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RFP Lunacy and Answering Repetitive or Impossible Questions: HRSA and Dental Health Edition

I’ve talked before about RFP absurdity, and now I’ll talk about lunacy more generally: the HRSA “Service Expansion in Mental Health/Substance Services, Oral Health and Comprehensive Pharmacy Services” program (see the RFP in a Word file here) asks in Section 2.6, “Applicant describes how oral health services will be provided for special populations, such as MSFWs, homeless clients, and/or public housing residents.” The services provided are supposed to be dental—teeth cleaning, cavity filling, bridges, etc., and last time I checked, teeth cleaning is the same for pretty much everyone: you go in, sit on an uncomfortable chair, and let the dental hygienist muck around in your mouth. The RFP writer is probably trying to say, “How will you recruit these hard-to-reach populations and make sure they get their teeth cleaned?”

Furthermore, the question the RFP writer probably means to ask in Section 2.6 has probably already been asked in Section 2.5: “Applicant demonstrates how the oral health services will take into account the needs of culturally and linguistically diverse patients.” Here, once again, as far as I know “special populations” are like the rest of us—do the homeless need their teeth cleaned in some special kind of way? Don’t culturally and linguistically diverse populations also need, um, you know, clean teeth?

These two questions are also odd because they presume to demonstrate extraordinary sensitivity but actually implies that the homeless, public housing residents, and the like aren’t human like the rest of us. Every human has about the same dental procedure performed: a dental hygienist or dentist evaluates you by examining your mouth, screens for oral cancer, scrapes the plaque off, takes X-rays, and then decides what to do next. If you need a root canal, you get a root canal. As Shylock says in “The Merchant of Venice,” “If you prick us, do we not bleed? If you tickle us, do we not laugh? If you clean our teeth, do we not have fresh breath?” Okay, the last rhetorical question is an insertion, but it shows what’s so wrong with the presumptions behind the RFP and the way those presumptions weaken the RFP itself.

Questions like 2.4 are almost as bad: “Applicant also describes how the oral health service will be delivered within the context of the patient’s family and community to address specialized oral health needs.” Oral health service is usually delivered within the context of an operatory, where the dental hygienist and dentist work on your mouth. It’s not usually, so far as I know, delivered along with a Big Mac at McDonald’s. I answered this query by writing:

Oral health service will be delivered within the context of the patient’s family and community by understanding, respecting, and integrating both family and community life into the continuum of dental care. This means that extended family will be included in the care process to the extent necessary, and community norms will be evaluated and respected in providing care.

I have no idea what this means, as when I have a toothache I normally am not terribly interested in what my family or community says—I’m interested in what a dentist says she’ll do to fix it. But regardless of what it means, it’s one of three questions in the RFP that essentially ask the same question. When you’re confronted with page limitations and repetitive questions, you have two fundamental choices: repeat what you said, either verbatim or in slightly different words, or refer to the answers given in preceding statements. In general, we think it’s better to repeat what was said previous, or at least repeat portions of it if possible, because the reviewer will at least be able to put a check in the box indicating that the question was answered. It’s in front of the reviewer, which is particularly important if different reviewers are reading different proposal sections.

But in situations with extreme page limitations, we will sometimes refer to previous answers. But to do so, it’s vital that you pinpoint the section where the preceding answers occurred. Don’t just say, “as stated above,” unless what you’ve stated is immediately above. Say, for example, that, “as stated in Section 2.4, we’re committed to delivering services to special populations in the context of family and community…” That way, if the reviewer is bold enough to look at the preceding section, the reviewer might actually be able to find the relevant material. No matter how long and dreary the proposal, it’s incumbent on the grant writer to go find where the material exists and leave a pointer to that material in the later section. It’s also vital to answer the question rather than just observing, no matter how accurately, that the question has already been answered, which is a fast way to lose points by acting superior to the reviewer.

No matter how repetitive a question might be, you should answer it.

Why so many RFPs are so poorly constructed is a fine question and one I wish I could answer well. One assumption is that the people who write RFPs almost never respond to them, or, if they ever do have to respond to respond, it’s to someone else’s RFP. With that in mind, the best rational reason I can imagine is that it’s hard to figure out who would be best at delivering services and who most needs services. The problem is similar to figuring out how much to pay should be offered in a large organization. Tim Harford discusses it in The Logic of Life:

All the problems of office life stem from the same root. To run a company perfectly you would need to have information about who is talented, who is honest, and who is hardworking, and pay them accordingly. But much of this vital information is inherently hard to uncover or act upon. So it is hard to pay people as much or as little as they truly deserve. Many of the absurdities of office life follow logically from attempts to get around that problem […] (89)

The various levels of government don’t have perfect information about who will use grant funds well, and hence they issue byzantine RFPs to try and extract this information by force. But I’m not convinced funders are really getting anything better than they would if they issued a one-page RFP that said, “Provide dental health to at-risk populations. Tell us who, what, where, when, why, and how you’re going to provide them in a maximum of 30 double-spaced pages. You must submit by June 13. Good luck!” Instead, we get mangled RFPs like the one mocked above and blog posts that, like this one, are designed chiefly to demystify a process that shouldn’t be shrouded in the first place.

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