Article 108. Bringing Reform To Inner Cities

Bringing Reform To Inner Cities
By Lawrence Rosier
                   
Ideas for Rebuilding Inner Cities
An examination of the situation of inner city residents yields only one positive thing all many residents have is free time along with an enormous desire to change their current prospects. What they don’t have is nearly everything else.

The approach I recommend for rebuilding inner cities is the creation of safe havens. Environmental enclaves where one is relatively safe and nurturing, education and commerce can be protected.

1. Make Schools Safe for Learning.
Move police stations to the schools across the street if possible. Place cameras everywhere there might be violence in the school. Make the schools the safest place in the city. Open the school libraries and gymnasiums using volunteers after school and at night for tutoring and adult education.

2. Make the School the hub of the Community.
Emphasize cradle to grave education. Education should start with babies in the “Parents as Teachers Program” progress through kindergarten and into the public schools and beyond. The recently enacted “No Child Left behind Program” holds public schools, more correctly teachers, responsible for the educational progress of their students. This is a controversial mandate in the inner city because it will take super human effort by the best teachers to meet the requirements. The corollary to this should be that no bright child should be held back allowing them to skip grades until they are challenged.

This should be the environment which nurturers the students which will attend charter high schools and job training technical schools.

3. Bolster Neighborhoods by Creating a “Sense of Community”.
We need to recognize the importance of the “Sense of Community”. Most high rise tenements built for welfare families fail for this reason. The “sense of community” fails when the majority of the people living in an urban community cannot recognize those who actually live in the area. With increased anonymity comes increased crime that forces the elderly to barricade themselves in their apartments.
The idea of a “sense of community” can be developed by fencing off floors within a high rise apartment building providing a safe haven for those who live there. Place cameras in public areas. Block off through streets creating urban enclaves and provide local police stations with foot or bicycle patrols. Provide recreation facilities for the youth and encourage the development of a micro economy. Active community organizations provide involvement opportunities for citizens of the enclaves developing a source of community pride.

Extreme high crime communities should be gated and fenced with surveillance cameras everywhere. As more and more of the community enclaves are developed gangs and their accompanying crime can be forced into a small enough area where police can get control of the situation.

4. Encourage the Development of Community Micro Economies
A micro economy occurs when local people get together to form small businesses that fill the needs of the community. In many cases the county extension offices as a part of the states university system nurture these small businesses. The State and or the Federal Government may provide the necessary seed money for the startup of the businesses. Micro economies are important because they provide a safety net for the families in the community. The positive micro economy is a much more desirable and less expensive than the crime and drug dealers, which form the negative economy.

Examples of micro economy businesses are day nurseries, home run catalog businesses, gift shops and craft manufacturing. Often festivals and annual community events aimed at bringing tourists to the area bolster these businesses. But for the most part they should be self-sustaining and provide day to day services in the community.

 5. Form Community Volunteer Groups to Cleanup the City
Cleanup city streets especially vacant city lots where community gardens can be established. One innovative way of doing this is to have local contractors establish fenced brick yards where used bricks can be purchased from the public. It won’t be long before vacant lots will be brick free for gardeners.

6. City Government Reform
Lowering city property and business taxes establishes a growth program that attracts residents and businesses back to the city. This fuels the creation of needed jobs and bolsters the cities economy. Raising property and business taxes does just the opposite.  The revenue to lower taxes is made available when city government is reformed and downsized.

7. Consolidation of City Governments or Urban Secession?   
Its all about how to provide better services to urban dwellers with the most efficiency. Most large cities do not provide adequate crime prevention and protection to their city residents fueling the desire for some communities to secede. At the same time there are movements to combine city governments so that services such as fire and police can gain economy of scale. Whether to combine or to secede depends largely on local conditions such as tax bases and economies. Which brings up a third possibility “Government Reform” by allowing local ward committees to manage some local services. And a fourth possibility is for city governments to gain the economies of scale they desire through reciprocal agreements with other cities to share city services.

By not asking the right questions cities and suburban communities can find themselves with even greater problems than they have now. For example an urban community that wishes to secede from a greater metropolitan city to gain local control of its services will need to know if they have enough of a tax base to provide those services.  If they don’t then they should pursue the third option to gain local control of some services provided to their community.  In other words the metropolitan government should be reformed by allowing decisions on local services to be made at the local level. This is the same Japanese management principle that I have recommended elsewhere to make bureaucracies more responsive by “driving down the decision making power to the lowest level of effectiveness”. This type of arrangement works well where inner city crime is high. and local control can be established by blocking off through streets and in forming gated communities. These communities should have their own police station. The goal here is to establish a “Sense of Community” which I would define as when a majority of the community knows if someone either lives in the community or is an outsider.  I have recommended that this method be used to drive crime out of a major metropolitan area by establishing small communities one at a time. Each community would need a micro economy to make it sustainable.

It is to the advantage of some more affluent suburban cities to annex a neighboring depressed city. Especially those that prevent it from growing through expansion.

8. Community Development and Economic Growth              
Many small towns and communities often confuse “Community Development” and “Economic Growth” as going hand in hand. They seem to think that all community development projects lead to economic growth. While it is true that enhancement of community services can encourage economic growth indirectly a more focused approach will yield better results.

For example many communities seek out large chain store mall developments while discouraging manufacturing as being undesirable. This may be a good policy if there are nearby manufacturing facilities or tourist sites that can draw outside revenue. True economic growth comes from revenues brought into the community from outside. While large chain stores in fancy malls bring customers from surrounding communities and encourage people to move to the community they also replace the mom and pop stores, which were the foundation of the community. The sales employees may be better off through higher wages and benefits but what you are really seeing happening is a kind of churning of the community’s economy. When the communities leaders grant special tax incentives and other giveaways such as free land to the mall developers there can be a near zero result in economic growth.

The economic churning while for the most part may bring improvement to the community but it cannot match the manufacturing and tourist revenues that is needed for real economic growth. The bottom line is to provide tax incentives for the manufacturing and tourist industries that will bring in revenues from outside the community. The big chain store malls will follow these revenues to the community without the extra incentives.

9. Breathing New Life into Contiguous Depressed City Suburbs
Many older metropolitan cities especially in the mid-west and eastern US have for the last sixty to seventy years experienced the decline of the suburban towns encircling it. These neighborhood towns are mostly independent with each having its own city government charter and school district. The main difference between them is that unlike small rural towns each is composed of a unique socioeconomic level. Some are wealthy prosperous towns contiguous with lower socioeconomic towns that have been in decline for decades. The most prosperous communities unable to expand their city limits have fueled the flight to new suburban communities far from the metropolitan center. Now with wealthy inner cities surrounded by blighted neighboring towns it is time for them enter into a type of “suburban renewal” once thought only done in metropolitan city centers.

The approach here is for a wealthy community to annex a neighboring town disbanding its city government charter and integrating its school district with its own. The advantage for the wealthy city is in obtaining space to expand and grow. While the advantage for the annexed city would be to experience new life and enhanced property values. In some cases just an image change is enough to bring new life to a community. The most viable situations would be where most of the blighted areas would be bulldozed and new homes and businesses built. This whole process has become more capable through the recent US Supreme Court’s ruling on condemning private property for private redevelopment. Before this ruling this would have been difficult if not impossible. While many states have recently enacted laws restricting the application of this new ruling law makers have failed to see the benefits of the ruling.

Article 107. How States Can reduce Costs through Reforms

How States Can reduce Costs through Reforms

Lawrence Rosier Consulting
12143 Cedar Grove Rd.  Rolla, Missouri 65401
Phone 573 578-4716 lawrencerosier4@gmail.com  
See Article 102 About Lawrence Rosier

My Reform Models:
1. General Reform Model (Enterprise Lean, Management budgeting & scheduling and Team Management).
2. Consolidation Model (used where applicable mostly in the Federal Government)
Ref: Article 48, 81. Consolidation in the Texas State government
3. The Effectiveness Test (used where applicable mostly in the Federal Government)
Ref: Article 49
I Recommend Enterprise Lean
Enterprise Lean developed by Toyota is currently being used in: Washington State, Iowa and Minnesota governments to make continuous improvements in government processes. It has also been successfully implemented in the Cleveland Clinic well known for its health care.  The process consists of working teams that meet regularly to review and discuss how the work they are doing can be improved upon. I recommend that Enterprise Lean be implemented throughout state government. State employees become excited about their jobs with their involvement providing innovative solutions to work problems. 

My General Reform Model works best with the following Criteria:

• Repeatable processes (relatively routine)

• Sufficient Backlog for Continuous operation 

• Operation efficiently designed (Enterprise Lean & New Management Sys.)

• Balanced Operations, Budgeting, Scheduling, Reporting

Balanced Work Loading
Savings are from working smarter not harder and elimination of wait times.
90% of all inefficiency is from people waiting on others to do their jobs. This because we have come to accept the fact of waiting as just a part of the job. We can eliminate or at least significantly reduce wait times by doing the following:

• Determine the sequence of the flow of jobs from work group to work group.

• Set a reasonable Time for all work groups to process the work.

• Balance the work load by adding and removing personnel so that each work group can do their work within the time set. This balanced process will eliminate wait times.

Examples of Major Savings in Health Care:
Cataract Surgery in Burma (CBS 60 minute segment "Out of Darkness" by two eye surgeons).  Drs. Geoffrey Tabin and Sanduk Ruit, and their revolutionary, low-cost, 10-minute procedure caught the attention of 60 Minutes, the prestigious CBS television news magazine. The eye surgeons started the Himalayan Cataract Project to eradicate as much unnecessary blindness as possible, and so far, together with partners have screened and treated over 7.3 million people, provided more than 625,000 sight-restoring surgeries and trained hundreds of other doctors.  The Doctors were doing about 200 eye surgeries per day.  I give you this example of how little a cataract surgery actually costs in Burma $25 in the US $4000 both eyes.

Second Example:
Cataract Surgery in Missouri Dr. Jones, Jones Eye Center West Plains Mo. Dr. Jones reaches out to small communities 50 to 100 miles from his practice in West Plains to do Cataract surgery, when there are enough patients to make it worth while about 17 to 20 patients.  In a week he can perform 40 eye surgeries paid for by Medicare at $2000 each eye. The surgeon is grossing nearly $4 million annually from Medicare.  These examples prove that certain health care operations can be reduced significantly in cost.  By following my approach most routine health care operations can be reduced by 60%.

Third Example:
The developers of Obamacare were only interested in passing the bill and not in trying to reduce US health care costs.  US Private health care costs double that of European Government provided health care. This suggests that we move Medicaid and Medicare routine operations to state run Primary care hospital systems where management reforms can be implemented.
These examples prove that there are $billions to be saved in the current Healthcare system by following my recommendations.

My Recommendations to States for making Major Reductions in Health Care Costs 

State Government Run Urgent Care and Primary Care Hospitals
Urgent Care Hospitals for Critically ill Patients need only to implement Enterprise Lean.

The Process develops Savings in Primary Care Hospitals
Primary Care non-profit Hospitals for Routine non-life threatening operations without an ER, implement Enterprise Lean with efficiently Daily plans.  The State may enter into an agreement with nonprofit hospitals to implement these reforms or implement the reforms in state operated hospitals.  These hospitals may already be serving mostly Medicaid and Medicare patients.   Medicaid estimated savings is 60% of current Primary Care costs, close to $1 billion in the State of Missouri. Ref: Articles: 106, 105, 104, 101.

Government Run Cataract Surgery Clinic Suggestion
The State can establish Cataract Surgery clinics in each of its major cities. Saving 90% of the current cost of Cataract Surgery. This is a massive savings to Medicare and can be funded by the Federal Government.

Rural and Urban Emergency Health Care (Solution to over-run Urban ERs)
Combination: Fire Station, Ambulance and Emergency Health Care Clinic.  This approach significantly reduces the cost of over-run hospital Emergency Rooms in Urban areas.  The Clinics provide emergency health care for small rural towns.

Contact Lawrence Rosier
Lawrence Rosier Consulting
12143 Cedar Grove Rd.
Rolla, Missouri 65401
573 578 4716
lawrencerosier4@Gmail.com

Article 106. US Governments New Budgeting and Management System

US Governments New Budgeting and Management System

Top Down Budgeting Practices
Congressional budget committees at times makes across the board cuts to Federal programs without the knowledge of where cuts can be made and have the least effect on services. Although commendable for its boldness this is a wild and irresponsible attempt at cutting the budget without knowing consequences but it is also a common approach made by the US Government.  The key message is that Congress does not know where or how large of cuts to make and still maintain government services.

Once the New Government Management System has been implemented budgeting personnel will know what Departments and Agencies are over staffed and how many personnel are needed to maintain government services. This is where precision cuts have an advantage over across the board cuts. Across the board cuts harms areas where government services are under staffed and has little to no effect on other over staffed areas of the bureaucracy.

Recommended New Bottoms-Up Budgeting and Management System

Implementation of Enterprise Lean Teams
Starting with the implementation of Enterprise Lean Teams throughout the government. This reform brings a positive cultural change to the organization.  Bottom level functional Lean Team employees become members of Lean Teams and are motivated by empowering them to improve their jobs through innovation. By bringing innovation and continuous improvement to the government’s processes the government will save $billions through increased efficiency both now and in the future. This reform amounts to a win-win situation for government employees as well as the tax payers through employee empowerment and by ending bureaucratic waste.  See Article 104. Enterprise Lean and the New Government Management System.

The key activity I require by my Lean Teams that they develop a Daily Plan, a graphic depiction of the processes that they do on a daily basis.  This depiction may be in the form of a wall chart where each operation performed by members of the Team are depicted graphically in the sequence that the work is done. The accuracy of the wall chart depends on an accurate time for each process.   When the wall chart has been reviewed and no other improvements are known photos of the wall are made and passed to other teams doing the same operations in other government locations.  The final wall chart is not carved in stone but available for continuous improvement.  This activity gets the highest possible efficiency from the function.

Implementation of The New government Management system
The New Government Management organization will be within the Office of Inspector General organization which I recommend be separated from the Government Departments and reports directly to the Office of Management and Budget. 

The new Government Management System is used to set staffing levels and a bottoms-up budget using the Lean Team study data.

First  OIG (Office of Inspector General) Analysts will be trained as Facilitators setting-up and organizing each Lean Team.  The number of VA Lean Teams will depend on the number of functions within each hospital.  An OIG Analyst will be able to Facilitate about 20 Lean Teams. After setting-up the Lean Team the OIG Analyst will monitor and assist in the development of the wall chart. The OIG Analyst will become the manager of his Lean Teams.

The OIG Analyst will be trained to manage about 20 Lean areas:
1. He will work closely with each Lean Team in making improvements including the installation of additional equipment.
2. He will develop and monitor a schedule for each Lean Team based on patient backlogs.
3. He will make a monthly progress report for each Lean Team.
4. He will create a bottoms-up manpower budget for each Lean Team.
5. He will create a annual bottoms-up budget for his functional Lean Teams.
The annual functional bottoms-up budgets are summed establishing an actual min cost at the highest efficiency for the Department all other costs are negotiable.

An Advantage of this Approach
The advantage of this approach is that all actual manpower and operations costs are known creating a minimum known budget.  This means that only addition added budget items need to be negotiated and not the entire Agency Budget.  It also means that with a steady backlog little scheduling and management is needed.  The function nearly runs itself like the health care routine Procedure Clinics.

Where tasks are variable the Lean Teams will be more involved with scheduling and management of daily activities.