Health

One paper (Blum 2007) suggests that ‘new governance offers exciting approaches to government efforts to more efficiently oversee, and in some cases, actually influence the directions of health services’.

Highlighting the existing Quality Assessment Performance Improvement (QAPI) program, which already mirrors themes evident in new governance approaches, the scheme incorporated requirements on hospitals to improve performance yet enhance a regulated framework and uphold an individual approach to address problems unique to its own situation. The four criteria were ‘an ongoing, hospital-wide program that measures reduction in medical errors; a clearly defined policy on supporting data to identify and measure quality; a priority-setting process for improvements that tracks and analyses adverse patient events and implements preventive actions; and the implementation of quality improvement projects proportional to the scope and complexity of a given hospital’s services’.

While Blum notes that the QAPI program ‘is structured in such a way that if the flexibility model wanes, traditional command and control mechanisms are readily available to be drawn upon’, he suggests that this is ‘not outside the concepts of new governance’.

And after the 1999 report by the Institute of Medicine (IOM), which was critical of American hospitals given its estimate that between 44,000 to 98,000 patients died as a result of preventable errors, there has been a greater willingness to identify medical errors, analyse causes of such errors and develop guidelines to prevent future mistakes. For instance, US federal legislation was enacted in 2005 to establish regional Patient Safety Organisations ‘to voluntarily collect reported data on medical errors from physicians and other providers, analyse this data to discern patterns and trends, and feed the data into a national database’. By 2002, 20 US states had enacted legislation ‘mandating the reporting of adverse events as part of their hospital licensing requirements’ (Blum 2007).

There is also the British example where a number of innovative changes have been applied to reduce the number of stillbirths at Luton and Dunstable hospitals. With involved people keen to make changes that would reduce the incidence of stillbirths, particularly community midwives who deal directly with patients, an interaction of ideas had led to policy changes with long-term potential. Though still early to make an absolute conclusion, the stillbirth rate has improved from 9.5 per 1,000 births in 2004 to 7.2 by 2007 with the number of stillbirths classed as avoidable reduced from 11 in 2004 to two in 2007 (NAO 2009: 22).

Prison rehabilitation

There is also a need to encourage public innovation in prisons. Arizona’s Department of Corrections received a 2008 Innovations in American Government Award was with its Getting Ready: Keeping Communities Safe Prison Re-entry Initiative, implemented in 2004 and developed with no new funds or enabling legislation. This involved promoting inmate re-entry into society by structuring the prison environment like the outside world with real-world job training and educational opportunities. In contrast to conventional correctional systems which give staff almost complete control over prisoners, the Arizona scheme provides inmates ‘with graduated incentives and privileges to reward good behavior’, which include being ‘encouraged to earn high school equivalency diplomas, achieve and maintain sobriety, work full time, and participate in victim-focused volunteer activities during leisure time’. Further, prison life mirrors the real world with wages improving with post secondary education and good work evaluations, while status improves with community service.

The results are indeed positive for both the community and prisoners given that three quarters of the inmate population earned high school equivalency diplomas and completed bona-fide jobs training. With about 42% of all Arizona inmates released returning to prison within three years prior to the program, prisoners who participated in the Getting Ready program prior to their release were 35% more successful in the community than inmates of comparable risk. In addition, inmate-on-inmate violence was reduced by 37%, inmate-on-staff assaults by 51%, and inmate suicides by 33%. It was estimated that lower rates of institutional violence and re-offending saved Arizona taxpayers about $US1.6 million (Ash Institute 2008).

Also winning an award from Harvard University’s Ash Institute as the winner of the 2008 Annie E. Casey Innovations Award in Children and Family System Reform was Missouri’s Division of Youth Services (DYS). Heralding a new philosophy for youth offenders at its 42 locations across Missouri, DYS has taken a therapeutic approach by viewing youth ‘as a direct product of their experiences and capable of turning their lives around through a step by step change process’. Included in the program are group meetings with 10 to 12 of their peers to talk through challenges, and individualised educational assistance and participation in a host of volunteer and community engagement activities. In addition to the youth served by DYS treatment centres, others are diverted from the juvenile justice system all together through community-based programs supported by the Division, while low risk youth ‘receive day treatment and family support while living at home’.

Measured improvement is indicated by a reduction of juvenile crime with 90% of youth avoiding further incarceration for three years or more after graduating from the program. Other studies indicate that a re-offense rate of 9% for Missouri youth compare favourably with Florida, Maryland, and Louisiana (29%, 30%, and 45% respectively). Further, DYS promotes academic achievement with 90% of involved youth earning high school credits, 48% returning to public schools, and 70% progressing more rapidly than same-age peers in core subjects (Ash Institute 2008).

Renewable energy

The importance of public leadership in regard to the promotion of renewable energy has been illustrated by the example of Rizhao, a coastal city of nearly 3 million on the Shandong Peninsula in northern China. There the Shandong provincial government provided policy measures to encourage the development and adoption of solar energy use. This included subsidies to the research and development activities of solar energy industries to improve efficiency and reduce costs of their products.

As a result, the cost of a solar water heater was brought down to the same level as an electric one (about $190), equivalent to about 4–5% of the annual income of an average urban household and about 8–10% of a rural household’s income. Solar water heating over 15 years amounted to savings of $1800 when compared to running a conventional electric heater. Benefits included 99% of households in the central districts using solar water heaters; most traffic signals, streetlights, and park illumination being powered by photovoltaic solar cells; over 30% of households in the suburbs and villages using solar water heaters, and over 6000 households have solar cooking facilities; and a reduction of 3,340,000 tons of CO<₂ emissions and SO<₂ by 12,500 tons annually (Bai et al. 2009).

Environmental warning systems

The UK’s Environment Agency also proved innovative with an improved Flood Warning direct system. With Britain hit by severe flooding in Autumn 2000, affecting 10,000 properties in over 700 locations and costing about £1 billion, the Environment Agency’s investigation produced a report featuring recommendations for improvements to flood warnings, emergency planning and flood defences. With feedback suggesting that the system would be more effective if it could deliver flood warnings in the way that best suited the individual user: by telephone, SMS message, fax, or e-mail, the new Flood Warning Direct system is now centred around a computerised map with a database of properties and registered user details with a flood warning sent automatically sent to registered users within the affected area via their preferred means (NAO 2009: 25).

E-governance

The importance of e-governance has proven vital to any government’s bid to modernise service delivery online and save resources, as indicated by governments typically spending around 1–1.5% of GDP on public sector information technology (IT) systems to aid communication about the availability and use of government services to the public beyond the use of the telephone.

Take the example of Service Canada, begun in 2005 after a decade of efforts and extensive research and planning to improve e-governance in Canada. Designed to provide a one-stop service through in-person, telephone, Internet and mail delivery channels, it employs over 22,000 employees to serve the country’s 32 million citizens with over 580 in-person points of service across the country.

Though a 2006 national survey showed that only a small percentage of Canadians were aware of its existence and responsibilities, Service Canada answers more than 56 million telephone calls (over 80% of all calls to the federal government, excluding the Canada Revenue Agency) and handles more than 14 million unique visits to its website.

More importantly, the benefit of Service Canada is illustrated by improved service delivery to disabled Canadians. At the time of writing, the Province of Ontario had 44 separate and different programs providing services and benefits for disabled persons living in the Province. Because they do not share information readily, Service Canada will be to integrate such programs to ensure one-stop access that will require applicants to provide their personal information only once (Flumian, Coe and Kernaghan 2007).

Housing

Receiving a 2008 Innovations in American Government Award in regard to public housing was New York City’s Acquisition Fund as National Model for Creating and Preserving Affordable Housing, a key element of New York City Mayor Michael Bloomberg’s $US7.5 billion New Housing Marketplace Plan to provide affordable housing for 500,000 New Yorkers. In a $US230 million partnership with the private finance sector, the Fund finances the purchase of land and buildings for affordable housing by encouraging small developers to compete in a tough real estate market. Established in 2006, and supported by the City’s leading financial institutions, 10 national philanthropies, and the City of New York, the Fund encourages banks to offer credit to smaller developers by providing low-interest capital at higher advance rates and lower recourse levels than are available from conventional financial institutions, and it can respond faster than typical government funding cycles.

With the Foundation contributing $US33 million, city funds $US8 million, and private banks $US192.5 million, the Fund will build and preserve 30,000 affordable housing units over 10 years with 75% of units reserved for low income residents (Ash Institute 2008).

Regionalism in federal societies

The importance of ‘experimental regionalism’ helps explain Germany’s attempt ‘to instigate regions to cooperate and to define regional development programs’ (Furst 2006). The discussion of ‘experimental regionalism’ refers to the state confining itself ‘to defining the objectives, “organising the game” and assessing the results but relies entirely on the voluntary participation of regions/joint local actors to comply and to be inventive enough to find new solutions. In addition, competition is crucial for motivating and challenging regions, at least at the outset of ‘the game’, when regions submit their proposals and bid for the financial resources offered by the agency’.

The example of Bavaria promoted experimental regionalism where the government takes over the costs of a number of projects for a period of four years (around half of the cost) but with regressive contributions (in the first year 80%, in the second 60%, in the third 40% and in the fourth 20%). Further, a ‘balance conference’ is to be held every two years to disseminate and assess the knowledge on regionalisation and to initiate exchanges of experiences (Furst 2006).

Government service delivery

An excellent example of improved government service delivery is demonstrated by US attempts to improve complaint and inquiry services to government departments. Starting in Baltimore and soon spreading to Chicago, New York City, Barcelona, Tokyo, and dozens of other cities around the world, the ‘311’ phone service speeds up the inquiry process. By dialing 311, the program offers an immediate response via a highly sophisticated customer relationship-management software system which directs one’s issue to the appropriate agency and then logs, tracks and monitors the inquiry to the end. After speaking to a real live person within 10 seconds of placing the call, with well trained customer service representatives dealing with the inquiry 85% of the time, the inquirer is given an email acknowledgment of the call, detail of how it will be resolved, and a tracking number for the inquirer to go online anytime to see if the issue has been fixed and who is working on the complaint. Within a few days, the inquirer is sent a follow-up letter from the chief executive officer (or equivalent). Such a process hastens the ability of citizens to report quality-of-life issues which helps government and society improve services. For instance, New York City has seen excessive noise inspections increase by 94% and rodent exterminations increase by more than a third, while the waiting time for the building review process with an inspector has improved from more than a month to less than a week.

The 311 service also improves government planning performance. This is because the millions of data points collected each month encourage better resource decisions because trends are spotted that would be previously unseen. For example, whereas New York City had a chronic Sunday morning parking problem before 311, thus leading to a flawed conclusion that churchgoers are habitual parking violators which infuriated fellow New Yorkers, parking complaints are ‘now geocoded and routed directly to the nearest police precinct’s computer so they can be handled more expeditiously’ (Eggers and Singh 2009: 56–57).

The benefits of improved public sector phone systems is also demonstrated by a recent joint initiative in the US by multiple levels of government (Summit county, Ohio and they city of Akron) to purchase a single 911 emergency phone system that displays the location of calls made from cell phones on a map at the 911 dispatch centre. With this system saving the city and county nearly $150,000 and expected to lower operating expenses by 40%, both levels of government are strengthening their Collaboration Committee to identify new areas for sharing services and resources (Eggers and Singh 2009: 69–71).

Other US public sector innovation examples that improve service delivery have been a Florida Department of Children and Families program that has slashed customer wait times by 45 minutes, reduced turnover, and saved $11 million annually, developments that led to that department earning several awards and other state and federal agencies copying its efforts (Eggers and Singh 2009: 28).

Further, after the experience of airlines showed that higher toll prices during peak landing times could be used to regulate congestion, an initial Californian commercial pilot study applying the same principle to roads began to be replicated across the US. The 91 Express Lanes in California gave drivers a choice between ‘using a congested freeway, paying a heftier fee to use a less congested express lane, or altering their time of travel to avoid super-peak rush hours’ (Eggers and Singh 2009: 66).

In the UK, the British Broadcasting Corporation (BBC) has upheld its longstanding role to utilise the latest technology to improve service and information delivery for customers which also provides an important public policy benefit. For example, after numerous surveys revealed that the BBC’s customers wanted more innovation in regard to public programming and technology choices, the BBC developed ‘backstage.bbc.com,’ in order to promote the ability of amateur innovators to use BBC content and tools to build sites and projects that meet the needs of customers in unique needs. As a result, rather than rely on headlines like ‘A1 Cambridge shire — Narrow lanes both ways at the B1081 Old Great North Road junction in Stamford, speed restriction of 40 kms,’ the new system combines such linear data with feeds from Google maps to help readers to locate bottlenecks in real time. Further, the Homepage Archive, by keeping all the information published by the BBC, allows users to track the evolution of the homepage and its content from one day to help innovation processes. This builds upon the BBC’s own continued efforts to develop R&D activities that maximise the new digital technologies by taking advantage of development ideas from all over the world (Eggers and Singh 2009: 77–78).

Working with the community for mutual public-community benefit

An example of community input to help government address a complex and difficult problem was illustrated during the 19 days it took to control Southern California’s wildfires in October 2007, a disaster that destroyed nearly 1500 homes and more than 500,000 acres of land with around one million people evacuating their homes.

This was seen by the role citizens played in assisting local fire departments. With disaster management and recovery efforts requiring constant information flow on fire perimeters, evacuation centres, and road closing, it was citizens who organised themselves rapidly through social networking sites to assist the authorities to coordinate the emergency response. After pictures of fires were posted on Flickr; more than 100 social groups were established on Facebook to support people affected by the fires with KNBC.com (a digital news channel) also receiving live streaming video and user-submitted photos.

Of course, government agencies also sought to harness the collective wisdom via technology. This was achieved via a wiki application to give citizens, disaster relief associations, and private companies, real time information in case of a wildfire breakout in their area, while the National Aeronautics and Space Administration (NASA) provided detailed satellite images that showed active fire zones and the speed at which the fires spread.

However, the state’s fire agency was linked to the Web site of KPBS, a San Diego radio station, which provided 24/7 coverage of the wildfires using wikis to coordinate the effort. Using a fairly new application My Map, earlier used as a fun tool to pinpoint the best places to play golf or get a drink, KPBS employees produced a virtual map of Southern California with symbols for where to find shelter, what roads were closed, and what had burned, thus attracting more than 1.2 million hits (Eggers and Singh 2009: 85).

The importance of community efforts is also illustrated by the ‘Fix My Street’ website in the UK built by the voluntary organisation My Society to help fix physical problems such as potholes and vandalism in the local community. With users required to enter their postcode or street name, click on the exact location on a map of the area, write a detailed description of the problem, and even add a picture if they choose, about 25,000 problems were reported to local municipal councils (Eggers and Singh 2009: 87).

Another example of major input by the community was illustrated in Chicago where the Bethel New Life community-based organisation created the Bethel Center to represent the huge resistance in Chicago’s West Garfield Park neighborhood to the transit authority’s proposed closure of the elevated Green Line transit rail stop. By using grants from various government agencies and nonprofit foundations, Bethel built a three-story, 23,000 square foot, environmentally friendly, state-of-the-art facility across from the transit stop which offered employment counseling and job placement, commercial services, a computer technology centre, a 106-child day care centre, and retail space. The building not only made it viable for the transit authority to retain the stop in the economically weak neighborhood, but led to the US Environmental Protection Agency awarding the centre its 2006 National Award for Smart Growth Achievement for equitable development (Eggers and Singh 2009: 68).

Government leadership in regard to public–private partnerships

The role of government leadership to enhance the performance of public–private arrangements has been recently demonstrated by policy development in the European Union. In response to earlier criticisms about not enough accountability and the risk of fragmentation of the single market, the European Union introduced a New Regulatory Framework for electronic communications networks and services in 2002 that requires Member States to guarantee independence of National Regulatory Authorities from service providers in order to promote the interests of citizens (universal service, consumer protection, data privacy) (Sabel and Zeitlin 2008).

The role of government leadership in public–private partnerships to achieve certain goals is also illustrated by policies intended to relieve traffic congestion and raise important taxation revenue. For instance, the experience of the Netherlands demonstrates that the use of tariffs and collection by commercial organisations at well-designed parking facilities at the right locations has helped deal with congestion problems and generate a considerable positive cash flow for local governments (Koppenjan and Enserink 2009). And as evident by the national audit offices of the United Kingdom and the Netherlands, the focus on economic performance has now been softened with sustainability targets attached to public–private partnerships to help ‘establish a framework for sustainable urban infrastructure policies by developing indicators and standards, formulating ambitions, benchmarking local, regional, and provincial authorities, and developing accountability and reward systems’ (Koppenjan and Enserink 2009).

The CIA also use the private sector to enhance its security needs. For instance, the CIA funds a nonprofit organisation, In-Q-Tel, to fund and deliver technological solutions for many CIA needs, including data mining, strong encryption, and the ability to search the Web for valuable information. This is achieved by In-Q-Tel providing seed capital to small start-up companies to develop new technologies. In-Q-Tel invested in the Keyhole, Inc. company in February 2003 after the latter developed the software now known as Google Earth before Google acquired Keyhole in October 2004. As a result, the CIA links to In-Q-Tel allow the intelligence agency to receive relevant information tailored to the CIA’s needs in line with stringent security requirements (Eggers and Singh 2009: 82).

Another successful public–private partnership is illustrated by the United Nations Foundation and the Vodafone Group Foundation co-launching a $30 million technology partnership (EpiSurveyor) in 2005 to enhance develop mobile technology to respond to emergencies and collecting health data. EpiSurveyor provides the first free, open-source software for collecting health data with researchers in the field using handheld computing devices to collect data and transfer the information to desktop computers for processing and analysis. It is estimated that this approach will cut the cost of program assessments, which account for 10% of project expenses (Eggers and Singh 2009: 63–64).

The BBC has also formed multiple joint ventures to overcome constraints such as borrowing limits, reduced risk-taking ability, and marketing inexperience in order to generate additional revenue. For example, a 1998 joint venture with the media company Discovery allowed the BBC to greatly expand its reach via BBC America in the US and Animal Planet worldwide. Further, Discovery invested £175 million in factual programs to take advantage of the BBC’s reputation (Eggers and Singh 2009: 71).

The BBC, by promoting Innovation Labs with its series of creative workshops, has also allowed independent media companies an opportunity to offer their ideas to BBC commissioners. After the program attracted 29 companies in its first year and generated 170 ideas, 13 external ideas were selected for further development. Since the first year, the Innovations Labs has gained popularity in more regions and has built traction among start-up private media companies (Eggers and Singh 2009: 77).

Another UK example of public–private partnership to enhance innovation has been the launch of the Oyster card (the contactless ‘smartcard’) in 2003 by Transport for London in partnership with a private company. The Oyster card, which allows passengers to ‘touch in’ and ‘touch out’ on the automated barriers, has resulted in cheaper travel while reducing queues to buy paper tickets. It is currently used to pay for 90% of all London bus and underground travel (Eggers and Singh 2009: 66).

There is still a long way to go in terms of pubic sector innovation, although the above examples are all positive examples that prove that it works and is needed.

But some nations are leading the way. For instance, the 2007 UK Innovation Survey suggested that all central government organisations surveyed were able to cite innovations either currently underway or already delivered, although data was not available. And evidence from senior civil servants indicates that 96% of respondents agreed that their organisation provided support when things go wrong despite good risk management, compared with 65% when asked a similar question in 2004. In addition, nearly 90% of respondents agreed with the statement ‘my organisation looks upon risk as an opportunity as well as a threat’, compared with 65% in 2004 (NAO 2009).

 

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