Hospital autonomy may be a quick fix for them, but what about the rest of government?
Why do I say this? I have worked in the past in local government for more than 23 years and I have come to the realization that until systems are "fixed," we will continue to have a bureaucracy that functions, at its optimum, at a snail's pace.
Some of this is a necessary evil and results from the requisite checks and balances that must exist in a government, small or large. Chief among government's challenges are:
— Slow personnel hiring and an inadequate outmoded civil service system (merit system).
— Tedious and/or inadequate procurement processes.
— Slow vendor payments; insufficient funds with which to operate.
— Inability to act swiftly to respond to a changing community need.
— Collective bargaining agreements that stifle creativity in changing/developing flexible job specifications.
It is clear to anyone who effectively manages a large entity, a government agency or a large corporation that success occurs when you have ready resources, a steady cash flow, ability to change to meet shifting consumer needs and the ability to remove ineffective employees.
Many of the issues I have already mentioned stymie the effective operation of our hospitals and government. They need to change, and change now.
If the hospitals are given the autonomy they seek, what do we do about the rest of government? Are we prepared to live with the oftentimes poor but costly quality of public services we now receive? Much of which stems, I believe, among other reasons, from these very same problems. Until we fix these systemic problems, we will continue on our merry way while not fully understanding why things do not work the way we would like.
We now even hear advocates for giving the Department of Education some of the autonomous changes that we are now looking to give to the hospitals. Why? Because like health care we want public education to improve and improve quickly. What then will happen after that? Do we then give these seemingly easy changes to other departments on a piecemeal basis?
Do we understand how in other departments, like Human Services, a cancer patient who needs to go off-island for immediate care cannot get a ticket because travel agencies have not been paid? Do we understand how difficult it is to quickly respond to the needs of child abuse victims when the systems are so bureaucratic in nature? Will the powers that be then give the Department of Human Services special dispensations as they are now doing for others? Where will it end?
I believe that making systemic change is critical if we are to ever see real improvements across the board. Where else, I ask, in the United States do you see a governor personally approving every lease and contract, numbering in the thousands, signing all travel documents for each employee traveling outside of the territory, every hire and fire document and myriad other basic daily functioning documents? (When can you find time to govern and plan?)
These "safeguards" perhaps did not impede good government 25 or so years ago when they created them, but in truth there has been little notable change over the years.
A word of caution: There has emerged a whole culture within the V.I. government of people who find legal and not-so-legal ways of going around the law to speed up action. Do we want this? You be the judge when it comes time for us to pay back to the federal government out of limited General Fund (taxpayer) dollars for these "circumventions."
Yes, we need to increase our revenues, but we also need to spend what we do have much more wisely. There are several steps we should take, but chief among them are:
— Looking elsewhere at the best practices of the private sector or successful federal, state or city governments and use them to improve our operations.
— Placing the responsibility for signing hire and fire documents in the civil service system (which needs revamping) on the head of personnel.
— Making our procurement commissioner truly function as the contracting officer for the government, and staff that agency with professionals.
— Review our costs of operations and place into the private sector more of our operations, returning government to what services they do best.
We cannot afford to wait another day. We must attack the problem, not just the symptoms, whose impact we see so clearly in the hospitals and public schools.
Editor's note: Catherine L. Mills of St. Thomas, a former Human Services commissioner, holds a master's degree in social work. You can send comments to her on the articles she writes or topics you would like to see addressed at source@viaccess.net.
