Park That Stimulus!
Plus: How informing patients can lower Medicaid costs, a great resource for performance reporting, and more
Everybody is talking about how the new stimulus package is going to be used in states, towns and cities. One of the big complaints we keep hearing is that a lot of this money will go to silly things. A couple of weeks ago, the Wall Street Journal, for example, seemed to take issue with some projects related to municipal golf courses and upgrades to city parks.
While we get the idea that there are doubtless more pressing matters in the world than golf courses -- things like roads and bridges -- we think that the Journal and others may be missing something here. For one thing, as a stimulus bill, if cities can quickly generate jobs working on golf courses, those are just as real as jobs paving roads. Secondly, if you ask executives to give you the real reasons they settle their companies in one place as opposed to others, lifestyle amenities are rather high on the list.
Of course road safety is somewhat more important than new and improved sand traps. But that doesn't mean that cities concerned with economic development (which by the way can help stimulate more jobs itself) are wastrels and spendthrifts.
Want to save Medicaid dollars? Here's something we just came across from the Agency for Healthcare Research and Quality (AHRQ) that sounds like a great tool. According to a study funded by AHRQ, there's an enormous amount of money to be saved by simply making sure that patients know what to do with themselves when they go home after a hospitalization.
Apparently, patients who get full and proper information about medication, follow-up care and so on are 30 percent less likely to be readmitted or visit an emergency room within 30 days of discharge than those who get minimal education. The study argues that total costs -- including hospitalization and outpatient care -- were an average of $412 lower for the patients who receive complete information than those who don't. Note to legislators: This feels like the kind of change that could potentially be put into statute.
Interested in performance measurement? Boy, do we have a recommendation for you! It's called the Public Performance Measurement and Reporting Network at the Rutgers School of Public Affairs and Administration. There are loads of resources there, including sample measures, reports, articles and presentations. Registration is free. The network's list service is also useful, as it allows public managers the opportunity to ask questions about the measurement dilemmas they're facing.
In the "best laid plans" department: A proposal in West Virginia to save money on temporary workers by discouraging sick leave use has turned out to add to county expense -- not subtract from it. The Charleston Daily Mail reports that the Kanawha County Board of Education set up a bonus system for teachers and other school workers who used three or fewer sick or personal leave days. That's a tiny fraction of the fifteen days they're allotted each year. In the first year of the program, the county calculated that it saved about $900,000 on substitutes and other temporary employees. But can you guess what went wrong? It paid out $1.6 million in bonuses -- $700,000 more than it saved.
Earlier this month, the school board announced it was scrapping the incentive program. The local education association says it's worried that employee absenteeism will now creep back up. But we like to look at the silver lining: At least students will no longer be subjected to hacking, coughing teachers who are going for the bonus.
There's a lot of political pressure to outsource government work to the private sector in Texas. So it's not a surprise that the Department of Transportation now contracts out nearly 75 percent of its road work. Contracting for new construction is very common, but Texas also contracts for a lot of routine maintenance work, engineering and design work and inspections of new roads.
Here's the trouble. A new report from the 2009 Texas Sunset Advisory Commission has analyzed costs of in-house vs. outsourced work and found that in many cases, the inside job is far less expensive. Potholes filled by Texas employees cost $23 each to repair on average. Those filled by contract employees cost $129 each. Sealing cracks cost $327 per mile for employees and $812 per mile for contractors.
An article about the report in the Austin American-Statesman noted that an internal analysis of engineering costs between 2005 and 2008 found private engineers were three times as expensive as state employees as a percent of total contract costs. "I can tell you without question it is substantially more costly to turn out a set of plans with a consultant than with in-house engineers," Zane Webb, the recently retired director of the DOT's maintenance division, told the newspaper.
Sometimes outsourcing makes a lot of sense, but the assumption that it's always a money-saver just doesn't stand up to scrutiny.
After we brought up the question of the relationship between spending and education a couple of weeks ago, we heard from James A. Tucker, an attorney with the Alabama Disabilities Advocacy Program at the University of Alabama. He referred us to an issue of The American Prospect from November 2002. The pertinent comment: "Former Texas Lieutenant Governor Bill Hobby once wondered aloud how people know we won't solve the problems of public education by throwing money at it. 'We've never tried it,' he said."
We pointed out the addition of a few new criteria to the Baldrige Award recently, and we've since received a note from Michael Jacobson, the articulate manager of performance and accountability for King County, Washington.
"Your B&G report touched a nerve with me today," he wrote. He went on to argue that measures like the Baldrige are all too often based fundamentally on private-sector models, with minor modifications made for governments. We gave him a call to hear a little more, and here's what he had to say:
"In the performance arena, there's not a well defined standard or specification for what performance management is. So people have looked to structures that have been built for the private sector as a potential model for the public sector. And they've tried to adapt and adopt these systems over time. We were asked to look at some legislation that had to do with the Baldrige, and found that they have a new classification for governments. But the expectations are almost exactly the same as for the private sector. They use words like 'supply chain' and 'verticality.' Those are private-sector words that nobody in government uses. I don't even know what they mean. Some governments are pursuing this path and getting a lot out of it. But I remain skeptical and even confused about how to provide 'supply chain thinking' to the delivery of election ballot counting or wastewater treatment services."
Manager's Reading List: Our ongoing feature about books to read, recommended by B&G readers
From Cynthia Green, a public policy analyst and former board member of the Governmental Accounting Standards Board:
"The Nine: Inside the Secret World of the Supreme Court," by Jeffrey Toobin. "Toobin humanizes the United States Supreme Court, providing an in-depth look at the various members of the Supreme Court and an analysis of how their personalities, political views, and circumstances have shaped the history of the Court's most important decisions over the years. Informative, entertaining, it will satisfy your curiosity about these secret chambers."
Read the full archive of Managers Reading List suggestions.
"Queue management." That's what they call the effort to reduce the problems associated with people waiting in lines. Visitors to Disneyland are treated to the state-of-the-art in this regard, as numerous efforts are made to entertain them while they're waiting to be entertained.
Recently, our bank branch installed television sets so that you can watch the news while waiting to make a transaction. (Frankly, though, when news about the economy comes up, it nearly drives us to take our money out of the bank and hide it under the floorboards.) We wonder how many cities, counties and states have taken advantage of these kinds of ideas for offices that tend to accumulate long lines of customers, including those at departments of motor vehicles. We think we wouldn't mind waiting in lines nearly as much if we could watch re-runs of "Leave It to Beaver" while we stood and shuffled ever forward.
Red light cameras seem to be increasingly popular, even as debates about safety, privacy and effectiveness continue. But at least in Duncansville, Texas, nobody can say they're not sufficiently utilized. According to the Dallas Morning News , some 45,000 citations were issued at only four intersections. This is particularly remarkable given that the entire population of Duncanville is estimated at only 42,500. Maybe it's all those heavy-footed folks from nearby Dallas who don't want to pause on their way to do some bass fishing in Joe Pool Lake.
Research Assistant: Heather Kleba
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