Count Your Blessings? Sure, But Count Your Problems Too
Government agencies that embrace problems rather than avoid them turn out to be highly effective, writes Shelley Metzenbaum.
Firefighters used to spend a lot more time fighting fires. In 1980, nearly 30 percent of calls to fire departments pertained to fires. By 2004, only 7 percent did and the absolute number of fires dropped by half. With fewer blazes, firefighters could take on other problems, including medical emergencies.
The Coast Guard has similarly slashed the number of major oil spills by more than 80 percent in the past two decades and the total volume of spilled oil by even more.
At one Veterans Administration medical center in Kansas , wrong-medication errors fell 74 percent and incorrect dosages 57 percent in five years.
How did these improvements happen? The answer is simple, sophisticated and perhaps surprising. You've heard of counting your blessings. These government agencies decided instead to count their problems.
It is tempting to run from our problems. Yet government agencies that embrace problems rather than avoid them turn out to be highly effective. Government systems that count unwanted incidents, whether societal hazards or procedural problems, have found remarkable success cutting their number and seriousness.
Most problem-counting systems share four common features. First, they systematically count problems or unwanted events. Second, they gather information about key characteristics of each event to identify the most common "who, what, where and when" features. Third, they work hard to identify likely causal factors, especially those that can be prevented. Finally, they continually develop, test and assess prevention methods and aggressively promote effective ones.
Take, for example, the accident-counting system run by federal, state and local traffic safety agencies. State and local officials gather information about every fatal accident, noting possible causal factors, including the equipment involved, operator characteristics, physical environment and, where relevant, the socio/cultural environment in which the accident took place. They record information not just about the accident itself, but also about pre-event conditions that might affect an accident's likelihood or seriousness and post-event conditions that can influence its consequences.
The National Highway Traffic Safety Administration then compiles the information into a database and looks for patterns and anomalies. Which human, equipment and environmental characteristics are most commonly associated with high-cost accidents and which with low? Which causal factors can be influenced? With this information, all three levels of governments can search for effective prevention practices and tackle the most serious problems. Many local communities, for example, focus road redesigns on intersections with the highest number of accidents. States, with NHTSA support, run annual "Click It or Ticket" campaigns every Memorial Day weekend to increase seatbelt use, equipment shown to save lives. By identifying the most prevalent and preventable problems, then designing and testing programs to reduce accidents and their costs, government has steadily nudged the automobile fatality rate downward over the last 40 years, despite dramatic increases in road congestion: from 5.5 fatalities per 100 million vehicle miles traveled in 1966 to 1.45 in 2005.
Effective problem-counting systems need not be as sophisticated as NHTSA's to be effective. The city of Boston, for example, knew that tenants complained about inadequate heat every winter. By studying the pattern of complaints received, city officials noticed that a small number of landlords accounted for most of the complaints. Officials sent off stern, penalty-threatening warnings to the offending landlords and complaints dropped sharply.
Counting and characterizing unwanted incidents to reduce them can work remarkably well across a range of policy areas and government functions. Agencies that conduct inspections can target and assess the effect of compliance-boosting programs by counting facilities (or equipment) with problems, the number of problems found per inspection and the most prevalent problems encountered. Agencies that receive applications can study decisions that took longer than the target response time. Studying complaints, an indicator of unwanted events, can reveal both the most common callers, whose complaints can be considered based on the value of their prior complaints and common preventable problems. Problem counting can even help agencies manage legislative and media inquiries. Simply listing the nature of the inquiries may reveal common themes and timing patterns that help an agency better anticipate and respond to, or even reduce the number of, unexpected inquiries.
As agencies struggle to improve program effectiveness and efficiency using performance measurement, they should explore the possibilities afforded by problem counting and characterization. Information technologies now make it more feasible and affordable than ever. So keep counting your blessings, but don't forget to count your problems, too.
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