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Read the latest Governing Management Letter 
Our "entrepreneurial journalism award" goes to a whole slew of Virginia newspapers, including the Daily Press, Richmond Times-Dispatch, Virginian-Pilot and 17 others. Journalists at those papers set about finding out how easy it is to get government documents that are legally available to the public. So they went out to 134 local governments to get the stuff. They said they were just interested citizens and didn't identify themselves as having anything to do with a newspaper. (Some may think that's journalistically unsound, but we applaud this kind of approach for this type of investigation.) The results were troubling. According to the Daily Press, in Newport News, "A reporter in Shenandoah County was told the sheriff released information only about crimes that he thought should be known to the public." This was hardly unique. In about one in every four instances, the person seeking the information was denied access. Only 13 of the entities provided all the information requested. And in 10 percent of cases, reporters were given this wildly irrational excuse: "We can't give you a document if you can't tell us exactly why you want it." This is like an automatic teller machine asking you "What are you going to spend the money on?" before it complies with your request for $100 of your own money. Honestly, this isn't a big shock to us. We've spent far too much time trying to pry documents free from government employees who miss the fact that the word "public" in "public documents" refers to pretty much everybody—not just government employees. We're sick of trying to convince people how much management matters. And we'll bet a lot of you are too. But if the topic comes up again, we've got the killer response for you—the one that should end the conversation pretty quickly. First a few facts. Hospital-acquired infections cost an estimated $28 billion annually and are responsible for more than 50,000 deaths. Addressing this problem could conceivably be one of the biggest targets in medicine's ongoing struggle to save lives and money simultaneously. But the sad truth is that the states have been afraid to require hospitals to publicly report data about hospital-acquired infections. When leaders in Pennsylvania began to seriously consider making this disclosure a requirement a few years ago, they ran into big obstacles. "The rhetoric coming from the experts, the CDC, the infection control professionals was all about how you can't do this," Marc Volavka told us. He's the executive director of the Pennsylvania Health Care Cost Containment Council (PHC4). "They said, 'You can't collect the data appropriately and you can never publicly report it.' " Fears that the press would misuse this data by comparing hospitals in an unfair fashion were particularly common. But Volavka and others in Pennsylvania persevered in the face of robust criticism. "I was crucified," he recalls. Now, Pennsylvania leads the nation in its efforts to require comprehensive public reporting of hospital infection data. That $28 billion figure—which is extrapolated from Pennsylvania's data—is much higher than previous national estimates. The result of the state's efforts, according to Volavka: "Even though the broad hospital community was not thrilled, the public response and public attention has driven every hospital in this state to refocus. We have more resources focused on infection control and we're starting to see hospital by hospital, infection rates drop.... Allegheny Hospital has virtually eliminated central-line bloodstream infections and ventilated pneumonia. Charles Cole Hospital is a small rural community hospital, underfinanced, under-resourced. They did a demonstration project with us and reduced urinary tract infections by 70 percent." These are health-care results that didn't need fancy new medicines or procedures. All that were required were some solid performance measures plus public attention to set the stage for improvements. (And by the way, PHC4 did a lot of press education, and concerns about unfair coverage proved unfounded.) The old maxim comes to mind: Light, indeed, is the best disinfectant. Read the whole PHC4 report here. "The police auditor is a new form of citizen oversight of the police in the United States," writes Professor Samuel Walker of the University of Nebraska at Omaha. He makes a persuasive case, pointing to police auditors in Los Angeles County and Philadelphia. Ironically, in Walker's own backyard, Omaha officials decided to fire the city's public safety auditor, Tristan Bonn. According to the Omaha World-Herald, she was fired "shortly after she released a report critical of traffic stops made by police officers. [Mayor Mike] Fahey said Bonn released the report without his approval and conducted herself unprofessionally." We can't speak to those specific points, but we can tell you that her report seemed strong to us, and was thorough in pointing out ways the Omaha police could help heal fissures with the community. One recommendation under "Improved Customer Service": "Stop cussing. Stop telling people to 'shut up.' Stop being rude to people. Answer your phone. Return your phone calls. Answer questions asked of you. Be courteous. Be helpful. Remember that taxpayers are your shareholders. Remember that you are a service organization. Remember the golden rule of policing: treat EVERY person the way you would wish to be treated. This is the most simple and basic instruction and yet is almost entirely overlooked. Plus, it is free. It does not cost one cent to treat people with respect." These are words that almost every public-sector employee could live by. And if that's the kind of advice cities can get from police auditors, then it feels to us like every big police department should have one. For the Omaha report, click here. Here's a public official to watch: Alex Sink, the newly elected chief financial officer of Florida. She's got a lot on her plate, including helping to figure out what to do about the state's contracting practices. Based on the little we've seen so far, our money is on her to do a fine job. Not long ago, it looked like Florida was about to pass an overhaul of its insurance industry that could be exceedingly expensive to the state. Sink was the voice of reason at the table, arguing that the state could be gambling its fiscal house on the idea that it could assume a lot of risk formerly carried by insurance companies—without running into problems. That makes sense if you're willing to bet that there aren't going to be too many really bad storms. Or even one major hurricane. Not a bet we'd take. And neither did Sink. A reform did make it through, but one which was much less risky for the state. Smart doctors and new technology are the kinds of things that come to mind when you think about ways to make hospitals—public or private—work better. Far more mundane is the question of call lights. But anyone who has ever spent much time in a hospital knows that one of the great frustrations many patients encounter is the sensation that the little button by the bed is hooked up to a paperweight someplace in the basement. A study by the Alliance for Health Care Research found that the proper utilization of call lights can reduce patient falls and increase satisfaction overall. The key: Don't rely on call lights to find out when a patient needs something. Instead, hospitals can use more frequent and effective nursing rounds to easily take care of many of the services that otherwise wait until a call light is pushed—and that's often at meal or medication time, when hospital staff is at its busiest. What's more, many of these needs don't even require a registered nurse or a licensed practical nurse but can be taken care of by less-expensive, certified nursing assistants. This kind of study isn't just useful for hospital administrators. Efficiencies are available all over the place, once managers start questioning long-held assumptions about the way things are done. Here's the report. The old joke is that you can make loads of money as a consultant by telling centralized organizations to decentralize and by telling decentralized organizations to centralize.
But it seems pretty clear that however the pile of power is divided, there's a lot to be gained in centralizing information, if nothing else. As Ronald Reagan said, "Trust, but verify." The Minnesota Office of the Legislative Auditor just issued a captivating report. The state has been known for its largess in providing cash to nonprofits, for a variety of important uses. The total payments for nonprofits in 2005 were $4.7 billion of which almost $1 billion went out in the form of grants to about 1,900 separate nonprofit organizations. According to the report, "The state's approach to managing grants to nonprofit organizations is fragmented and inconsistent, and does not provide adequate accountability." The Legislative Auditor's office found significant problems. In 35 of the 50 grants it reviewed, "grant managers did not compare grant payment requests to grantees' financial records in order to verify that grantees used state grant funds as intended." If we read this right, that means that the state could give $1 million to an alcoholism-abuse center without knowing for sure that most of the money wasn't used to host wine and cheese parties. Minnesota has always seemed like one of the better-managed states in the union. We're pretty confident that this report—and an earlier one that came from Governor Tim Pawlenty's administration—will result in change. We'll let you know what happens. Congratulations to Montana for getting its act together in replacing a failed tax computer system, called POINTS, with one that actually works. The new one is dubbed IRIS.
The old system cost the state about $39 million over the years. Moving to the new one cost another $27 million. Though Montana has been hobbled with the old technology for too long, at least it's now on the right path. Which leaves this question: Aren't there good ways to figure out when a state or city is pouring good money after bad on an IT system? Seems like this happens all the time. We knew enough to get rid of our mini-van when it became clear that it was turning into a four-wheeled money pit. And we don't know anything much about cars. Dave Wanzenried, a Montana state senator, talked to us a little about this syndrome. Said he, "I was the first one and the most tenacious one in 2001 to say, 'We've got a problem here.' Everybody said, 'No. It's OK.' Eventually we got other legislators to say we better watch this between the 2001 and 2003 session. The department continued to spend money on the system. We put a stop to it in 2003." Wanzenreid argues that one of the most important ways to avoid problems like those Montana has faced is to encourage people to admit failures before they become calamities. For some more tips from him, click here. While we were visiting our son at the University of North Carolina a few weeks back, we took the opportunity to catch up with an old friend, Willow Jacobson, who is an assistant professor of the School of Government. Little did we know how much we'd learn. Our friend's breadth of interest in human resources led to a variety of stimulating conversations. One of them focused on the way government managers can function better if they recognize the different styles necessary to use with different age groups (Generation Xers, Baby Boomers, etc.). We asked if she'd be kind enough to write a piece about this for the B&G Report. She did. Click here to read it. We've seen the homes and cars of a bunch of civil-service types, and have yet to see a Rolls-Royce in the garage. Yet we keep hearing about "overpaid" government employees. Sure, governments are occasionally pushed by unions into paying more than they can afford. Still, it feels like most governments are in the same boat. They cast their recruiting line to find a few good fish—while dozens of other boats are swarming about in the same small lake. The lesson, in both cases, is that it pays to have the right bait. This all came to mind as we were reading about Miami Gardens, Florida. It's a recently incorporated city in Miami-Dade County. And it's hiring a brand new police department of about 150 at a time when there's a shortage of law enforcement personnel nationwide. Miami Gardens' approach was described in the Miami Herald: "I looked at what other places were offering," said Danny Crew, the city manager, "and then I topped it." The results have been startling. As of a few weeks ago, the city had gotten more than 100 applications for seven captain slots and more than 1,000 applicants overall. Obviously, this is a strategy that requires money and a fair amount of political willpower. But we're going to be watching Miami Gardens from now on—waiting to see how well its police department fares. If it has better-than-anticipated results, that might teach us something worthwhile about the benefits of hiring the best and brightest-even if they cost a bit more. Sometimes it may be that productivity isn't linked to high or low salaries in absolute terms—but rather how those pay levels relate to expectations. Assistant Professor Alexandre Mas at the University of California-Berkeley's School of Business just released a report that found that police performance declined sharply when officers lost in arbitration over their wages. His findings were riveting: "Per capita number of arrests were 12 percent higher in the months following arbitration when arbitrators ruled in favor of police officers compared with when they ruled against them." When unions lost in arbitration, "police officers averaged 6.8 fewer arrests per month per 100,000." This next finding is our favorite. According to a School of Business release, "if two unions each received a 5 percent raise, but one asked for 6 percent and the other asked for 15 percent, then the officers that demanded the smaller amount would make 90 more arrests per 100,000 capita each month following arbitration than the union that demanded a larger raise." As Mas explains, "How a pay raise impacts productivity is a function of the expectations that workers had about the pay raise." Here's a summary. And while we're talking human resources, what do you think of residency requirements for job applicants? We ask, because we've never been sure what we think, and maybe someone out there can help inform us. On the one hand, there always seemed to be some sense in hiring home-town folks first—why not use government hiring as a way to keep unemployment low? On the other hand, isn't it in everybody's best interests to hire the best qualified candidates—regardless where they live? This brings us to Buffalo, New York, the second-largest city in the state. Apparently, teachers aren't inclined to come to Buffalo for a variety of reasons—including the city's chronically difficult fiscal situation, which required a series of layoffs over the last five years. What to do? According to Peter Simon, writing in the Buffalo News, a new policy "allows district officials to waive the residency policy in 'high need' instructional areas. There are now 12 of those areas, including English, math, reading, science and special education. Of 160 teachers hired for this school year, 124—or 78 percent—were in one of those shortage areas and therefore eligible for residency waivers." Of course, some other cities have gotten rid of residency requirements. But it seems like it's a clear sign that they aren't a good idea when you have to except more than half your workforce from them. Is the cost of workers' comp a problem for your budget? If so, you're hardly alone and we'd recommend that you take a look at the work that's been done in Berkeley, California. That city has put a great deal of effort into making its workplace safer and healthier. It spends $300,000 per year on gym memberships for employees; buys $600 chairs for employees to help avoid back injuries and generally focuses on safety training. It also has instituted a series of efforts to prevent injuries and reduce their severity. James Mason, the city's occupational health and safety officer for the last five years, points to better employee health as the first benefit. But it's hard to deny the lure of the dollar savings. "The overall bill for workers' comp is about $30 million. Over the last three years we've seen a dramatic decrease in the number of claims and the amount spent per claim," says Mason. Total savings so far: about $6 million. When we chatted with Mason, he made an interesting distinction between the kind of approach safety-management professionals like himself take and traditional risk management. "The general focus in risk management is learning how to mitigate the overall financial impact by controlling the loss or reducing the risk," he said. "And if that can't be done, risk managers will try to insure against the loss. "Safety professionals don't think as much about the insurance end. We find methods to do a job in a different, safer way — or with protective equipment — while coaching behavioral changes, with a long-term focus on cultural modification. It's a subtle difference, but one that is pretty new to public administration, although it's been used in the private sector for some time." We have a crush on the Legislative Analyst's Office in California. Management of that state is almost unfathomably complicated, and if it weren't for the LAO, we'd be up a creek. Some press reports we saw about the governor's budget proposal left us wanting to know if California was really likely to end up with a $2 billion reserve next year. So we went to the legislative analyst's site and found this: "The 2007-08 Governor's Budget proposes a major redirection of transportation funds, reductions in social services, and a variety of other actions to eliminate a significant shortfall in 2007-08. The plan assumes that adoption of its proposals will result in a balanced budget with an over $2 billion reserve. However, the budget contains a significant number of downside risks and is based on a number of optimistic assumptions. Its key proposals also raise serious policy and legal issues. Adverse outcomes in just a few of these areas could easily eliminate most or all of the proposed reserve." We don't really think California is unusual in the fragility of its budget estimates. It's our guess that any number of other states are 'in the same position. The difference is that they don't have the LAO to point it out. You can read this particular report by clicking here, or you can visit the full Analyst's Office site. "No Easy Answers." That was the title of a report by respected researcher Doug Kirby back in 1997. The topic was teen pregnancy. In 2001, he came out with another report called "Emerging Answers." And now, here's some really nice news. We're told that his next report, due out in May will be called "Multiple Answers."
Now that's progress. Fact is, a December 2006 report from the National Center for Health Statistics showed that the overall teen pregnancy rate in 2002 was 35 percent lower than its peak in 1990. Though we really dislike using four-year-old data, it's the best available—and there's no reason to believe the trends have changed since. One of the reasons for progress: successful programs that focus on changing attitudes and perceptions of what peers are doing. The underlying key here is a heightened understanding of what works and what doesn't work. Call it performance management if you want a fancier title. It's simply clear that government makes progress in areas like this only if it reproduces good programs and doesn't replicate ineffective ones. This is what is increasingly happening in the teen-pregnancy field. Kirby has a list of programs that have been implemented and evaluated and are consistently effective, and he is happy to send it to anyone interested. His email is dougK@etr.org. "One should implement the best programs," Kirby told us. "If they're not effective, then evaluate and develop the second generation. It was the fourth generation of programs that really consistently had a positive result." The question isn't whether or not Alabama legislators deserve a pay increase. But there's apparently a debate over whether the vote on these raises—in the next couple of months—can be done through a voice vote or not. Of course, with a voice vote legislators can't be held strictly accountable for this potentially unpopular action. In a state where politicians need all the good will they can get from the voters, this potential hit-and-run strategy seems like a bad idea. How can big cities reduce traffic congestion? For some time now, people have been looking toward London's "congestion charging" system, which has been utilized to keep cars and buses moving smoothly in the central city. The scheme, almost entirely outsourced, involves charging a nearly $16 fee for any vehicle that enters the heavily-trafficked zone between 7 a.m. and 6:30 p.m. Monday through Friday. People who live in the area get a 90% discount, and exemptions exist for people with disabilities, emergency vehicles, taxis, buses, etc. This system relies on video cameras linked to automatic license plate-recognition technology. At the same time London placed these high fees on car use, it invested heavily in alternatives to automobiles, including public transportation. Just a few months ago, the University of Minnesota's Hubert Humphrey Institute of Public Affairs came out with a report about the London effort that should draw the attention of any number of large U.S. cities. Some of the results: Total traffic entering the charging zone is down 22 percent; network speeds have increased from 8.5 miles per hour before the change to 10.1 miles per hour in 2005; and traffic delays on main routes entering the charging zone are down 20 percent. Not bad. You can read the University of Minnesota study here. Hot off the presses (again) is a really useful book called Performance Measurement: Getting Results. Originally published a few years back, it's been updated and re-released. The author is the Urban Institute's Harry Hatry, one of the pillars of the group of men and women who have pursued the best ways to hold government accountable. Harry is a believer in the power of this process—but he's retained a dedicatedly cautious and critical approach, which makes us appreciate his work even more. The nine things for which performance measurement can be used, according to the book: 1. Allocating resources
Want a copy? Order one here. Research Assistant: Heather Kleba © 2007, Congressional Quarterly, Inc. Reproduction in any form without the written permission of the publisher is prohibited. Governing, City & State and Governing.com are registered trademarks of Congressional Quarterly, Inc. |
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