Academic journal article The Public Manager

Getting to the Bottom Line in Local Government: How San Diego County's Health and Human Services Agency Uses Decision Support Techniques to Help Agency Executives Make Better Decisions All Around

Academic journal article The Public Manager

Getting to the Bottom Line in Local Government: How San Diego County's Health and Human Services Agency Uses Decision Support Techniques to Help Agency Executives Make Better Decisions All Around

Article excerpt

This is a story of what one very complex local agency, part of one of the largest county governments in the United States, did in order to enhance the effectiveness of its operations and to position itself for the future. The County of San Diego Health and Human Services Agency (HHSA or the agency) has created a decision support division, unique in government, particularly local government--the Strategic Planning and Evaluation (SPE) unit--that provides a wide range of strategic management and accountability services.

Why the imperative to do this at the local level? Improving public decision making is absolutely essential, especially in a time of resource constraints. Local government is being hit hard by state budget crises, and in California, the budget gap by current estimates is enormous--$38 billion. At the same time, and appropriately so, the public at large expects government agencies to be responsible stewards of public monies and accountable to community needs. Spurred by a unique and complex organizational structure in HHSA, SPE was created and is a model for meeting executive needs for decision support. Its purpose is to create a competitive advantage for the agency through strategic planning, results-oriented management, and accountability.

It Happened by Necessity: The Agency's Complexity

In 1996, the Board of Supervisors approved the merging of several county organizations into a single agency. HHSA was created, integrating all social services, health, and behavioral health services, and the agency delivers these services through six geographic service delivery areas or regions. Today, the agency has: a budget of $1.7 billion; about 300 discrete programs; more than 6,000 employees; six regions, four centralized operating divisions, seven support divisions; and a 20-member executive team.

The primary goals of the agency redesign were to integrate services and to manage the delivery of these services through geographic service delivery regions that would better meet the diverse needs of all county residents. To the extent possible, a "seamless service network" was to be created, in which services are family-focused and tailored to regional or community needs, whether these services are delivered directly or by contractors. In addition, the redesign was intended to increase service capacity, reduce internal administrative costs, and help the agency become outcomes driven.

The redesign was as unique as it was expansive in scope, particularly given the diversity of services for which the agency was responsible. Now, most agency services are delivered through six regions, each of which is managed by a regional general manager who has enormous responsibilities not only to ensure effective delivery of a wide range of services but also to nurture and sustain connections with the community.

As a whole, the agency is organized as a matrix model in which programs are managed across the six regions. The 20-member executive team is comprised not only of the regional managers, but also program or division directors (for example, a public health officer, and directors of children and adult mental health). Also, each of the regional managers serves multiple roles--as leads for individual programs (in effect, program managers) in addition to overseeing the integrated operations of their respective region. Finally, individual programs vary in the degree to which they are regionalized--with some services, such as senior services, managed more centrally for a variety of reasons, including the preferences of advocates for the senior and disabled populations. As a result, the agency is best described as a hybrid form of the matrix model, posing considerable management challenges.

The agency's current director is an advocate of integrated services with a Ph.D. in clinical psychology who most recently served as director of the Alameda County Social Services Agency. …

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