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July 30, 2010 > Transforming county operations

Transforming county operations

Submitted By Gwen Mitchell and Laurel Anderson

Five project teams, tasked over six weeks with identifying challenges and strategies for immediate and long-term improvements in the way Santa Clara County government operates, have made their recommendations to heads of County departments. The inaugural group of mid-managers has completed training in the County's new Center for Leadership and Transformation (CLT) launched by County Executive Jeffrey V. Smith during the spring. Smith's mantra is that Santa Clara County can become a leader among counties in the nation.

"We're sufficiently large, yet nimble enough to make the necessary changes," Smith has told employees throughout the organization. "The County faces very difficult fiscal challenges so we must make decisions based on new models, find ways to become a leaner, more efficient organization and must innovate."

"Line managers and supervisors often have their finger on the pulse of their operation," said Smith. "They understand what is needed for service-delivery and ideally have the confidence of senior management. So, they're uniquely positioned to be change agents. Our goal is to empower them to identify and make changes needed for the organizational effectiveness."

The first five project teams in the County's Center for Leadership and Transformation made a series of recommendations that promise several million dollars in savings.

Information Technology
The IT project team set out to determine how the County could create efficiencies and cost savings in information technology and systems. At the Chief Information Officer's suggestion, the IT group analyzed non-core software in all County departments. Many County agencies had acquired software and implemented systems over time, on a department-by-department basis, resulting in an information technology system resembling a patchwork quilt. The cost each pays for software licenses varies significantly, depending on the number of users and rates in effect when purchases were made. For example, one office paid as little as $8 per user, another $17 and another $21 for similar antivirus licensing software. The County's the annual software-maintenance cost is estimated at more than $13M. By consolidating and negotiating the purchases, when contracts such as the anti-virus contracts expire, the group projects that just a 10 percent improvement in software-maintenance costs could yield savings of at least $1M.

During a brainstorming session, Team 2 decided to tackle the issue of bureaucracy. Whether it is a function of too many decision makers, the long planning horizon required for recruitment and appointments, rules and regulations governing procurement of goods and services or micro-management, a number of barriers slow the process and reduce productivity.

"Our goal is to establish an ongoing process to break through barriers," said Rapid Action Force (RAF) Project Team Leader Amando Cablas. "We can create a culture of change and innovation by implementing a program to fast-track approval of new ideas."

The group determined that some ideas fail to gain support because they are impractical. Others do not gain traction because it is simpler to continue with business as usual. The team recommended creating a Rapid Action Force in the County Executive's Office of Budget and Analysis to solicit and evaluate new ideas and quickly implement those that meet certain criteria. For instance, they must be cost-effective, budget neutral, create lean workflow and can be implemented in 90 days or less. The RAF's presence in the County Executive's Office gave it the required authority to overcome any organizational opposition or inertia.

Temporary Employees
The third project team examined the County's policies that restrict retention of temporary (Extra Help) employees and the opportunity cost. Extra Help employees are hired for a specific task and duration, such as during tax collection season, elections; or temporarily cover for illness, disability or transfer of the employee; or to fill an unanticipated need such as epidemics, disasters, or an influx of specific populations, perhaps with language assistance needs. To ensure a competitive process for permanent County jobs, Extra Help employees may only work for a limited time and are unable to apply for all county jobs.

Training a new employee costs an average of $27,500. That investment is lost when a temporary employee leaves and a further $27,500 is spent to train a replacement worker, if the position is needed on a longer-term basis. Retention of Extra Help employees would save between $1.4M and $4.1M for 50 to 150 new hires.

The Employee Services Agency will consider the recommendation to centralize recruitment for certain types of extra help across County Departments to shorten the recruitment period of qualified candidates. ESA will also follow up on the recommendation to examine providing extra credit for relevant County service in civil service examinations. This will give extra help employees with relevant experience better access to permanent jobs and result in less training and orientation and generate cost savings for hiring departments.

Electronic Medical Records
Use of Electronic Medical Records (ELMR), the system for outpatients, at the Valley Medical Center (VMC) was assessed: With 400 providers and 1,500 users, it is in situ at regional VMC care sites and ideally would facilitate better coordination, information sharing and patient care between the hospital and the clinic system. During the next implementation phase, ELMR will expand to include medical specialties. When complete, the system will streamline the patient clinic visit process.

The ELMR team examination of the system led to a series of recommendations - some technical and some process improvements, including the possibility of sending text-message reminders of appointments to patients, and eliminating duplicate data entry.

The Patient Registry Team, led by Dr. Angela Suarez, identified 31 disparate systems that maintain patient information. It is recommended that the County implements a patient registry with a single view of patient information by linking fragmented data, and uses aggregated patient information for pro-active population and chronic disease management. The proposed patient registry would link the four critical areas: Decision Support; Lab; Diagnostic Imaging; and the Emergency Department. Such a registry would allow providers to monitor and intervene in all their patients' care, not just those who seek care in the physician's office. Full system implementation would require a financial investment in hardware, software, interfaces and system maintenance. However, the group outlined the intangible benefit as improved patient care.

Next Steps
The County's Executive Management Team will receive Rapid Transformation Principles and Processes training at Stanford University in August. The Office of Budget and Analysis is creating a website that will monitor and track projects' results. Director Leslie Crowell brought the Rapid Transformation concept to the County Executive after reading a newspaper article about it last year and follow-up discussions with Behnam Tabrizi, a consulting professor at Stanford University and author of "Rapid Transformation: A 90-Day Plan for Fast and Effective Change."

"This exciting project for the County is not a theoretical exercise," said Crowell. "We're bringing together cross-functional teams address current county issues and produce actionable results."

"Employees of large organizations often think they can't change bureaucracy. I want our story to be: Yes we can. We can change things," said Smith.

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