What the CIO Council could learn from the public health community's 'President's Challenge'

Clear and measurable goals can turn information-sharing into real performance gains.

steve kelman

Teaching recently at a Harvard Kennedy School executive education program for heads of state public health agencies, I had a chance to lunch with Dr. Terry Cline, director of the Oklahoma Department of Health, who is just finishing up his term as president of the Association of State and Territorial Health Officials, an interagency association of public health departments. Through the program -- I was teaching about performance measurement in government -- I learned about an effort, led for the last five years by each year’s leader of ASTHO, called The President's Challenge.

The President’s Challenge has developed into an annual specific performance goal initiated by the organization’s president-elect the year before taking office -- to give the association time to discuss and develop strategies for meeting the goal before the person begins the year as president. The president seeks commitments from as many as possible of ASTHO's members to work on the goal. The idea is that the individual state health departments will each work individually in their state on the goal, while also sharing information on lessons learned about what strategies seem to be working.

The challenge was initiated by Judy Monroe, then the chief state health officer in Louisiana (now at the Centers for Disease Control and Prevention in Atlanta), who was trying to think of an appropriate focus for her term as association president. She came up with a relatively easy goal, under the control of each state health department, to remove unhealthy activities inside the offices of the state health departments themselves. (When state health chief in another state, she had noticed the office had a smoking room.)

Over time, the goals have become more outcome focused, and less under the exclusive control of a health department. This year's goal -- actually, it extends over two years – is to reduce by 15 percent the number of deaths due to prescription drug overdoses. With the development over the last decade of more-effective painkillers, prescription drug prescriptions have quadrupled – and so have deaths by overdose, due to galloping use and addiction.

According to Cline, 15 percent is an ambitious stretch goal, and it’s too early to know whether it will be met – but clearly nobody is going to be punished if performance improves but comes up short (that’s a good thing, by the way). The association has developed a mix of approaches, and has involved more than 20 federal agencies and national nonprofits in the effort. In all, 47 states have signed onto the challenge, eight of them just in the last month as they have seen the information-sharing among the different state associations.

This story originally caught my eye as an example of effective use of performance measurement to challenge people in pursuit of a valuable goal, to share information and learn, and to do all this in a non-punitive way. It still catches my eye for those reasons.

However, as I thought about these efforts, I realized this President's Challenge provides another lesson as well. There are countless inter-organizational councils in the United States, representing agencies in different states, or across different departments of the federal government. In our own IT area, the four that most quickly come to mind are the CIO, CAO, CFO, and CHCO councils. Each is potentially -- and to varying degrees in reality -- a forum for information-sharing. But I think these associations should up their game and undertake common challenges, with real performance goals, each year the way ASTHO does.

I actually did something like this in the 1990s as administrator of the Office of Federal Procurement Policy -- with government-wide procurement improvement "pledges" that senior agency procurement executives signed and pursued. But that was a personal, one-off initiative. This idea deserves to become part of the modus operandi of interagency councils across government.