Since forming Sage Squirrel Consulting, we have naturally been asked “what do you do”? We have struggled a bit to answer that succinctly, so before we went to the HCBS Conference we drafted an “elevator” speech – the commercial we can deliver in about 30 seconds: We help navigate change in HCBS/LTSS by adding subject matter knowledge and experience in operations and organizational design as well as capacity to organizations (agencies, states, companies) that are implementing new programs or updating business processes.
Sometimes we are still met with a blank stare which just baffles us because it seems so clear to us., Maybe people don’t always know what we mean by “operations”. We aren’t policy experts; we aren’t experts in reimbursement or rate methodology, and we aren’t an IT solutions provider. We don’t appear to fit into any of the functional buckets that LTSS consultants get pegged into. We do understand policy; we are well versed in reimbursement methodologies; and we have implemented an IT solution or two along the way; but – we see all of those things through the lens of operations.
I don’t have a great ready-made description of what constitutes operations, so I went to Wikipedia. Here’s what they had to say: “Operations management is an area of management concerned with designing and controlling the process of production and redesigning business operations in the production of goods and services. It involves the responsibility of ensuring that business operations are efficient in terms of using as few resources as needed and effective in terms of meeting customer requirements. … The operations function requires management of both the strategic and day-to-day production of goods and services.” What’s so hard about that?
In the private sector, it’s pretty easy to see the goods or services are that are being produced. It’s a widget, or a banking transaction, or a burger. Companies have a clear interest in producing them as efficiently and effectively as they can; the alternative is costly. Inefficient processes are expensive and result in poor customer experience and lost revenue. Most private sector companies work continuously to stay efficient and effective, updating business process and technology on a regular basis to be competitive. It really is change or die.
It’s not always as clear that government has an interest in effective operations, because it’s not always clear that government HAS operations. With a few exceptions, government (at the state and federal levels) is rarely seen as the provider of services, but rather as the funder and overseer of how services are delivered. Government may be the gatekeeper to the receipt of services; or the quality assurance monitor that accompanies the receipt of services. When people look at government services, they rarely see a “customer” the way the private sector does. Government processes often may be seen as wasteful and inefficient – sometimes because of regulatory requirements, sometimes because of what are perceived as bad employees, ineffective bureaucrats. Government employees sometimes get a bad rap in the operations department.
That bad rap is largely undeserved, in my opinion. I’ve had the great good fortune to work in Indiana state government with a vantage point that allowed me to see across most state agencies. I’ve also met and worked with a large number of people from other states and federal agencies through NASUAD. The overwhelming majority of individuals that I have worked with have been dedicated public servants who are trying to do the best job that they can. Many of them simply aren’t equipped to think about operational opportunities and challenges and most of them are working in a culture that is focused on compliance over effectiveness and efficiency.
There are a lot of good reasons that government is not as nimble as the private sector. Governments do not generally face competitive pressures to stay current; in fact, governments may need to be perceived as stable by citizens in order to preserve the public trust. The lack of financial resources and complex statutory and regulatory requirements can make keeping technology and processes up-to-date very challenging. There is also some inertia associated with the fact that government leadership changes on a regular basis. New leaders come in who want to make their policy mark while the day-to-day operational running just keeps on running the way that it always has by people who aren’t challenged to change or improve, or even empowered to do so.
There’s a belief in some circles that operational inefficiency is a deliberate ploy to impede people’s ability to gain access to publicly funded services for the purpose of limiting expenditures. This is a false premise. The overwhelming majority of public employees are truly public servants who are working to have an impact on the greater good and to serve their states. If they are in human services, it’s nearly always to improve the lives of people who are vulnerable or less fortunate. You simply cannot over-estimate the power of an entrenched bureaucracy in a culture that values compliance and stability above efficiency and customer experience. Some new leaders come in with a desire to impact that culture, but in an arena dominated by the electoral cycle, rarely have the opportunity to stay long enough to impact the larger organizational culture.
Debbie and I are of the very firm opinion, however, that it doesn’t have to be this way. Government does have customers – they are called citizens. Citizens have every right to ask for timely and efficient processes – in their Medicaid application determinations, their license plate transactions, in the payment to the providers that the state relies on to provide direct care and other services. They have the right to expect consistency and accuracy in transactions that impact their lives, like child welfare investigations, or the determination of eligibility for services, or the enrollment of a new service provider. Competitive pressures in these areas may be limited, but efficiency and consistency are hallmarks of effective governance, and all of us as taxpayers expect government to be both efficient and effective in the use of our resources.
Given the centrality of operational excellence to the mission of Sage Squirrel Consulting, through this blog, we are going to expand on our “elevator speech” over the course of the next few weeks. We might need a bit more than 30 seconds for our “elevator speech”! Going up?
#SageSquirrel, #BeyondCompliance, #LTSSTransformation, #OperationalEffectiveness