Point 1:Transparency in business and in government means that you know what’s going on (or can find out). You have access to information about the organization’s processes and results, it is clearly presented, and it is understandable. It is difficult, if not impossible, to understand accountability when transparency does not exist. In the emerging ISO 26000 standard for social responsibility, both transparency and accountability are important.
Point 2: In data management, we struggle with the concept of provenance: how to track what happened to your data at every step of its journey – from being collected, to being operated upon by a host of processes and algorithms, to being evaluated, analyzed and visualized.
Although hundreds of well-trained eyes are watching over the $700 billion that Congress last year decided to spend bailing out the nation’s financial sector, it’s still difficult to answer some of the most basic questions about where the money went.
Despite a new oversight panel, a new special inspector general, the existing Government Accountability Office and eight other inspectors general, those charged with minding the store say they don’t have all the weapons they need. Ten months into the Troubled Asset Relief Program, some members of Congress say that some oversight of bailout dollars has been so lacking that it’s essentially worthless.
Bottom line: achieving transparency requires successfully managing provenance. But in the case of the bailout, are transparency problems an information technology issue, or a policy issue?
Today’s Washington Post has an article by Minnesota senator Tim Pawlenty on the effective design of national health care reform, entitled “To Fix Health Care, Follow the States”. He argues that the federal government should model its initiatives after successful state-based systems that link outcomes to value:
In Minnesota, our state employee health-care plan has demonstrated incredible results by linking outcomes to value. State employees in Minnesota can choose any clinic available to them in the health-care network they’ve selected. However, individuals who use more costly and less-efficient clinics are required to pay more out-of-pocket.
Not surprisingly, informed health-care consumers vote wisely with their feet and their wallets. Employees overwhelmingly selected providers who deliver higher quality and lower costs as a result of getting things right the first time. The payoff is straightforward: For two of the past five years, we’ve had zero percent premium increases in the state employee insurance plan.
Minnesota has also implemented an innovative program called QCARE, for Quality Care and Rewarding Excellence. QCARE identifies quality measures, sets aggressive outcome targets for providers, makes comparable measures transparent to the public and changes the payment system to reward quality rather than quantity. We must stop paying based on the number of procedures and start paying based on results.
Pawlenty also notes that healthcare reform should not focus solely on access to health care, but also the cost and quality of the service – that is, the value that is delivered. The Malcolm Baldrige National Quality Award (MBNQA) Criteria for Performance Excellence provides a framework that has been tailored over 20 years by a huge collaboration of experts to help business, industry and the government better solve this kind of “wicked problem”. The Minnesota solution sounds like it has applied concepts very similar – if not identical – to those presented by the Baldrige Criteria.
When will the government employ the successful problem-solving frameworks it has developed itself (e.g. MBNQA) to solve its most pressing problems?
Health-care reform is bogged down because none of the bills before Congress deals with the staggering waste of the current system, estimated to be $700 billion to $1 trillion annually. The waste flows from a culture of health care in which every incentive is to do more — that’s how doctors make money and that’s how they protect themselves from lawsuits.
The article goes on to talk about “defensive medicine,” the practice of ordering tons of diagnostic tests to refine a diagnosis or a treatment plan for the purpose of avoiding malpractice suits. Howard suggests that physicians are cultured into this way of doing business as a defense against potential risks and potential malpractice cases – he even mentions one case where a doctor reacted to a lawsuit by changing his behavior in favor of defensive medicine. A solution, however, is possible:
Containing costs, as Rep. Jim Cooper (D-Tenn.) noted on “Face the Nation” recently, requires overhauling the culture of health-care delivery. Incentives need to be realigned. That requires a legal framework that, instead of encouraging waste, encourages doctors to focus on what’s really needed. One pillar in a new legal framework is a system of justice that is trusted to reliably distinguish between good care and bad care. Reliable justice would protect doctors against unreasonable claims and would expeditiously compensate injured patients. The key is reliability.
The culture of a system – in this case the U.S. health care system – influences the behavior of individuals within the system. This behavior can be waste-producing. When it is, we need to look towards the cultural influences or the structure of the incentives that drive that behavior, and examine ways to address the root cause(s).
It reminds me of the requirements gathering phase of a software development project. Stakeholders spend hours trying to hash out what functions and behavior they expect from their software, and how reliable they want it to be. It is always a challenge to avoid designing the system (that is, how it will look or act) when the essence of what you need to know is what the system needs to do.
I see evidence in the growing national healthcare debate that many people have opinions on the design of the system (e.g. who gets coverage, how pre-existing conditions are handled, how much it costs, who pays), whereas most citizens and Congressmen aren’t even touching the requirements for a successful system (e.g. what scenarios it should support, what behaviors it should provide incentives for, or its reliability/requirements for how much waste the system can and should generate).
In my opinion, one requirement for a successful health care system is that it provides incentives for you to remain healthy and stay out of doctors’ offices and hospitals. A tax credit for a health Body Mass Index (BMI), or maybe lower interest rates? I’d go for that… it would even stimulate me to boost the economy a little more by buying rollerblades or something.
There have been criticisms of Obama’s handling of the budget so far. For example, critics bristle at the thought that Obama approved the fiscal year 2009 budget with earmarks (this is covered in an article by George Stephanopoulos on March 1, “Obama Will Sign Omnibus Despite Earmark Pledge”). But the fiscal year 2009 budget – executed in March 2009 – is retroactive. It is intended to cover operations of the government and all government-funded agencies (including research facilities, and university-driven research and development) from October 1, 2008 through September 30, 2009. Failure to pass that budget would have meant a swift and immediate crisis, catalyzing a domino effect of layoffs in the highly specialized industries. This could have a nontrivial and long-reaching impact on national competitiveness by depressing not only technological innovation, but also by cutting off practical opportunities for university students and researchers to contribute to innovation as they receive mentorship and training.
Zients has twenty years of business experience as a CEO, management consultant and entrepreneur with a deep understanding of business strategy, process reengineering and financial management. He served as CEO and Chairman of the Advisory Board Company and Chairman of the Corporate Executive Board. These firms are leading providers of performance benchmarks and best practices across a wide range of industries. Currently, he is the Founder and Managing Partner of Portfolio Logic, an investment firm focused primarily on business and healthcare service companies.
President-Elect Obama has hired a quality manager, and her name is Nancy Killefer. She is the newly appointed “Chief Performance Officer” whose mandate is to manage budget reforms while eliminating waste in government processes, ultimately making it more effective. An MIT & McKinsey alum, Time calls her the “first official waste watchdog.”
“We can no longer afford to sustain the old ways when we know there are new and more efficient ways of getting the job done,” Obama said during a news conference this morning at his transition office. “Even in good times, Washington can’t afford to continue these bad practices. In bad times, it’s absolutely imperative that Washington stop them and restore confidence that our government is on the side of taxpayers and everyday Americans.”
This is a fantastic indication of our new administration’s commitment to quality, and its recognition that the current economic crises can only be solved by fiscal pragmatism and solid foundations.
As he named Killefer, Obama promised to scour the federal budget to eliminate what doesn’t work and improve what does to “put government on the side of taxpayers.” He said: “We can no longer afford to sustain the old ways when we know there are new and more efficient ways to getting the job done.”
Nancy, you should join ASQ (if you’re not already a part of the organization). There are 100,000+ of us, more or less, that not only support you but want to help you develop a high-performance government. We come from all industries, are adept at process improvement at creative solutions for increasing efficiency, and can be effective advocates for your mission. Let us know how to help!
In a 2004 post, one observant blogger noticed that the presidential campaigns for George W. Bush and John Kerry weren’t “doing something new, something uniquely suited to the new medium that wasn’t possible before but perfectly fits with the types of communication the Internet enables.” This person remarked that “right now political activity online is in the eToys era. What will be the Google of politics?”
For a couple of generations, it was conservatives who had the more effective political infrastructure. They used direct mail and talk radio to run circles around liberals in raising money and communicating their message around the filter of the establishment media. Some of that money flowed into think tanks that helped nurture ideas and operatives. 2008 was striking because the technology/communications advantage was decisively with the Democrats. Obama and other Democrats used this to raise vastly more money than McCain and to mobilize legions of people who had not previously been engaged with politics.
The mission of Google is to organize the world’s information – to transform the relationship between people and information in such a way that collaboration, innovation, and insight are electrically catalyzed. The mission of the Obama campaign was to organize and inspire the people of the United States – to transform people’s perceptions of relationships with one another and convince them that they could achieve a more hopeful future together. And they used Web 2.0 to do it elegantly. Not only did this campaign spread the infectious meme of hope to so many young Americans, including those who previously didn’t have it, it was very easy for anyone who wanted to contribute to know exactly what to do. The Obama campaign made its needs actionable so it was easy for anyone with a little motivation to get involved, and make a difference.
Obama is the Google of politics: He has technological expertise and an audience his political competitors simply cannot match. Looking ahead to 2010, House and Senate Democrats will be jealously eyeing Obama’s e-mail lists and technology secrets — giving him even greater leverage over them. Republicans will be forced to invest serious money and time to narrow the technology gap.
Now that the campaign that organized the Google of politics transitions to the White House, I am hopeful that this penchant for innovation might infect other areas of government. I don’t have my expectations set unreasonably high, but I’m pleased that we can try out a new mindset in American government. I am tired of the politics of fear, I am conscious of idealism, and I am dedicated to action. I know that millions of Americans don’t feel this way today, and are wary of what a new Administration might bring… to them I say, keep an open mind. The condition of the country could get worse, but it could also get better. Let’s be open to learn from a new experience. Whether you voted for him or not, it is possible to acknowledge Obama’s campaign as both masterful and innovative; one that efficiently leveraged the power of collaboration in remarkable ways in just 21 months.
Today is Monday, November 3rd. Election Day, when the U.S. picks its 44th President, is less than 24 hours away. And as of Saturday night, just 72 hours before the polls close, 27 MILLION early votes and absentee ballots had already been placed. This represents almost 13% of the total population that’s eligible to vote this year, and 22% of all the people who voted in 2004. (The numbers are from Michael McDonald’s dataset; he is an associate professor specializing in voting behaviors. The VEP column in his table represents the total number of eligible voters over 18 and not in prison, on probation or on parole. )
Remember, long ago (or maybe more recently) in statistics class, when you learned that you could learn a lot about the properties of a population by taking a random sample? Having approximately 20% of the vote already in from a sample expected to be between 120 and 150 million is extremely significant – remember, these are actual votes, and not someone’s report of what they may or may not vote “for real”. Assuming that systematic errors have not played a large part in early voting behavior, the winner is already determined, and we just don’t know it yet.
“We go around in a circle and suppose, but the answer lies in the middle and knows.” –Robert Frost
However, ignoring systematics is indeed a significant assumption, one that’s discussed by Peter Norvig, Director of Research at Google, in his excellent explanation of the accuracy of polls. Which is why the campaigns are rightly pushing EVERYONE to get out there and vote – to mitigate the impact of systematic errors. (After all, you don’t want to stop voting if the other side keeps voting.) So if you are reading this and you haven’t voted yet, DO IT! Go vote!
I see three potential scenarios:
Breakthrough: the decision has already been made, is accurately reflected in the actual sample of early votes, and the votes placed on Tuesday won’t change the pattern at all. The additional votes amount to nothing (other than beating down or insuring against systematic error).
Breakdown: a flood of voters overwhelm the capacity of the voting stations, the voting machines just can’t handle it, and the polls close before everyone can get through the door and get an error-free ballot submitted. I think there might be social unrest if this is the case.
Breakout: a single demographic (or two) comes out in droves to vote on Tuesday, breaking out of wherever they’ve been hiding, and shifting the balance of the race in a huge upset. Certainly a possibility.
Whatever happens, the 2008 Election reflects a mythical struggle between structure, order, hierarchy, stability, and tradition on one side; revolution, dynamism, community, collaboration, and exploration on the other. One potential leader clearly has more experience on one side of the coin, and the other potential leader is stronger in the opposite area. Each candidate has plenty of experience on the side of the coin he’s promoting. The difference will be how the voter determines which standard the candidate’s experience should be measured against!
Why am I interested in all this? First, because polling is measurement, and quality assurance requires effective measurement. But more importantly, because the themes of this election parallel the struggle that many organizations face with quality and innovation – getting the job done reliably is paramount, and experience is important, but we cannot lose sight of the way we need to reinvent ourselves and our companies to continue being competitive. Accepting the wilder side, where structures are not sacrosanct and community is more productive than hierarchy, is hard to swallow.