The City of the Future is in Ohio
Cincinnati has nothing to lose by adopting a data-savvy governance model that turns tradition on its head. The results might start a national trend.
By Susan Crawford
Apr 27 2015
<https://medium.com/backchannel/the-city-of-the-future-is-in-ohio-3cd70daccdee>
Outputs: the stuff a business or institution produces. Outcomes: the changes in the world produced by the outputs. Outputs are easily measured — and easy to put a pricetag on. Outcomes are fuzzier but ultimately more important. As Deborah Mills-Scofield wrote in the Harvard Business Review a few years ago, the difference between outputs and outcomes is “fundamental and profound.”
In medicine, rewarding outputs can lead to unnecessary testing that robs patients and the entire healthcare system of time and money. Reforms to Medicare enacted this month will shift doctors’ focus from outputs — the number of tests carried out, the number of patients seen — to outcomes in the form of patient healthiness and improved quality of care. It’s long overdue: Sen. Ron Wyden (D-OR) says the current formula for paying doctors is “horrendously flawed.” The variable dictating whether or not tests are ordered before cataract surgery? The eye doctor, not the patient’s characteristics: A recent study published in the New England Journal of Medicine says that 36 percent of eye doctors ordered possibly unnecessary tests for three-quarters or more of their cataract patients, and a determined 8 percent of doctors ordered tests for every single one of those people.
Outputs are what we can measure. Outcomes are what we really want.
So what would happen if a city’s services were managed, top to bottom, to focus on outcomes rather than outputs?
We’re about to find out in the great state of Ohio. Cincinnati, the Queen City, whose population is expected to grow to more than 300,000 in 2020 (following years of population flight) is determined to make the crucial shift.
City Manager Harry Black, on the job since last fall, is implementing a comprehensive, soup-to-nuts, performance-managed approach to Cincinnati’s governance. He’s taking desired outcomes — thriving neighborhoods, safer streets, fiscal sustainability — and tying them to written performance management agreements negotiated face-to-face between his office and city department heads. That’s not the only thing he’s doing, though: the performance agreements in turn tie to a performance accountability program, CincyStat, that uses frequently-refreshed, visualized city data to drive relentless assessment of the departments’ work against those desired outcomes and performance goals.
Black, previously the CFO of Baltimore, brought Chad Kenney, former director of Baltimore’s groundbreaking CitiStat program, with him. Kenney, a former Teach for America corps member with a math background, is running a new office of Performance & Data Analytics for Cincinnati and ensuring that those all-important performance agreement/CincyStat meetings are effective.
All too often, of course, highly desired outcomes get hung up because several city departments are involved, and they never get coordinated enough to smoothly ace the goal. Black’s team has a way to deal with this: focused “Innovation Lab” events devoted to revealing bottlenecks in operations like the thorny process of obtaining a permit for an alteration of a commercial building. Black says the lab will give civil servants an opportunity to “see exactly how we can streamline the process.” And he is committed to open data as an element of this streamlining: Opening data to the public may not only facilitate transparency generally but it can help departments see what datasets their colleagues in other departments have on tap. Open data is critical to helping the third floor of city hall know what the second floor is up to.
None of this is particularly novel in the private sector. But it’s a cultural shift to see a city in this way. Most city departments — the department of transportation, the department of public works — see processes that affect citizens’ lives from their own individual perspectives. Having an enterprise-level management approach to city government makes Cincinnati unusual, and Black says his “totally comprehensive performance management program” is unique in American cities.
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