Health outcomes and humanitarian relief: Is "meaning well" good enough?

We often look for technical solutions to people problems, especially around social goals: Education, healthcare, housing, nutrition, disaster response.

The quality improvement guru Edward Deming acknowledged this by saying that "improvement would be easy without the damn people." The key to improving outcomes is to redesign process. But changing how we do things requires changing the mind set and behavior of the professionals delivering services. It requires a commitment and realization that everyone is responsible for constant improvement and learning. It requires measurement, reflection, and accountability when goals aren't reached.

James Kim, MD, PhD, co-founder of Partners in Health, has called for medical schools to start teaching the science of healthcare delivery. The reason is that doctors should learn how to assess, define, measure and improve their outcomes. Curriculum at Dartmouth Medical School, where he is now president, is being redesigned to reflect this. Tools and processes of the science of healthcare delivery, Dr. Kim notes, could also be applied to other social endeavors. Imagine the science of educational delivery or the science of humanitarian delivery.

This is where social endeavors can learn a lot from business processes. In business there are known measurable outcomes, staying in budget is a priority, and your implementation team knows whether its achieving its objectives. In the realm of social outcomes, however, we fall short. Its ok to be a little fuzzy on the budget, to NOT track outcomes and effectiveness, or to lack a long term commitment to specific projects. "Doing the right thing" can become an excuse to execute poorly around social objectives. There is no value proposition.

Dr. Kim reminds us that the poor of the world have long understood that bad execution around social objectives means death for them. For too long poor execution has been tolerated, even celebrated.

Which brings us to improving outcomes around social endeavors. Consider the Haiti response efforts. Though tragic and unexpected the post-disaster needs, difficulties with logistics, distribution and coordination, were completely predictable. We've seen this situation over and over again. And each time responding organizations, the media, policy-makers, funders and the public react with surprise as if it's all new. Learning from mistakes is important, but NOT converting such learning into process improvements is wrong. Even though it is usually "only the poor" (whether in Haiti, New Orleans, Aceh or Darfur) who suffer the most from our inability or unwillingness to improve execution, repeatedly making the same mistakes is contrary to the moral reasons for responding to disasters in the first place.

So how effective are response efforts in Haiti? Are you aware of any measures of effectiveness? How many people have been housed in temporary shelter, and how does this compare to established guidelines, recommendations, or previous emergencies? What are measures of success in terms of food distribution? What needs expressed by the Haitian population are being addressed?

More basically, if asked how effective the response has been, how would you answer, and what data would that answer be based on?