Smart Management

States Struggle to Manage Medical Transportation

The dialogue around providing accessible health care includes such big issues as high-priced prescriptions, overuse of emergency rooms and a burgeoning need for long-term care. One topic that gets relatively little attention, but could have a big impact on accessibility, is transportation. It represents a tiny fraction of the total spent on health care, but it has been a big challenge for states to manage.

This piece of the health-care puzzle affects 7.1 million people, according to the nonprofit Altarum Institute, which provides health-care research and consulting. A chunk of this group are Medicaid patients. The federal government requires transportation reimbursement for all Medicaid recipients.  READ MORE

A Real Opportunity for Cross-Boundary Digital Government

What we've called "cross-boundary digital government" for the last decade or so has focused on standardization for shared technology services among programs within state-, local- or federal-government enterprises. After all, we don't want 50 email systems or data centers or networks within a single jurisdiction or agency. We want the efficiency and effectiveness of just a few.

But a focus on technology within jurisdictions or enterprises stops short of the larger and truly government-wide opportunities. We need to take advantage of the new opportunities that will be available with the changes in administration that will follow this year's elections. READ MORE

Bad Bosses

Each year, the Equal Employment Opportunity (EEO) program in San Francisco gets about 300 complaints from employees. But when the EEO investigates, it finds that a tiny portion -- under 10 percent -- are actually the result of discrimination or harassment. Rather, most complaints come from weak managerial skills that leave employees feeling mistreated when they're passed over for a raise or a promotion, or shifted from one job to another. "About 90 to 95 percent of our complaints identify issues with managers," says Linda Simon, deputy director of the city and county Department of Human Resources.

All the managerial systems in the world, it appears, aren't strong enough or thoughtful enough to overcome the problems that can be created by supervisors or managers who lack communication skills, fail to listen to employees, treat them poorly or don't provide honest feedback about job performance. READ MORE

The Complex Challenges of Measuring the Impact of Social Programs

When is a comparison group not a comparison group? In social-science research, figuring that out may mean the difference between conclusions worth building programs on. A recent economic analysis in the New York Times examining anew a decades-long initiative helping low-income families move from high-poverty areas demonstrates how challenging program-impact evaluations can be. But greater understanding of how to compare may lead to more informed policy.

Dorothy Gatreaux was an African-American mother living in Chicago's highly segregated public housing who successfully sued the Chicago Housing Authority for racial discrimination. The resulting 1976 consent decree created a voucher program that gave 7,500 low-income families the opportunity to move to less racially segregated, more affluent neighborhoods in the city and its suburbs. (I worked in the U.S. Department of Housing and Urban Development's headquarters and provided program support in the settlement negotiations.) READ MORE

The Myth That More Rules and Oversight Can Fix Government

When things go awry in for-profit and non-profit organizations, the operative working assumption is that responsibility lies with management. That is, management is responsible for institutional performance by definition.

In government, however, the operative working assumption is altogether different. Successes and failures there cannot be blamed on management, because only tidbits of authority are vested there. Fault must lie elsewhere. Two possibilities present themselves: inadequate rule-making and insufficient political oversight. What is rarely examined is what is most often the real culprit: the authority that public-sector management should have but doesn't. READ MORE