The B&G Interview: Questions for Laura Chick, controller for the City of Los Angeles
Ready for a look into the future of performance measurement? Then visit Virginia's three-month-old Web site, Virginia Performs. As John Kamensky, senior fellow with the IBM Center for the Business of Government, reports in a column in PA Times, the monthly newspaper for the American Society for Public Adminstration, "The new governor, Tim Kaine, seems to have set a new bar for performance leadership."
We agree. We're particularly impressed at the complete and open fashion in which the state discloses the progress (or lack thereof) in a long list of broad and critical indicators across areas such as the economy, public safety, transportation and so on. It also indicates the degree to which the state can influence the outcomes of those indicators. So, for example, a reader will discover that poverty in the state is becoming more of a problem -- but that this is an area in which the state has limited capacity to make change. On the other hand, another area in which the state needs improvement is infrastructure condition, and that's one over which the government has a great deal of control.
But the state doesn't just leave its performance management system at this very high level. The Web site allows users to click directly from a broad indicator to an enormous amount of detail describing that issue. It includes links to information about all the major state programs involved, featuring performance measures related to that issue.
We could go on. But the work speaks better for itself than we ever could.
"Chronically late." That's how the New York State budget was described for years. But a few years ago, the state came up with an on-time budget. It did the same last year. And this year, it was 11 hours late (which, as far as we're concerned, isn't really late; it's kind of a rounding error in time). All of which is good. The disheartening thing is that apparently promptness has a price. The first line of the front-page New York Times piece on the budget read: "Lawmakers finished passing an estimated $120.9 billion budget Sunday morning that they had not had time to read and had barely debated." (The italics are ours, and are intended to convey frustrated dismay.)
So, there we were riding home from our daughter's soccer game (regular readers of this space may notice that we frequently see deep truths about government management while watching teenage girls maul one another over possession of a large ball). And our 16-year-old indicated that she's altered her style of play thanks to her coach. This could be a good thing, but it turns out that she feels so withered by his frustration when she makes a mistake that she's now taken to making the safe, sure play rather than one that could turn a game but has a higher risk of failure.
And so it is in government, far too often. Project managers are frightened to report the first sign that something is going over budget, for fear they'll be blamed. Better to wait, ride it out, and hope there's a new project manager in place if things really go wrong. Lower-level managers frequently say no, to perfectly reasonable requests for slight changes in process, because it's better to frustrate employees than to risk the personal repercussions if something new doesn't work out well.
A 2006 report from the University of Missouri highlights this phenomenon in nursing homes (you can read an abstract of that report here). The paper discovered that as long as staff members feel they will be blamed for medical errors they report, patient safety will remain at risk. Nursing home staffers clearly understood the need to know about errors so that they could improve care, the report said, but no one was willing to get others in trouble.
Electronic health records are a much-praised notion in the federal government and in states, counties and cities. But according to a piece in the March 2007 issue of the American Journal of Nursing, there's a hitch. Much of the technology produced thus far has been designed to help physicians easily retrieve a body of vital information. But the needs of the nurses who end up entering a lot of this data haven't been adequately addressed. For one thing, it can be pretty inconvenient entering lots of this documentation at a bedside in a small patient room. In fact, about half the nurses surveyed first "recorded information on paper and then transferred it to the EHR -- thereby duplicating their work." The piece also reported that the majority of nurses surveyed were frustrated by multiple EHR systems, "such as handheld units at the bedside as well as terminals at the nurses' station."
We're absolutely convinced that electronic health records can save governments enormous sums of cash in their Medicaid programs while improving the quality of care. But, like all managerial efficiencies gained through new technology, the user's point of view is ignored at great risk.
Talking with Nick Vagianelis, director of civil service operations in New York State, is always fun. He's one of those people who likes searching for the big picture. Recently, he educated us a bit about a critical trend in state hiring: turns out that there's an ever-growing number of older men and women taking jobs in state government who would rarely have applied in past years. "We've hired retirees from Verizon, management analysts who are looking for second careers or may have been downsized, people who have worked in big hotels or the food service industry," he told us. "And we're starting to see definite participation by military retirees who are generally very well trained."
You hear a lot about how the "aging of the population" is somehow a bad thing -- leading to greater health care costs, and so on. But it feels to us like an abundance of well-trained, smart, hard workers -- whether they're 25 or 65 -- is a very good thing.
We weren't certain how much of a national phenomenon Nick's comments represented. But about a week ago, we came across a four-page report from the California Budget Project titled "More Californians are Working Later in Life."
While the report doesn't focus on government employees, its main conclusion is that "the share of Californians approaching or at the traditional retirement age -- age 65 and older -- who are employed increased considerably between 1995 and 2006, after a decade and a half of little change. This trend reflects a number of factors, including improved health and longer life expectancy, as well as diminished retirement security."
Florida teachers spent between 21 percent and 51 percent of their week on paperwork and data collection, according to a February 2006 report by the state's "paper-reduction task force." Any teacher who spends half his or her work time filling out forms isn't spending nearly enough time with students. The state responded to the report with several legislative changes -- a couple of which, curiously, seemed to be a call for more reports about the overload of report-making. We don't know whether the legislative moves had any impact, but the Brevard WatchList, an excellent newspaper blog in Brevard County, Florida, tried to find out. The response it got led to the conclusion that the teachers are still shuffling paper too much of the time.
While we're hesitant to quote anonymous blog entries, this one had the appealing ring of truth -- and was too good not to share: "The paperwork in education has grown to where we now do paperwork on the paperwork. Everyone and everything needs an assessment. The assessments need assessments. We had a meeting at school yesterday on how to fill out paperwork for the district on an assessment of a reading assessment. After school today in our faculty meeting was another tutorial on how to fill out new paperwork the district wants for student information -- this time though they got smart and did it on triplicate paper so that cut down a bit on our paperwork -- the funny thing though is we have to keep this particular filled-out paperwork in the student's file but then record our findings again on the computer in a class assessment site so whoever needs to see it in the powers that be can do it."
And while we're talking about information overload, there was a terrific little piece in the Orange County Register a couple of weeks ago about the use of disclosure to keep campaign financing in line. Early in the article is a quote from a California assemblywoman who says that "full and timely disclosure...will do more to keep the system clean than modifying the time during which contributions are made."
But reporter Brian Joseph didn't take that at face value. As he points out, "California already has one of the nation's toughest disclosure laws and anyone interested in reviewing the records can easily be buried in an avalanche of data. In fact, campaign finance experts in California and across the country told me an increased disclosure may actually further obscure the influence of money in politics." Doug Heller, of the Foundation for Taxpayer and Consumer Rights in Santa Monica, is then quoted as saying, "It's a forest and trees kind of issue. When you're investigating campaign interests, you want to see trees. But with disclosure, you're creating a black forest."
This is right on the money. Transparency and full disclosure are good things, of course. But they need to come along with mechanisms to help users sift out the information that's important to them. We've long wondered whether sources who send us boxes full of documents to review for an article are really trying to be of assistance -- or are just clever enough to know that we can't read and understand everything in a box that's too heavy to lift.
Lest anyone think we're suddenly anti-information, here's an example of two state agencies that deserve a lot of credit for providing citizens with much-needed information about health care costs. They do so on a new Web site, created by the New Hampshire Department of Insurance and the state's Department of Health and Human Services. It may not be the first state to develop such a site, but it's still worth pointing out. The site has only been live for a few weeks now. We tried it out (using a local ZIP code we found in the World Almanac), and the individualized information it provides was great.
In the retail business, they talk about "big pencils" when it comes to important store buyers who can get the best price from manufacturers. We just came across an impressive program in which the National Association of Counties helps give many of its members big pencils by negotiating on behalf of multiple entities. Other levels of government -- and even agencies within one government -- could certainly benefit by taking a look at the effort.
Here's how it's described on NACo's Web site: "By pooling the purchasing power of counties throughout the nation and using volume purchasing as leverage in the private sector, NACo helps bring better quality, improved benefits, and/or lower costs products & services than individual counties can negotiate on their own. Most services offered have been competitively solicited by a lead public agency and the resulting contracts are immediately available to counties and other local governments [to] use." Among the areas in which NACo offers this service are energy audits, inmate medical-claims management, and pre-employment background checks.
What to do with kids who break the law? A growing body of evidence says that many of them can be helped through alternatives to juvenile facilities. When Florida's Office of Program Policy Analysis & Government Accountability explored this terrain, it found that so-called "diversion" approaches, which provided therapy in a home environment, could be very beneficial to youth offenders -- and save a chunk of money besides. But there was one surprise that jumped out of the research: Kids who were forced to stay at home with electronic monitoring devices were "twice as likely to be arrested for a misdemeanor or a felony as those who [were in the same program and] did not receive monitoring," said the report, which came out in February.
Why this shocking conclusion? "Electronic monitoring hindered the development of trust between the therapist, the family, and the youth, and made it more difficult to engage the youth and family in the treatment. Department staff and therapists also report that electronic monitoring encouraged families to depend on the department to monitor their youths' behavior, and interfered with the treatment goal of helping families learn to provide effective monitoring themselves." We never would have guessed this.
There's a larger lesson in this that goes beyond corrections: It's not enough to measure the performance of a program overall. Aggregate performance measures are crucial; but the keys to fixing problems lie in the details. We've talked to managing-for-results expert Harry Hatry about this for years: Disaggregating data is key.
While we're on prisons, we wanted to vent a bit about the "blood-from-a-stone" school of state revenue raising. That's exactly what some states are doing when they allow private vendors to charge unconscionably high rates for calls made from prisons -- a chunk of which is rebated back to the state. Aside from a certain unpleasant mean-spiritedness involved, it may even be counterproductive. Here are our questions -- and we're very open to hearing answers that may not have occurred to us: Don't we want prisoners keeping in close contact with their children? Mates? Parents? Aren't those the kinds of connections that may keep them from heading back to prison time after time? So, despite the millions of dollars states can pick up this way, mightn't they wind up spending pretty healthy sums re-incarcerating the men and women who have been disconnected from anyone who cares about them?
Were we ancient Greeks, we'd be praying every day to Hephaestus, the god of machines and technology, as we battle with our computers, telephones and other electronics to get them to do what we want. With this in mind, you'll understand that we took some solace in the following story from our very capable research assistant, Heather Kleba. We had asked her to send individual e-mails (not a bulk mailing) to the 50 state budget officers pointing them to our interview last month with New York's former budget director John Cape. Her e-mails got through to 45 and five bounced back. Then she got through to four. And that left Georgia. Heather is a persistent sort, and here's her report:
"Georgia actually had a pretty poor site in terms of trying to find contact info (most government pages seem to keep the email addresses or phone numbers near the bottom of the page, but I had to search for them.) I found [the director of planning and budget's] e-mail, and I sent the Management Newsletter (not as an attachment). It immediately bounced back to me as 'undeliverable: message you sent blocked by our bulk e-mail filter, you do not have permission to send to this recipient.' "So, I double- and triple-checked the e-mail address just to make sure I had not made a typing error. Then I sent it again because I've had some experience in the past with cranky e-mail systems. It again bounced back to me with the same message. So, I called the budget office and explained my situation, and they had no idea why it kept coming back. They had me spell out the e-mail address to them, and it was correct. "So, the very nice lady on the phone offered the e-mail address for the director's assistant. I sent the Management Newsletter to the assistant. It bounced back again with the same message."
Here's a bit of unsolicited advice to new governors: As you make every effort to begin your first term with a slew of accomplishments, remember that your senior staffers need a little rest. Some years back, during the Clinton administration, we spent a day with a high-level official at the federal Office of Management and Budget. We sat in with him through a series of about 15 meetings over a six-hour period. Our dominant memory of the day was that a good chunk of the staffers -- who were working 16-hour days -- seemed to be drowsing off at one time or another in every afternoon meeting.
First there was 4-1-1 -- information about telephone numbers. Then there was 3-1-1 -- provided to give citizens easy access to a wide range of government service providers.
And now there's 2-1-1. These three digits allow people who need help in a variety of ways -- from getting an oxygen tank on a Sunday to dealing with a hurricane -- to connect with largely non-governmental organizations that can give assistance. They also provide a way for good-hearted folks who want to help their community to find the appropriate volunteer-ready organization. The effort to spread use of the lines has been spearheaded by the United Way of America and the Alliance of Information and Referral Systems (AIRS), which estimates that 2-1-1 lines are now available for 65 percent of the U.S. population (to learn more, click here).
There's no question that, in theory, 2-1-1 lines are a great innovation. In practice, there's no idea that's so good that it can't be mucked up with inferior management. And with the incredibly rapid spread of this effort, it feels almost inevitable that problems are going to start cropping up all over the place despite the good intentions of the people involved.
For 2-1-1 lines, a lot depends on how well the database is managed and on the skills of the people manning the phones. In a world of changing budgets and priorities, human service programs come and go and keeping a database up to date and accurate is a challenge. The key here is making sure not to just throw money into a 2-1-1 system without appropriate performance measures. But what should you look at?
Enter Susan Lepler, formerly a project director for the Center for Governmental Research in New York State. Along with research associate Erika Rosenberg, she developed guidelines for evaluating a 2-1-1 service in a 12-county area that includes Rochester. Here are the six major outcomes on which she believes 2-1-1 services should be evaluated:
1. The caller gets a response in a timely fashion.
2. The caller is satisfied with the information and referral they get (measured through a survey).
3. The information given is accurate.
4. The phone number is accessible throughout the region, with cell phones included. (This is complicated because it requires negotiation with individual cell phone companies.)
5. The number is widely known and recognized in the community as the number to call for help.
6. It provides real-time community service assessments so that planners can improve their response to community needs and demands.
Lepler's study (available here) provides suggested benchmarks and targets and breaks the outcomes down into smaller elements. For example, the caller satisfaction measure is broken into five separate parts. "Being courteous and being helpful are really two different things," Lepler told us. "You can be helpful but do it in a rude way."
Research Assistant: Heather Kleba
