Business of Government Blog Index

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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

Scorecarding Agency Open Gov Plans

The Obama Administration announced today a scorecard of the quality of the plans submitted earlier this month by 29 major agencies.  Using a checklist of 30 criteria, the scorecards show all agencies rating either a “yellow” or a “green” on their scorecards. These plans are being referred to as “version 1.0.”

The three agencies with the best ratings were the Department of Health and Human Services, the Department of Transportation, and NASA.

In addition, the White House has created a “leading practices” webpage where agencies can showcase their best efforts in four areas:

• Leadership, Governance, and Culture Change
• Transparency
• Participation and Collaboration
• Flagship Initiative

The Open Government Working Group, comprised of executives from each of the major agencies, continues to meet regularly to share leading practices.

It’ll be interesting to see what the separate scoring of agency plans looks like when the advocacy groups announce their results in coming days!

IRMCO 2010

This week the General Services Administration (GSA) is hosting its 49th annual Interagency Resources Management Conference.    An estimated 300 Chief Acquisition Officers, Chief Financial Officers, Chief Information Officers, Chief Human Capital Officers, Inspectors General, program managers and other senior executive leaders are attending.   It is the most well known government-wide, government-only conference where leaders delve into emerging management issues and how they are being confronted.  You can learn more about IRMCO at www.irmco.gov

This morning I moderated a panel “Expanding on the Management Agenda” with the four senior Office of Management and Budget officials who are leading the Obama Adminstration’s management efforts:

• Vivek Kundra, Chief Information Officer and Administrator for E-Government and Technology,
• Danny Werfel, Controller, Office of Federal Financial Management,
• Dr. Shelley Metzenbaum, Associate Director for Performance and Personnel Management, and
• Daniel Gordon, Administrator, Office of Federal Procurement Policy

Together they addressed the 6 strategies that according to OMB’s Jeff Zients “offer the greatest potential to improve performance”

1. Eliminate waste,
2. Drive top priorities,
3. Leverage purchasing scale,
4. Close the IT performance gap,
5. Open government to get results, and
6. Attract and motivate top talent.

Importantly, they did not dwell on each of the 6 strategies so much as explain how they are working together, in what I would describe as a pragmatic, problem-solving approach – looking to take the best of what works – in other governments, the private sector and recent federal efforts – to transform the way government works.   It is apparent from their individual priorities as well as the way they describe how they are working together that the current OMB team is operating in a very coordinated and integrated fashion – where fixing problems and improving mission performance is no longer “someone else’s  job,”  but instead, everyone’s  job.

But will it work?

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.”

5 (not just 4) names to be Comptroller General

On Tuesday, Congressional Democrats sent President Obama a list of four candidates to nominated as the next Comptroller General.  The four are Rep. Todd Platts, Linda Bilmes at Harvard’s Kennedy School of Government, Acting Comptroller General Gene Dodaro, and former Assistant Comptroller Ira Goldstein.  Today Congressional Republicans sent their own letter to the President recommending Stuart Bowen, the special inspector general for Iraq reconstruction.   The letter was signed by House Minority Leader John Boehner, Senate Minority Leader Mitch McConnell, Senate Committee on Homeland Security and Governmental Affairs ranking member Susan Collins and House Committee on Oversight and Government Reform ranking member Darrell Issa.

Topic 2: Implementing the Recovery Act

Congress passed the $787 billion Recovery Act in early 2009.  The Act – sometimes referred to as the stimulus bill – focused on job creation, but it does so through hundreds of existing and new federal programs.  Implementing these programs falls on the shoulders of thousands of state, local, non-profit, and private organizations.  The Act also spawned new governance models.  What are the implications of these models for national policy leadership, accountability, and our federal system?

Progress to Date. The Act has helped fill about one-third of projected state budget shortfalls.  But it also created a series of daunting management challenges, thanks to a highly specific, and sometimes conflicting, set of federal goals and objectives.  For the most part, the Act relies on a wide range of third parties – over 130,000 entities reported on their spending in October 2009 in the first-ever required progress reports stipulated by the Act.

Key Challenges in Implementation. Implementing the Recovery Act has sparked a series of management challenges:

• Complex federal program structures and reporting requirements for over 300 new and existing programs.
• Conflicting purposes in the Act, such as starting projects immediately, but also developing long-term, thoughtful implementation designs.
• A heavy reliance on third-parties to implement programs, where the third parties have different priorities.
• High political stakes at all levels of government in sharing responsibility for failures or shortfalls.
• Increasing centralization of authority over program implementation in the White House and by governors
• An accountability “stress test” created by the Act in terms of accountability, transparency, and oversight requirements

Research Questions Based on Forum Discussions. Following are highlights of some of the research questions developed:

• Which program design features (such as maintenance of effort and segregation of Recovery Act funds from other funds) have worked?
• How has the Recovery Act strengthened the role that states and governors play in the intergovernmental process?
• How has the Recovery Act changed the audit function in government?
• What elements of the Recovery Act might be appropriate to extend to all intergovernmental programs in the future (e.g., increased public transparency)?

(Note:  the background discussion paper for this topic was prepared by Paul Posner, George Mason University)

Leading the Federal Emergency Management Agency (FEMA)

A Conversation with W. Craig Fugate, FEMA Administrator

In the last decade, whether as a result of natural or manmade disasters the nation’s emergency response apparatus has faced enormous challenges.  Overcoming these challenges and forging a national emergency response network for the 21^st Century requires innovation and teamwork. 

Recently on The Business of Government Hour, I had the opportunity to speak with Craig Fugate, Administrator of the Federal Emergency Management Agency (FEMA) about his efforts in this area.  In this interview, Administrator Fugate discusses such issues as the challenges facing his agency, the national emergency response network, how FEMA is leveraging social media/ web 2.0 technologies, the importance of individual preparedness, and how technology can assist FEMA and its partners respond more effectively to disasters.

“The federal government had been responding to disasters caused by natural hazards, and since the 1800s”, says Fugate.  The Congressional Act of 1803 was the earliest effort to provide disaster relief on a federal level after a fire devastated a New Hampshire town. From that point forward, assorted legislation provided disaster support. In 1979, the Federal Emergency Management Agency (FEMA) was established by an executive order, which merged many of the separate disaster-related responsibilities into a single agency. Since then, FEMA has dedicated itself to the mission of helping communities nationwide prepare for, respond to and recover from natural and manmade disasters – a mission strengthened when the agency became part of the Department of Homeland Security (DHS) in 2003. FEMA leads and supports the nation in a risk-based, comprehensive emergency management system of preparedness, protection, response, recovery and mitigation. As of November 2007, FEMA has responded to more than 2,700 presidentially declared disasters. According to Fugate, FEMA is divided into 10 geographical regions composed of regional offices and a regional administrator and staff in those regions. He noted that among that staff: FEMA has a little over 4,000 career service staff with temporary hires (or what FEMA calls its disaster reserve) right now between 3,000 and 4,000 people. This number may go up or down depending upon how many more recent disasters are declared.  

FEMA’s role during disasters is spelled out in the Stafford Act, and recently expanded in the post Katrina Emergency Reform Act.  Though there seems to be some widespread public misconception as to its actual duties during a disaster.  Administrator Fugate provides an overview of the legislative authority that defines what it can do and outlines the proper role of FEMA in response to a natural and/or man-made disaster. 

Craig Fugate on FEMA’s proper role in emergency disaster response

With its ever evolving mission, FEMA faces tremendous challenges. Fugate identifies a host of challenges facing his agency and the national emergency response network.

Here’s Craig Fugate on: Challenges facing FEMA and the national emergency response network

FEMA manages two significant assistance programs: the individual assistance program and the public assistance program, respectively. Individual Assistance can include low-interest loans, income tax relief, cash grants, unemployment assistance, and crisis counseling. Its Public Assistance (PA) is a grant program to assist state and local governments and certain private nonprofit (PNP) entities. The PA Program provides: assistance for debris removal, implementation of emergency protective measures, permanent restoration of infrastructure, and encourages protection from future damage by providing assistance for hazard measures during the recovery process.  

Craig Fugate on: Managing FEMA’s individual and public assistance programs

Fugate takes issue with a government-centric approach to disaster response.  Government is just one partner in the critical teamwork approach that should define emergency and disaster response for the 21^st century.  He underscores the importance of personal preparedness in advance of disasters.

Craig Fugate on: Fostering a culture of personal disaster preparedness with Ready.gov

FEMA is also leveraging social media tools in pursuit of its mission.  Here’s Craig Fugate on: Leveraging Web 2.0 and social networking tools in disaster response 

You can access the complete program and hear my entire conversation with Craig Fugate, FEMA Administrator at The Business of Government Hour –Interview with Craig Fugate

Making Sense of Open Gov Dialogues

Two dozen federal agencies are running on-line dialogues between now and March 19^th to gather insights on what citizens would like to seen them include in their OMB-required Open Government Plans.  These first-ever open dialogues are an important symbolic step toward better engaging citizens in their government.  But in the end, how will agencies make sense of thousands of comments and ideas?  The on-line system being used allows users to vote on different contributors comments (either for or against) but that still doesn’t help, especially if a particularly vocal interest group “takes over” the dialogue.

Following is an example of the summary results of an on-line dialogue hosted by some of our IBM colleagues a few months ago.

For nearly a decade, IBM has been hosting internal (and eventually external) on-line dialogues with its employees, academics, business partners, and clients.  It calls these dialogues, “Jams,” and runs them for an intense 72-hour period (in contrast, the federal dialogue is being run over a 5-week period).

Case Example: Summarizing the “Smart Work” Jam

Back in September 2009, IBM hosted a Smart Work Jam with 2,000 participants from 68 countries with 5,000 posts across seven pre-defined topics (much like the federal dialogues).  Participants were invited (in contrast, the federal dialogue is open to anyone who registers).  There was also a kick-off session at the beginning that participants were encouraged to listen to, involving a “rock star” policy wonk, James Surowiecki (author of “The Wisdom of Crowds”)

The Smart Work Jam fostered “a number of ideas that hit upon key themes around the evolution of the workforce, the nature of work and technology that enables it, and the impact it can have on people and organizations in healthcare and government.”  The Jam organizers summarized the results of the dialogue in a readable 18-page report.  In addition to it being a potential model for federal agencies as they summarize their own dialogues, the content of the report is a good read.

Some interesting insights:

• Swarming talent: “In the future, teams will self-organize with the speed necessary to address very short lived opportunities or problems.  For this to happen, organizations will need to enable transparent skills identification, easy access between people, and convenient, secure online places for teams to meet and organize their work.”
• Leadership based on tasks and contribution, not position. “Leadership, like the work, will be accomplished more collaboratively.  Information sharing will allow the collective team to monitor workflow and organizational capability on an ongoing basis.  What will result is collective, open, real-time leadership and decision-making.”  What this implies is that leadership will be contribution-based, not position- based.  Credentials come from a record of success.
• Social networks are part of the fabric of organizations. Social networks create avenues for people to connect and “create personal connections with meaningful conversations and deeper relationships . . . as part of [an organization’s] day-to-day functioning. . .”

In this new world, “People matter more than ideas. In fact, it is actually more important to have A-grade people than it is to have a slew of A-grade ideas.”  This implies that implementation is more highly prized than innovation!

The report goes on to talk about how a results-oriented work environment will become the norm (which is predicted by the Millennial generation’s work ethic), and that this workforce will be motivated by providing it with more autonomy.

As for the application of Smart Work ideas in the public sector, nearly 40 percent of participants thought government could best empower citizens by providing greater data transparency, “enabling the wisdom of crowds to be applied at national and local levels.” And, that there should be more engagement by issue.

UPDATE:  Now here’s a cool “mashup” created by some folks during the snowstorm!  It aggregates the comments and participation stats across all the agencies participating in the Open Gov dialogue.

Leveraging research into healthcare quality, costs, outcomes, and patient safety

A Profile of Dr. Carolyn M. Clancy, Director, Agency for Healthcare Research and Quality U.S. Department of Health and Human Services

Healthcare remains one of the most pressing issues of today, with a system mired in ever-increasing costs, inconsistent quality, and access pressures. Many of the healthcare reform proposals being reviewed in Congress attempt to remedy one or more of these issues. Research continues to identify ways to improve the quality and safety of healthcare, ensure access to care, increase the use of health information technology (IT), and find new ways to translate clinical research into practice. “The mission of the Agency for Healthcare Research and Quality,” explains Dr. Carolyn Clancy, director of AHRQ, “is to improve the quality, safety, efficiency, and effectiveness of healthcare for all Americans. We pursue this goal by supporting research and working very closely with those who provide care—clinicians of all disciplines—as well as with patients and policymakers, so that they can use information to improve the delivery of healthcare.”

Dr. Clancy manages a broad portfolio of scientific research that promotes enhancements to clinical and health system practices. “About 80 percent of our budget goes to grants and contracts with many academic institutions, community health centers, and hospitals focusing on improving healthcare. We now fund work in almost all 50 states,” explains Clancy. She describes her main responsibility as one of ensuring that all parts of AHRQ work together. “My day-to-day work,” notes Clancy, “is actually communicating what it is that we’re trying to do—connecting the dots between the research we’re supporting and healthcare you’re going to get.” AHRQ comprises five research centers and three offices, but she states that, “We really organize our work around portfolios: comparative effectiveness; patient safety and quality; health IT; improving value in healthcare; prevention and care management; and innovations.”

The U.S. spends more on healthcare than any other nation, yet numerous studies have found that there is really no relationship between spending and the quality of care. For Clancy, it is critical to make sure that “what we do for patients matches their needs and preferences and actually helps them to get on with their lives.” Comparative effectiveness research (CER )—systematic research that compares different interventions and strategies to prevent, diagnose, treat and monitor health conditions—offers promise. According to Dr. Clancy, the purpose of this research is to inform patients, providers, and decision makers by responding to their needs about which interventions are most effective for patients under specific circumstances. The Recovery Act allocated about 1.1 billion dollars for CER , with some $300 million allocated to AHRQ’s already-established CER portfolio. “We live in a very exciting time,” admits Clancy, “because of all of the advances in biomedical science. More and more, it’s not the case that there’s one thing to do for a particular condition—there are multiple choices. How do you make those choices?” CER is looking to fill that gap. “We think this research will help make sense of all of the rapidly expanding options and innovations in medicine. It’s all about focusing on patients’ needs, and applying the best of science to meet those individual needs,” says Clancy. 

As the nation’s lead research agency on healthcare quality, safety, efficiency, and effectiveness, AHRQ plays a critical role in the drive to adopt health IT. “I think many people don’t grasp that healthcare today is, by and large, a paper enterprise.” Her agency funds research that identifies ways to expand health IT adoption and use. It seeks to identify best practices for making health IT work and tools that can help hospitals and clinicians successfully adopt it. According to AHRQ-funded research, electronic health record adoption continues to increase slowly. The initial capital investment continues to be a significant barrier to adoption. “We believe,” asserts Clancy, “that health IT can improve the quality of care….At the same time, it can deliver customized information to the point of decision making, based on scientific evidence. That’s our goal, and we are very excited about it.” 

According to the Centers for Disease Control and Prevention, nearly 2 million patients suffer from a healthcare-associated infection in U.S. hospitals each year, resulting in 99,000 deaths and annually incurring an estimated $28-$33 million in excess healthcare costs. AHRQ funds research that aims to identify risks and hazards that result in medical errors, while seeking to find ways to prevent patient injury associated with delivery of care. “This is a growing problem,” admits Clancy, “We’ve seen people suffering serious consequences because of these infections, which are largely avoidable.” Clancy describes the Michigan Keystone ICU Project as a successful example of how to foster a culture of patient safety. It is a joint partnership between Johns Hopkins University and the Michigan Health and Hospital Association, funded by an AHRQ grant. “We supported a team from Johns Hopkins,” notes Clancy, “They focused on reducing serious bloodstream infections, using some relatively straightforward steps that can actually reduce the infection rate dramatically.” 

 ARHQ-funded research means little until its findings and lessons learned are disseminated. Dr. Clancy declares that the ultimate goal is to translate AHRQ’s research findings into clinical practice—hopefully resulting in healthier, more productive individuals and an enhanced return on our nation’s substantial investment. “We work extensively to communicate what we’re doing and to disseminate it in practical ways.”

Listen to:  The Business of Government Hour Interview with Dr. Clancy

Managing the world’s largest nuclear waste cleanup

Profile of  Inés R. Triay, Assistant Secretary, Environmental Management at the U.S. Department of Energy

During the Cold War, the U.S. nuclear stockpile reached more than 30,000 nuclear weapons. Research and production of these weapons resulted in large volumes of nuclear waste—some of the most dangerous materials known to mankind—posing significant environmental risks and challenges. “The U.S. Department of Energy has under its purview the Environmental Management program, which is responsible for cleaning up the legacy of the Cold War,” says Dr. Inés Triay, assistant secretary, Environmental Management within the U.S. Department of Energy. She leads an office  charged with the safe and complete cleanup of the environmental legacy brought about from five decades of nuclear weapons development and government-sponsored nuclear energy research. “We manage the largest environmental cleanup effort in the world. Originally, we had two million acres at 108 sites in 35 states. We work in very challenging environments with hazardous and dangerous material, solving some of the most complex technical problems in the environmental field today,” says Triay. She notes that her job is “to make sure that the cleanup is conducted in a safe, secure, and compliant manner. It is to make sure that we continue to be vigilant about the life cycle cost of this cleanup. This cleanup extends decades; it is my job to come up with strategic options to shorten that time frame that we’re going to need in order to ensure the effective cleanup.”

The cleanup encompasses radioactive wastes, spent nuclear fuel, excess plutonium and uranium, thousands of contaminated facilities, and contaminated soil and groundwater. EM has identified radioactive tank waste processing as one of its key priorities. This involves constructing and operating facilities that stabilize radioactive liquid tank waste and treat it into a safe, stable form for disposition. This is such a challenging problem,” explains Dr. Triay. “We have 88 million gallons of highly radioactive waste. This waste is in underground tanks, some containing on the order of a million gallons….We have these underground tanks in three main places: Savannah River site in South Carolina, our Hanford site in Washington state, and our Idaho site.” According to Triay, EM continues to move forward and clear hurdles in finalizing the design, construction, and operation of three unique and complex tank waste processing plants. “The bottom line is: these facilities combine for a total project cost of over $14 billion. It is imperative that we stick to the total project cost and duration for these projects, delivering on time and within costs, as based on the current scope and scale. This particular waste is the highest risk of our program; it is imperative that we do this job right,” underscores Triay.

The 2009 American Recovery and Reinvestment Act (Recovery Act) provided the EM program with $6 billion above its normal appropriation. Seventeen sites in 12 states are receiving Recovery Act funding. The department selected areas where the projects were “shovel-ready”—projects with scope, cost, and duration already established. “The second thing that we did,” explains Triay, “was to choose projects that have an established regulatory framework. We also identified projects with proven technologies, existing contract vehicles, and proven performance and success.” Those projects focus on accelerating cleanup of soil and groundwater, transportation and disposal of waste, and cleaning and demolishing of nuclear weapons facilities. “We endeavor to keep that life cycle cost managed and validated. We want to ensure that we can demonstrate to Congress and the taxpayers that this investment [Recovery Act funds] actually reduces the life cycle cost. We want to demonstrate that the return on investment of having the work done earlier is a significant benefit,” says Triay. “With the Recovery Act funds, we envisioned a portfolio that is going to reduce the footprint by about 40 to 50 percent by 2011.”

In order to achieve this ambitious goal, Triay believes that the most important thing is to have a committed, focused, and technically capable staff. “It is all about the people,” declares Triay, “They are the most prized resource of an organization like ours, and for that reason, it is always a challenge to recruit and retain the very best. I think that, for those who want to work in science and public service, the Department of Energy, under the leadership of Secretary Chu, is a perfect place to explore those two passions.”