This article appeared in Govloop.com on December 5, 2017

The work products from most agencies are created, marked up and published in a digital form. It took years but the government is now mostly digital. Many agencies put up a good fight, however digital won. Certainly, some agencies still publish their work as hardcopy but most do not. Looking for information now requires the use of a computer, not so much a trek to the file room. File cabinets are not yet a thing of the past but I have not seen a new one in a while.

I recently saw a picture of a congressman holding up a hardcopy form of a proposed bill they had just voted on. The bill literally had text crossed out with a sharpie and replacement text handwritten in the margins with arrows. The content of the bill aside, what struck me is how old-fashioned and unofficial marking up hardcopy pages looked.

Government agencies work electronically just like the private sector does. Sure, some participants use hardcopy for taking notes but the document actually being marked up is almost always electronic with track changes turned on. Typically some team member(s) creates the original draft. A small group then collaborates to iterate the draft into a more final-like version. Various stakeholders then have the opportunity to digest and comment on the material. Revisions are made up to the moment of “policy” approval.

During the whole process, the work product is kept digital.  It gives everyone access to the current version while it is being worked on and easier to share with the rest of world when it is time to publish the final version. Even when our work gets “public noticed,” we may accept hardcopy comments. But most often, we expect the comments to come in digitally.

Contrary to how secretive the workings of government are often portrayed, the reality is that the process is usually transparent and online. While government agencies are very protective of private information, public information is generally readily available for all to see and interact with.

Day after day, week after week, for many years, government agencies create and post all sorts of information online. As the amount of information online increased, the amount of information worked on and stored in “hardcopy” decreased. Think of all of the agencies at all of the levels of government that produce and publish digital information. Most agencies have thousands and thousands of online “pages” and there are thousands of agencies. The magnitude of government information online is huge and growing.

Over 87 percent of the adult United States population has internet access. Worldwide it is estimated that over 3.8 billion people have internet access. Quite literally posting digital content gives that information the biggest potential audience it can have. No other method of sharing information even comes close. Government agencies literally share most of our information in the manner that most people have access to; the internet.

Sure, there is a huge potential audience for the information but what is the reality of how many view the information? The reality is government sites get an enormous number of views. A quick look at the analytics.usa.gov site shows that the Federal government websites get millions of page views every day. Federal sites had over 2.5 billion visits over the past 90 days. Now add to those all of the views of each of the state agency sites from all of the states. Then, add all of the views for all of the municipal sites within each state. Next, add all of the views for all of the other types of government sites.  Lastly, add them all up and – holy cow – that is a lot of views.

Besides the information posted by government agencies, think about all of the related information posted by public interest organizations, consultants, interested parties (pro and opposed), businesses, academics, students, former and present clients, news organizations, bloggers and the list goes on.

The number of file cabinets in government may be decreasing but the amount of information posted on or about our programs is a lot and continues to grow. The vast majority of that information is available to anyone online from anywhere in the world at any time. Sure, many people don’t know that our information is available but it certainly is not a secret.

The reality is government agencies, as a whole, are using technology to create content and make that content as accessible as possible to the most people as possible. We are not perfect, but the days of marking up hardcopy with a sharpie are mostly in our past. Moreover, the information is actually being accessed and used by millions of our fellow citizens.

FYI – 13 percent of adults in the USA do not have internet access. Surveys show the top two reasons why they do not have access are: no interest and too complicated.

One final thing:

Now that so much government information is online, what happens next?

There exists a virtual community surrounding most of our areas of interest. When people search by topic, your site is likely just one of many they find. Your information may be “official” but is it the easiest to understand or use. When is the last time you searched for the same topics on which your agency posts? We are part of a virtual community.

My guess is learning to better interact with our online communities is what is likely to be a big part of what is next.

 

Paul Leegard is part of the GovLoop Featured Blogger program, where we feature blog posts by government voices from all across the country (and world!). To see more Featured Blogger posts, click here.

What we perceive often depends on how close we look.
Scaleandperception.com

 

This article wsa published in Govloop.com on December 8, 2017

Most people don’t trust government, according to Pew Research. Since 2007, the amount of constituents agreeing they can trust the government “always” or “most of the time” has not surpassed 30 percent.

It might surprise the general public, but people who work at government agencies actually know what they are doing – more often than not. In fact, many government employees are widely recognized experts in their fields. The processes followed are pretty good and are being continually improved. Government agencies generally accomplish good in an efficient manner.

But trust is still important. The perception that government cannot be trusted is a very real problem. This post talks about what can be done to restore the perception of trust. Of course, both you or your agency must be, in fact, trustworthy. Perception is very important but not as important as actually being worthy of trust.

Assuming you and your agency are trustworthy but not perceived as such, how can trust be gained?

Study after study shows most people will not change a belief even when given rational arguments contrary to that belief. Ordering people to trust or not trust something does not work. Trust does not work that way. Bribery can gain cooperation but not trust, in fact, it might reduce trust.

First and foremost, remember that the public is not the enemy. They are us, we are them. This is not about who is better or worse. It is not about who is smart or who is not. It certainly is not about politics. This is exactly about having the work your agency is doing being perceived as trustworthy.

The trick is to not try to change the old perception but rather to reinforce a new perception. People might not trust “the government” but they certainly can trust the important work that you and your agency do. The “government” that people do not trust is this abstract, monolithic thing; not the reality of the work you and your agency do.

People tend to believe the information presented over and over again regardless of the information’s actual validity. The phenomenon is called the illusory truth effect. Repetition helps make it familiar, being familiar makes it believed. Unfortunately, familiarity can overpower rationality. However, being both rational and familiar is the sweet spot that reduces the cognitive dissonance (having inconsistent thoughts, beliefs or attitudes).

If you want people to believe the work you do can be trusted, repeatedly communicate that truth. Put it in every communication. Find ways for the public to get the message over and over and over again. Be honest. Be straightforward. Be positive. Say it over and over again. Experts at agency X solved the problem. Agency X works hard to help all of us. Agency X is a trusted resource for everyone. Agency X provides a trusted safety net when it is needed the most. Agency X is working together with stakeholders for the greater good. You get the idea.

Do not message that mistrust is unjustified. That reinforces the negative perception. Focus on the positive message. State it over and over again. Make it familiar. “The work the agency does can be trusted.” We are not asking them to like government, only trust the work we do. Being liked would be nice but the goal is to be trusted and respected.

Think about all of the crummy toys we “needed” as kids. We saw the commercials thousands of times. In hindsight, how many of those toys did you actually need? Sure some of those toys were wonderful but many were not. Either way, we truly believed we needed those toys because we were repeatedly told we needed them thousands of times.

Remember that people rarely change their mind on that which they believe. People do not trust government. That cause is probably lost for a generation. The new perception is not about trust of the government; it is about trusting the work done by our agencies.

We humans need to interact with each other for our mutual survival as a species. Government establishes and enforces the rules under which our interactions with each other are governed. Without government, every interaction would be contentious. Think of examples of illegal interactions outside the purview of government: gangsters and drug lords and the like. Compare that to interactions made within the purview of a trusted government. In cases of alleged cheating, there is legal recourse judged by a jury of our peers, not violence.

The work of government is, as it always has been, important. Governments that are corrupt or work against the greater good do not deserve to be trusted. Our agencies and our government employees have integrity. We work for the greater good. We live in a time where many people think their government is not trustworthy. We cannot fight that. It is what it is. The best we can do is make it known that the work we and the agencies we work for deserve to be trusted. Of course, we actually have to deserve that trust.

Make it known, over and over again that the work our agencies do is worthy of being trusted. Did you notice I repeated the idea “we and the agencies we work for deserve to be trusted” many times? I repeated it to make it familiar. By the way – did you know that work that government agencies can be trusted?

 

Paul Leegard is part of the GovLoop Featured Blogger program, where we feature blog posts by government voices from all across the country (and world!). To see more Featured Blogger posts, click here.

 

What we perceive often depends on how close we look.
Scaleandperception.com

 

This article was first published in Govloop.com on December 1, 2017

The benefits of being a positive person and of supporting a cause bigger than yourself includes: happiness, longer life, improved self-worth, better physical and mental health and the list goes on.

Trying to make the world a better place in a positive way = good for you. Being a self-centered negative jerk = not good for you.

Assuming you choose the former over the latter, as a practical matter you need a list of positive things that will make the world a better place. Where do you start? What process would come up with such a list?

There are thousands of people and organizations that work very hard to convince you to support their cause. The trick is to figure out what interests you and will make the world a better place. There is only one person who can answer which causes you are interested in: you.

About a year ago, I had read about the benefits of being a positive, altruistic person. I decided I wanted to actually make a list of positive things that interested me and which could make the world a better place. Not saying you should follow the same process but I can categorically say, making the list is well worth the effort. Below is the process I followed.

For several weeks, a couple times a week, I blocked out 15 minutes on my calendar to research and think about what positive things could be done to make the world a better place. Note: I blocked out 15 minutes but most often I actually ended up spending more like 30 minutes. I decided to limit my list to five items.

I made the self-imposed rule that the list would never be more than 5 items. So when a new idea came up I had to decide whether it was good enough to replace something else on the list.

Of course, “better” is in the eye of the beholder. However, I felt the eye of the beholder should be informed by some objective criteria. As I moved from session to session I found my definition of “better” evolved. I also decided that any idea had to be something I would be willing to tell others about and had to be within the realm of realistic and possible.

Ideas can be of any scale: Is it a global thing, a regional thing, a local thing, an interpersonal thing or a personal thing? The ideas do not have to be original or clever. Positive ideas held for the only purpose of opposing something was also contrary to the whole idea of the project.

Here are the criteria I landed on for making the world better:

• Better means a better quality of life first and longer life secondary.

• An idea could benefit either just humans or the combination of humans and other organisms. However, the idea can’t be about harming other organisms.

• Ideas could be about our relationships with others, personal wellbeing or about the environment but could not harm our relationships, wellbeing or the environment.

• Better could be about learning/changing the way we think about something or about actually changing a physical something.

• An idea could help many and harm a few, but in all cases, the idea is to be about helping the many and not basically about harming the few.

Many ideas felt great at first, but upon reflection, not so much. My list was not a “best of” list. It was a list of things that interested me and in my personal opinion would help make the world a better place. The list was not about how to accomplish any items on the list.

Here are the five ideas on my final list. I did not rank them at the time or since.

• Learn to use connected devices better and encourage others to do the same. We are in the information age and learning to use the tools of the age is a very positive thing to do.

• Make government information more accessible and encourage others to do the same (a job-related goal).

• Replace many of the billions of trees that have been cut down over the last couple hundred years.
  • Take carbon out of the atmosphere and put it in the ground where it belongs;
  • Increase the amount of oxygen in the air;
  • Provide a habitat for more organisms, increasing bio-diversity;
  • Stabilizes the soils reducing erosion.

• Help people understand that reality, for all its warts, is a very rich and satisfying place to live. None of us are perfect, accepting each other for who and what we are is a better path forward.

By inclination and nature, I am not an activist or a community organizer. The call is not that you follow me. But I highly recommend coming up with a list of positive things you think will make the world a better place.

The final item on my list was:

Work on being a better blogger with a positive message about making the world a better place.

Being a blogger and this blog post is me working on this last item.

Finally, this is the signature line from my work email. “Plant trees – Your grandchildren will breathe easy and the water will flow cool and clear.”

 

Paul Leegard is part of the GovLoop Featured Blogger program, where we feature blog posts by government voices from all across the country (and world!). To see more Featured Blogger posts, click here.

What we perceive often depends on how close we look.
Scaleandperception.com

This article was first posted at Govloop.com on November 17,2017

Careers last a long time. Your career is literally the entire period of your work life. The reasonable base expectation for our work lives is we did our job well and, in return, earned a living. For the record, doing your job(s) well and earning a living over the period of a career is something to be proud of in and of itself.

As the years passed, I have come to realize that a career is about the journey and not the destination. A good career is about what happens on your career journey and how you reacted to whatever it was. In the end, the journey was what it was. Whether or not you feel yours was a good career; it’s in hindsight to decide.

The dictionary definition of Career is a person’s progress or general course of action through life or through a phase of life, as in some profession or undertaking.

We cannot change the past of our careers. The best we can do is heed the lessons our past taught us. This is not to imply you should want to change your past. There are people who work at the same job for decades, growing in experience and learning new things all the time. There are others who seem to have just one year’s worth of experience repeated for years on end. Let me be clear, no matter where you are in your career, changing where you have been is not an option. Your option is how you are going to react now.

The future of our career is yet to be determined. The best you can do about the future is to keep it in mind as you do your job day to day. The past is in the past and the future will be what it will be. Some of the future is in your control but you do not control as much as you might think you do. The real key to a good career is doing the best you can today. It is a real cliché but learn from your past, keep an eye on the future all while living in the present.

In the real world, the trajectory of our career path is not a straight, upward-pointing line. Our paths are influenced by numerous factors – some within our control, some not. Budgets get cut back, technologies change, people have children, interests change, opportunities change, relationships get interesting and the list goes on. Through it all, remember that your job is what you have right now and doing your job well is important. However, your career is long and it will ebb and flow.

Here are some basic thoughts on what might make for a good career:

1. Be as competent as you can be at doing your job. Try new things. Let experience teach you what works and does not work. Be willing to be wrong once in a while, but learn from it. Get training and education. Take a class or go to a seminar. Attend sessions at a conference. Learning is inherently valuable to your career.

2. Suggest and or try new ways to get your job done. Be open to trying new ways suggested by others. Sure, it might be at the expense of your current job but have faith in your ability to land on your feet.

3. It is okay to be ambitious about getting ahead. But it is not okay to hurt the career of others to get ahead. In fact, helping others get ahead is a great answer when you get asked, “why do you want to be promoted?”

4. Be genuine, not a robot. Open up to others and be open when others confide in you. Getting along with others is important in almost every career. It is certainly an important part of being a decent human being. Be reasonably social.

5. Sooner or later you will have a load of crap plopped on your lap. First, clean up the mess the best you can. Do what you can to prevent it from happening again. Worry about who was to blame later. Never take revenge but take the high road instead.

6. Relationships are formed by sharing experiences with others. Form relationships by sharing experiences with coworkers. Lone wolves make good novels but generally not great careers.

7. Do what it takes to learn about your agency or organization. What groups do what things? What are the goals? Who is in charge of what? Be curious.

Overall, education, experience, people skills, willingness to do some of the dirty work, organizational knowledge, camaraderie and the like are what make for a good career.

 

Paul Leegard is part of the GovLoop Featured Blogger program, where we feature blog posts by government voices from all across the country (and world!). To see more Featured Blogger posts, click here.

What we perceive often depends on how close we look.
Scaleandperception.com

 

This post was first published on November 10, 2017 in Govloop.com

Many of our government agencies have a ton of information (content) that might be helpful to certain people in certain circumstances. But most of the time – to be honest – government agencies have a huge amount of boring content. Yet periodically the right person, having access to that content at the right time, would be a very good thing.

If all of our agencies’ content were to be displayed directly on our websites, wouldn’t that be overwhelming? Who could possibly find anything? Instead, we often put a bunch of links to documents on our web pages. We tell everyone the information is on the web – but likely, we know, it would be hard to find.

The new team was told to get my input on their proposed web page. The proposal was basically a bunch of links under banners with category names on them. It looked nice and they were excited. I knew almost no one actually uses this type of page. It is a tough lesson to learn because you have to observe the analytics for extended periods. I liked them and thought they could handle the truth. I told them, “They call content, ‘king,’ for a reason.” This post is about lessons learned from a project I occasionally worked on since late 2012.

The old Minnesota Stormwater Manual was an 885-page document. The link to it was four layers down from the home page. Additionally, the link was in the middle of 10 to 15 other links. All things considered, the manual still received a couple of thousand dowloads.

The updated Minnesota Stormwater Manual uses read-only wiki technology to display content directly on web pages. The updated manual has received over 9.3 million page views and counting. Note: it is a technical manual targeted for stormwater management professionals, not the general public.

What magic gets a technical manual over 9 million page views in only 4.5 years? Here’s the trick: The web search engines are able to index the entire content when the content is put directly on the web pages. When the content was in a pdf file, the search engines indexed just the title of the document, not the content.

Once the content is indexed, a search for relevant information can include your site in the search results. The requester does not need to know the site existed, let alone how to navigate around the site. They just looked up a topic and the search engine pointed them to the relevant information on your site.

Search engines are a modern miracle. The search engines seem to know what you want, even when you don’t. For example, I entered, “How many search results do people click on?” and somehow it knew to return an article titled, How many Google searchers go to page two of their search results? The answer= Academic research indicates that 91 percent of searchers do not go past page one of the search results and over 50 percent do not go past the first three results on page.

The search engines are sophisticated. They rank sites that have good relevant information higher than sites that do not. Lots of sites try all sorts of tricks but the actual best way to get your pages ranked high is if the page contains good content. It also helps to link to other pages with good content and have them link to such pages.

The search engines do not give extra credit for clever names or the perfect use of color. Search engines like respected, authoritative information from respected sources which are interlinked. The content – boring or not – from a government agency is generally exactly the type of information they rank highly. When the content is interlinked with other government/academic content, it increases the odds your page will appear near the top of a search result set.

Having lots of quality content really is the magic solution to making it easier for content to be discovered by the right people at the right time. The internet is full of tools to make it easy to find and use content. If your site has good content, displayed directly on web pages and if there is a demand for that information, it will be found.

Content is called king for a reason. Make sure the internet can see your actual content, not just a link.

Finally, getting the right information to the right people at the right time is the goal. While the number of page views might help justify funding, accomplishing the goal of your agency is key.

 

Paul Leegard is part of the GovLoop Featured Blogger program, where we feature blog posts by government voices from all across the country (and world!). To see more Featured Blogger posts, click here.

What we perceive often depends on how close we look.
Scaleandperception.com

 

This post was first published on November 3, 2017 in Govloop.com

Continuous process improvement projects (CIP) are a good way to better a process that needs more than a minor tweak. That said, before you dive into the CIP pool, consider whether doing the process improvement project makes sense in the big-picture direction your agency wants to head.

You can liken CIP to pulling a wagon: A squeaky wheel can get greased, ignored or sometimes replaced. The right choice depends on the planned use for the wagon.

Kids grow up and wagons grow old. Our needs change, technology changes, things wear out and sometimes it just isn’t cool to pull an old wagon. In these cases, you don’t grease the wheel, you replace or go without the wagon instead. Maybe the wagon is best repurposed as a planter.

Most agencies have a process that produces an irritating “squeak” every time it is used. Before deciding to spend significant resources improving that process, take the time to make a strategic decision about the bigger picture that process is a part of. Is it time for the organization to no longer do the thing for which the process is used?  Is it time to bring in new technology that would make the process obsolete? You get the idea.

The fix, replace or ignore decision can be facilitated by calling a meeting with the stated goal of discussing the options before approving a CIP. Be straightforward and direct. Based on the direction the agency is heading, does it make more sense to improve the process, implement new technology – so the process is no longer needed – or do little/nothing and live with a poor process?  The meeting need not be long or terribly formal.

Who should be invited to this strategic meeting? My advice is to invite people who are good at seeing the big picture and at least one person who embodies one or more of the following qualities:

• Interfaces with elected officials and or the public
• Is knowledgeable about your agency’s technology
• Is familiar with the agency budget
• Does or has actually done the process in question

The following cautionary tale actually happened, but not exactly this way. Situations like it happen all of the time.

The agency’s process for reporting by regulated parties was notoriously cumbersome. Everyone wanted it improved. We got an e-mail from the Assistant Agency Director stating consultants were retained to conduct a CIP project to improve the process in question.

Our senior manager addressed the subsequent CIP session with words like: “excited,” “energy,” “you are the experts,” “please participate fully,” – and you get the idea. There were whiteboards, flip pads, markers, muffins, large post-it note pads and more. It was a great session of brainstorming, listing, prioritizing, discussing, summarizing, confirming, reporting out, memorializing, thank you for participation, you guys were great and the like.

The result was:

• The wording on the form should be clarified.
• The forms will be e-mailed in rather than snail-mailed.
• One of the three approval signatures is eliminated.

We guesstimated the revised process would reduce processing time by 25 percent. The CIP session did what it was asked to do, however, it did not do what the sponsors of the session  – Assistant Director and Senior Manager – hoped it would accomplish.

In a budget meeting several months before the CIP session, elected officials and management briefly discussed this notorious process that almost all stakeholders hated. Someone had suggested replacing the current snail-mail process with a new online reporting system that would improve both flexibility and control. Everyone in the room nodded in agreement and the hearing proceeded to a different topic.

Based on that brief mention, the agency’s strategic plan was modified to include: “The agency will endeavor to maximize flexibility and control by taking advantage of new technologies where practical.”

The consultants were then retained to repair the process. Prior to retaining the consultants, it would have been better to hold a “big picture” meeting to briefly discuss whether the goal should be to repair, replace or do little or nothing to the process. The session should have been about replacing the technology.

A couple of weeks later, I am standing in a long line to pay for my lunch. In front of me was the manager who sponsored the CIP project. I told him it was a good session. He nodded and asked, “What would it take to replace the whole process with a new an online app?” We chatted for a minute and I told him that I would write up a request to the technical team to consider the feasibility of an online system.

The new online system works well. It took twice as long as I thought it would and cost more than I ever thought it could. The stakeholders like it much better. The manager now gives me a nod when we pass in the corridor.

The experience re-enforced the importance of calling a meeting to discuss the big picture before deciding what to do about a squeaky process. BTW: Besides improving processes, CIP sessions are excellent team- building experiences. A person like me might end up feeling comfortable enough to have a meaningful discussion with someone way above their pay grade in a lunch line.

Paul Leegard is part of the GovLoop Featured Blogger program, where we feature blog posts by government voices from all across the country (and world!). To see more Featured Blogger posts, click here.

What we perceive often depends on how close we look.
Scaleandperception.com

This post was first published on October 27, 2017 in Govloop.com

We all know that the use of social media, smartphones, tablets, the Internet of Things (smart thermostats, coffee makers, headphones, watches, etc.) and countless apps are now intertwined with processes used in virtually every segment of the economy. Certainly, you have noticed connected technology is rapidly finding its way into government. It might be obvious but being good at using connected tech is/will be good for your career.

I have had a long career in government. Thinking back to when personal computers (PCs) were first introduced, they were used for a few things but not many. I was in county government and had to get board approval to purchase a PC because my supervisor felt it was too risky for him to approve, even though it was in the budget.  Over the next several years the use of PCs increased to the point of being pervasive not only in the county but also at most workplaces.

The ability/inability to use the influx of new technology was game-changing to many people’s careers. Let’s just say if the past is an indicator, being good at using smartphones, tablets and other connected devices will be better for your career than not being good at it.

As PCs were introduced, the ability to use a PC was not required for most jobs. However, having PC skills was definitely a plus in promotion/new hire situations. As PCs became more widely used, the inability to use a PC caused many who were not PC users to have their jobs marginalized –  i.e. given an undesirable special assignment while a PC literate employee took over their old job. I do not remember anyone being actually fired for not being a PC user but I know of several who were made uncomfortable enough to quit or retire earlier than they would have otherwise. By the late 1990s, the ability to properly use a PC became an outright requirement for most jobs.

Today’s use of connected technology is following a track very similar to when PCs started to become pervasive in the government sector. Some employees knew the technology well enough to not only use the tech but also to understand the possible and appropriate use of the tech to get things done. They would be the ones to propose solutions using the tech. Employees who did not understand the tech, at best, remained neutral, but at worse, often opposed its use for reasons that made little sense to those who knew the tech.

The key to remember is those who knew how to use the tech were the ones who had the ideas and ability to do things in a new and better way. Knowing new and better ways are a big plus when being considered for promotions. Sure, you still need to know how to manage people and think strategically, but having a clue as to what is possible and practical sets you apart from other candidates.

By the way, both back then and now, many staffs are often more skilled at tech than their supervisors and managers. Time to up your game because  not understanding tech is career-limiting for you also.

The odds are good that connected tech has found expanded use in the agency you work for. Connected tech is being used to collect and disseminate information as part of all sorts of current and planned processes. It will not be long before the ability to use connected tech will be as much of a job requirement as the ability to use PCs.

If you are not already “connected,” know that today’s connected technology is much easier to use/learn than yesterday’s PC technology.  If you don’t have a connected device (smartphone or tablet) your excuses may be valid. But be warned, choosing to be disconnected may well become a career-limiting decision.

In case you were wondering, the trick to learning to use devices and the apps is to go to the browser and ask/enter your “how to” question.  It will return a “how to” answer and you will learn.

While you are learning to load and use apps, think about how connected technology might help your agency to achieve its goals.  The odds are good you will be asked for that information as one of your promotion/new hire interview questions.

Finally, when your boss asks you to stop playing with your phone, let him/her know that you are not playing with your phone. You are working hard at learning connected technology to better serve the agency and the public.  Worth a try anyway. Good luck.

 

Paul Leegard is part of the GovLoop Featured Blogger program, where we feature blog posts by government voices from all across the country (and world!). To see more Featured Blogger posts, click here.

 

What we perceive often depends on how close we look.
Scaleandperception.com

 

Imagine if every single person in the United States had access to quality health care services without the risk of financial hardship. Now imagine this hypothetical healthcare system costing a third less than the current system and resulted in better outcomes. Imagine the difference it would make to both businesses and their employees. Imagine the difference it would make for people if they had access to good healthcare at a very reasonable cost no matter what else was happening in their life.

Universal healthcare is a reality for hundreds of millions of people around the world. The United States is the only industrialized country without universal healthcare. The United States pays the highest percentage of our GNP on healthcare. In the United States, life expectancy at birth is ranked as 43^rd best. Our infant mortality rate is rated 170^th.

We spend about $9,892 per person per year on healthcare coverage. The countries with the best outcomes spend two-thirds to a half of what the United States spends. There is no credible ranking of healthcare systems which rank the United States system very high. Compared to other nations, the United States healthcare system is ranked,  37^th,  84^th, 11^th of 11 countries and you get the idea.

The bottom-line is the current U.S. healthcare system cost the most and delivers mediocre results. Medical expenses are the leading cause of bankruptcy. Over twenty-eight million of us do not have health care coverage.  The list of reasons we need to fix the U.S. healthcare system goes on and on and on and on. It is time for a better healthcare system.

The people of the United States need a universal healthcare system. Our political system is not functioning at the level needed to get us there. Likely major corporations will form consortiums which will “create” a version of Universal healthcare which we (the population of the USA) may then join.

The World Health Organization defines universal health care as “…all people having access to the health services they need (prevention, promotion, treatment, rehabilitation and palliative care) without the risk of financial hardship when paying for them.”

The major components of a universal healthcare system are:

• Governance – The policies, strategy, and plans
• Financing – Who pays for what
• Workforce – The people who provide the healthcare service directly or indirectly
• Information systems – The key component and primary focus of this post
• Access to affordable essential medicines, vaccines, diagnostics and health technologies of assured quality

Governance

Governance of healthcare in the United States is a combination of federal and state regulation which came to be from a wide variety of forces. It is a mish-mash mess. What we need is a standardized set of rules focused on quality healthcare outcomes. Our rules should not be primarily about politics and or profit margins. Assuring good, cost-effective healthcare outcomes for all Americans is the goal.

The strange thing about needed governance is there are already established best practices. The information is available. We already have processes in place to monitor and update the best practices. Sure, there are debates about the processes but the discussion will be about tweaks not starting from scratch.

Healthcare does not exist for the primary financial benefit of the stockholders of healthcare providers. Healthcare does not exist to enforce religious beliefs of the few over the many. Healthcare is about providing quality healthcare to everyone.

Financing Healthcare

Healthcare is currently paid for by a variety of methods. Taxes, employer benefits, private insurance, direct payments, health savings accounts, grants, and the like.  I am sure I have missed several of them. The goal is coverage “… without the risk of financial hardship when paying for them”. A new universal healthcare system will likely be paid for by some combination of the same sources.

The real debate will more likely be about whether the system will be single payer healthcare or multi-payer. Single payer is a single public system, think Medicaid or Medicare. Or multi-payer which is a combination of both public and private payers.  Since our political environment is as dysfunctional as it is, likely a multi-payer system will be needed.  Think a combination of Medicaid, Medicare, employee benefit plans, and private individuals all paying for coverage from a universal healthcare plan.

Workforce

Per the Bureau of Labor Statistics, there are about 19 million healthcare workers in the US. That is a good base of experienced, knowledgeable healthcare workers. We also have about one-half million health and medical finance related employees.

As we transition into a universal healthcare system the number employees in various healthcare related categories will likely shift. Predicting how much it will shift and who will shift is a fool’s errand. There are just too many variables. The key to remember is that we have an educated population and we have the potential to educate even more of our population. We have the infrastructure and processes in place to educate and help people transition to a new work environment.

Information systems

One of the unique things about the USA is internet usage is pervasive. The universal healthcare solution for the United States can assume that people are connected because we have the infrastructure in place and in fact, the vast majority of Americans are connected.

We also have secure cloud services and the ability to use “big data” analytics. There are existing apps for many healthcare-related activities and the expertise exists to create more apps as needed.

I am not going to pretend I know the secret sauce for an instant universal healthcare system. However, from my perspective, the key is the ability for a patient’s complete electronic medical records to be available to whomever the patient designates.

That will allow the user to easily seek other opinions. It will also break the virtual monopoly healthcare providers enjoy because once they get someone in their system, it is convoluted/hard for them to move to another provider.  It would facilitate the ability to shop for a qualified but less expensive provider.  It will also allow the analytics to suggest a more appropriate provider.  Maybe the analytics will be able to warn the patient that the prescribed service is not deemed appropriate to the malady. Maybe the provider would be less likely to suggest an inappropriate service since they know the system will raise a red flag.

The right information system designed with the best outcome for the patient is probably the key for the U.S. to move toward a universal healthcare system.

Access to affordable essential medicines, vaccines, diagnostics and health technologies of assured quality

In recent years retail, transportation, accommodation, and other industries have shown the power of systems to fundamentally change those industries. There is little doubt that systems will fundamentally change access to healthcare. Disruptive technology will likely revolutionize healthcare delivery.

Conclusion

Our political environment makes it unlikely universal healthcare will be achieved by the political process.  More likely businesses and other groups will form alliances which will result in the creation of a universal healthcare option.

The reality is, we need a system designed to work best for the people of the United States. It needs to cost less than we spend now and the outcomes need to be better.  We want that system to result in all people having access to health services including prevention, promotion, treatment, rehabilitation and palliative care without the risk of financial hardship when paying for them.

Deplorable = Deserving strong condemnation; completely unacceptable.

Bastard = an offensive or disagreeable person —used as a generalized term of abuse

The deplorable bastards’ real goal was to promote their own financial and geopolitical interests.  How they did it is what makes them deplorable bastards.

They acquired individual Facebook profiles and a bunch of other information such as age, sex, education, income, voting record, address, congressional district, occupation and the list goes on and on for many tens of millions of Americans. They also acquired information on what Facebook articles we had previously “liked” and when we “liked” them.   From that information, they knew things about what we tended to fear and what we tended to support.

Based on that knowledge and using sophisticated systems, they posted a combination of misleading and absolutely fake articles on our Facebook walls, in our twitter feeds and in our e-mail inboxes. They then tracked how we reacted to what they posted.  Based on that information the posts were refined and re-posted.  This cycle of posting, observing the response, modifying message and posting another reinforcing message, was repeated over and over and over and over again. For month’s on-end, millions and millions of us were each shown thousands of targeted posts

 

Both the campaign and the Russian government were involved.  There is a legal brouhaha as to whether the campaign colluded with the Russians. Time will tell if there will be legal consequences. Legal consequences aside, that the bastards successfully did the above, is not disputed.

The goal was to diminish faith in our leaders, destabilize democracy and maybe convince, enough of us, to vote for an objectively incompetent candidate.  To quote the candidate, “I could stand in the middle of Fifth Avenue and shoot somebody, okay, and I wouldn’t lose any voters, okay?”

The deplorable bastards placed a continual stream of misleading/fake posts on our Facebook walls.  Each article customized to our individual profiles designed to reinforce the following types of feelings:

• Fear and mistrust of the establishment.
• Fear and mistrust of people who do not look like you.
• Fear and mistrust of people who are not from where you are from
• Re-enforce the idea that the way to reduce our fears, is to “drain the swamp” and “seal our borders”.

They essentially trained us to hate and mistrust each other.

The mechanics of how the above worked are sophisticated but similar to what is done in many legal and morally defensible advertising campaigns of our modern world. Targeting advertising to individual’s preferences is not illegal or immoral, it is effective.  Ads and other such posts promoting products and services are continually posted on our social media based on our preferences and profiles.  They judge our reactions and update the posts on our walls to increase their sales, etc. For example, when I got within 6 months of turning age 65 I started seeing many ads for and articles about Medicare Advantage Plans.

What made these deplorable bastards different is the immoral use of grossly misleading and fake articles with the intention of getting us to support a deplorable agenda against our personal and social best interest.

So, how does one convince honest, hardworking people to believe things that are not true and contrary to their personal self-interest?  If you are waiting for a dramatic reveal of intrigue and hidden secrets you will be disappointed.

Here is the truth.  We learn about ourselves based on the feedback the world gives us about ourselves.  If a child has a feeling they are loved, then shown information saying they are loved, it is likely they feel more loved. If a person has a mild fear, then are shown things that reinforce their fear, the fear gets more profound.

If the feedback we receive from the world is honest and sincere, our feelings about ourselves will generally align with reality.  People who are more loved in reality will likely feel more loved. People who really do have more to fear will be more likely to feel more fearful.

The deplorable fraud was in the volume of misleading and fake feedback provided to millions of us in a form we were receptive to.  That misleading and fake feedback reinforced the fears and suspicions for those of us who had mild fears and suspicions already.  The huge volume of negative (fake) information overwhelmed the glimpses of reality that act normally to temper our fears and suspicions.

We see inner-city violence on the news and develop a mild fear of the violence in the inner city.  But when we do business in the city or attend concerts in the city without incident, the fear of violence is thus not reinforced and the fear does not grow.  However, if you see story after story, day after day, about how the inner-city is a war zone it reinforces your fear. The real world evidence you have that the inner-city is not a war zone gets overwhelmed by the news and stories on your Facebook feed. You will very likely come to believe the inner-city is a war zone.

The deplorable bastards created a bunch of misleading and fake negative behavior feedback loops.  Feedback loops are powerful and those not based in reality are dangerous.  They used sophisticated systems to repeatedly spread misleading and knowingly untrue information to reinforce their agenda of fear and suspicion of millions of people.  These deplorable people are bastards.

Here are some stories about the deplorable bastards. 

http://www.philly.com/philly/news/politics/presidential/facebook-russia-fake-posts-trump-election-clinton-20171006.html

http://www.npr.org/sections/alltechconsidered/2017/04/03/522503844/how-russian-twitter-bots-pumped-out-fake-news-during-the-2016-election

https://www.cbsnews.com/videos/secret-weapon/

https://www.washingtonpost.com/business/technology/russian-operatives-used-facebook-ads-to-exploit-divisions-over-black-political-activism-and-muslims/2017/09/25/4a011242-a21b-11e7-ade1-76d061d56efa_story.html?utm_term=.3505a1c9ce44

https://www.nytimes.com/2017/09/07/us/politics/russia-facebook-twitter-election.html

http://www.politico.com/story/2015/09/trumps-social-media-guy-214309