Transformative Scale: The Future of Growing What Works
Photo: Year Up
(This research is part of Bridgespan's transformative scale efforts. To learn more, please visit our Transformative Scale Resource Center.)
This article originally appeared on the Stanford Social Innovation Review website.
In just 12 years, Gerald Chertavian has nurtured Year Up from start-up to star status among nonprofits that offer job training and educational support to disadvantaged urban young adults. A remarkable 84 percent of Year Up's graduates land full-time jobs or enroll in college within four months of completing their year-long skills training and internship program. Such success has propelled the program's annual enrollment from 22 students in one city in 2001 to more than 2,000 students in 12 cities today.
Year Up's growth can be captured by a simple catchphrase: "scaling what works." It is a phrase that has energized social entrepreneurs and philanthropists alike, and a rallying cry to direct more funding to interventions that actually get results. Leaders such as the Edna McConnell Clark Foundation,1 Grantmakers for Effective Organizations,2 Results for America, the Coalition for Evidence-Based Policy, and many others have worked tirelessly to advance this effort. Even the federal government embraced the idea. Soon after taking office in 2009, President Obama launched initiatives to identify and support social programs with proven benefits. This is critical work, and it must continue. (See the sidebar Continue to Expand Proven Programs.)
But success has its limits. Chertavian now confronts a dilemma shared by many other successful social entrepreneurs.3 He has a proven program and steady site-by-site growth. Yet, Year Up reaches only a tiny fraction of the 6.7 million low-income young adults in the United States who are out of work and out of school. "Given the magnitude of the problem, we can't be satisfied with a plan that just doubles the size of Year Up," says Chertavian. "We need a new path to close the gap between what we've achieved to date and what we still need to accomplish."
That new path requires innovative ways of thinking about scale. It is no longer sufficient simply to scale what works in an incremental manner. Three years ago, a Stanford Social Innovation Review article proposed the notion of scaling impact rather than organizations, asking, "How can we achieve 100x the results with just 2x the organization?"4 More recently, Chertavian and other social sector pioneers have started to tackle an even more fundamental question: How can we grow our impact to actually solve problems we care about? In short, how can we achieve truly transformative scale?
Strategies for Transformative Scale
In their quest for answers, these pioneers are experimenting with ways to help far more people while keeping a lid on the growth of their own organizations. Reviewing their efforts to date, we can identify nine approaches that hold real promise for addressing at a transformative scale a number of major social problems. The approaches that follow aren't exhaustive, nor are they necessarily new. But they represent a set of experiments that build on all our progress to date and could grow impact in ways that lead to lasting solutions.
The nonprofit sector historically has been a proving ground for social innovations. Once nonprofits perfect a program, the challenge is how to move from small-scale demonstrations and pilots to reach large numbers of people who could benefit. One way to accomplish this is to hitch a ride with an existing network or system that can replicate a program in hundreds, if not thousands, of locations.
Sixty percent of Americans live within three miles of a YMCA. Capitalizing on this fact, the national Y is using its nationwide network of community Ys to spread a diabetes prevention program that originated with the National Institutes of Health (NIH).5 By altering participants' eating and exercise habits, the program reduces the incidence of type 2 diabetes by 58 percent in at-risk individuals.
Critical to the success of this effort was the Y's ability to create a sustainable funding model for the program. The original NIH model involved health professionals working one-on-one with high-risk individuals, a high-cost approach that prevented widespread adoption. Together with the Indiana University School of Medicine, the Y adapted the program to a group model led by trained community instructors. Using this model, which delivered the same compelling results at one-fourth the cost, the Y was able to persuade health insurers to reimburse program costs. That, in turn, cleared the way for the Y to expand the program to 614 locations, with many more to come.6
The potential to deliver successful programs using the existing infrastructure of a national nonprofit network is huge, but getting there won't be easy. Any initiative that chooses to go this route has to figure out how to ensure that providers in a widely dispersed network can reliably deliver consistent results.7 This means investing in systems such as a network-wide approach to performance measurement. Social entrepreneurs who wish to extend their impact via networks also will have to relinquish some control to achieve the scale they seek.
Rather than relying on a single player, such as the Y, to help bring a program or initiative to scale, it's possible to teach a collection of unrelated nonprofits or agencies to deliver a successful program to far greater numbers of beneficiaries. In some cases these organizations can further drive down costs by using volunteers.
Year Up chose this route when it partnered with Miami Dade Community College in 2012 to establish the Professional Training Corps. Modeled after the Reserve Officers' Training Corps (ROTC), this program sets students on an associate degree track while providing them with the professional development and internship experience that mirrors the Year Up program. The pilot, if successful, will provide the template for spreading the program to community colleges across the country and reaching a projected 100,000 students a year.
Organizations that pursue this pathway typically must build a new set of capabilities. "Doing"—actually delivering a program—and "enabling"—training another organization do so—are two quite different processes, and it's important to be very clear about what is required to do enabling well.
Successful social-sector initiatives typically involve lots of moving parts that combine to deliver the desired results. But what if you don't need all the parts to get the same or nearly the same results? If you can identify the essential components that account for most of your impact but require only a fraction of the total cost and effort, then it may be possible to break them out and take them to scale.
KIPP, the Knowledge Is Power Program, is a national network of public charter schools that has taken this approach to leadership training. Since opening its first two schools in 1995, KIPP's network has grown to serve more than 50,000 students in 141 schools in 20 states and Washington, DC.
Two years ago, KIPP launched the Leadership Design Fellowship, an eight-month program for public and charter school district administrators that provides intensive training on KIPP's principal-development model. KIPP chose to scale this aspect of its work based on a core belief that outstanding schools are built and sustained by great leaders. The idea behind the fellowship program is that its graduates—some of whom lead districts touching hundreds of thousands of students—will implement KIPP's principal-training model in their own school systems, thus extending KIPP's impact without adding to its size.
The challenge for KIPP and others who unbundle and replicate elements of a successful program is to ensure that the new, lower-cost model actually works and increases total impact. The gold standard for evaluating program effectiveness is the randomized control trial (RCT). While some nonprofits may have strong RCT evaluations of their full programs, they may not have tested, or even considered, the distinctive impact of unbundled subcomponents. Sometimes such testing can be built into the original RCT. For example, multiple groups can receive variations of the model that include only certain subcomponents. At the same time, many social sector leaders are asking if there is a faster, less expensive path for assessing the potential of unbundled approaches than traditional RCTs, which often come with a seven-figure price tag.
Lower-cost RCT models are a research priority for the Coalition for Evidence-Based Policy. It recently announced a three-year initiative to demonstrate the feasibility and value of low-cost RCTs.8 Leading evaluation organizations like MDRC and MIT's Poverty Action Lab, and some new players like IDinsight, also are experimenting with low-cost approaches that have promise. No doubt, nonprofits and funders interested in the unbundling pathway will benefit from these new approaches as they either confirm when unbundling works or show when total impact is higher with the full model.
Technology can provide another lower-cost pathway to growing a program's reach and impact. Khan Academy, for example, delivers instructional videos online to millions of people around the globe. As a result, the organization has remained very small even as its audience has exploded.
Even traditional nonprofits can use technology to accelerate the spread of an existing program or practice.9 College Summit, whose mission is to help increase college enrollment and success rates among low-income high school graduates, has gone this route. Currently, the organization partners with 180 high schools in 12 states and serves upwards of 50,000 students. But with a $2.5 million grant from the Bill and Melinda Gates Foundation, College Summit has developed 20 Facebook apps that can help guide many more low-income students through the college admission process and support their success on campus. Apps deliver automated alerts for important deadlines; facilitate the formation of teams of family, mentors, and friends for support and encouragement; or guide students through the process of transferring from community college to a four-year university, among other services. Time will tell whether this experiment succeeds. What's clear today is that this kind of technology-enabled project, while potentially risky, could help nonprofits significantly expand the reach and impact of their work.
Nonprofits and funders committed to far-reaching social change understand that their goals cannot be reached without the support of a critical mass of organizations and individuals working together as a field. Key players include policymakers, researchers, community groups, accreditation agencies, service-delivery enterprises, advocacy groups, talent recruiters, funders and investors, and others.10 Field-building strategies often follow one of two paths: growing the field by raising awareness of an issue to generate support and funding, or improving the performance of existing players already committed to the field.
Building on the evidence base created by Big Brothers Big Sisters of America in the 1990s, MENTOR: The National Mentoring Partnership, exemplifies both approaches. More than 5,000 organizations provide mentoring to three million disadvantaged young people, but another 15 million youth need these services. Moreover, not all kids currently enrolled in mentoring programs are served effectively. MENTOR works to close this mentoring gap by enhancing the quality and quantity of mentoring relationships for America's young people. Its goals are to increase the resources and capacity of the mentoring field to reach more children, and to improve the effectiveness of the field by developing and disseminating standards, research, and state-of-the-art tools. This field-building effort complements the work of Big Brothers Big Sisters of America, the largest mentoring organization in the United States, reaching more than 200,000 young people—but still only a fraction of those in need.
Others have pursued leadership development as a way to improve the performance of an existing field. For example, in K-12 education, organizations like New Leaders for New Schools, the Broad Superintendents Academy, The New Teacher Project, Teach for America, and the Center for Inspired Teaching have produced a wave of leadership talent that has helped to shape the education reform movement. Few other fields have such a robust leadership development pipeline, which may bode poorly for their ability to achieve true transformative scale and impact even given significant programmatic innovations.
Meanwhile, fields also need data and metrics to track and improve performance and to channel resources to what is working. Expanded use of data—thanks in large part to the advent of low-cost information technology platforms—is one of the most powerful forces shaping fields today. The Strive initiative in Cincinnati, OH, involves a wide range of players agreeing on performance metrics and sharing data against the common goal of every child being successful "from cradle to career."11 Similarly, the United Nation's Millennium Development Goals established a set of well-defined, sector-wide measures to drive the field of global development, and the Common Core State Standards are driving the use of data to strengthen US public education. Such efforts align the strategies of diverse players towards shared goals and measurement, enable assessments of what is working on the ground, and support learning and improvement.
One caution is that field-building investments take a long time to play out, and their effectiveness can be difficult to assess. But in many instances, it is the absence of appropriate investments in field infrastructure, including business-to-business functions like talent sourcing, financing, and match-making for mergers and collaborations,12 that severely limits the potential for transformative impact.
Our public systems, like education, juvenile justice, and child welfare, operate at a massive scale. But too often they are not achieving impact at scale. Public system reformers often pursue one of three distinct avenues to achieve transformative impact: change a critical component of the system; inspire change by demonstrating a better way and embarking on a change management process; or gradually inject new leadership.
The Annie E. Casey Foundation is choosing the first approach in its efforts to change the juvenile justice system. Over the past 20 years, the grantmaker has invested more than $100 million to try and change decisions about whether to send a troubled young person to jail, to a detention facility, or to home-based rehabilitation. Rigorous evaluations show that the home-based option championed by the foundation works best for most kids and for society by decreasing recidivism and strengthening families. "It's fair to say that the entire field of detention and even juvenile justice has been fundamentally changed" by the initiative, says foundation CEO Patrick McCarthy. The program has spread to 200 sites in 39 states and is poised to continue growing.13
An illustration of the second approach to changing public systems can be seen in the way that high-performing charter schools in Boston (e.g., Brooke, Excel Academy, and MATCH)—as in many cities—have shifted the debate in the public system by setting a new bar for what is possible in urban education.
Finally, Teach for America demonstrates an approach to changing a system that relies on an infusion of new leadership and talent. With 170 full-time staff members devoted to alumni services, it is investing heavily in the continued development and placement of its 30,000 alumni, with the goal of injecting highly capable, reform-minded leaders into key positions within the education system and other public and private entities that affect it. The aim is to achieve impact at a transformative scale by changing the education system from the inside out.
These examples acknowledge and respond to a simple truth: the path to transformative scale in sprawling public systems requires changing the systems themselves. Otherwise, as Casey Foundation CEO Patrick McCarthy notes, "A bad system will trump a good program every time."
Government funding is often considered the Holy Grail for social-sector initiatives. An act of Congress, for example, can theoretically turn a demonstration project into a national standard overnight. Well-known examples include the adoption of hospice care, which spread nationwide after gaining Medicare reimbursement, and state-funded kindergarten, which began as privately funded programs in a number of cities but transitioned to public dollars in response to widespread citizen demand.14
The Nurse-Family Partnership (NFP) provides a more contemporary example. NFP serves low-income, first-time mothers by partnering them with a registered nurse who provides ongoing home visits that continue through the child's second birthday. Today, NFP reaches more than 26,000 mothers in 43 states. When well implemented, the program has been shown to significantly improve the life outcomes of both mother and child, and to provide $5.70 in benefits to society for every dollar spent.15
In 2010, Congress established the Maternal, Infant, and Early Childhood Home Visiting Program and committed $1.5 billion over five years to expand and improve state-administered home visitation for expectant and new mothers. (Currently, 13 home visiting programs meet federal eligibility criteria.) The legislation was the result of support by the Nurse-Family Partnership National Service Office and President Obama, among others.
At the same time that it provides a model for policy change that leads to scale, this example also illustrates the challenges facing any social initiative advanced by the federal government. The 13 programs approved for federal funding are not identical, and many states are ill-equipped to identify which programs will provide the best outcomes given their particular context and needs. As the Pew Center on the States concluded in 2011, many states "are not prepared to capture or maximize the additional investment."16
In some cases, a for-profit business model might be the most effective strategy to achieve transformative scale. In the developing world, businesses have helped address the basic needs of many millions of the poorest people, providing necessities such as clean water, health care, electricity, agricultural supplies, communications, and financial services. In Mexico, Farmacias Similares became a runaway hit by selling prescription medicine for at least 30 percent less than the competition and by making doctors available for $2 a visit.17
Sometimes nonprofits and philanthropists can play a critical role in unleashing the scaling power of for-profits by demonstrating the viability of a new market or business. Microfinance is the classic example. The concept started out as a project run by nonprofits and government agencies. Over time, these organizations built a track record of sufficient scale and financial performance. The result: commercial entities—and eventually the enormous for-profit capital markets—became convinced that microfinance was a viable business model and invested heavily to grow it.
Many market-based approaches to social problems require a combination of nonprofit, philanthropy, and government support to prove an innovation is worthy of for-profit investment.18 None of this is to suggest that for-profits are the solution in every circumstance, or to minimize the significant challenges that can emerge as they try to balance profit and social impact. Yet, with access to enormous capital markets and a business model that inherently promotes scale, we need to better understand and embrace how for-profits can be part of the solution to many social problems.
For a certain category of issues, impact at a transformative scale requires altering the attitudes, beliefs, and behaviors of many people so that the change becomes the new social norm. Public health and issue-based advocacy groups, among others, have developed an extensive suite of social marketing and grassroots-organizing tools that they deploy to obtain these results—as in the campaign for smoking cessation in the US.19 But two recent innovations are worth special attention.
First, more and more organizations are building informal, peer-to-peer networks to achieve transformative scale. This work is based on the understanding that many norms and practices are shaped in a community, and therefore, certain types of changes must be scaled through the community. In Senegal, the practice of female genital mutilation was largely eliminated in one generation through the work of Tostan, an African-based nonprofit that helped to spark a process among villagers of discussions and advocacy that spread from village to village.20
Second, a burgeoning body of work in behavioral economics and psychology helps us understand how people make both large and small choices in everyday life. Sometimes those choices are harmful to both the person and to society, such as filing taxes late or overeating. The UK government recently created the Behavioural Insights Team, aka the "Nudge Unit," that aims to steer people to better choices through small behavioral changes. For example, standard letters warning people to pay their overdue car tax get only about an 11 percent response. A simpler test letter declaring in big letters "Pay your tax or lose your [make of car]" got double the normal response. Another test letter with a photo of the car in question got triple the normal response rate.21 Many of the issues that the social-change sector cares most about affecting, such as health, education, and criminal justice, are rooted in behavioral choice that may be subject to similar nudges.
Considerations for Making Headway
All of these strategies hold promise for moving from selective and limited impact to transformative scale. Exploring them will require experiments (and some failures). But in the long run, the social returns can be huge. At the same time, it is important that we are realistic about the magnitude of the work ahead. Several cross-cutting considerations are important no matter which strategy one chooses to pursue:
Be clear about success: Crystal-clear objectives are the essential component of any strategy. To achieve transformative scale, your core objective must be to solve the problem (rather than simply to expand a successful program). Such a definition opens the door to new perspectives, pathways, and resource allocation.
Focus on a well-defined unit of impact: Without evidence of impact, there's no reason to scale. Always be clear about the impact you are aiming for and measure continuously to ensure that you are achieving it. As you experiment with new pathways to deliver impact, be aware that the results may be different from those achieved by long-standing programs. A clear unit of impact also enables one to keep an eye on whether a new pathway is actually serving the intended population, a common pitfall of technology solutions and for-profit models.
Rethink capitalization: All transformative scale strategies require thinking differently about capital. We must be serious about funding overhead and infrastructure, about making risk capital available that can support the failures that will inevitably occur in the quest for big solutions, and about providing an entirely different magnitude of both growth capital and ongoing revenue. One of the illusions we need to overcome is that these pathways are cheaper than conventional replication strategies. While it is often true that the unit cost of the intervention goes down in these scenarios, the total system cost will almost always be higher given the vastly larger population that is being targeted.
Innovate to drive down costs: One of the great barriers to scale is the cost of interventions. Although it is generally true that you get what you pay for, it is also true that the social sector in the developed world has paid very little attention to the critical link between cost and achieving real scale. We have much to learn from social innovators in developing countries who have no choice but to hold costs at rock-bottom from the very start as they aim to serve massive numbers of beneficiaries. Furthermore, lowering costs improves the return on investment for a given approach, in some cases making it sufficiently positive that entire new streams of revenue become available (e.g., for-profit insurers reimbursing for the Y's Diabetes Prevention Program).
Focus on driving demand: Both "push" and "pull" dynamics, "supply" and "demand," are required for transformative scale. It isn't enough to focus only on supply, with a build-it-and-they-will-come mentality. Truly unlocking demand (of beneficiaries and of funders) can be a game changer.
Invest in new capabilities: Grantmakers should keep in mind that transformative scale often requires major investment in capabilities that many nonprofits don't currently possess. That means funders need to take risks on the investments required to build these. And nonprofit management teams must not fool themselves into thinking, for example, that shifting from hands-on service delivery to consulting or to a web-centric strategy will be easy. It may require different people, major training investments, new technology, or more sophisticated financial management systems among other forms of costly, but good, overhead.
Engage the community: The success of transformative scale strategies often hinges on the involvement of local communities in the formulation and implementation of the solution. Knowledge of local circumstances and the deep engagement of local players can be critical to helping a solution to spread and stick.
Taking "what works" to transformative scale will be the defining challenge of the social sector in the coming decade. The hard work of figuring out how to do that has begun. Now we need to test which strategies are truly viable, perfect them, and ultimately push ourselves to new ways of thinking and acting that will determine our ability to address in full the most important challenges facing this country and the world.
Jeffrey Bradach is cofounder and managing partner of The Bridgespan Group. Before joining Bridgespan, he was on the faculty of the Harvard Business School. Abe Grindle is a consultant in Bridgespan's Boston office. The authors would like to thank editor Roger Thompson for his work on this project. An abbreviated version of this article appears in the Spring 2014 issue of Stanford Social Innovation Review special supplement Smarter Philanthropy for Greater Impact: Rethinking How Grantmakers Support Scale, sponsored by Grantmakers for Effective Organizations.
Sources Used For This Article:
1 Nancy Roob and Jeffrey L. Bradach, “Scaling What Works: Implications for Philanthropists, Policy Makers, and Nonprofit Leaders,” The Bridgespan Group, April 2009.
2 Grantmakers for Effective Organizations launched the Scaling What Works initiative in 2010. It has produced research reports, webinars, tools, and videos. Access the information at http://scalingwhatworks.org/resources.
3 Bill Shore, Darell Hammond, and Amy Celep, “When Good Is Not Good Enough,” Stanford Social Innovation Review, Fall 2013.
4 Jeffrey Bradach, “Scaling Impact,”Stanford Social Innovation Review, Summer 2010.
5 Taz Hussein and Michaela Kerrissey, “Using National Networks to Tackle Chronic Disease,” Stanford Social Innovation Review, Winter 2013.
6 Kristen V. Brown, “YMCA Diabetes Prevention Program May Be U.S. Model,” San Francisco Chronicle, September 5, 2013.
7 Daniel Stid, Alex Neuhoff, Laura Burkhauser, and Bradley Seeman, “What Does it Take to Implement Evidence-Based Practices? A Teen Pregnancy Prevention Program Shows the Way,” The Bridgespan Group, November, 2013.
8 For background on the Low-Cost RCT Competition, see: http://coalition4evidence.org/low-cost-rct-competition/.
9 For another example, see Pathways to Grow Impact, Philanthropy's Role in the Journey, Grantmakers for Effective Philanthropy, 2013, p. 10.
10 The Strong Field Framework: A Guide and Toolkit for Funders and Nonprofits Committed to Large-Scaled Impact, The James Irvine Foundation and The Bridgespan Group, June 2009, p. 3.
11 John Kania and Mark Kramer, “Collective Impact,” Stanford Social Innovation Review, Winter 2011.
12 Among the many strategies to improve the performance of existing players, mergers and collaborations have broad appeal for their potential economies of scale and more uniform delivery of high-impact, evidence-based services. See Katie Smith Milway, Maria Orozco, and Cristina Botero, “Why Nonprofit Mergers Continue to Lag,” Stanford Social Innovation Review, Spring 2014.
13 See Patrick McCarthy, “The Road to Scale Runs Through Public Systems”, GEO Supplement to Stanford Social Innovation Review, Spring 2014, p. 12.
14 For additional commentary on this pathway, see GEO’s Pathways to Grow Impact: Philanthropy’s Role in the Journey, p.10.
15 Lynn A. Karoly, M. Rebecca Kilburn, and Jill Cannon, Early Childhood Interventions, RAND Labor and Population, 2005.
16 “States and the New Federal Home Visiting Initiative: An Assessment from the Starting Line,” Pew Center on the States, August 2011.
17 Michael Chu and Regina Garcia-Cuellar, “Farmacias Similares: Private and Public Health Care for the Base of the Pyramid in Mexico,” Harvard Business School Case 307-092, January 2007. (Revised April 2011.)
18 Matt Bannick and Paula Goodman, “Priming the Pump: The Case for a Sector Based Approach to Impact Investing,” Omidyar Network, September, 2012.
19 For example, see GEO’s description of the Robert Wood Johnson Foundation’s anti-smoking strategy and its use of marketing in Pathways to Grow Impact: Philanthropy's Role in the Journey, pp. 9–11.
20 Aimee Molloy, However Long the Night: Molly Melching’s Journey to Help Millions of African Women and Girls Triumph (New York: HarperOne, 2013).
21 Leo Benedictus,“The Nudge Unit–Has it Worked So Far?” The Guardian, May 1, 2013.
22 For background, see www.emcf.org/our-grantees/our-grantee-portfolio/youth-villages/performance/#youth-served.