Government
Victory for Quality
On Wednesday, President Obama appointed Dr. Don Berwick to run Medicare and Medicaid. Just to summarize Berwick’s credentials, he’s a pediatrician, clinical professor at the Harvard Medical School, former leader and advisor on a number of government councils and task forces aimed at improving the quality of healthcare, and a former Baldrige Judge.
I wrote about Berwick’s nomination on April 19th, pointing out that the immediate past president of the American Medical Association said that he “is widely known and well respected for his visionary efforts that focus on optimizing the quality and safety of patient care.” According to USA Today, his “nomination was immediately hailed as a brilliant choice by policy experts from across the ideological spectrum.”
The Centers for Medicare and Medicaid have not had a permanent administrator since October 2006. Obama nominated the perfect person to fix this problem while addressing a much bigger one: how to deliver high-quality patient care for less. Berwick’s Baldrige and healthcare background provide an unusual systems perspective for tackling an issue that is critical to the country and to all Americans.
Kudos to Obama for finding the right person and for making the recess appointment that puts him to work.
For those keeping score of Baldrige people in high positions, we now have Berwick at Medicare and Medicaid; Terry Holliday, former superintendent of Baldrige Award-winning Iredell-Statesville Schools, now commissioner of education for Kentucky; and E. David Spong, CEO of two Boeing divisions that won the Baldrige Award, now president-elect of the American Society for Quality.
Do…
8Jul2010 | Steve George | 0 comments | ContinuedChanging County Processes
What happens when a new county executive initiates radical change? Exactly what you would expect.
Jeffrey Smith came to Santa Clara County to help close a $230 million deficit. He implemented hoshin kanri (policy deployment), which some moronic union official described as “some airy-fairy thing.” Many of the people responsible for doing the planning ignored him and a number of department heads submitted budgets the old way, according to a story on MercuryNews.com (“Santa Clara County new executive’s strategy has fans, skeptics,” Julia Prodis Sulek, May 14, 2010).
Smith has taken a county hospital from the threat of losing $300 million in funding because of a pattern of violence to a national award for patient safety. He’s a former doctor, lawyer, and hospital administrator and he understands that the same old, same old just won’t work anymore.
“We can no longer rely on old processes and procedures,” he says. “My job is to enable the organization to make the dramatic changes, which will be difficult.”
Hoshin kanri, popularized by Toyota, helps an organization focus on a shared vision and goals and involves people in developing strategic and action plans to achieve those goals. I worked with Zytec in 1991 when it won the Baldrige Award and one of the reasons it won was its robust hoshin kanri process.
One of Smith’s responsibilities is the county’s Valley Medical Center, which faces budget problems. Seven of the county’s eight clinics are not accepting new patients because they are overloaded. Smith wants to help people solve the problems that…
25May2010 | Steve George | 0 comments | ContinuedSupport Berwick!
Last week I posted an article about how President Obama had nominated Dr. Donald Berwick to head the Centers for Medicare and Medicaid Services. Berwick is a former Baldrige judge, a current Harvard professor, and the president and CEO of the Institute for Healthcare Improvement, a nonprofit that promotes innovative ways to improve patient care. He has been a forceful voice for systemic change to America’s healthcare system.
In the article, I warned about a likely Republican effort to block the nomination, which would have nothing to do with Berwick and everything to do with partisan politics. Well, no sooner had I posted the article than the Republican Policy Committee prepared a memo denigrating Berwick. You can read the memo and its refutation on Think Progress, but here is a key passage:
Donald Berwick…has a history of support for government rationing of health care resources on cost grounds. He has spoken favorably about Britain’s National Institute for Health and Clinical Excellence (NICE), which denies patients access to life-saving treatments the National Health Service (NHS) deems too expensive. The American people should have their eyes open to the ramifications of NICE-style rationing in the United States as part of Democrats’ brave new health care world.
In reality, Berwick supports less intensive, less invasive, and less expensive healthcare if it is more effective than the most aggressive care. In the Republican world, that equates to denying patients life-saving treatment.
In the face of such distortions, we need to show our support for Dr. Berwick. Please contact your…
27Apr2010 | Steve George | 0 comments | ContinuedBureaucracy Detector Test
As a native Iowan, I’m proud to pass along the Bureaucracy Detector Test, developed by Iowa’s Department of Management to expose performance gaps in state government. It turns out that, with a few wording changes, you can apply the test to any organization. Here’s the test:
Bureaucracy Detector Test
Rate the following on a scale of 1 (not at all) to 7 (often):
- ____ To what extent do agencies in your jurisdiction feel accountable for following rules, regulations, and procedures prescribed in law or policy?
- ____ To what extent do agencies in your jurisdiction feel accountable for producing measurable outcomes for people?
- ____ To what extent to agencies in your jurisdiction encounter rules or procedures that impair their ability to perform?
- ____ To what extent are agencies in your jurisdiction allowed to interpret the application of a rule or law themselves, as opposed to having someone in another agency responsible for enforcing the rule or law make the interpretation?
- ____ To what extent do agencies in your jurisdiction spend time or money to comply with rules, laws, or reporting requirements that they feel are a waste of time?
- ____ To what extent do the people in agencies responsible for enforcing administrative rules and regulations understand the work in a frontline agency and what is important to the success of the frontline agency in meeting the needs of those that agency serves?
Scoring
For the odd numbered questions, enter the sum of the three numbers here: ____. For the even numbered questions add the three numbers, subtract the total from 21,…
25Mar2010 | Steve George | 0 comments | ContinuedAdvice for the Country’s First CPO
In June 2009, President Obama made Jeff Zients the country’s first chief performance officer with a mandate to make the government run smarter and cost less. Considering that the federal government employs two million people, and that most citizens would not put “smarter” and “cost less” in the same sentence with “federal government,” he’s got some work to do.
In “Obama’s efficiency expert” (Fortune, Jia Lynn Yang, December 29, 2009), Zients observed, “What President Obama has done with the chief performance officer title is say, ‘Management matters.’” In recent testimony before the Senate Budget Committee, he said, “The test of a performance management system is whether it is used…the current approach fails this test.”
I think the test of a performance management system is how effective it is. Whether it is used is a test of leadership, which also happens to be when management matters.
I have some advice for CPO Zients: Instruct every department and agency of the federal government to integrate the Baldrige model. Demand annual Baldrige assessments. Implement strategic and action planning processes to address the opportunities for improvement. Track and post every unit’s scores. By the time Obama leaves office in seven years, you will have institutionalized the best performance management system available throughout the federal government.
To make your job easier, the Baldrige program is run by the National Institute of Standards and Technology—a federal agency! And the Baldrige program is open to all government entities.
In fact, a federal agency won the Baldrige Award in 2009: the Department of Veterans…
7Jan2010 | Steve George | 1 comment | ContinuedFederal Government OFIs
Forty percent of federal employees in a recent survey agree or strongly agree that the government has a robust performance management system, compared to 64% of private sector respondents. Somebody needs to point them toward the Baldrige program. We hope that the first federal government organization to win a Baldrige Award, the VA Cooperative Studies Program in 2009, can show its peers how performance management is done.
McKinsey and Government Executive magazine recently surveyed more than 500 federal employees from dozens of agencies about key elements of organizational performance and compared the results to private-sector benchmarks. You can read a summary of the survey here. On the positive side, the survey found that federal employees are more motivated than private-sector employees, better understand the direction their organizations are going, and are more supportive of their organizations’ cultures and values.
As for opportunities for improvement (OFIs):
- 29% agree that they are consulted on issues the affect them (compared to 40% in the private sector)
- 34% agree that they operate in an open and trusting environment (49% in private sector)
- 34% agree that they are encouraged to provide honest feedback to people within the agencies (48% in private sector)
- 29% agree that managers provide helpful coaching to develop senior management capabilities (41% in private sector)
- 22% believe their agencies recruit top talent from outside (32% in private sector)
- 38% agree that their agencies hold challenging reviews to evaluate performance against plans (56% in private sector)
- 55% agree that they have clear explanations of what has to be achieved in their jobs (68% in…
The City as a Baldrige System
A city is a complex system. It would make sense, then, to manage it as a system, to understand how each subsystem—transportation, energy, education, healthcare, public safety, etc.—supports a well-run and effective city system. It would make sense to coordinate these subsystems to optimize the city system. It would make sense to collaborate and innovate to reduce costs at a time when cities must cut costs, and to improve services at a time when citizens demand more of their cities.
“It is time for systemic solutions, enabled by technology, to build smarter cities that can reduce financial and human/social costs while increasing quality of life,” write Rosabeth Moss Kanter and Stanley S. Litow in a Harvard Business School working paper entitled, “Informed and Interconnected: A Manifesto for Smarter Cities” (June 15, 2009). The paper identifies eight challenges that cities face and offers examples of practices and programs that suggest possible solutions.
The authors conclude by noting that “real reform and community transformation will require that a new model be built, and built from the ground up.” I disagree. A model for community transformation already exists: the Baldrige model. It promotes systemic solutions. It addresses designing, managing, and improving effective and efficient subsystems. It calls for collaboration and innovation. And it provides a proven framework for evaluating and improving performance in every area important to a city’s success.
I encourage you to read the award application summary (pdf) of the City of Coral Springs, Florida, which received the Baldrige Award in 2007. The application doesn’t show…
5Oct2009 | Steve George | 0 comments | Continued
