Archive for the ‘Health Care Reform’ Category

Business of Government Blog Index

May 10, 2010

The Business of Government Blog has moved to a new address, as of May 10.  Please visit us in our new location at:  http://www.businessofgovernment.org/blogs/the-business-of-government

Please re-set your RSS feed to the new blog site address, as well. . . .

Following is an index of blog entries between the start, September 1, 2009, and the end of April 2010, organized around some major themes:

Web 2.0 and Social Media

Launching the BizGov Blog (09-01-09)

Blogs as Public Policy Forums (09-02-09)

Cloud Forecasting: A New Report (11-12-09)

Social Media Trends for Government in 2010 (11-25-09)

Gov/Web 2.0 Predictions for 2010 (01-06-10)

Virtual USA and Web 2.0 (03-19-10)

Middle Managers in a Web 2.0 World (03-31-10)

Using GIS to Increase Citizen Engagement (04-16-10)

Open and Transparent Government

What Do You Do With 110,000 Data Sets? (09-04-09)

New Transparency: Recovery.Gov (09-30-09)

Open Government: Implementation Guidance from OMB (12-09-09)

Implementing the Open Government Directive (12-15-09)

The Open Government Dialogue (Agencies launch 5-week effort) (02-09-10)

Making Sense of Open Gov Dialogues (02-10-10)

Virtual USA and Web 2.0 (03-19-10)

Congressional Transparency Caucus Formed (03-25-10)

Open Gov Plans Countdown (04-02-10)

Open Gov Plans Released, And . . . (04-09-10)

Scorecarding Agency Open Gov Plans (04-27-10)

HUD’s Open Gov Plan Focuses on Mission (05-05-10)

Collaboration

Using Czars to Govern (09-11-09)

Creating Spirit Communities (09-30-09) (based on book by Rosabeth Kantor)

The OMB Prize Memo (03-09-10)

Harnessing Informal Networks (03-10-10)

Virtual USA and Web 2.0 (03-19-10)

Passionate About Collaboration (04-23-10)

Citizen Participation

Blogs as Public Policy Forums (09-02-09)

Citizen Participation: An Update (09-15-09)

Using Crowdsourcing in Government (09-16-09)

Engaging Citizens in Oversight (09-22-09)

Citizen Engagement Newsletter by GSA (10-01-09)

On-Line Town Halls (10-26-09) Congressional Management Foundation Study

Citizen Participation: Other Countries Are Stepping Out (12-07-09)  UK and Australian Initiatives

Redefining the Role of Citizen in a Gov 2.0 World (02-04-10)

Using GIS to Increase Citizen Engagement (04-16-10)

Congress and Citizen Engagement (04-22-10)

Government Performance

The New Obama Performance Team (09-25-09)

Jump-Starting Performance Management (09-28-09) (Senator Carper Hearing)

Priorities and Principles for Performance (10-06-09) (OMB’s Zients Debute)

New Senate Task Force on Performance (10-23-09)

OMB’s New Performance Principles (10-29-09) (Zients’ Senate Budget Testimony)

More on the Senate Performance Hearing (10-30-09)

Data-Driven Performance: Senate Budget Hearing (12-11-09)

Happy Birthday GPRA! (12-16-09) by Jonathan Breul

Performance Reporting: Rhetoric vs. Reality (12-18-09) by Jonathan Breul

Using Performance Measures (12-22-09)

Managing Performance: A Series (12-23-09)

Model 1:  Performance Administration (12-24-09)

Model 2:  Siloed Performance Systems (12-28-09)

Model 3:  Performance Management Framework (12-29-09)

Model 4:  Performance Governance (12-30-09)

Obama’s FY 2011 Management Initiatives (02-02-10)

Obama’s Stealth Management Revolution (02-11-10)

The OMB Prize Memo (03-09-10)

Key National Indicators Are Now Real (03-23-10)

IRMCO 2010 (04-12-10) by Jonathan Breul (conference panel examining Obama Administration management initiatives)

Workforce and Employee Engagement

Federal  Jobs:  A New Era (09-03-09)

Recognizing Civil Servants (09-18-09)

Ask Employees How to Fix It, Part I (09-17-09)

ISO Good Ideas:  Ask Employees, Part II (09-23-09)

Governing by Suggestion Box (10-20-09)

Dealing with Poor Performers (10-16-09)

Motivating Workers (01-04-10)

Chances to Innovate (01-08-10)

Managing Guerrilla Employees (02-12-10)

Balancing Innovation, Risk, and Control (03-03-10)

How Leaders Make a Difference (03-04-10)

Middle Managers in a Web 2.0 World (03-31-10)

Mocking Public Service (04-29-10)

Labor-Management Forums and Performance (05-04-10)

Health Care Reform

Health Care Reform Implementation (Part 1)  (11-30-09)

Health Care Reform Implementation (Part 2) (12-03-09)

Doing Big Things in Government (12-01-09)

Sustaining Health Care Reform (12-02-09)

But will it work? (03-29-10) by Jonathan Breul

Implementing Health Care Reform (04-26-10)

Recovery Act

Engaging Citizens in Oversight (09-22-09)

New Transparency: Recovery.Gov (09-30-09)

Recovery Act: Shifting Mindsets (11-06-09)

Recovery Act Reporting (02-15-10)

Research Topic 2: Implementing the Recovery Act (02-24-10)

Implementing the Recovery Act: The Blog (03-17-10)

Contract Reform

The Insourcer’s Apprentice: OMB’s Jeff Liebman (10-8-09)

Out- and In-Sourcing: True Confessions (11-11-09)

Bottom-Up Procurement Reform (10-13-09)

OMB: Trying a Change in Tone to Collaborating with Agencies (10-22-09)

Acquisition 2.0:  OMB’s Latest Acquisition Guidance (10-28-09)

Signs of Procurement Revolution (11-24-09)

Obama Procurement Agenda (03-12-10)

Program Evaluation and Use of Analytics

New OMB Program Evaluation Guidance (10-07-09)

Davenport:  Make Better Decisions (10-27-09)

Risky Business:  What is Enterprise Risk Management? (10-15-09)

Financial Management

Fiscal Sanity: Lessons from Around the World (12-08-09) by Jonathan Breul

FY 2009 Financial and Performance Reports (12-10-09) by Jonathan Breul

Debt Commission in the FY 2011 Budget? (01-04-10) by Jonathan Breul

Fiscal Summit and America’s Fiscal Challenges (05-06-10)

Presidential Transition, the First Year

Link to the IBM Center’s Presidential Transition Blog, 2008-2009

Falling Behind on Appointments (09-24-09)

Searching for a New Comptroller General (12-14-09) by Jonathan Breul

Improving the Presidential Transition (01-12-10) by Michael Keegan

TWOFER (two new reports: Assessment of Presidential Transition and Fiscal Future) (01-14-10) by Jonathan Breul

Leadership Matters (Rajiv Shah, USAID, and Haiti Earthquake) (01-15-10)

Lessons on Reform

Lessons of Reinvention (09-07-09)

Dispatch from Saudi Arabia (11-2-09) an International Conference on Public Administration

Reinventing Saudia Arabia (11-03-09)

Saudi Conference: Lessons for Us (11-05-09)

Recovery Act: Shifting Mindsets (11-06-09)

Calling on Corporate Leaders: Now vs. Then (White House CEO Forum on Modernizing Government) (01-19-10)

Finding Bright Spots (01-25-10)

Doing What Works (a new initiative by the Center for American Progress) (02-18-10)

Why Execution Stalls (03-08-10)

Modernizing Government: Forum Results (03-24-10)

Australian Management Reform (04-06-10)

White House Management Advisory Board (04-21-10)

Agency Transformation

HUD Transformation Initiative (01-12-10)

HUD’s Open Gov Plan Focuses on Mission (05-05-10)

Veterans Affairs: “Transformation 21″ and Beyond (01-21-10)

Public Management Research

Framing a Public Management Research Agenda (02-22-10)

Topic 1: Performance Improvement and Analysis (02-23-10)

Topic 2: Implementing the Recovery Act (02-24-10)

Topic 3: Federal Contracting and Acquisition (02-25-10)

Topic 4: Technology, Transparency, and Participatory Democracy (02-26-10)

A High Performance Government (04-13-10) Volcker’s new reform campaign

Oversight

Engaging Citizens in Oversight (09-22-09)

Searching for a New Comptroller General (12-14-09) by Jonathan Breul

Final Four to lead the GAO? (03-22-10) by Jonathan Breul

Congressional Transparency Caucus Formed (03-25-10)

5 (not just 4) names to be Comptroller General (03-26-10) by Jonathan Breul

Deperately Seeking a Watchdog (04-05-10) by Jonathan Breul

Conversations with Leaders and The Business of Government Magazine

The Business of Government Magazine: Fall 2009 (12-09-09) by Michael Keegan

Conversation on Human Service Delivery in New York City (02-05-10) by Michael Keegan

Allen, Thad (12-11-09)  by Michael Keegan

Childs, Robert (12-29-09) by Michael Keegan

Clancy, Carolyn (02-01-10) by Michael Keegan

Fauci, Anthony (12-10-09) by Michael Keegan

Fugate, Craig (02-17-10) by Michael Keegan

Hunter, Christine (01-08-10) by Michael Keegan

Thompson, Alan (01-06-10) by Michael Keegan

Triay, Ines (01-23-10) by Michael Keegan

Implementing Health Care Reform

April 26, 2010

Implementing the Recovery Act has been a major challenge.  But it pales in comparison to the complexity facing those implementing the health care reform bill.  Office of Personnel Management director John Berry says implementing this new law will be equivalent to being “the moon shot of our generation.”  Last week, Senator Mark Warner reinforced Berry’s observation, calling it “the mother of all implementation challenges.”

The Obama Administration is gearing up to meet the many deadlines in the bill.  In fact, it’s created a separate website to provide information on this: HealthReform.Gov.

However, there is also a major public management challenge involved as well.  As a result, the IBM Center is sponsoring a separate, new blog (with an optimistic title) – Implementing Health Care Reform — to provide insights into the implementation of this effort.  It is being co-authored by Professor Don Kettl, one of the preeminent academics in the field of public administration, and dean of the University of Maryland’s School of Public Policy; and Jack Meyer, who holds a joint appointment in both the School of Public Policy and the School of Public Health at the University of Maryland.

Be sure to visit the site, and book mark it!

But will it work?

March 29, 2010

The Congress has passed and the President has signed the new health care reform legislation.  But, will it work?

This is the question that The Brookings Institution’s R. Kent Weaver raises in a new Issue Brief:  “But Will It Work?: Implementation Analysis to Improve Government Performance.”  According to Weaver, even though many implementation problems occur repeatedly across programs and can be predicted in advance, legislators often pay little attention to them when programs are being enacted or overhauled.    Weaver’s solution is to have the Government Accountability Office (GAO) perform implementation analysis for major legislative proposals in Congress, much like the Congressional Budget Office does with budget scoring.

Weaver’s Issues in Governance Studies Issue Brief outlines major elements of  Implementation Analysis and argues that it could lead to major improvements in policy performance.   He identifies a number of problems that are likely to be highlighted by Implementation Analysis:

-  Interpretation  (i.e., leaving legislation open to later interpretation)

-  Organizational mission issues (potential conflicts between established organizational missions and new tasks)

-  Organizational and coordination issues (where cooperation of several organizations will be needed)

-  Resource and organizational capacity constraints (a realistic assessment of financial, workforce and technology resources)

-  Time lines (underestimating organizational and resource challenges involved in policy change)

-  Political interference (mechanisms to insulate decisions from inappropriate interference)

-  Program operator issues (problematic  behavior of front-line workers)

-  Target compliance issues (the “targets” of government policies may fail to behave in ways that were anticipated)

Kent Weaver concludes his very thoughtful set of recommendations with sensible modesty, acknowledging that “Implementation Analysis is certainly no panacea to avoid government problems.”   He concludes, however, that “Implementation Analysis offers a potentially powerful new tool to ensure that governments make informed decisions and that government policies live up to their promise.”

Key National Indicators Are Now Real

March 23, 2010

Almost three years ago, I blogged on the need for a Key National Indicator System so we, as a nation, could track our progress using data, not diatribe.  It’s happened.  A provision buried on page 1,489 of the health insurance reform bill makes it real!

The legislation creates a bipartisan commission to oversee the development and implementation of a Key National Indicator System by the National Academies of Science. Congress has 30 days to appoint the 8 members of the commission.

The National Academies can partner with an independent non-profit entity – such as the State of the USA – or it can develop the Indicator System itself.  The project is appropriated $70 million, through fiscal year 2018, to develop and maintain the Indicator System.

This effort was launched in 2003 by then-comptroller general David Walker when he headed the Government Accountability Office.  He, and others, hope that providing an independent, non-partisan, non-governmental source of information about how well our country is doing will help provide a factual basis for policy decisions, and hopefully moderate ideological approaches to deciding on nation’s future.  As GAO puts it: “A well-informed nation is an essential component of a healthy democracy.”

More importantly for the performance world, it could also serve as a solid foundation for creating a more results-oriented approach to governing!

Doing What Works

February 18, 2010

The Obama Administration’s favorite think tank, the Center for American Progress (CAP), has launched a new project, Doing What Works.” Led by Reece Rushing and Jitinder Kohli, it has three objectives:

  • Eliminating or redesigning misguided spending programs and tax expenditures focused o priority areas such as health care, energy, and education;
  • Boosting government productivity by streamlining management and strengthening operations in the areas of human resources, information technology, and procurement; and
  • Building a foundation for smarter decision making by enhancing transparency, performance measurement, and evaluation.

At their kick-off event, they released a pair of reports:

Doing What Works: Building a Government That Delivers Greater Value and Results to the American People,” which lays out some specific steps the project will take:

  • Challenge the status quo.  Highlight misguided spending priorities and tax expenditures that should be eliminated or reformed, with particular attention to CAP priorities:  health care, energy, and education.
  • Measure what works.  Showcase examples of what a stronger measurement and evaluation system might look like to guide policy and management choices.
  • Experiment and innovate.  Test different approaches to improving results and apply lessons to other programs and agencies.
  • Coordinate and consolidate.  Identify federal programs that perform similar functions or serve the same people, and find ways that they could be better coordinated or consolidated.
  • Enlist the public.  Thousands of extra eyes can be employed to spot problems, offer solutions, and bring fresh perspectives. 
  • Be ready to execute.  Identify best practices to improve basic government systems, such as  information technology investments, contracting procedures, and the hiring process.

The report notes that such efforts are necessary because “a serious discussion of fiscal choices will only be possible if there is greater confidence that scare public resources will be wisely spent.”

The second report, “Golden Goals for Government Performance” offers five case studies on how to establish goals to achieve results.  The five case studies – the state of Victoria (Australia), Virginia, Scotland, the state of Washington, and the United Kingdom – each created an institutional focus on achieving broad societal outcomes.  Their experiences offer a possible path for the federal governmental performance model:

  • Define clear “outcome” goals at the highest level feasible.
  • Focus on the handful of goals that can only be achieved through collaboration across agencies.
  • Make sure public servants and the public are clear about what the goals are, and who in government is responsible for delivering them.
  • Build strategies to achieve these goals.
  • Evaluation agency programs on the basis of the contributions they make toward these goals.
  • Make the data on progress toward these goals transparent to the public.
  • Make the effort a joint one between the executive and legislative branches.

The case studies are both inspiring and revealing.  The report is worth reading.

Leaders Speak – A Conversation on Human Service Delivery in New York City

February 5, 2010

We are introducing a Special Edition of The Business of Government Hour — Leaders Speak —     focusing on human service delivery: the challenges being faced and innovations being forged in our local communities.

Today state and local governments are under tremendous pressure to do more with less. Nowhere is this more evident than in the delivery of human services – that social safety net bringing to those most in need, a leg up, well-being, and ultimately self sufficiency.  As we continue to engage government executives who are changing the way government does business, we explore human service delivery in the City of New York with three key city agency executives.

What about New York City’s ambitious plan to eliminate homelessness?  How are New York City social services agencies managing to do more with less? How is technology making human service delivery more efficient, effective, and citizen-centric? AND, what can federal agencies learn from these local efforts.

Today, our guests — Robert Hess, Commissioner, New York City Homeless Services, Kamal Bherwani, Executive Director, NYC’s HHS-Connect, and Robert Doar, Commissioner of the New York City Human Resources Administration — offer their extended reflections on such questions.

You may hear directly from our guests by clinking on the links embedded in this post.

All across America, small towns and large cities are facing the social realities of homelessness, and the steady increase in demand for homeless services.  While providing shelter and services to those in need is critical, the national conversation is shifting from managing to ending homelessness, especially chronic homelessness. New York City has embraced such a goal, and has begun to reshape and expand its services to prevent homelessness in a more comprehensive and coordinated way than ever before.  From a system that did little more than provide cots and meals to single adults and families, it is now recognized nationally and internationally for providing quality shelter and related services in humane settings, with a client-centered philosophy.

“The Department of Homeless Services in New York was created in the early ’90s.  Before that, we were part of the Human Resources Administration in the city,” explains Robert Hess, Commissioner, New York City Department of Homeless Services. The mission is to support individuals and families that are experiencing homelessness and to help them move back into the community.

Here’s Robert Hess, Commissioner of the New York City Department of Homeless Services on the: Challenges facing the NYC Department of Homeless Services

New York City Mayor Michael Bloomberg issued a five-year plan to end chronic homelessness.  There’s no one size fits all approach to this issue and Commissioner Hess underscores the importance of finding strategies that work – and learning from doing: New York City’s five-year plan to end chronic homelessness

The New York City Human Resources Administration is the largest department of social services in the city of New York.  According to Robert Doar, Commissioner of HRA, “we have the biggest collection of programs and the largest groups of New Yorkers who we serve. We have the Medicaid program.  We provide health insurance to more than 2.5 million New York City residents.  We have the food stamp program.  We provide food assistance or benefits to help people purchase food for about 1.6 million New York City residents.  And we have the cash welfare program, which is a much smaller program, which we serve about 350,000 New Yorkers. We haveother programs in the area of social services: domestic violence, adult protective services.  Our principal role is to provide a safety net and a support for people who are particularly vulnerable or are struggling — help people get into employment.”

Commissioner Doar identifies three key challenges facing his agency and how he’s meeting these challenges: Challenges facing the New York City HRA

With the dramatic fall in city revenue and even more troubling revenue picture at the state level, they’ve required a series of spending reductions for all programs.  Commissioner Doar tells us how he’s doing more with less and meeting reduction targets: approaches to “doing more with less” in human services delivery

Local and state governments are under tremendous pressure to do more for citizens and to do it better. Technology has enabled governments to do just that and nowhere is this more evident than in the delivery of human services.  To meet such ends government Chief Information Officer’s have found it necessary to identify and implement technologies that make operations more responsive to the needs and expectations of its citizens. Over the last several years the city of New York has made a concerted effort to implement technologies design to make it more accessible, transparent, and accountable.

Kamal Bherwani, former chief information officer for New York City’s Health and Human Services and former executive director of HHS-Connect describes the city’s HHS-Connect initiative and the strategic vision that frames it: vision & principles behind NYC’s HHS-Connect

This post introduces three dedicated public servants delivering social and human services in one of the largest city’s in the world. You can access the complete program and hear the entire conversation at Leaders Speak – Human Service Delivery in New York City

Redefining the Role of Citizen in a Gov 2.0 World

February 4, 2010

What does it mean to be a citizen in a Gov 2.0 world?  President Obama’s FY 2011 budget is being dissected for its shift in the size and scope of government.  But several initiatives in the budget, and things happening at the state and local levels, point to subtle — but significant –shifts in the role of citizens in their government.

A prominent role these days is engaging citizens in oversight and accountability.  A CNNTech article by John Sutter, “Cities embrace mobile apps, ‘Gov 2.0’” describes how Craig Newmark, founder of Craigslist, sends an electronic note to San Francisco City Hall via an application called SeeClickFix to report an overheated train car.  Sutter says this gives citizens “more of a say in how their local tax money is spent.”  Cities all over the country are releasing public data to the web and mobile application developers are creating “mash up” applications to make it easy to use.  Some say it “could usher in a new era of grsssroots democracy.”

In DC the DC 311 iPhone app allows users to take photos of graffiti, potholes, etc., and send them to a city database that catalogs work requests.  The photos are linked to a GPS location so officials can see the problem, and other citizens can, as well.  Other examples of “citizen posses” include the “Coalition for an Accountable Recovery” which tracks the implementation of the Recovery Act.

But these examples do not offer the only vision of how citizens’ roles have changed.  After all, we can’t become a nation of fault finders.  There has to be a more positive view of the role of citizens than just conducting oversight.  Although, the Obama Administration encouraged this new role when it put in place Recovery.Gov, which posts all the spending of the $787 billion stimulus bill.

I can see a series of new or expanded roles for citizens, other than oversight.  These include:

Increased involvement in dialogue. This is where conversations are back and forth, and where both sides learn.  One example is the new on-line town hall format described in a new report by the Congressional Management Foundation.  There, members of Congress are beginning to engage citizens in far more meaningful discussions of issues.  The Obama Open Government initiative is encouraging agencies to use approaches like this.  On February 6th, a wide range of agencies will be simultaneously launching public dialogue efforts, to run over a five-week period, to engage citizens around issues such as transparency and collaboration.  The General Services Administration has already launched its dialogue site to allow people to comment and vote on ideas.

Being better informed about issues.  This is where citizens can gain a broader understanding of the implications and tradeoffs in making big decisions, or even local decisions.  An example of becoming better informed about the larger context is understanding the progress and position of the US, or your community, in areas such as health care, environment, or the economy.  The stateoftheusa.org tries to provide such a perspective.  Another “big picture” forum examines the fiscal future of the country.  At the other end of the spectrum, there are sites that provide information about your neighborhood and encourage interactions and awareness at that level, like Neighbors-for-Neighbors in Boston, EveryBlock.com, or CrimeReports.com.

Providing ideas and solutions.  Sometimes people with different perspectives can solve problems that the experts have a hard time with.  A prominent example is the increased use of “crowdsourcing.’  This is where an organization sends a problem out to a group of people asking for contributions or solutions to a problem. One example is Apps for America, where a nonprofit group sponsored a contest to find the best uses of government-provided information.  The Obama budget for FY 2011 commits to expanding the use of contests and awards for innovations.

Being empowered by information to solving their own problems.  Too often, complexity creates a need for “middle men” such as tax advisors, lobbyists, and attorneys.  Reducing complexity, or providing information more openly or using “plain language” to describe things can make a huge difference.  The Open Data efforts by the Obama Administration are one step in this direction.  Ongoing efforts to create Plain Language in government writing is another.  Streamlining application processes to be more citizen-centered is also another approach, which seems to be a stronger trend in other countries.

Becoming involved in co-delivering public services.  This is more common at local levels, but a high-profile example at the federal level is called “peer-to-patent” where citizens could help determine whether an idea was new and worth being granted a patent.  Another is by helping the elderly complete their tax forms via a volunteer program called VITA.  And another is “citizen responders” in the case of emergencies.  This not only saves money, but involves citizens in a direct way in government.

Becoming engaged in framing public decisions.  In some communities, such as Des Moines, IA, citizens became engaged in measuring the performance of city services and then involved in helping set city budgeting priorities.  Similarly, citizens in Washington, DC, did the same when Tony Williams was mayor, in his citywide Citizen Summits.  At the federal level, several years ago Congress created a Citizens Health Care Working Group to engage citizens in developing recommendations for reforming health care.  Some advocacy groups want opportunities for citizens to actually make decisions, but this step may require some careful thought, especially given experiences such as California’s referenda being driven by special interest groups.  This has resulted in the legislature not being able to make needed trade-offs and the state now faces fiscal challenges that may be difficult to address.

The more traditional roles, of citizen participation via hearings or a spectrum of other forms of engagement, including innovative forums such as President Obama on YouTube answering questions about his new budget, will continue.  But the opportunities to actively engage citizens is still evolving.

If you have other ideas, please feel free to contribute!

Veterans Affairs: “Transformation 21″ and Beyond

January 21, 2010

The Department of Veterans Affairs, like HUD, is undertaking significant transformation efforts with congressional support.  Its initial “Transformation 21” plan was framed around its fiscal year 2010 budget.  Subsequently, more is on the way, but it has not yet been fully released.

Transformation 21. VA secretary Eric Shinseki released his Transformation 21 initiative in early 2009.  These early efforts focused on a series of focused initiatives:

  • Creating a “virtual lifetime electronic record” to ensure uniform registration of all military service members, in conjunction with the Defense Department
  • Accelerating a “telehealth” and home care initiative, primarily for older, chronically ill veterans in order to keep them out of hospitals
  • Eliminating homelessness among veterans
  • Self-service devices so veterans can improve interactions with VA staff, and an integrated “veterans relationship management” system
  • Developing a human capital plan for strategically managing VA’s staff of nearly 300,000

He has had some success, according to an early assessment.

In addition, his is one of the very few agencies that has obtained congressional authority to forward fund at least part of its budget.  Congress gave VA the authority to forward fund its medical services in advance by one year.  This responds to the concerns of veteran advocates, who complained that, because of congressional delays, VA received its budget late in 19 of the last 22 years.  This has disrupted the delivery of health services.

Subsequent Transformation Initiatives. The Transformation 21 effort was only the beginning.  With its feet now on the ground, the new VA leadership team is putting together a farther reaching plan, framed around 13 major initiatives.

VA seems to be mirroring some of the transformation efforts that the Defense Department undertook almost a decade ago (which makes some sense, given that some of the Defense reform executives are now at VA and leading the working groups).  The Defense effort, now called the Business Transformation Agency, started with an inventory of over 5,000 business systems and then led to the integration of a number of major systems – such as acquisition and human resources – across the department.

VA started this approach several years ago with the integration of its technology staff.  It took congressional action to move about 5,000 IT staff from reporting to hospital administrators to reporting to a central IT office and giving the departmental chief information officer decision authority over major IT project spending.   But even with the major restructuring nearly completed, VA has begun re-thinking its IT investment approach.  After the White House IT Scorecard rated a number of VA projects as failing, the CIO created a rigorous process to track all of its ongoing IT projects.  It also is transitioning from a series of disconnected projects to a set of portfolios around major initiatives.  For example, one portfolio is being created around a veteran-centric benefit system, where there will be a “single face” to the veterans.

VA is also undertaking a major overhaul of its procurement system, which has been widely seen as broken.  VA reached out to 210 vendors, asking them how it could do its business better.  It has committed to train all of its 4,900 acquisition personnel in the Federal Acquisition Regulations, in project management, and in leadership skills.  VA is also overhauling its contract vehicles.  For example, it is creating a new contract vehicle for IT solutions, one for purchasing commodities, and another for buying software licenses.  Together, these could save the department millions that could be better spent on services to veterans.

Similar transformation efforts are underway in VA’s personnel office and its financial management system.  However, the greatest emphasis is on mission delivery functions that focus on VA’s recently identified four strategic goals:

  • Improve the quality and accessibility of healthcare, benefits, and memorial services while optimizing value.
  • Increase Veteran client satisfaction with health, education, training, counseling, financial, and burial benefits and services.
  • Raise readiness to provide services and protect people and assets continuously and in time of crisis.
  • Improve internal customer satisfaction with management systems and support services to make VA an employer of choice by investing in human capital.

These were then broken down into a series of 13 “greatest challenges,” such as eliminating homelessness among veterans and eliminating the backlog of pending benefit claims.

The VA leadership is planning on using operational management reviews, dashboards and “temperature checks” along the way to emphasize execution, not just planning.  How is this playing out with Congress?  In fiscal year 2010, VA received a record budget increase.

Model 4: Performance Governance

December 30, 2009

(a continuation from the December 23, 2009  blog on “Managing Performance”)

The fourth “idealistic” performance model described by Bouckaert and Halligan is the “performance governance” model, which offers a prominent role for citizens.  None of the countries covered by the book had such an approach in place at the time it was published in early 2009.  This model was more of a prediction by the authors.  However, subsequent to the publication of their book, three of their case study countries have launched such initiatives:  United Kingdom, Australia, and the United States

This model differs from the “performance framework” model in that the framework model focuses on government while the “performance governance” model focuses on a broader policy ecosystem to include citizens, non-profits, and the private sector as well.

In this model, multiple interdependent actors contribute to the delivery of public services.

British business author, Stephan Osborne, describes “new public governance” as a “plural state where multiple inter-dependent actors contribute to the delivery of public services and a pluralist state where multiple processes inform the policy making system.”

Bouckaert and Halligan say there are several strands of performance governance:

  • The broad and diverse movement to embrace “joined up government, horizontal management, whole of government, integrated governance and more generally collaboration and networks.” And . . .
  • “The engagement with the citizen as governance becomes more externally focused and encompasses the movement to engage citizens in performance measurement and re-evaluation of performance in an democracy.” This includes deliberative democracy and stakeholder analysis.

Defining the value added of networks is one key challenge for performance governance.  American academic Robert Agranoff writes that it is possible to measure collaborative performance along four perspectives:  specialists, the participating organizations, the network itself, and the network outcomes.

One way to operationalize the notion of “value added” in networks is to look at it through the lens of a “production of welfare” framework that goes beyond economy, efficiency, and effectiveness to also include equity, participation, advocacy, and innovation.

The performance governance model extends beyond the performance framework model in that it consists of co-governance, co-management, and co-production with the third sector and the public/citizens (and possibly adds the elements of co-design, co-decisions, co-implementation, and co-evaluation as described in the framework model).

Interestingly, the performance governance model is reflected in an institutional mechanism gaining popularity in the U.S. called “national strategies.”  This approach began as a congressional requirement for national defense in the late 1990s and was used more widely in the homeland security arena under President Bush.  It was also used in several domestic arenas, such as the 2005 National Strategy for Pandemic Influenza.  However, it is also being promoted again by Congress as part of the pending healthcare reform legislation, which requires the development of a national strategy for quality improvement in healthcare.

The Business of Government Magazine – The NEW Fall/Winter 2009 Edition

December 9, 2009

The Center is pleased to announce the publication of its Fall/Winter 2009 issue of The Business of Government magazine. This issue focuses on a range of public management issues facing us today. Whether it’s the federal government’s response to the recent financial crisis, the H1N1 flu, or its movement towards greater transparency and accountability, we’ve gathered thoughtful perspectives from some of the leading practitioners and academics in the field.

Conversations with Leaders — We feature conversations with dedicated public servant leaders, from a wide variety of disciplines, who share their extended reflections on the work they do and the service they perform. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) spoke with us about the organization he has led for over 25 years and life-saving work it champions. Admiral Thad Allen, commandant of the U.S. Coast Guard, tells us how he has successfully used social media tools such as his iCommandant blog and other Web 2.0 strategies to improve operations, collaborate, and connect effectively. Making connections has been central to Dr. Bob Childs’ efforts in building the Information Resources Management (IRM) College into what he calls a global hub for educating, informing, and connecting information age leaders.

Profiles in Leadership  — Over the last several months, we interviewed on The Business of Government Hour many government leaders who are changing the way government does business. Our profiles in leadership highlight government executives exploring such issues as the use of comparative effectiveness research in healthcare, DoD TRICARE’s emphasis on prevention and disease management, challenges leading a global supply chain, managing and reporting on the $700 billion Trouble Asset Recovery Program (TARP) and using Recovery Act funds to accelerate the largest environmental cleanup in the world.  Check out profiles of:

It is said that transparency promotes accountability. This theme has become a central focus of the current administration. Our Forum: Toward Greater Transparency and Accountability in Government explores the movement toward greater transparency and accountability in government. From a variety of perspectives, each article outlines how this movement will provide both opportunities and challenges to government executives.

And don’t miss this issue’s Viewpoints on security issues surrounding the recent presidential transition, leadership comparisons of the last three NASA Administrators, and ways to collaborate more effectively cross-boundaries using Web 2.0 technologies by authors Martha Kumar, Professor Harry Lambright, and John Kamensky, respectively.

With each edition, we try to fuse the practical with the reflective—bringing together insights from government executives leading major government programs and thought leaders studying ways to improve how government works. It’s about connecting research to practice. We do this in a variety of ways and this magazine plays a central role. Let us know what you think, contact me at michael.j.keegan@us.ibm.com.  Look forward to hearing from you.


Follow

Get every new post delivered to your Inbox.