Monday, December 31, 2007

An illustrious and heuristic new year to us all

So, an anonymous friend or stranger, commenting in the post below, reminded me that I started this blog to be an undisciplined but thoughtful problem-solving forum.  A cruel reality that I think needs to be held up before I return to my original purpose is this:  This year's "reform" discussion is doomed to stupidity because no credible and systemwide effort to measure, identify, examine or rationalize what actually happens in this system has been performed and the pressures against the cost of the system are too urgent.  I expect smart and well-intended people using all the information tools available to put forth ideas for gently reducing the funding our system.  Those people, if they believe they know how the system works now and where the problems are have over-rated their guesses and gossip. 

But, maybe in the midst of the coming catastrophe, there will be opportunities to talk about accountability, transparency and adding features to the system that will make it smarter.  Here's my new year's list of topics I hope will be seriously discussed.

1.  Those of us with client-level perspectives know that the regulations guiding this system are routinely not followed.  In the end, we need to decide if we believe that a client-centered system is truly more valuable and more cost-effective.  If we do, we need spare and judicious regulations routinely followed with consequences for those who ignore the rights of clients to guide their program plans.  

2.  Efficiency, the economic concept, unlike the political euphemism, "efficiency," is the heart of justice.  In an efficient system, some of us would lose our jobs but those most vulnerable in the system including clients, direct-care workers and families would be likelier to benefit from the money and effort spent.   The honest definition of efficiency is the value added for the cost expended.  Skilled and management workers need to understand that a more efficient system might need some of us less, but moral individuals should be ready to be counted in that number.  I can still fix old cars and might get my roping back with practice.

3.  The system needs to get much, much smarter.  We don't measure and track outcomes.  At the policy level there is no hopeful way to direct resources where they will help the most.  At the client level, there is no reliable way to choose the most helpful support among alternatives. The cost of neglecting the intelligence of our delivery model will be tragic this year.  If vendors, regional centers, unions or other stakeholders seek to delay or deter transparent evaluation and easy access to information about quality, they deserve to be ignored or over-run.  It is a very late hour to start this conversation in earnest.  

4.  There is real magic available in self-directed services.  The regulations are too many and the funding too sparse for some people to benefit but for those who can make it work, significantly lower costs and better quality of life will likely be the rule rather than the exception.  The silver line around the gathering squall is that SDS will appeal to many who have been leery of it.  First chance we get, though, those eligibility criteria should be revisited and relaxed.

5.  Be kind to the grouchy, negative, critical and portly.

Best wishes to all of you in the new year.

3 comments:

Doug said...

I just realized this post is almost identical in content to the one below. Hey, I tried.

paul said...

“I wonder if you've lost your heuristic muse (the 3 criteria of your first post). The recent posts seem to be densely laden with cynicism. what's happening?”

I, a fly on this wall, cannot say if any ‘heuristic muse’ has been lost. I have not been that vigilant. But after 3 years a reasonable person could suggest that any heuristics or musing have failed as a tool to stimulating interest, furthering investigation, further discussion, or even as a means to create, “opportunities to talk about accountability”.

Perhaps cynicism, “densely laden” is what is in order?

Pedagogy aside, it is plainly clear that the many critical points, subjects, and introspection presented by Doug are ONLY presented here, or at least rarely other than here. Even during times of plenty (amuse me for a bit) discussions rarely move away from funding. And – when there is a fiscal crisis the ONLY subject that is discussed is MONEY. While there may be “opportunities to talk about accountability, transparency and adding features to the system that will make it smarter” … “…in the midst of the coming catastrophe”, we would be a bit more than delusional to think that the blue bloods will take advantage of such opportunities.

Perhaps – problem 1

Doug said...

Thank you, Paul. The thing about cynicism is it's always well-grounded and therefore, most suitable for burying in. I don't mind being occasionally reminded to stay positive as long as my friends don't mind being reminded that precious little has been done to prevent or prepare for the entirely predictable crisis now upon us.