“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.”

This is the current version of our Sage Squirrel elevator speech. After we’ve said this, we try to share our mission which is to help our clients go “beyond compliance” by focusing on operational and organizational effectiveness, creating systems that are accurate, consistent and efficient (“ACE”) for payers, providers, and recipients.  These themes carry through the experiences Debbie and I have had across government, non-profit, and business environments. This is the second in a series of blogs we are doing to elaborate a bit on our elevator speech by sharing some experiences we have had or situations we have observed.

In January of 2005, I was working in the Indiana State Personnel Department.  The incoming governor came into office with a change-driven agenda and the desire to make government work like business.  I was in a terrific position to watch and participate in some key initiatives.  One of his goals was to transform how workers were appraised and how pay raises were distributed.

Up until that point, raises were across the board and there was little that people could do to move through their pay grades.  Performance appraisals were perfunctory at best and the process was largely perceived as an exercise in documentation.  I was tasked with updating the forms that were used.  This turned into a much larger project because performance management isn’t just about the form – it is about the definition and understanding of performance and how individual performance related to overall organizational performance and how that can drive continuous improvement.

This required culture change and some agencies were more successful than others in navigating that change.  The notion of “SMART” goals was foreign to large number of managers in state government at that time, including a lot of executives.  We conducted an extensive campaign of education and communication, starting in cabinet meetings and then meeting with all agency heads and division directors.  I was stunned at the numbers of agency leaders who said that the idea of performance was irrelevant to the work that they did.  They insisted that their roles were regulatory in nature, that they were not accountable for anything but compliance.

Why do businesses do business?  Because they can make a profit doing so.  When they are unable to make an adequate profit, they adjust – they cut costs or they increase prices, or they work to increase revenue through increased sales.  That profit motivation drives ongoing innovation and a constant quest for increased efficiency and continuous improvement that is a hallmark of operational effectiveness.

Why does government do government?  There’s no way that I can reduce that to an easy answer, but I can tell you for sure there is no profit motive in government.  Government does many things that the private sector would NOT do because there’s no profit in it.  Public safety and rural postal delivery come to mind as examples where the private sector might take a pass.  Child welfare might be another one. Government does these things because they have to be done.  Government, regardless of party, has a responsibility for ensuring the safety, liberty, and some measure of well-being of citizens. It’s part of the pact with citizens in exchange for the taxes we pay.

I don’t want to paint with too broad a brush here, but I think it’s fair to say that government does not always do things as efficiently as possible. I think it’s also fair to say that government is not always good at measuring the effectiveness of what they are doing and whether or not they are actually achieving stated policy outcomes. To me, that’s unfortunate because doing these things is also a big part of the pact with citizens. I think it’s fair to expect that the government should collect no more than what is actually needed in taxes and that they should do everything possible to make sure that those monies are spent effectively and efficiently.

There is a tremendous amount of subject matter knowledge in state governments – you need that subject matter knowledge in order to craft policy that supports the above outcomes.  There is also a tremendous sense of mission in most of the public servants that I have worked with.  Most are working in the public sector because they want to contribute to a greater good in some way.  What is in shorter supply in state governments are managers that have the skills to evaluate and facilitate ongoing and rigorous improvements in efficiency and effectiveness in the operations that support those policy outcomes. (the reasons for this are probably the subject of another blog!)

What you end up with are systems and processes that are built around compliance.  These are usually systems or processes that are built within programmatic or functional silos.  They are frequently not user-friendly for external users.  They almost never support person-centered practices, nor do they facilitate going beyond compliance in service to larger objectives.

Businesses also operate in a complex regulatory environment. Most successful businesses find ways to incorporate regulatory compliance into the success of their business mission.  A simple example –food-related illnesses are terrible for restaurants.  Conducting food safety checks is one way to ensure that their food does not cause a food-related illness.  Documenting those checks is a defense against claims of food-borne sickness. But the success of the business is still measured by its ability to survive and generate profit.

Compliance is a floor. In the LTSS world in particular, compliance alone is not enough to meet the challenges of growing demand, exploding expenditures, evolving regulatory requirements and changing consumer preferences. But sometimes organizations, particularly government agencies can get tunnel vision around compliance.  Human service agencies must address organizational fragmentation, funding siloes and ineffective business processes. It doesn’t matter if you get the policy right if operations and implementation are not effective. You have to go beyond compliance.