Reinvention Efforts Stuck in Rhetorical Overdrive

P> The Defense Performance Review, the Defense Department's official response to Vice President Al Gore's sweeping National Performance Review, enjoyed gung-ho beginnings at the Pentagon, complete with high-level support, its own office and a dedicated staff. By fall 1995, however, the DPR office was closed, the staff dispersed and its remaining functions transferred to the Office of Performance Improvements and Management Re-engineering. That office's director, Blair Ewing, acknowledged, "We are now performing [DPR] functions."

Ewing said all the people assigned to DPR were on detail or temporary assignment. His office, though, now has six permanent staff members working on NPR issues full time. Ewing said DPR has not died in the Pentagon, which proves its commitment through the work underway at reinvention labs throughout the military (see sidebar). DoD's reinvention labs, he explained, "address the need for better technology or the use of technology as a way to achieve better government."

In addition, Ewing believes NPR enjoys a higher ranking within the Pentagon's power structure now that it falls under the Office of the Deputy Assistant Secretary of Defense, Comptroller's Office.

However, a former Pentagon official charged that DoD intentionally disbanded the DPR and allowed the program to be consumed by the bureaucracy it was meant to streamline. According to the former official, DoD has lost sight of the DPR mandate and deliberately sidetracked the program because it has lost its focus. The former official also said DPR got off to a rocky start and enjoyed little high-level support.

Bob Stone, national director of the NPR, countered that the Secretary of Defense closed the DPR office in an effort to integrate all management reforms within the mainstream of DoD. According to Stone, "Reinvention is going on in 1,001 places in DoD, and we're very pleased with what they're doing." As proof, he offered a list of almost five dozen so-called "Hammer Awards" given to various defense offices since 1994. The awards, named after re-engineering guru Michael Hammer, cover a variety of re-engineering activities. They range from answering the phone on the first ring in the Navy's Field Assistance Project Analyst Team to a program that donates excess computer equipment to elementary and secondary schools.

Ewing said John White, deputy secretary of defense, is such a staunch supporter of DPR he doesn't want the performance review done by a DPR office. "He wants to do it himself," Ewing said.

The NPR mandate

Vice President Gore outlined 12 major recommendations for DoD in the September 1993 document, "Creating a Government that Works Better &amp Costs Less." Most of the recommendations were aimed at saving money through revamping management and administration. However, some recommendations, such as the effort to maximize the efficiency of DoD health-care operations, were based on the use of emerging technology.

Another of Gore's recommendations, to outsource non-core defense functions, calls for hiring private companies to perform tasks that range from towing cars to performing certain information technology functions.

Given the prevalence of high technology and office automation throughout DoD, many other DoD NPR recommendations also would have required a significant technology component to be successful.

But in a September 1994 status report on the NPR, Gore highlighted only two technology-related efforts for the Pentagon. The report stated, "DoD has authorized funding to accelerate deployment of currently available commercial technology in 12 health-care regions," and "the concept of paperless outpatient medical records is currently being tested at Scott Medical Center in Belleville, Illinois." (See sidebar)

In his 1995 book, "Common Sense Government, Works Better and Costs Less," Gore listed no recommendations for DoD under the NPR -- technology-related or otherwise. In fact, he postponed the announcement of DoD recommendations for later that year. But to date, no new DoD recommendations have come out of the NPR office.

In a December 1994 Government Accounting Office report titled, "Implementation of NPR Recommendations: Dept. Of Defense," the GAO stated that by the end of 1994, only one of the original 12 NPR recommendations for the DoD had been fully implemented, and the remainder had advanced to some degree. GAO's lukewarm appraisal of the Pentagon's NPR progress also noted that "DoD does not expect to finish implementation of some recommendations until as late as the year 2000."

Your think tank or mine?

Although Stone said the NPR is alive and widespread in DoD, and the Pentagon is doing a good job carrying out this transformation of government, Don Kettl, a non-resident fellow at the Brookings Institute, Washington, D.C., looks at the situation somewhat differently.

Kettl does not think DoD has made a conscious effort to let DPR die, but he said, "DoD has always been a different case with NPR." Kettl said DoD's privatization initiatives, which are more central to many of the Pentagon's strategic initiatives, represent the reincarnation of NPR in DoD. He also said, "NPR across the government has been awfully uneven." While studying the results of the NPR initiative, Kettl has found that some departments have been very aggressive in their efforts to implement NPR recommendations, while others have not.

However, John Barry, economic policy analyst for the Heritage Foundation, criticized the entire NPR initiative. "Taxpayers don't want government to waste their money more efficiently," he said. Barry said many NPR recommendations were normal, day-to-day things that most businesses would do to improve efficiency anyway. Although Barry characterized the goals of the NPR as worthwhile and noble, he said the savings generated by NPR are very small, and that they pale in comparison to those that would result from implementing Republican proposals to reduce the size of government.

Those sentiments are echoed by a conservative defense specialist who serves as a staff member on the House National Security Committee, which is the successor to the House Armed Services Committee. The staff member said, "We [Republicans] would like to see the NPR and DPR empowered so we don't have to take on all the reform ourselves." The staff member also criticized the administration's claim that its reduction of government by more than 200,000 workers resulted from the NPR. "It was more a result of the end of the Cold War than efficiencies in government," the congressional staffer said.

Stone dismissed the criticism and said there is a strong bipartisan belief in many of the NPR principles so that even a new administration would continue government and DoD reinvention efforts in a similar way.

For an update on NPR initiatives, documentation and reports, see the NPR's World Wide Web home page at http://npr.gov/.

1993 NPR Recommendations to DoD

-Rewrite policy directive to include better guidance and fewer procedures.

-Establish a unified budget for DoD and give commanders more flexibility to solve problems.

- Outsource non-core DoD functions.

-Create incentives for DoD to generate revenues.

-Establish and promote a productivity-enhancing capital investment fund.

-Create a healthy and safe environment for DoD activities by cleanup of hazardous wastes, use of environmental technology and pollution prevention.

-Establish a defense quality work place to encourage quality management concepts.

-Maximize efficiency of DoD health-care operations.

-Give DoD installation commanders more authority and responsibility over installation management.

-Reduce National Guard and Reserve costs.

-Streamline and reorganize the U.S. Army Corps of Engineers by reducing the number of division offices and allowing the Corps to work with OMB and other agencies to maximize Corps' engineering and technical capabilities.

Source: "From Red Tape to Results, Creating a Government that Works Better and Costs Less, Report of the National Performance Review." Appendix A. Sept. 7, 1993.

Technology Initiatives Underway at DoD Reinvention Labs

1. U.S. Air Force Provider Workstation program.

2.U.S. Air Force Combat Weather Facility program.

3.DoD Central Imagery Office Exploitation Process Re-engineering Laboratory.

4.Defense Logistics Agency's Full Business Cycle Electronic Data Interchange project.

Improved Medical Record-Keeping Raises Quality of Patient Care

Just as the NPR spawned the DPR, the DPR begat the Medical Defense Performance Review, where Lt. Col. Larry C. George now serves as deputy director at Scott Air Force Base in Illinois. The MDPR is increasing the use of commercial, off-the-shelf technology and accelerating deployment of medical care in DoD Health Region 5, where Scott base is located.

One project, the Provider Workstation program, provides health-care workers with a computerized tool for documenting ambulatory patient care. Although work on this program started before the current administration's DPR initiatives were announced, the workstation program achieved its transition to an operational prototype under the auspices of the MDPR.

The workstation program will eventually be deployed as part of the Composite Health Care System, a large legacy system that is in the final stages of installation worldwide. George characterizes the CHCS, a minicomputer-based system, as "a great technology in the mid-1970s." However, he said, "We're trying to pull [CHCS] up into the modern day and age."

George sees the workstation program as one way to accomplish that goal. The program is deployed across the entire clinical operation, from the front desk to the laboratory, with direct-care providers as the primary users. The workstation program runs a PC-based, image-oriented application. Care providers can perform ambulatory coding and patient-level cost accounting, as well as create an image-based patient record.

"We're using the Provider Workstation as a platform to begin collecting data," said George.

George said the workstation program uses an on-screen image of the paper form that care providers use for record-keeping. Open Image software from Wang enables care providers to use the workstation program to add structured data elements to a relational database. Once the data in entered, users can attach other documentation, such as video clips or X-ray film to the patient's record. "Our primary document is that image, supplemented by the other stuff," said George, who feels that their approach to recording information is unique. "Everybody else is doing a relational database supplemented by images," he said.

There are now 90 users working with the workstation program in its operational prototype stage. So far, they have recorded more than 40,000 patient visits, which represent about 40 percent of the total workload. If the workstation program is deployed throughout CHCS, its impact on patient care could be significant, because DoD health care services treat about 8.7 million beneficiaries at 127 hospitals and clinics worldwide.