Measuring performance, assessing costs and using the information to improve the effectiveness of programs, policies and services.
Reporting: Reporting on performance to clients, partners, stakeholders, parliamentarians and Canadians in a balanced and objective way and engaging them in the process of planning, continuous learning and improvement of programs, policies and services.
The results-based management strategy for the FNI HCC integrates four key components: ongoing data collection, program evaluation, reporting on performance and accountability for results.
The ongoing data collection strategy is based on the regular collection of FNI HCC information against the identified performance indicators for the activity, output and outcome components of the program logic model. The collection of performance information is intended to be systematic and part of the service delivery and management practice for FNI HCC Program.
This ongoing approach is meant to support the First Nation and Inuit communities that are delivering FNI HCC services, as well as the program manager and staff of the First Nations and Inuit Heath Branch, Health Canada in the administration of the program.
The data collected will demonstrate how the program is progressing toward the achievement of the expected outcomes. The evaluation strategy will draw on the performance data as one of the lines of evidence in an in-depth study of outcomes achievement. This will also include testing of the causality displayed in the logic model and examining unintended outcomes within the program and on other programs.
Community Goals: The first step in developing a results-based program is articulating community goals. By clearly articulating a small number of shared goals, the leadership can focus staff energy on making progress in key areas.
Program Plans: A program plan shows the logical links among a program’s objectives, the inputs and activities to achieve those objectives, the performance targets, and the intended results in terms of outputs and outcomes.
Performance Measures: Measures describe what was expected to happen and what was achieved. They should provide good performance information which allows people to judge how well the goals are being met and to plan for the future.
Data Collection: Ongoing data collection provides program administrators with the most timely feedback from community members, using surveys, discussion groups or other feedback mechanisms. With this current feedback programs can be adjusted to better achieve their objectives.
Performance Targets: Each performance measure should have a corresponding target. Targets answer the question, “how big a change do you hope to see in the future?” They are commitments to attain certain results in specified time periods. They should directly reflect the anticipated progress to be made toward priority goals.
Reporting: A good performance report presents more than just data. It presents an analysis of what the results mean and potential strategies for improving performance. There are several ways in which to analyse results. Graphical tools such as pie charts, bar charts or other diagrams are often helpful. These are usually accompanied by an explanation giving the context for what the results actually mean. The form of the performance report will reflect the particular accountability practices of a First Nation.
Realignment: Continuously making program changes and improvements based on findings.
Tensions in Accountability: Tension may become evident between the funder, the program deliverer and the recipient of service. This becomes a challenge for program deliverers to determine whose needs to make the priority.
Implementation: The transition to results-based management may take several years. Sustained commitment from the First Nation leadership is vital to success.
Fear: As with any change, some people feel threatened by an emphasis on performance. They may feel that failure to achieve results would jeopardize their professional or personal credibility.
Cost: Using performance information requires time and money. Governments, program managers and individuals may feel that they do not have the human and financial resources to manage or budget for results.
NCFNG Governance Lessons Learned
Results-Based Organizations are imperative for any governing body to accurately measure the effectiveness of its governance. In measuring the effectiveness of First Nations governance, a key result would be the extent to which the structures have moved the people toward their strategic vision. However, for decades First Nations communities have functioned within organizational structures driven not by their vision, but by federal government funding opportunities.
Sources and More Information
First Nations & Inuit Home & Community Care Program
FNI HCC Program Profile
First Nations Self-Evaluation of Community Programs
Challenges and Lessons in Results-Based Management