Unlocking the Potential of Performance Management with Goodwill Nurse-Family Partnership

The state of Indiana maintains the seventh highest infant mortality rate and eleventh highest child death rate in the nation. Between 2012 and 2017, there were more than 215,000 births in Indiana by women enrolled in Medicaid — approximately 42% of all births. And around a third of these births — about 77,000 — were to first-time mothers.

Since its founding in 2011, Goodwill of Central & Southern Indiana Nurse-Family Partnership® (Goodwill Nurse-Family Partnership) has been working with first-time, low-income mothers. Goodwill Nurse-Family Partnership has served more than 4,000 mothers, pairing them with nurse-home visitors that help boost their knowledge, their confidence and their birth outcomes.

For mothers like Dianna and Senora and Dominique, this means crucial support for learning how to bond with their baby and keep their babies safe. It means critical resources and guidance for housing, education, employment, and childcare; and it means regular prenatal check-ups to help them achieve a healthy pregnancy and birth. For babies like Nayeli and Jaycob and Rain, it means having professional care in their corners before they’re even born.

Despite the known benefits of high quality prenatal care, thousands of families still lack access to programs like Goodwill Nurse-Family Partnership that can start them off on the right foot.

To address this shortage, the Indiana State Department of Health awarded $6.5 million to Goodwill of Central and Southern Indiana in 2018 to expand Nurse-Family Partnership in 19 Indiana counties. This allows Goodwill Nurse-Family Partnership to serve 11 of the 13 Indiana counties with the highest infant mortality rates and effectively doubles Nurse-Family Partnership’s capacity in Indiana. As Goodwill Nurse-Family Partnership looked to scale their services they wanted to know:

How could they use data-driven insights to guide their expansion?

Goodwill Nurse-Family Partnership hired Social Finance to create a system to use data to drive better outcomes for mothers.

The first phase of our work involved determining which operations elements were most important to improve outreach and outcomes for new moms. Social Finance analyzed NFP’s programmatic data that tracked operations over time and identified three crucial operational indicators: the number of moms referred, the number of moms served per nurse, and the overall mother attrition rate (those dropping out of the program). These factors were chosen because they influenced each step of the Goodwill Nurse-Family Partnership program: accessing mothers in need, enrolling them in services, and helping them complete the full two-year program.

From there, Social Finance developed a set of process improvement suggestions, including:

• Utilizing a daily diary smartphone application for nurses to capture how they spent their days. Using the resulting information, Nurse-Family Partnership could adjust nurses’ schedules to reduce their travel and meeting times, and reallocate those moments saved to patient visits.
• Developing a digital performance-management dashboard. With access to insights on key performance indicators, through the Domo data visualization platform, Goodwill Nurse-Family Partnership field coordinators could view nurse caseload information, referral traffic, and participant conversion percentages and opt-out rationales in real time.
• Proposed a process that allowed for stakeholders to reconvene at a later date to assess the effectiveness of the recommendations on the targeted operational indicators.

Today, Goodwill Nurse-Family Partnership is leveraging the insights and performance management best practices recommended by Social Finance to better serve mothers, including the more than 900 who have enrolled so far in 2019. In one instance, the program used lessons learned to increase referral traffic in various expansion service areas — most notably, Johnson County, where referrals have doubled.

At Social Finance, we know that humility is critical — our recommendations are never right 100% of the time. We also know that implementation is the key challenge, so we partner with organizations for the long-haul. The nature of performance management is cyclical — it involves collecting data, discussing performance, and adapting to improve the likelihood of positive outcomes. By providing long-term support, we believe we can help our partners have more impact on the families and communities they serve.