Streamlining government

As the US government attempts to tighten its belt in the face of a worldwide recession, once again, public officials are trying to do more with less. Technology is being highlighted as the enabler of a Leaner and more agile system, both in government and its healthcare agencies. Terry Mason, Commissioner for the Chicago Department of Public Health explains the importance of effective IT for a Lean organization.

“If we want to look at what health is about, we need to look at the social determinants of health”
-Terry Mason

The rapid pace of change in technology has no doubt empowered people, but it’s also made us more demanding of organizations, particularly organizations that are slightly slower to react, such as the government. However, this requires different agencies to work together and crucially, it needs funding. 

Most famous for beginning his tenure by telling city hall to shape up, Terry Mason explains how at the time he came into the Chicago Department of Public Health (CDPH), it employed 1200 people, had around 45 different locations and involved at least 20 different services, but had not yet taken advantage of the technology to help manage both the day-to-day operations or to help drive the collection of data for performance metrics. As well as this, he talks of the need for the department to be more financially responsible and transparent.

“We embarked upon a journey when we came here in 2006 and said, ‘Well, let’s take a step back.’ I don’t come out of a public health background; I was in private practice as a urologist and had a very small business, so I was used to operating like a speedboat,” he says, discussing his background. “When I came over into government I understood that now I would have to operate more like a steamship; there’s tremendous institutional inertia one must overcome to do anything, and there are a number of reasons why that is.”

“Some of it’s good; some of it’s protective or at least gives the appearance of being protective, and some of it is just plain obstacles. So we had a number of challenges, but in order to make sure we addressed it properly, I took a medical model. 

“First, I took some time to learn the organization – I took a year to do that. We did our year of discovery, and then once we came out of what we decided as an executive team to do a year of education because we realized that one of the biggest problems was that there was no investment in educating staff. So many people were still doing tasks the way they’d been doing them for the last 20 years, and that the technology divide, which existed out in the city in general, was even more pronounced within the organization. Before you could even bring in any technology we needed to at least elevate the various and sundry levels of competencies that people had.

“The other thing was to talk about a vision of where the department was going, so we then completed our strategic plan to find our priorities for the organization. Excellence in management was one of those seven strategic priorities that we identified, along with number one being to establish a real organizational focus in chronic disease, so once we got to that and understood what we had to do, we brought in speakers to educate the staff.” 

Mason explains how meetings were established for staff to be educated all at once, and in doing so communication issues came to light; for instance, one of the problems highlighted was the that of transmitting information down to every level. Once these issues had been highlighted, the organization then took on the strategy to become project-driven.

“We do a series of projects, whereby we get grants which start at this time and end at that time. It has a defined beginning, something you do in the middle and a defined end with a report out, and now we’re actually backing into that the national management system, which gives us, on top of that, a better way to organize a lot of those things.

“We felt that this would be a wonderful opportunity to take that along with looking at re-examining workflow; people here did a lot of things ‘because that’s the way we’ve always done it’. That’s the thing that we heard a lot of in this instance. We took that as our culture change, so we then exposed a lot of people to a different kind of learning in the accelerated solution environment.”

He notes the benefits of having Carlo Govia in the department, Mason’s First Deputy Commissioner and Chief Financial Officer, who comes out of that industry and who helped to facilitate and understand how things were to be done most efficiently. Mason says that during that year, the department began to educate people and bring them on the journey in which it was headed.

“We looked at how could we then process map the entire organization, just for our current state, where we were, how we did it and so on, and we still have some issues that we need to continue to investigate. We understood the organization, how it was doing and what it was doing. We now have a methodology for thinking about transformation, and that’s what we need to do with our people,” he says.

Lean
Streamlining the education of the people within the organization is just as important as streamlining the processes, and as a result directly impacts the residents of Chicago. All of the organization’s staff, as residents, are taxpayers, and therefore have a fiduciary responsibility to the taxpayer to provide them with the best value for the dollar that they provide in tax revenues. Mason notes the importance in ensuring that people are as well trained as they could be – tools are provided in order to do a job most efficiently, and technology in its various forms is these tools. He notes the power of technology in the organization’s transactions, in communicable disease investigations for outbreaks, such as swine flu, managing grants or getting contracts ready.

“When we were beginning to outsource our data center, for example, to a company that manages that and has a big installation on the east coast and one on the west coast, that’s far more robust than we could ever hope to do in the city of Chicago. The fact that rather than going with this big, behemoth kind of way, with a mainframe, code-writing mentality. we now have very powerful, singular applications.

“You have ways now to link these different applications so that you can create a quasi-enterprise resource managing system (ERP), to get the best in breed of these particular applications all working together to provide the kind of benefit that we need in order to give our people the tools they need to be as efficient as they can in a very Lean way and remove and strip off all of that maintenance cost that you need for these huge, behemoth, SAP-like systems.

“I don’t have to worry about that because the individual people have to maintain the best in breed of what they do. As long as they do that, we create the interfaces for them to work together, so that now all of our things are stored in a virtual space and we can move everybody from a box kind of thinking to a cloud kind of thinking, where you only need internet connectivity to get into your system. So you move the mentality of working on a computer to working in a system, and that is the big challenge and the big piece that we’re moving quite effectively.

“The President of the United States said a couple of things that really hit home with me, and those things, particularly since he’s from Chicago, make it critical that we do everything we can to be in lockstep with what the President says. He said two things, number one, that it’s not about big government, it’s about effective government; on the IT question, he said that he would like to see government implement IT at the speed of the private sector, and those two things together said to me that we had to figure out a way to make that happen, so we could not constrain ourselves to the idea of big, expensive, one-system approaches to a problem,” says Mason.

He explains how the department then began to look at things that they identified as being core competencies and as having the ability to market, bringing those things together in a quasi-ERP to make government tools more effective and save costs. Most important was ensuring that such implementations could be done at a similar speed to the private sector, so the department opted for a multi-month strategy to address the issues of government.

Compliance
Pervious strategic plans of government agencies have often led to a complicated technology environment of infrastructures, systems and departments. In order to ensure that business needs drive the IT application requirements of CDPH, a number of requirements have been imposed on the department by federal and state grantors, and particularly since the stimulus package the government must now be more transparent both internally and externally. By operating on a project basis, CDPH can put together all of the contracting, procurement and financials to help maintain focus on the business of public health.

As well as this, Mason explains how the department is attempting to become more streamlined through integration of the various arms of the department, be it clinical operations, shared services, strategic affairs or personal health. “We had a situation where we had an organization that was a bunch of castles trying to exist in one kingdom, and each castle had its own siloed operation and it duplicated a lot of those things at each of those organizations,” he explains.

“What government now has to do is figure out how it’s going to make all of that transparent. You need the systems in place to capture that data on an ongoing basis and that precludes having a structure and the technology and a methodology by which the work is done automatically, rolls up and continues to roll up so that you’re not scrambling, trying to go get data on a bunch of different Excel spreadsheets. Rather, if you start out with a project management tool and you set up the metrics in those project management tools with the red, yellow, green to let you know where you go, those roll up.

“The finance piece is tied to that roll-up, as is the service delivery piece. The idea is that when I turn around, on the back of my desk, I’ve got two or three monitors so that in five minutes or less I am able to see exactly what’s going on in the entire organization, based on looking at a series of metrics that roll up from the bottom all the way to the top. They give me those important indicators that I need so I can then focus my activity and energy on where it needs to be, and those things are transparent to everybody in the organization; the then system allows me to drill down to the lowest level of detail that gives me the answer that I need instantaneously. The business case is to be able to get that information faster –the quicker I do it the sooner I can make a decision, move or change some things that are impacting that in a way that I never could do before.”

Mason explains how IT has not only contributed to the department’s efficiency, but has also made him a better leader. “We used to be at a situation where it was always at the 11th hour that we were scrambling because we had unspent grant dollars and our systems were antiquated. Now you’ve got 30 or 60 days to try to spend, redirect or figure out what you’re going to do with these grant dollars. The systems allow us to look at what’s going on with our grants and our burn rate; there were some other issues that we had that didn’t give us that visibility in a current enough way.”

He adds that now information can be assessed on a regular basis, ensuring that all of the annual grants are used sufficiently and adding further financial support to the department’s projects, aligning the strategic priorities of the department and taking into account the needs of the funder and the requirements on the dollars. There are more questions being asked – is the right equipment being bought, could the money be spent differently – and more resources being used to manage realistic guidelines, goals and objectives.

He concludes with a return to healthcare: outlining its purpose and reasserting why the discussions of technology are important. “If you really want to get to what health is about, health is not what goes on in hospitals or what goes on in doctor’s offices or with medication,” he explains. “That’s medical care. If we want to look at what health is about, we need to look at the social determinants of health. Those things look huge because they’re things like poverty, housing, education and other social structures and social policies, but that’s where we need to be. Other countries around the world have dealt with those things and have created more corporate benefit for their citizens. Other countries around the world spend half of what we do on so-called healthcare, and if we could divert some of the dollars we’re already spending through a health lens, we might be able to move the needle in on some of those problems that plague us.”

Terry Mason is Commissioner for the Chicago Department of Public Health.