As the Legislature kicks off the 2024 General Session, many budget discussions will focus on how the Legislature can allocate funding to facilitate solutions. Meanwhile, the Legislative Fiscal Analyst’s (LFA) Performance and Operations team will focus on improving internal processes for working with agencies that implement appropriated funding. A crucial step of process improvement is identification of problems, not just symptoms. Enter the ‘Seductive Seven’; alluring would-be solutions which may not actually address underlying problems. They include simply adding:
- Technology
- Data
- Money
- Strategic Planning
- Reorganization
- Training
- Balance/Accountability
While these may superficially appear as solutions and offer short-term benefits, eventually core problems will resurface. As well intentioned as these approaches can be, they can mask the underlying cause and create an opportunity cost, where resources are used to address the symptoms rather than resolving the problem.
Avoiding the Seductive Seven
The LFA Efficiency Evaluation of the Medical Examiner’s Office demonstrates the allure of the Seductive Seven. The problem was simple—the Medical Examiner’s Office was not meeting professional timeliness standards for autopsy reports. A quick assessment of the situation may suggest additional funding to hire more pathologists as the solution. However, operational solutions were identified that could be implemented within existing budgets, such as:
- Improving the process of information collection to avoid delays,
- Delegating administrative and case management tasks differently, and
- Protecting pathologist time from unrelated interruptions.
While the Seductive Seven require additional resources, Efficiency Evaluations use operations improvement techniques which can typically provide a solution within existing constraints.
‘TOP’ Frameworks Focus on the Customer
As W. Edwards Deming said, “a bad system will beat a good person every time.” With this sentiment in mind, LFA’s Performance and Operations team participated in the Transformational Operations and Performance (TOP) program offered by the University of Utah’s David Eccles School of Business during the 2023 interim. TOP is one of many process improvement techniques used during Efficiency Evaluations. The TOP certificate program focuses on process improvement within government systems. The Performance and Operations team adapted principles taught in the course for various operations within LFA in addition to the Efficiency Evaluation process. TOP principles were also key in producing the Medical Examiner’s Office evaluation in partnership with the Governor’s Office of Planning and Budget.
Focusing on why a process exists within a larger system is critical to identifying opportunities for improvement. Understanding the why requires identifying a primary customer. In government, customers are referred to as taxpayers, inmates, students, clients, drivers, residents, etc. The Performance and Operations team asks five questions when identifying a primary customer:
- Who is being served?
- What is their primary need?
- Why can’t non-government organizations better fulfill this need?
- What problem is being solved by executing the process?
- How do we know if our system is performing better or worse?
Knowing your customer is key to underlying cause of breakdowns in a process. In the case of the Medical Examiner’s Office, the agency was viewing the primary customer of their final autopsy report as the family member of the deceased. However, entities such as law enforcement, attorneys, or insurance companies use the details of these reports more frequently than families. Identifying the correct primary customer requires a clear understanding of the end user for any product. While families of the deceased should be an important consideration in the process (or ‘strategic partner’), it was key to diagnose that they were not the primary customer for this particular report.
The Rules of Flow
After defining the primary customer, another critical step in process improvement is identifying the constraint. While constraints are typically thought of as the limiting factor, they can also be the biggest lever to improve results. Constraints control the speed and quality of the process and are often the most expensive or resource-intensive step.
In the Medical Examiner’s Office, pathologists are key to getting autopsy reports completed. Additionally, there are certain tasks that only pathologists can perform given their training and expertise. As such, the resource of pathologists’ time is both expensive and critical to producing the goods and services of the Medical Examiner’s Office. After identifying the constraint, best practice is to prioritize and build a system around the resource to ensure that it is utilized efficiently.
The TOP class provided the Performance and Operations team with the ‘Rules of Flow,’ which are strategies to help prioritize constraints and ensure that all other steps in a process are designed around these limited resources. Returning again to the example of pathologists’ time in producing final autopsy reports, it was recommended to reduce or eliminate administrative work which can be performed by alternative staff, retaining pathologist time for tasks requiring their specific expertise. The Office can continue to improve the flow-through of their process by utilizing administrative staff to ensure all information required by the pathologist is ready, such as investigative and toxicology reports.
LFA looks forward to working hand-in-hand with state agencies to improve government services for the citizens of Utah. In the new year, the Performance and Operations team will be focused on applying the Rules of flow, identifying primary customers, avoiding the Seductive Seven, and providing updates on budget.utah.gov.
You can read the 2023 annual update for the Performance and Operations team along with past reports here.