Reader Question 18. Stuck in the Middle of a Bureaucratic Maze
Question: “I am a supervisor in one of my states largest bureaucracies, which is charged with dispensing Medicaid support to the public. The number of rules imposed by the Federal and State Governments are phenomenal. My people interview clients determine their eligibility and manage the clients’ accounts. With recent budget cuts many of my current clients are no longer eligible. The paper work takes up most of my people’s time yet I will have to lay off several of them. I am seeking advice on what I should do. I feel like I am stuck in the middle of a maze.”
Answer: First you should consider the fact that you are not alone the same problems are repeated in other states throughout the US. I am assuming that you do not have budget authority for the Medicaid function this makes the situation more difficult. I have recommended that “functions” be budgeted rather than departments or agencies since an agency can be responsible for several functions. If your manager has full budget responsibility here are some recommendations that you can implement or pass on to him.
The reason for most of the rules is to reduce fraud when a client submits false paperwork and the paperwork gets into the computer system it can take months of investigation to uncover the fraud. The problem is primarily with your state’s computer systems. Most state computer data bases are not integrated and will not allow cross checking of individuals before the false paperwork gets into the system. Modern integrated databases use the Structured Query Language (SQL). This would reduce the number of fraudulent applications getting into the system and reduce investigations.
Try to setup prescreening situations where the most eligible are moved swiftly through the application process and only the questionable are set aside for a more rigorous screening. Also you should level your work load by setting up appointments which you may already do.
Be careful of what you measure or place priority on. If you are constantly checking backlogs in in-baskets your people are going to know this and will strive never to have an empty in-basket. What you will find is that when backlogs are high it will take less time to process a client than when backlogs are low. Set up a “Work Improvement Team” (WIT) that can meet when backlogs are low in a conference room. And task them to generate ideas for continuously improving the function’s processes. For more information see Article 8. “Work Place Continuous Improvement” and Article 11.“Adaptation of Manufacturing Quality Improvement Techniques to Achieve Efficient Government”.
Use your watch to find an average time to process the most eligible clients that you have separated through prescreening. Try not to focus on putting a time on questionable applications and instead focus on stopping fraud. Separate client visits applications (questionable from routine) and other visits. Time them and count their numbers. From this data you can arrive at a staffing level for your office. A number which you can work with and can be used to justify your annual budget. For more information on how to do this see Article 4. “Finding the Correct Office Staffing Level’ and Article 5. “Government Bureaucracies and Document Turn-Around Time”.
