Monday, December 08, 2014

A thought about evaluation.

I have long wondered about "organization theory". In the organizations in which I worked, people participated for their own reasons. Sometimes they did so on a time limited basis, or even a short term basis. I remember interns and graduate students, as well as post-docs. Sometimes staff was composed of people who worked for my organization, people loaned from other organizations, and people who were paid by organizations contracting with my organization; by and large, we all worked together. I sometimes worked on projects in a collaborative way with people with whom I had no formal organizational link. The idea that an organization has a charter and staff agree to work to accomplish the objectives of the organization in exchange for the remuneration provided seems not to work too often. Note too that I belong to the school that believes that people in organizations work under conditions of limited information, making decisions by processes that are of limited rationality.

Moreover, there seems to be an idea that organizations have boundaries, and that they obtain inputs from institutions outside those boundaries and place the goods and services they produce into institutions outside those boundaries. It has always seemed to me that organizational boundaries are permeable or even fictitious, and that many actions of people within an organization done in the context of that organization, are in fact done in other organizations or in the private sphere.

I recently heard someone say that evaluation should be conceived as providing a platform to allow people to help an organization do better. I like that idea.

It occurs to me, however, that different people have different abilities and that it might be better to think of different platforms to allow different kinds of people to best make their contributions. Consider an organization providing health services. It might have a platform for public comment, another for medical staff providing curative service, a third for preventive medicine staff, another for support staff, still another for outside experts to suggest how health services are and should be evolving.

In the case of K-12 schools, one might have a platform for teachers, one for students, one for parents, one for others in the community, one for administrators, one for curriculum experts, another for ICT opinions, and one for those who might provide teaching aids and materials.

Many years ago a group of engineering students asked me to help them do a project related to related to a real need. I had friends in the local (Latin American) ministry of health office and asked them to identify such a project. They told us that the decision was soon to be made as to where to locate a new hospital in a mid size city that already had several hospitals. Several potential locations had been identified, but they thought the students could provide useful comparative information on those locations.

I taught the students some location theory and agreed to provide computer time for their work. Part of their project was to estimate how many patients would go to the hospital, depending on which site was chosen, where those patients would come from, and what their conditions might be expected to be. Thus the work of the students helped officials to estimate the effect of choice of site on utilization of the facility, and on the health of the city's population. Officials later told me that the information had been useful in the face of pressures based on other factors to chose a less medically useful site.

The example illustrates that real data (obtained from the patient records of existing hospitals) and well executed analysis count. One or more of the platforms for evaluations should enable the inclusion of real data and in depth analytic study of the current situation and future alternatives.

One of the things that the local officials asked them to add was information on the safety of nursing staff traveling to and from the hospital at night (for each site). The staff in question did not own cars, and traveled by bus; if the nearest bus stop were at some distance from the hospital and the streets poorly lit, the women would be in some danger on the trip. That would make recruitment and retention of nursing staff difficult, and hospitals need nurses.

Clearly, hospitals are justified as helping to deal with the medical needs of the population, and all the people involved in deciding where to put a new hospital will agree to that objective. But the safety of nursing staff and the ability to attract and retain nursing staff are also legitimate concerns. So too are costs. So too are the politics of satisficing the expressed demands of the electorate.

Thus there will still be a need in the health sector for managers to put together information from the various platforms in which people contribute to making health services better, taking into account the various objectives, to select a program to implement, and to lead in that implementation.

I suppose a similar argument could be made for most organizations.

1 comment:

Anonymous said...

Why not simply ask the city to alter bus routes? If the staff could not afford to drive, the same would be true of patients, their families and visitors.