For more than three decades, Nurse-Family Partnership (NFP) has worked to keep children healthy and safe and improve the lives of moms and babies. We consistently evaluate and monitor our efforts to glean evidence that our model gets results and is worth expanding and replicating. But over the course of the past three years we’ve learned that research and outcome data are not everything. NFP today prioritizes a complementary source of gauging what works: listening to NFP moms and implementation partners.
The institutionalization of gathering end-user and partner feedback, and making it part of the way we work, has become our innovation engine, influencing changes to our systems, services, and even our business model. It’s a model that any nonprofit can apply to improving and even transforming its strategies. Feedback ultimately creates deeper relationships and greater equity between an organization and the people it seeks to help—in essence, giving nonprofits the best chance to get it right.
Streamline Feedback Technology
Nurse-Family Partnership pairs specially trained nurses with first-time moms-to-be who are usually in their late teens or early 20s and living in poverty. (Photo courtesy of Nurse-Family Partnership)
Organizations’ clunky IT systems can present difficulties for the people they seek to help. Some technologies, such as data collection systems, involve too many steps that could be automated. Sometimes organizations have legacy processes that are outdated or unnecessary given tech advancements. And sometimes organizations miss important aspects of data-gathering and analysis altogether. The customers who fill out your forms, register for services, and input their data, not surprisingly, tend to be the first to spot any of these issues (especially if they are younger and more tech-savvy than staff managing the systems). Asking them for ideas pays off.
NFP, for example, works by pairing specially trained nurses with first-time moms-to-be who are usually in their late teens or early 20s and living in poverty. Nurses visit NFP moms beginning early in their pregnancy until the child’s second birthday, and they record the details of each visit. But thanks to end-user and partner feedback in 2016, the NFP National Service Office had a realization that its systems, which support these visits, needed revamping.
We received a Listen for Good (L4G) grant through the Fund for Shared Insight that provided us with a five-question, anonymous survey and steps to analyze feedback and let respondents know how their input led to change. This survey includes the Net Promoter Score, a measure frequently used by businesses to assess how likely a customer is to recommend a product or service to someone else.
We sent the survey via text message, which allowed us to hear directly from NFP moms. We also convened moms around the country for focus groups and interviews. We asked them what was and wasn’t working for them. And we found their answers so helpful that we decided to create a parallel survey to hear from NFP nurses, supervisors, administrators, and other implementing partners. When we asked if they would recommend us, we found out that they were less satisfied with the way we ran things compared to the moms we served, almost 90 percent of whom promoted our services.
The way we ask nurses to record their visits was a big issue. They and other partners found our analog data-collection systems overly time-consuming for mothers. Nurses recorded their insights from visits on hard-copy forms and binders, which meant a lot of time spent on paperwork. To rectify this, we’ve prioritized replacing our seven-year-old data collection system. Our new system, which launched in fall 2018, is a more user-friendly, mobile-enabled platform. It also has advanced data validation to ensure cleaner and more reliable data, and improved reporting functions, so nurses and other partners can better apply the data to their next interaction with a mom and better track outcomes for all moms they serve. We know there is still a lot more to do to ensure the new system best meets nurses’ needs, so we are continuously asking for and prioritizing their input as we make enhancements.
We added additional survey questions to learn why moms engage with NFP, and how they communicate with nurses. We are also developing a dashboard to monitor our net promoter trends and other satisfaction metrics with all our partners. We have institutionalized a program that streamlines data collection and both ensures that we close the loop with people who provide feedback and act upon the feedback we receive.
Innovate Services
Services, too, can fail to keep up with the times. And it’s far too easy to assume high enrollment in one’s services indicates high satisfaction with all they offer. Here again, end-users of such services often have the best ideas for adapting offerings to their current and future needs.
At NFP, for example, our core service has been nurses conducting home visits with first-time, low-income moms, recruited through their public assistance and community programs. Based on rich, qualitative data from L4G we have changed both the way we reach prospective moms and the ways they can connect with their nurses.
We used to almost exclusively drop off fliers at offices of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and churches, and rely on third-party referrals. But when we held in-depth focus groups with current clients and eligible moms, and asked “How can we reach you?”, we learned where the young moms spent time—on their smart phones, posting photos and streaming music. To supplement those strategies, we now have a firm helping us buy advertising on Facebook, Instagram, the music streaming site Pandora, as well as pregnancy apps. We stream other ads on Spotify and Pandora to increase brand awareness among the general population.
Nurse-mom visits often required driving or taking public transportation. We heard that they wanted more ways to connect virtually. We also heard that moms would like to learn from and connect with other moms. To respond to this feedback, we developed guidance on using telehealth tools like FaceTime or Skype. We are also piloting an app called Goal Mama, which will provide a forum for nurses and moms to connect about many topics and help moms track progress toward achieving their goals.
To continue gathering ideas and translating them into service improvements, we have committed to customer responsiveness by creating an easy-to-use online feedback form and a customer review committee for implementation partners to provide ongoing input. We then review and incorporate customer feedback into our systems’ designs and other initiatives. Meanwhile, we have equipped our technical support team to respond to questions from implementation partners within 48 hours, effectively baking feedback into the way we work.
Inform Business Strategy
Gathering and applying feedback from end-users, implementation partners, and funders can ultimately improve an organization’s business strategy. Most of the people a nonprofit organization is trying to help, as well as those who help provide services and fund those services, are also working with organizations that may benefit from asking and listening. Moreover, those organizations’ strategies often offer lessons which can inform the strategies of other direct service agencies.
For example, NFP’s strategy of working with moms until their babies turned two was effective at improving outcomes. But based on feedback from NFP constituents who had experienced the power of other nonprofits’ alumni networks, we realized our program outcomes might still fall short. Waking up to that potential has transformed NFP’s program and HR strategy.
For one, we have changed our model to create lifelong affiliations for NFP moms. NFP alumni receive invitations to participate in local and national events, access to resources for their families, and an opportunity to join a Facebook group to connect with other NFP alumni as long as they choose to remain involved. We also look to NFP participants as future employees and have hired five NFP graduates to work on the outreach team, attracting moms from their communities into the program. We have also filled roles including manager of national outreach, education instructional designer, manager of alumni relations, and parent ambassador with NFP graduates. One NFP graduate became a nurse and now serves on our national board of directors.
Feedback has also influenced our strategic communication. Through donor surveys and brand awareness work, we learned that our funders cared deeply about breaking cycles of intergenerational poverty. While this goal has long been a part of NFP’s vision statement and program objectives, it was infrequently part of our narrative. Now, in addition to talking about healthy pregnancies and babies, we articulate our vision and speak of proliferating early mother and childhood education to increase the economic mobility.
At NFP, instead of focusing narrowly on the impact we can create through tested approaches, systematic input from constituents allows us to consider what more we might achieve via continuous improvement. Today our values statement incorporates the power of feedback: “With an intention and intense sense of urgency to change lives, we will actively listen to and persistently serve our families and our implementation network.” Institutionalizing feedback can provide the innovation engine for any nonprofit, changing its culture for the better.
This article is part of a series that was produced for Stanford Social Innovation Review by Milway Media with the support of the William and Flora Hewlett Foundation.
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Read more stories by Frank Daidone & Benilda Samuels.