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Georgia Department of Human Services

The shift: Reduce death, serious injury, and repeat harm by pulling the scariest outcomes out of the whirlwind

 

Execution challenge

Georgia DHS was responsible for the most vulnerable populations in the state — children, families, individuals with disabilities, and patients in state mental health hospitals.

 

Leaders faced:

  • Massive scale (20,000+ employees)

  • Constant crisis exposure

  • Fear-driven avoidance of the most critical outcomes

 

The most important outcomes — death and serious injury — were treated as unmanageable “acts of fate,” buried under urgent operational noise.

 

Organizational lag measure (WIG / outcome)

  • Reduce death and serious injury

  • Closely related outcomes:

    • Reduce recurrence of substantiated child maltreatment

    • Reduce foster care re-entries

 

This was the “elephant in the room” — everyone feared it, few believed it could be influenced.

 

System-level decomposition (lag → lead)

 

Department-level lag measures

  • Recurrence of maltreatment

  • Foster care re-entry rates

  • Investigation timeliness and quality

 

Lead measures (explicit behavioral shifts)

  • Differentiate allegations:

    • Investigate only cases meeting abuse/neglect thresholds

    • Route others to community support (not full investigations)

  • Weekly cadence meetings focused on:

    • Case flow

    • Decision quality

    • Completion rhythm

  • Frontline ownership:

    • Caseworkers helped design lead behaviors

    • Data was used to situate teams (“the score puts you in play”)

 

What happened along the way:

  • Caseloads dropped

  • Morale improved

  • Quality of response increased

  • Backlogs shrank — not by working faster, but by working smarter

 

Results

  • Repeat substantiated maltreatment cut by more than 50%

  • Foster care re-entries declined significantly

  • Sustained improvement across multiple indicators

 

Ancillary benefits

  • Engagement surged despite no financial incentives

  • Frontline staff described relief and pride

  • Leaders shifted from policing outcomes to enabling execution

 

Key takeaway:
Execution became possible when leaders confronted the hardest outcomes directly — and decomposed them into influenceable decisions.

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