When Officials Play Hide-and-Seek
Plus: The magic of checklists, the non-jobs effects of the stimulus, and more
Hide and seek? Have any of you noticed how hard it can be to find a phone number for government officials, or even just for their offices? You can search a Web site from top to bottom without finding any options other than to send an e-mail. We understand that there may be some efficiency gained in routing most contacts through computer screens. But there are times when human contact is far more useful. We can't help but wonder how many citizens feel like their government is just trying to avoid talking to them.
There's been a lot written lately about the magic of checklists to avoid problems in any project -- from building a house to transplanting a heart. And it certainly makes sense. We've been big users of checklists for years.
But we'd like to add a cautionary note for folks who adopt the idea without considering the fine print. Dr. Peter Pronovost, an intensive care specialist at Johns Hopkins Hospital, is a proponent of a very successful checklist for minimizing ICU bloodstream infections. His point is that you don't solve any problems just by having a list on paper. Culture change -- such as giving nurses the ability to question doctors -- goes along with it. The same kind of thing would be true in any field in which checklists are used.
Says Pronovost, "Checklists are useful, but they're not Harry Potter's wand. The science needed to best develop focused, unambiguous and succinct checklists for medicine's thousands of diagnoses and procedures is in its infancy, and there can be unintended consequences of reliance on simple tools."
Are you a little tired of reading articles about the stimulus act that just talk about employment figures? We think there's a lot of interesting information out there about the way the act is actually influencing performance. We're just starting to publish a blog, sponsored by the IBM Center for the Business of Government, that will go into a variety of stimulus-related topics. Ordinarily, we only mention sites that we think are really worth your reading. We hope that's the case here. But we are transparently biased.
One of our inspirations for the blog has been Stan Czerwinski, one of the GAO's leading experts about the act. The Recovery Act has multiple dimensions, he told us, "yet it's always about jobs, jobs, jobs. And jobs aren't what it's really about in a lot of cases. ... There isn't a lot of what we'd call 'outcome measurement' happening yet. In some respects that's interesting, and in other respects it's frustrating."
Fraud, waste and abuse. This troublesome troika comes up in nearly every money-saving plan states or cities adopt. Often, we think, very little comes out of the recommendations to eliminate any or all of them. But sometimes, there's good news to report. Consider some information from the federal Department of Health and Human Services. Apparently, states are using HHS dollars to pursue Medicaid fraud -- to dramatic effect. Number one on the list is Missouri. That state's Medicaid Fraud Unit has turned every dollar in fraud-recovery grant money into some $18.81 in savings. Also at the top of the list are North Carolina, Tennessee, West Virginia and Ohio. For the full list, we refer you to this news release from Missouri's Attorney General.
As regular readers of the B&G Report know, we've spent an alarming portion of our lives thinking about ways to fairly and accurately evaluate state and local government activities. As a result, we may be unusually frustrated by individuals and organizations who do so without sufficient care. It just muddies the field for all of us. We mention this thanks to a well-written post on the Cleveland-based Brewed Fresh Daily blog. There, Rob Pitingolo takes a look at a Forbes.com's recent ranking of America's Worst Winter Weather Cities.
He's got a variety of complaints, but here was the one that really struck us: According to Pitingolo, the ranking uses "year-round average temperature and the year-round average precipitation to draw normative conclusions about winter weather. This essentially means that any city with blisteringly hot summers is off-the-hook, regardless of what their winters are like, because the summer temperatures will skew the average. But it also means that cities with big variations in temperature benefit as well.
"Consider that the average high January temperature in Minneapolis is a frigid 22 degrees Fahrenheit. In contrast, Cleveland averages 33 degrees in January -- a significant 11 degree gap. But the average July temperature in Minneapolis is 83 degrees, versus only 81 degrees in Cleveland. When you average the numbers together, Minneapolis doesn't look quite nearly as bad as it should."
There is often no better way to find out what's going on in the world than by doing an actual survey of the people involved in whatever you're trying to measure. But it repeatedly becomes clear that there are huge hazards to using this type of data. Here's a perfect example, from research done by the University of Chicago and Arizona State University.
Apparently, when you ask people about their physical activity levels, 36 percent of white people say they meet the national health goals for physical activity, compared to 25 percent of blacks and Mexican-Americans. But when you actually monitor that physical activity, the percent of white people who meet the standard is really just 20 percent. What's more, on-the-scene monitoring of physical activity shows that some 27 percent of Mexican-Americans are meeting the standard -- even more than the survey indicated.
States and cities aren't new to the idea of taxing things that people are supposed to stop using. Cigarettes and liquor are big ones. Soda seems to be on the hit list, too. Now we see that Washington D.C. is the first community to levy a nickel-a-bag tax on plastic or paper bags in grocery stores. The idea is to cut down on the number of disposable bags scarring the landscape. Though the Washington Post reports that there's been a fair amount of pushback to the five-cent levy, grocers report they're going through about half as many bags as they used to.
But here's our question: Don't cities and states get used to the flow of new revenues? And if so, haven't they been effectively designing a series of internally-self-destructive tax streams? Just asking.
"User fees have always seemed like a sensible idea to us -- when they're utilized sensibly." Sound familiar? That's because you read it here in October. We went on to say, "We've been troubled by issues of fairness in states that charge fees to people when they file a lawsuit." The item referred to a court case filed in Oklahoma that alleged that such fees were unconstitutional.
So, here's the update on the case, from the Associated Press:
The Oklahoma Supreme Court Tuesday struck down three civil court filing fees state residents pay when they file lawsuits, ruling the fees are unconstitutional because they support non-court related activities.
In a 6-2 decision, the state's highest court ruled the fees helped pay for social welfare programs operated by the government's executive branch and that it was improper for the Legislature to require court clerks to collect them.
"The courts may not be a tax collector for the executive branch of government," the 21-page decision states.
Coming your way: We were thrilled at the number of responses we got to our request for examples of good civics education around the nation. Interestingly, several of you pointed to out-of-classroom programs that help young people get involved in local government in a hands-on way. In two weeks, thanks to the efforts of the ever-diligent Heather Kerrigan of Governing, we'll bring you a short laundry list of some of the programs we've heard about.
We promised to write another item on the technology gap between public and private sectors, based on responses to our query about that topic a few weeks back. Well, upon reviewing the information we got, it became clear that there is absolutely no consensus, no clear tale to tell. Doubtless this is because there is such enormous variation in the capacity of different cities, counties and states. So in lieu of that, here are some excerpts from a management analyst in a Pennsylvania county government who was particularly negative. Our hopes are that these excerpts will either make you feel good about your government, or at least feel like you have company out there:
The firewall prevents many important e-mails from reaching me. As a 'workaround' I was given access to my personal Yahoo account. Unfortunately, if there is an attachment, I cannot forward the Yahoo e-mails from work. Furthermore, this 'workaround' is not a solution if someone who has my business card tries to reach me via e-mail. Only if I am expecting an e-mail can I inform the sender to use my personal account.
I missed numerous meetings because the sender used an e-mail marketing tool to send out meeting notices that would not penetrate the firewall. Ironically this issue has since been resolved -- shortly after I informed the executive director of the organization why I had been missing meetings.
Although my work has been "e-volving," my technical abilities have not. Many of my duties now require me to use web-based applications. I have numerous problems from data not being stored to freezing to being knocked out of the system completely. A technician for one of the web-based applications found that my work computer is slower than dial-up. This issue has yet to be resolved.
We are supposedly "connected" to many of our offsite locations. As a result of our ongoing problems, the offsite employees have totally given up on e-mail, and even their fax machines are unreliable. This most definitely affects customer service.
I could go on and on, but I've got to make the most of my Internet time. I'm told my computer freezes up because by 11:00 the traffic volume is too great to handle.