The Path to Program Sustainability

Transcription

1 The Path to Progra Sustainability by Karen Buck The Sustainability Conunru A New Moel for Sustainability The Path to Progra Sustainability Step 1: What exactly are we trying to sustain? Step 2: How uch will sustaining that cost? Step 3: Does the environent support sustainability? Soe Ba News an a Powerful Tool Conclusion Sustainability: funers expect it an practitioners aspire to it. But how o you o it? The question of how to sustain evience-base progras has been iscusse, ebate, an worrie over. An in light of the recent recession an ongoing feeral an state buget challenges, the long-ter sustainability of these progras is a growing concern in the state an local public health agencies, healthy aging agencies, an counity-base organizations that eliver the. Yet the path between, think about sustainability uring planning, an, be sustainable before funing ens, reains elusive. Nonprofit Ipact uses a three-step process to buil a path between thinking about an achieving progra sustainability. Nonprofit Ipact has use this straightforwar process with nuerous agencies an organizations to eterine if the sustainability of a progra is feasible an evelop specific sustainability plans that ensure a future for iportant, ipactful progras an services. This article will introuce you to the path to progra sustainability, using two evience-base Self-Manageent Progras (SMPs) to illustrate each step. SMPs were chosen as an exaple because they share key characteristics with other types of What is an SMP? Self-Manageent Progras (SMPs) are evience-base progras that eliver a curriculu of skills an inforation to participants with a chronic isease. Soe focus on those with a particular iagnosis, such as iabetes or HIV, while others serve those with any chronic health proble. Healthy eating, exercise, self-avocacy, aherence to eication, an other selfanageent practices are taught an a counity of support is evelope. The evience base supporting SMPs is strong an eonstrates iportant health an quality of life benefits for progra participants an significant health care cost savings. An evaluation of Stanfor s Chronic Disease Self-Manageent Progra foun a cost to savings ratio of approxiately 1: Nonprofit Ipact, 1

2 evience-base progras. As with other evience-base progras, state-level healthy aging or public health agencies often serve as the lea SMP coorinator in their state an progras are elivere by local counity-base organizations incluing nonprofits, public health entities, Area Agencies on Aging, faith-base organizations, an private an nonprofit healthcare proviers. SMPs focus on evaluation an regularly onitor progra fielity to aintain the evience base both of which are coon priorities of evience-base progras. An lastly, ost SMPs are epenent to soe extent on feeral funing the future of which is in question. The Sustainability Conunru Before outlining the three steps on the path to progra sustainability, let s consier why the current approach to sustainability rarely works. The oinant funing an elivery oel followe by ost evience-base progras inclues: securing the ajority of funing fro one or two sources; working with local organizations an agencies to ipleent the progra; an gathering ata, learning lessons, an builing infrastructure. This oel serves to get the progra ipleente an elivers easurable results. However, the current oel fails to eliberately, ethoically plan for long-ter sustainability. Instea, the oel sees to assue that sustainability will be a naturally occurring sie effect: eonstrate results an a private funing source will eerge, partners will raise neee funs locally, or an organization will buil the progra into its annual buget. Unfortunately, ost practitioners have a great eal of evience to the contrary. Despite not leaing to long-ter sustainability, both the oel an the assuption that it will lea to sustainability persist. Nonprofit Ipact has foun that the root of the proble lies with a core isunerstaning about the very nature of progra sustainability: that sustainability equals oney. Sustainability an funing are not the sae thing. Progra sustainability is about uch ore than oney. This is-efinition of sustainability neglects iportant variables like operating environent, leaership, political support, huan capacity, an technological an organizational infrastructure. Instea, Nonprofit Ipact efines sustainability as: Having the huan, financial, technological, an organizational resources to provie services to eet nees an attain results towars ission IDENTITY on an ongoing basis; an requiring the organizational an prograatic infrastructure to carry out core functions inepenent of iniviuals or one-tie opportunities. A New Moel for BRAND Sustainability The current CAPACITY oel yiels sustainability CONSTITUENTS planning efforts structure that focus copetencies priarily on fining a new segentation revenue strea to systes culture practices replace one that is ening. At best, this approach postpones the sustainability question for a few ore years (i.e., until the new funer ens its support). CAPACITY structure copetencies systes culture practices ission vision values position iperatives goals IDENTITY ission vision values position iperatives goals BRAND analysis target profile engageent CONSTITUENTS analysis segentation target profile engageent Integrate Strategy for Success an Sustainability 2010 Nonprofit Ipact Visit to ownloa the Integrate Strategy booklet. v i sy C 2 The Path to Progra Sustainability

3 Nonprofit Ipact s Integrate Strategy for Success an Sustainability offers an alternative oel for sustainability one that consiers all aspects of a progra as a cohesive whole rather than singling out funing as the key to sustainability. The oel shows that a progra nees a strong, clear ientity, a base of engage constituents, an capacity that is aligne to eliver the results proise by its ientity an eet the nees of its constituents in orer to be sustainable. Progras with these characteristics are able to attract an retain supporters an achieve significant issionrelate outcoes. They have iscare the current oel an have a new sustainability oel in place one that efines their ientity, constituents, an capacity an guies the evelopent of the progra towars a ore sustainable future. The Path to Progra Sustainability Nonprofit Ipact has worke with any state an local agencies an counity-base organizations aroun the country on questions of progra sustainability. We have learne that while every progra s situation is unique, these three steps provie a path that fills in the gap between thinking about an achieving sustainability in ost situations. Each step poses a specific question progra leaers ust answer objectively an thoroughly. Your answers to the question pose at each step allow you to: Deterine whether or not it is feasible to sustain your progra; If so, evelop a custoize oel to achieve long-ter sustainability. Answering these questions can be siple or coplex, epening upon the situation. We will explain each step, the question it poses, an consierations for answering each question through the experiences of two ifferent SMP exaples: Progra A State-level healthy aging & public health agencies lea progra coorinators Offers 3 ifferent evience-base progras for variety of chronic conitions Progra B State-level chronic isease progra lea progra coorinator Offers 1 evience-base, isease-specific progra Serves 3,000+ participants/ year Robust central infrastructure (website, braning, nuber, etc.) Progra elivere by 30+ very iverse local partners with varying structure, capacity, an eication to progra Feeral an state grants fun central infrastructure; progra eliverers raise oney locally (private, state) Signs inicate ecline in feeral an state funs are on the horizon Serves 300+ participants/ year Liite infrastructure; state staff supplies curriculu aterials an soe technical assistance Progra elivere exclusively by staff of 3 hospitals; very eicate to progra Feeral chronic isease-specific grants fun state-level position (TA provier) an aterials costs SMP-relate line ites in ost recent grant application were e-fune 2013 Nonprofit Ipact, 3

4 Step 1: What exactly are we trying to sustain? The first step on the path to progra sustainability is to specifically efine what ust be sustaine. What constitutes successful progra sustainability can vary wiely. For exaple, when aske this question soe of our clients clarify that they want to sustain staff positions while others want to sustain a funing strea for local progra elivery partners, statewie prograatic infrastructure, or the availability of a progra for a certain isparate population. Answering this question is a critical first step as it efines the esire outcoe of a sustainability planning effort. This step forces conversation about what is negotiable an non-negotiable. It can illuinate any sacre cows, unerlying assuptions, or ifferences in opinion aong progra leaers. However you efine what is to be sustaine, that efinition hols irect iplications for the next steps along the path. Consier how our two SMPs answere the question: What exactly are you trying to sustain? answer also efines what is non-negotiable: anything that violates progra fielity. They want to aintain progra access an health an quality of life outcoes for progra participants an they see aintaining progra fielity as the way to o that. Progra B s answer to the question is quite ifferent an reflects its unique situation. This answer iplies the urgency of the situation (funing is ening) an the liite aount of irect control current SMP leaers have over whether or not the progra continues. The e-funing of Progra B eans that any progra-relate staff will soon be lai off or transitione to other tasks, inferring liite staff resources an a short tieline to work on sustainability. Progra B s answer inicates that the future of progra sustainability epens upon a new agency or organization taking on the state s prograrelate responsibilities an the three hospital partners continuing to eliver the progra espite that change. This iplies that the hospitals an the new agency/ organization ust be engage as full partners in any sustainability planning effort. Progra A Progra B We want to aintain access to our two priary SMPs for the citizens of our state (at the current level, or at a higher level) an ensure that the progra is elivere in a way that aintains progra fielity We want another organization or agency to take full ownership of our progra costs an tasks an of the hospitals that eliver our isease-specific SMP to continue offering the progra at the sae level of access Progra A s answer inicates that aintaining access to the progra is paraount regarless of who elivers it. This akes progra staff positions, existing elivery partners, or any central infrastructure negotiable. This is not to say that Progra A wants to o away with those staff, partners, or structures, but that they are open to new approaches. This openness cobine with the interest in increasing progra access if possible inicates a esire to explore ifferent options an scenarios. Progra A s Defining exactly what is to be sustaine is the job of progra leaers those with eep knowlege of an ecision-aking authority over the progra in question. Take the tie neee to have a thorough iscussion an to ensure that progra leaers are in agreeent. Be specific, explicit, an thorough. The ore clearly you efine what is to be sustaine, the ore easily you will able to navigate the next two steps on the path to progra sustainability. 4 The Path to Progra Sustainability

5 Step 2: How uch will sustaining that cost? The secon step on the path to progra sustainability is to eterine how uch sustaining the progra (as you efine it in Step 1) will cost. For soe reason, any progra leaers never stop to accurately calculate the cost of progra sustainability. Perhaps this is because unerstaning progra costs can be quite coplex. For exaple, costs ay vary wiely across a progra s service area, be share across any ifferent epartents, or be built in as a percentage of overhea rather than tracke in a progra-specific account. Regarless of this coplexity, it is iportant to coplete this step. This step grouns your efforts in reality an serves as a first check on the scope an scale of your plans. One client estiate that their vision of progra sustainability woul cost over $10 illion per year a willy unrealistic aount given that state s econoy an buget. An, you ust be able to answer financial questions confiently an accurately when iscussing progra sustainability with funers, potential supporters, an partners a task for which this step will leave you well prepare. Whether eterining what progra sustainability costs is a siple or coplex task, an accurate calculation will enable you to take the thir step along the path. To unerstan how uch their efinitions of progra sustainability cost, our two SMPs: Progra A s approach to eterining costs reflects the efinition of progra sustainability they evelope in Step 1. Unerstaning how progra elivery costs varie across their state an using that inforation to calculate an average per unit cost allowe the to buil ifferent cost scenarios one at the existing level of progra elivery an one at the hope-for higher level of progra elivery. An since for Progra A the current staffing, elivery oel, an infrastructure are negotiable, they requeste bis an reviewe salary surveys to unerstan what aintaining those ites woul cost outsie the governent sector. This approach helpe Progra A buil a variety of cost scenarios epening upon level of progra elivery, staff, an infrastructure. Progra B s approach also reflects their efinition of progra sustainability. They began by asking the hospital partners to share the value of the progra costs they provie such as eeting space, staff tie, an overhea. Next, accounting staff broke out the state-covere progra costs fro overhea an progra staff requeste bis fro outsie venors to unerstan how those costs ight change for a new sponsoring agency or organization. This approach allowe Progra B to prepare accurate financial estiates of the costs of progra ownership with potential new progra sponsors. For soe reason, any progra leaers never stop to accurately calculate the cost of progra sustainability. Work with accounting staff, partners, contractors, an grantees to unerstan actual progra costs. Reach out Progra A Progra B Aske progra elivery partners to report progra costs by line ite an reviewe financial reports Define an average per unit cost (i.e., progra elivery costs/ participant) Gathere bis to estiate costs of aintaining current infrastructure Aske hospital partners to share costs for the progra elivery coponents the hospitals provie Worke with accounting staff to calculate costs for progra aterials Gathere bis an researche what the private arket charge for the progra support the state use to provie 2013 Nonprofit Ipact, 5

6 Unerstaning if the environent is supportive answers the crucial question is sustaining this progra at this cost feasible? to national associations for relevant salary survey inforation. Contact colleagues in other states or progras that fulfill a siilar function an request expense inforation. Analyze grantee, contractor, an partner financial reports to unerstan cost variations across your state. Pick up the phone an get bis an estiates fro venors. The ore accurate your cost estiates, the ore reaily you will be able to answer the question pose by the thir step on the path to progra sustainability. Step 3: Does the environent support sustainability? The thir step on the path to progra sustainability is to unerstan if, an to what extent, your operating environent supports progra sustainability. Every progra operates in a unique environent in regars to sustainability. For exaple, in one state the prevailing political trens ay inicate growing support for progra-relate outcoes while in another, econoic conitions ay ake raising neee funs extreely challenging. Unerstaning if the environent is supportive answers the crucial question is sustaining this progra at this cost feasible? This step requires learning whether the progra s results are highly value an by who. It highlights relevant trens an issues that will ipact your progra, funing prospects, an partners. An it uncovers an exaines obstacles that can hiner an opportunities that can support sustainability. Conucting an objective analysis of your progra s environent for sustainability not only answers the question of feasibility. It also provies insight that infors the evelopent of the progra s sustainability oel. Consier what our two SMPs learne about their operating environents: For Progra A, the environent for progra sustainability appears proising. Current legislation is aking the healthcare inustry ore open to effective prevention efforts. An while that sae inustry has questions regaring the evience base, that feeback also tells Progra A exactly what kin of evaluation ata they nee to collect an how to package that ata. Once ore useful evaluation ata is evelope, Progra A is in a goo position to take avantage of prevailing trens. Progra leaers can cite the preceent of siilar progras becoing reibursable to open up new revenue streas an use their Progra A Progra B Opinions/Perceptions: coitent level of elivery partners varies wiely an the healthcare inustry questions if the SMP healthcare cost savings ata is applicable to their state Opinions/Perceptions: state staff assue that the hospital partners value the SMP in general, but lack any first-han inforation as to whether, an to what extent, the hospitals top anageent support the progra External Trens/Issues: healthcare refor legislation is currently being enacte an causing increase interest in an pressure for prevention External Trens/Issues: state buget cuts have increase an are affecting potential progra sponsors (e.g., local public health, Area Agencies on Aging) Obstacles/Opportunities: preceents of siilar progras becoing reiburse by insurance proviers exist; less than 10% of existing elivery partners are set up to process such payents Obstacles/Opportunities: no private founations are funing progras of this type; two of the hospital partners have robust counity benefit progras with eicate funing 6 The Path to Progra Sustainability

7 custoize evaluation ata to position as the answer the inustry nees to new legislative anates. These potential funing streas an partner relationships hol significant iplications for Progra A s sustainability oel by pointing to a steaier, ore reliable revenue source. Further, the variability in progra elivery partners coitent to the progra an their liite ability to process thir party payents iply that the oel requires a centralize eans of processing payents an a fully coitte elivery network that can eet growing progra access eans in orer to be truly sustainable. For Progra B, the environent is less supportive of sustainability. No private funers appear likely to replace the lost grant source an increase state buget cuts exclue that funing source as well. In fact, the state cuts have progresse to a point where the agencies an organization that Progra B ha consiere approaching to becoe the new progra sponsor are unable to take on any new initiatives. Meanwhile, progra leaers realize that they were uncertain as to whether the executive leaership of their hospital partners supporte the progra an its results, which le the to exaine those partners ore closely. They learne that two hospitals have strong counity benefit progras (a requireent that nonprofit hospitals enhance counity health/ wellness). Unerstaning the environent for sustainability left Progra B with only one potential sustainability oel convincing their hospital partners to take over full ownership of the progra. While this puts Progra B in a ifficult position, exaining the operating environent has le to a eeper unerstaning of what the hospitals have investe financially in the progra as well as insight into what kins of counity benefits two of the three partners are ost coitte to proviing. Progra B leaers can use this inforation along with the progra sustainability cost estiates an progra results ata to ake the strongest case possible to hospital leaership. To unerstan your progra s environent for sustainability, start asking questions. Conuct interviews or focus groups with funers, partners, contractors, grantees, an progra participants to learn which progra results they value an why. Connect with content area experts to fully unerstan how trens an issues will ipact the future of your progra an your participants. Exaine perceive obstacles an opportunities closely to see how uch they will hiner or support your efforts. Once you unerstan your progra s environent for sustainability, you can answer the feasibility question an begin to evelop the sustainability oel that best suits your progra. Soe Ba News an a Powerful Tool The three steps on the path to progra sustainability provie a systeatic eans to eterine if sustainability is feasible for your progra. But, this also eans that you ay learn that sustainability is not feasible. In the case of Progra B if the hospital partners refuse to take on progra ownership, no other feasible option exists. When this happens, consier why sustainability is not feasible. Is the tiing wrong, are the results elivere by the progra consiere a nice to have but not critically iportant, or ight a ifferent efinition of progra sustainability prove ore feasible? The three steps on the path to progra sustainability provie a systeatic eans to eterine if sustainability is feasible for your progra. But, this also eans that you ay learn that sustainability is not feasible. However, if the three steps show that sustaining the progra as you have efine it is feasible, then each step I p w t a w u o l 2013 Nonprofit Ipact, 7

8 A sustainability plan is such a useful tool that can be use internally an externally to ove the progra towars a ore sustainable future. Internally, the plan efines where the progra is going. provies inforation that infors the evelopent of a sustainability oel appropriate for your progra. An for any progras in that position, a sustainability plan is a useful tool to fully efine that oel an help turn feasibility into reality. A sustainability plan is a ocuent analogous to a business plan in the private sector. For an evience-base progra, a sustainability plan efines that progra s sustainability oel its ientity, constituents, an capacity. It also uses the inforation regaring costs (fro Step 2) an potential revenue sources (fro Step 3) to buil a revenue oel that eonstrates how the progra can be financially viable. Ientity: progra escription, track recor/ history, goals, expecte results Constituents: who is serve, strategic partners, custoers, copetition, arketing/ outreach strategies Capacity: how progra will organize to reach constituents an eliver results structure, staffing, systes, anageent/ leaership, progra elivery, etc. Revenue Moel: expense bugets, revenue sources, an funing strategies A sustainability plan is such a useful tool that can be use internally an externally to ove the progra towars a ore sustainable future. Internally, the plan efines where the progra is going. With this future esire state clearly outline, progra leaers can analyze the gap between where the progra is now an where it nees to go an ientify steps that nee to be taken. The plan becoes a guie for progra evelopent an can infor progra anageent ecisions. The plan also helps explain the new oel to staff. To ake the plan ost useful internally, any sustainability plans inclue sections that aress ipleentation. Externally, the sustainability plan is a powerful counication tool. It can counicate the oel to partners, contractors, an stakeholers an aress any fears or concerns proactively. The plan can also be use to invite investent in the sae way a sall business owner shares a business plan with their bank when applying for a loan. We have any clients who use their sustainability plans with private founations, state legislators, an feeral funers to ake a strong case for financial support. Lastly, the plan itself effectively counicates the thorough an thoughtful approach you are taking to sustaining your progra an signals that this is a serious initiative. Done well, it can position the progra as a provier of significant, iportant results rather than as one grant-seeker aong any. This can be especially useful when seeking new partners an supporters, especially ones fro nontraitional sectors. With this in in, ensure that your sustainability plan inclues a section that suarizes the proble the progra ipacts an why the progra s results atter in that context an that any jargon is translate into language that is unerstoo by your potential supporters. What follows is a saple sustainability plan outline, taken fro a plan we create for a client s evience-base progra: Introuction History an current situation Potential for ipact an sustainability Purpose an ethoology Ientity Proble stateent Progra overview/ content Mission, values, an goals Progra niche/ position Constituents Target arket (progra participants) Segent profiles, nees, an interests 8 The Path to Progra Sustainability

9 Strategic partnerships Public relations an outreach strategies Capacity Business oel Leaership an anageent Staffing (organizational chart) Progra elivery (roles an responsibilities) Systes, processes, an proceures Finances Revenue oel Estiate expenses an revenues Projections an scenarios Ipleentation Key ipleentation steps or ilestones Tieline Conclusion No silver bullet exists for progra sustainability. There is no one organizational structure, staffing ix, type of partnership or coalition, or funing strategy that works in every situation. An the current oel of securing the ajority of funing fro one or two sources, ipleenting the progra, an ocuenting results oes not ensure sustainability in the long-ter. The three steps of the path to progra sustainability offer a powerful, practical, an proven way to aress sustainability. The key to progra sustainability is not what worke in another state, how a funer expects you to structure your partnerships, or a new funing source instea it lies in following the three steps an answering: What exactly are we trying to sustain? How uch will sustaining that cost? Does the environent support sustainability? Follow the path an answer the questions eliberately, objectively, an thoroughly an what is learne will eterine if sustainability is feasible, an if so, will infor the esign of a sustainability oel that fits for your progra, your state, an your prograatic outcoes. The outcoes realize through evience-base progras are too iportant to leave to chance. It s tie to take a fresh look at our assuptions an is-efinitions an follow the three steps to real, long-ter progra sustainability. Karen Buck is a consultant with Nonprofit Ipact, a consultancy that specializes in planning an organizational evelopent in public health, eucation, an huan services. The copany works solely with governent agencies an nonprofit organizations. Since 1996, Nonprofit Ipact an its sister copany, Conservation Ipact, have serve ore than 670 clients on 900+ projects. Over the past few years, Karen has worke with nuerous clients to create organization-wie an progra-specific sustainability plans. During her tie with Nonprofit Ipact, Karen has helpe clients increase their sustainability an engage staff, partners, an counity ebers in capacity builing efforts. In aition to her work with clients, Karen is also a well-regare speaker an trainer who has been invite to present at any national conferences an to teach full-ay training sessions on topics incluing progra sustainability, project anageent, an partner relations anageent across the country. Karen cae to Nonprofit Ipact with 15 years of experience in key funraising an anageent positions with health, huan service, an civic engageent organizations. She has a aster s egree with honors in nonprofit anageent fro Regis University. For ore inforation Please call or eail if we can help you create a sustainable progra or answer any questions. We also invite your coents an feeback on the ieas in this article. Tools an resources that ay be of assistance an a escription of training progras an areas of consultation are available at Nonprofit Ipact, 9