More Reasons for Public Sector Reform


There are other reasons for public sector reform beyond preserving fiscal viability. Delivery structures for public services are slow to change, slow to take advantage of enabling technologies and slow to match their structures to evolving public needs.

The current delivery structure for health care for example has changed little in a hundred years. Around the world health care is still hospital and provider focused. This may continue to be appropriate for acute trauma, but that delivery structure not cost-effect efficient for primary care which is 80-90% of the health care provided. The hospital and provider focus is certainly not appropriate for the 75-80% of health care needs that fall in the chronic care continuum.

Changing demographics also indicate the need to reconsider and reformat public sector structures and delivery mechanisms. As populations age their needs, interests and capabilities change. As queuing to vote becomes more taxing for older voters, asynchronous electronic voting platforms should be examined. As mobility becomes increasingly challenged, publically supported social participation efforts become more important: on-line and shared shopping services, community kitchens, visiting programs. The demand for access to home and long term care can be expected to grow commensurately as the population ages. Both formats provide needed public support at lower costs than hospitals and are significantly less reliant on physicians as primary care providers again reducing costs and avoiding unnecessary testing and interventions.

Additional reform forces in the public sector include: the growing advocacy for citizen-centered programs serviced by coordinated teams of relevant providers; use of protocol guidelines to improve appropriateness in service delivery and mandatory, traceable decision support loops to insure that service guidelines are optimally followed. The new industrial revolution of personal computing and communication connects virtually everyone and provides instant access to a large part of existing knowledge. These technologies have changed society by connecting knowledge and people virtually and instantaneously around the world.

The professional competencies required in this new world are not the linear, exhaustively meticulous, and only hopefully cumulative lists currently promulgated through the current professional education structures. A more holistic approach is required. Organized learning schemas will have to incorporate more flexibility to legitimize use of asynchronous multiple information sources and formats, more team-based learning and the use of constantly monitored real-time competence demonstration in place of static, context free assessments.

The basic objective of professional educational experience will also change. Instead of badge collection (time in training, degrees, continuing education credits) the educative purpose will be to enable people of any age and situation to flexibly and appropriately adapt to the demands of multiple simultaneous and rapidly changing cultural contexts in their workplaces and personal lives.

As any of these reforms are piloted in any sector of public service, insuring close monitoring and results transparency through open data collection and dissemination will be important to implementation success and to acceptability by providers and the public.

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