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Birth, Death and Everything in Between: the Need for Seamless Government

When it comes to major life events, agency boundaries never line up with the challenges people face. There’s a federal push to get at the problem, and state and local governments should be part of the solution.

A Mayfield, Ky., home destroyed by the recent tornado.
(Alan Greenblatt/Governing)
Michael was a 65-year-old Texan living in a public housing unit until a fierce hurricane struck his town in 2017. He evacuated to a shelter, a wise move because when the clouds cleared he discovered his home was unlivable.

That was just the first disaster. The second was his struggle with a system trying to help him. Amid the tremendous challenges he faced, he forgot to renew his Supplemental Nutrition Assistance Program (SNAP) and Medicaid benefits, so he found himself not only without a home but also without nutrition assistance and health care. “I was so out of it — there were just too many things to keep track of,” he explained.

Like other major life events — including getting married, having a baby, losing a job, suffering a major illness and burying a parent — natural disasters bring deep stress, intense engagement with government and huge problems in navigating the system because of the tangled web of federal, state, local and nonprofit services. Michael didn’t know that the Red Cross could have helped him get temporary housing at a nearby hotel. He did eventually link up with a Red Cross case manager who helped him rewire his food and health benefits. Later on, the local public housing authority got him a new apartment nearby. But navigating the system proved a huge challenge.

In addition to the Red Cross and the housing authority, the effort to help Michael involved the Federal Emergency Management Agency (FEMA), the U.S. Department of Agriculture, the federal Centers for Medicare and Medicaid Services, the Texas health department, and the U.S. Department of Housing and Urban Development, among other players. That would be a staggering group of connections for anyone to manage in normal times, but all the worse in the middle of such a life-shattering event.

The problem, a nonprofit manager explained, is that “it isn’t anyone’s job to make sure the disaster survivor accesses the greatest amount of resources available. It’s on the survivor to navigate the system and they usually don’t know how.” At least 20 different agencies, at all levels of government, are typically involved in providing disaster assistance, and this doesn’t count nonprofit organizations like the Red Cross and neighborhood churches. It’s little wonder that Niki, a Florida disaster survivor, complained, “any information I needed I had to go out and find myself.”

In its new management vision, the Biden administration pledges to connect the dots far more effectively by organizing government’s services more around major life events. “Imagine,” the initiative’s vision document asks, “if the U.S. government understood each of its services through the eyes of our customers. How might Federal agencies change their approach or better work together?” The document reports on research efforts “to understand how customers navigate across multiple Federal agencies and even levels of government” — an acknowledgment that state and local governments will need to be part of any solution.

Managing from the Outside In

It’s not so much that government is blind to people’s needs. It’s that government agencies tend to focus on managing programs from the inside out, rather than connecting with citizens from the outside in. Agency boundaries never line up with the problems people face, and people struggle to find the help they need when they need it.

And it’s not just a problem on the dark side of people’s lives. We have friends whose trip to the hospital to deliver a baby came hours before New Year’s, so the blessed event provided a whole year of tax breaks for the family. But making that happen required a lot of paperwork. There’s the birth certificate, which the baby will need throughout life to get a passport, enroll in schools, obtain a driver’s license and apply for government benefits. Getting the tax break also requires a birth certificate to obtain a Social Security number. That means connecting the county health department as well as the Social Security Administration, even as parents are coping with diapers and 2 a.m. feedings.

Other countries have established life-event programs to crack this problem. New Zealand, for example, developed an award-winning website for expectant parents called “SmartStart,” which helps families navigate not only the services that are available to them but also everything from “trying for a baby” to “preparing for pregnancy” to “how to get fertility treatment.”

New Zealanders don’t need to know which government agency provides help on any of these issues — or even whether help might come from the government, a nonprofit or a private company. They can simply dive into a problem and follow the links to whichever source can best provide help. When help comes through government programs, the website has links that take customers directly to an online application for benefits.

The Importance of User-Centered Design

Other governments, ranging from Australia to Slovakia, also have created thoughtful life-events programs. The basic strategy is simple: Organize the system from the point of view of customers and the problems they’re trying to solve, and then use information technology on the back end to connect them to the organizations that can help, whichever they might be. People can lay out the what of the problem; IT can link to the who of the solution.

That’s what Biden’s management agenda is trying to do for the federal government, as a key to providing better services to customers. An important step in the strategy is identifying the 33 “high impact service providers” that have the biggest roles to play for customers. Interconnecting them to customers’ needs is a big first step in helping people navigate life events.

What we need is a truly seamless system, from the customer’s perspective, one that doesn’t require superhuman navigating skills. To make that work, state and local governments will need to be part of the network, and they’ll need to invest as well in user-centered design, including charts of the “customer journey” to map the steps — and voices — of customers and the pain points they face along the way. Starting with the customer, and walking in the customer’s shoes, can help chart a far more effective strategy for a world where no single agency — state, local, federal or nonprofit — is fully in charge of solving any problem.

If government is going to help people like Michael and Niki and rebuild trust in the public sector’s ability to perform, the life-events strategy offers enormous opportunity. Otherwise, people will have little confidence in a government that they connect with when they need help most. But that’s going to require a fresh way of looking at government management that sees the customer, not the program, as the basic building block.

Governing's opinion columns reflect the views of their authors and not necessarily those of Governing's editors or management.
Donald F. Kettl is professor emeritus and former dean of the University of Maryland School of Public Policy. He is the co-author with William D. Eggers of Bridgebuilders: How Government Can Transcend Boundaries to Solve Big Problems.
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