Hospital Errors, Public/Private Partnerships and Flexibility on Vacation Time

Plus: Performance evaluations, the challenge of cell phones and government, and more management news.
September 9, 2010 AT 3:00 AM
Barrett and Greene
By Katherine Barrett & Richard Greene  |  Columnists
Government management experts. Their website is

Transparency can be scary when it appears to increase the risk of litigation. That's one of the reasons the hospital community has been more than a little nervous about full disclosure of medical errors. We've seen this at work, for example, in the opposition to some states' moves to require publicly available data for hospital acquired infections.

It may be that some of those fears are unfounded, based on the results of a University of Michigan study. Nearly a decade ago, the University of Michigan Health System began requiring full disclosure of medical errors and offered quick compensation when they were detected. When researchers looked at the history — both before and after the requirement was put in place — they found decreases in new legal claims, in the time it takes to resolve claims and in total liability costs, according to a university release.

"This supports the possibility that patients may be less likely to file lawsuits when given prompt transparency and an offer of compensation," said one of the study's authors.

We have to admit that we're not regular readers of the Hindu Business Line. But our search for interesting tidbits for the B&G Report takes us far and wide, and we lit on an item we thought would be of real interest. The piece focuses on an attitude in India that public/private partnerships (PPPs) are a panacea to all that ails government. Sound familiar? It goes on to say almost exactly the same thing we've been saying in our writings about PPPs in this country: "It's not axiomatic that Government ownership causes inefficiency. Public sector managers are as competent as those in private sector. In fact, one's guess is it's more."

The article also argues that private-sector partners require a solid profit margin, while the government doesn't. We personally think there are instances in which PPPs can be valuable tools for government. But we are fascinated by the fact that the critiques of PPPs in this country are being heard all around the world.

Questions of control versus flexibility are always tricky. Based on a piece in the Columbus Post Dispatch, it appears that Ohio officials may have erred on the side of too-tight controls recently. According to the article, "State officials have scoured the files of thousands of former employees to find that more than 750 owe money — mere pennies in some cases — for more than exhausting their allotment of personal leave."

The state found an average debt of $233 per employee. We don't know whether that's sufficient to pay the state back for any costs associated with the enterprise, but apparently there were instances in which the state sent computer-generated letters to people who owed as little as 13 cents — far less, of course, than the price of the stamp on the letter. "The former head of the Bureau of Motor Vehicles was warned that if he didn't cough up 96 cents, state debt collectors would come after him." We're pretty sure that between postage and processing fees, the state will take a loss in getting those 96 cents back.

We understand that it's difficult to draw a line and say who should and shouldn't reimburse the state. The highest debt was $2,849 — well worth pursuing. But we do know that it makes sense to figure out a way to draw that line, or risk antagonizing former employees and potentially even losing money.

Performance evaluations can really upset people when they appear to emanate from a desire to prove that something isn't working. This common-sense idea was driven home to us a couple of weeks ago during a dinner with a close friend. We need to be a little oblique here to protect our friend — let's call her Sally — but the point doesn't require great specificity.

Sally works for a government-funded program that delivers a very popular service. In the past, the measures used to determine success or failure were far from adequate. But then a number of government leaders became eager to de-fund the program. So they instituted a further-reaching system of evaluations, not necessarily to figure out how to make the program work optimally, but to prove that it was ineffective. In the end, the agency wasn't de-funded. But people in the agency learned a negative lesson: Performance evaluations are a "gotcha" exercise, used by people who have a bias.

Of course, we don't think this is generally — or even frequently — true. But we do think that every time it happens, it sets the performance-measurement movement back a step.

A quote to share from Calvin Coolidge: "No man ever listened himself out of a job."

Cell phones may be making it increasingly difficult for cities, counties and states to get a real understanding of their citizens — particularly those in lower-income groups. You'll recall a great deal of discussion about the potential for inaccurate polling in the last presidential election, thanks to the fact that cell phone users are harder to reach than people who still rely on land lines.

The same phenomenon appears to exist with government agencies eager to follow up with their clients. Between phone numbers that have been altered, accounts that have been canceled and individuals who don't want to pick up on a call from an unrecognized number, this portion of the population is getting harder to reach. The problem is amplified by the likelihood that men and women in lower-income groups are more inclined to rely on cell phones.

Our thanks to contributors to the American Evaluation Association Discussion List (EVALTALK) for making us better aware of this issue.

"Data-informed vs. Data-driven." For a long time we've made it a cause to persuade people to use the word "informed" rather than "driven" in the names of a variety of efforts to heighten performance in the public sector. We've always maintained that the very idea of "performance-driven budgeting" or "performance-based budgeting" sounds far too formulaic and potentially alarms the people who are being driven.

With that in mind, we wanted to share an excerpt from a piece we found in the Washington Post's "The Answer Sheet" blog. It featured an article by Larry Ferlazzo, an English teacher at Luther Burbank High School (LBHS) in Sacramento. He is the author of a popular blog for teachers. Here are some excerpts from the pertinent section:

"Many reformers call for 'data-driven' schools. At LBHS, Principal Ted Appel is a strong believer in being 'data-informed' instead. He understands the value of data but recognizes that schools that are 'data-driven' might make decisions like keeping students who are 'borderline' between algebra and a higher level of math in the algebra classroom so that they do well on the algebra state test instead of being more challenged.

"Or, in English, teachers in data-driven schools might focus a lot of time and energy on teaching a 'strand' that is heavily represented on the state tests — even though that obsessive focus might take away from other instruction that can help the student become a life-long reader...

"In schools that are data-informed, test results are just one more piece of information that can be helpful in determining future directions."

We've also opposed the use of the phrase "best practices" among states, cities and counties. As regular readers know, we've long maintained that calling something a "best practice" makes it sound like it's a one-size-fits-all solution for every other similar government. And we don't believe there are many of these in the real world.

We've just come across one state leader who seems to be asking for something at the opposite end of the spectrum. Virginia Governor Bob McDonnell recently asked a new 24-member panel to "come up with a uniquely Virginia approach to health care improvement and systematic reform."

This leaves us wondering what exactly a "uniquely Virginia approach" would be?

Just for fun. This has nothing to do with management and is inspired entirely by the previous item.

Say "Unique New York," three times, quickly.

Public Civility Corner. Robbie LeFleur, director of Minnesota's Legislative Reference Library, wrote a while back to point us to a piece she wrote for the library's website. We've been meaning to share it with you for some time. But it's a bit longer than our usual items, and cutting wouldn't do it justice, so we've been holding on to it. So, in the school of "better late than never," here it is:

"Last week the Legislature was in gridlocked end-of-session negotiations. One discouraging effect of rancorous debates in the news is that some citizens develop anti-government attitudes, even when they have little actual understanding of the work done by lawmakers and the challenges they face.

"One of those angry people stopped in our library last week. He launched right in to his complaints about the Legislature and the court system.

"He had scant understanding of the legislative process, yet held several stereotypical anti-government views. As I helped him research the changes to a law, his pronouncements were amazing. 'You know they just sneaked that law in,' he told me, even though we were looking at a stand-alone bill. 'They always do that.' I helped him further; we looked at earlier changes to the law. He pointed to some deleted language. 'See that chicken-scratching there? They just scratch out anything they don't like.'

"He wanted to have a law changed, and wanted to know the authors of the previous law. We looked them up. 'Oh him, he's too old. He'd never agree with me. I don't think anyone should be in the government more than six years.'

"I mentioned that it might be difficult to meet with the legislators during this final week of session, and it was past the deadlines for new legislation. 'Can't they just sneak it in?' he insisted.

"When he left he was still angry about his issue, but happy with me and very happy with the Legislative Web Site. He didn't realize so much could be done from home, and that he could do the research himself. I wonder if he realized I am a government employee."