Doctors’ Individual Opioid Prescription ‘Report Cards’ Show Impact


Scott Calvert at the Wall Street Journal: “Several states, including Arizona, Kentucky and Ohio, are using their state prescription monitoring databases to send doctors individualized “report cards” that show how their prescribing of addictive opioids and other drugs compares with their peers.

“Arizona probably has the most complete one out there right now—it’s pretty impressive,” said Patrick Knue, director of the Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University, which helps states improve their databases.

Arizona’s quarterly reports rate a doctor’s prescribing of oxycodone and certain other drugs as normal, high, severe or extreme compared with the state’s other doctors in his medical specialty.

During a two-year pilot program, the number of opiate prescriptions fell 10% in five counties while rising in other counties, said Dean Wright, former head of the state’s prescription-monitoring program. The report cards also contributed to a 4% drop in overdose deaths in the pilot counties, he said.

The state now issues the report cards statewide and in June sent notices to more than 13,000 doctors statewide. Mr. Wright said the message is clear: “Stop and think about what you’re prescribing and the impact it can have.”
The report cards list statistics such as how many of a doctor’s patients received controlled substances from five or more doctors. Elizabeth Dodge, Mr. Wright’s successor, said some doctors ask for the patients’ names—information they might have gleaned from the database….(More)”

Open data, transparency and accountability


Topic guide by Liz Carolan: “…introduces evidence and lessons learned about open data, transparency and accountability in the international development context. It discusses the definitions, theories, challenges and debates presented by the relationship between these concepts, summarises the current state of open data implementation in international development, and highlights lessons and resources for designing and implementing open data programmes.

Open data involves the release of data so that anyone can access, use and share it. The Open DataCharter (2015) describes six principles that aim to make data easier to find, use and combine:

  • open by default
  • timely and comprehensive
  • accessible and usable
  • comparable and interoperable
  • for improved governance and citizen engagement
  • for inclusive development and innovation

One of the main objectives of making data open is to promote transparency.

Transparency is a characteristic of government, companies, organisations and individuals that are open in the clear disclosure of information, rules, plans, processes and actions. Trans­parency of information is a crucial part of this. Within a development context, transparency and accountability initiatives have emerged over the last decade as a way to address developmental failures and democratic deficits.

There is a strong intersection between open data and transparency as concepts, yet as fields of study and practice, they have remained somewhat separate. This guide draws extensively on analysis and evidence from both sets of literature, beginning by outlining the main concepts and the theories behind the relationships between them.

Data release and transparency are parts of the chain of events leading to accountability.  For open data and transparency initiatives to lead to accountability, the required conditions include:

  • getting the right data published, which requires an understanding of the politics of data publication
  • enabling actors to find, process and use information, and to act on any outputs, which requires an accountability ecosystem that includes equipped and empowered intermediaries
  • enabling institutional or social forms of enforceability or citizens’ ability to choose better services,which requires infrastructure that can impose sanctions, or sufficient choice or official support for citizens

Programmes intended to increase access to information can be impacted by and can affect inequality. They can also pose risks to privacy and may enable the misuse of data for the exploitation of individuals and markets.

Despite a range of international open data initiatives and pressures, developing countries are lagging behind in the implementation of reforms at government level, in the overall availability of data, and in the use of open data for transparency and accountability. What is more, there are signs that ‘open-washing’ –superficial efforts to publish data without full integration with transparency commitments – may be obscuring backsliding in other aspects of accountability.

The topic guide pulls together lessons and guidance from open data, transparency and accountability work,including an outline of technical and non-technical aspects of implementing a government open data initiative. It also lists further resources, tools and guidance….(More)”

The Ethics of Influence: Government in the Age of Behavioral Science


New book by Cass R. Sunstein: “In recent years, ‘Nudge Units’ or ‘Behavioral Insights Teams’ have been created in the United States, the United Kingdom, Germany, and other nations. All over the world, public officials are using the behavioral sciences to protect the environment, promote employment and economic growth, reduce poverty, and increase national security. In this book, Cass R. Sunstein, the eminent legal scholar and best-selling co-author of Nudge (2008), breaks new ground with a deep yet highly readable investigation into the ethical issues surrounding nudges, choice architecture, and mandates, addressing such issues as welfare, autonomy, self-government, dignity, manipulation, and the constraints and responsibilities of an ethical state. Complementing the ethical discussion, The Ethics of Influence: Government in the Age of Behavioral Science contains a wealth of new data on people’s attitudes towards a broad range of nudges, choice architecture, and mandates…(More)”

25 Years Later, What Happened to ‘Reinventing Government’?


 at Governing: “…A generation ago, governments across the United States embarked on ambitious efforts to use performance measures to “reinvent” how government worked. Much of the inspiration for this effort came from the bestselling 1992 book Reinventing Government: How the Entrepreneurial Spirit Is Transforming the Public Sector by veteran city manager Ted Gaebler and journalist David Osborne. Gaebler and Osborne challenged one of the most common complaints about public administration — that government agencies were irredeemably bureaucratic and resistant to change. The authors argued that that need not be the case. Government managers and employees could and should, the authors wrote, be as entrepreneurial as their private-sector counterparts. This meant embracing competition; measuring outcomes rather than inputs or processes; and insisting on accountability.

For public-sector leaders, Gaebler and Osborne’s book was a revelation. “I would say it has been the most influential book of the past 25 years,” says Robert J. O’Neill Jr., the executive director of the International City/County Management Association (ICMA). At the federal level, Reinventing Government inspired Vice President Al Gore’s National Performance Review. But it had its greatest impact on state and local governments. Public-sector officials across the country read Reinventing Government and ingested its ideas. Osborne joined the consulting firm Public Strategies Group and began hiring himself out as an adviser to governments.

There’s no question states and localities function differently today than they did 25 years ago. Performance management systems, though not universally beloved, have become widespread. Departments and agencies routinely measure customer satisfaction. Advances in information technology have allowed governments to develop and share outcomes more easily than ever before. Some watchdog groups consider linking outcomes to budgets — also known as performance-based budgeting — to be a best practice. Government executives in many places talk about “innovation” as if they were Silicon Valley executives. This represents real, undeniable change.

Yet despite a generation of reinvention, government is less trusted than ever before. Performance management systems are sometimes seen not as an instrument of reform but as an obstacle to it. Performance-based budgeting has had successes, but they have rarely been sustained. Some of the most innovative efforts to improve government today are pursuing quite different approaches, emphasizing grassroots employee initiatives rather than strict managerial accountability. All of this raises a question: Has the reinventing government movement left a legacy of greater effectiveness, or have the systems it generated become roadblocks that today’s reformers must work around?  Or is the answer somehow “yes” to both of those questions?

Reinventing Government presented dozens of examples of “entrepreneurial” problem-solving, organized into 10 chapters. Each chapter illustrated a theme, such as results-oriented government or enterprising government. This structure — concrete examples grouped around larger themes — reflected the distinctive sensibilities of each author. Gaebler, as a city manager, had made a name for himself by treating constraints such as funding shortfalls or bureaucratic rules as opportunities. His was a bottom-up, let-a-hundred-flowers-bloom sensibility. He wanted his fellow managers to create cultures where risks could be taken and initiative could be rewarded.

Osborne, a journalist, was more of a systematizer, drawn to sweeping ideas. In his previous book, Laboratories of Democracy, he had profiled six governors who he believed were developing new approaches for delivering services that constituted a “third way” between big government liberalism and anti-government conservatism.Reinventing Government suggested how that would work in practice. It also offered readers a daring and novel vision of what government’s core mission should be. Government, the book argued, should focus less on operating programs and more on overseeing them. Instead of “rowing” (stressing administrative detail), senior public officials should do more “steering” (concentrating on overall strategy). They should contract out more, embrace competition and insist on accountability. This aspect of Osborne’s thinking became more pronounced as time went by.

“Today we are well beyond the experimental approach,” Osborne and Peter Hutchinson, a former Minnesota finance commissioner, wrote in their 2004 book, The Price of Government: Getting the Results We Need in an Age of Permanent Fiscal Crisis. A decade of experience had produced a proven set of strategies, the book continued. The foremost should be to turn the budget process “on its head, so that it starts with the results we demand and the price we are willing to pay rather than the programs we have and the costs they incur.” In other words, performance-based budgeting. Then, they continued, “we must cut government down to its most effective size and shape, through strategic reviews, consolidation and reorganization.”

Assessing the influence and efficacy of these ideas is difficult. According to the U.S. Census, the United States has 90,106 state and local governments. Tens of thousands of public employees read Reinventing Government and the books that followed. Surveys have shown that the use of performance measurement systems is widespread across state, county and municipal government. Yet only a handful of studies have sought to evaluate systematically the impact of Reinventing Government’s core ideas. Most have focused on just one, the idea highlighted in The Price of Government: budgeting for outcomes.

To evaluate the reinventing government movement primarily by assessing performance-based budgeting might seem a bit narrow. But paying close attention to the budgeting process is the key to understanding the impact of the entire enterprise. It reveals the difficulty of sustaining even successful innovations….

“Reinventing government was relatively blind to the role of legislatures in general,” says University of Maryland public policy professor and Governing columnist Donald F. Kettl. “There was this sense that the real problem was that good people were trapped in a bad system and that freeing administrators to do what they knew how to do best would yield vast improvements. What was not part of the debate was the role that legislatures might have played in creating those constraints to begin with.”

Over time, a pattern emerged. During periods of crisis, chief executives were able to implement performance-based budgeting. Often, it worked. But eventually legislatures pushed back….

There was another problem. Measuring results, insisting on accountability — these were supposed to spur creative problem-solving. But in practice, says Blauer, “whenever the budget was invoked in performance conversations, it automatically chilled innovative thinking; it chilled engagement,” she says. Agencies got defensive. Rather than focusing on solving hard problems, they focused on justifying past performance….

The fact that reinventing government never sparked a revolution puzzles Gaebler to this day. “Why didn’t more of my colleagues pick it up and run with it?” he asks. He thinks the answer may be that many public managers were simply too risk-averse….(More)”.

Encouraging and Sustaining Innovation in Government: Technology and Innovation in the Next Administration


New report by Beth Simone Noveck and Stefaan Verhulst: “…With rates of trust in government at an all-time low, technology and innovation will be essential to achieve the next administration’s goals and to deliver services more effectively and efficiently. The next administration must prioritize using technology to improve governing and must develop plans to do so in the transition… This paper provides analysis and a set of concrete recommendations, both for the period of transition before the inauguration, and for the start of the next presidency, to encourage and sustain innovation in government. Leveraging the insights from the experts who participated in a day-long discussion, we endeavor to explain how government can improve its use of using digital technologies to create more effective policies, solve problems faster and deliver services more effectively at the federal, state and local levels….

The broad recommendations are:

  • Scale Data Driven Governance: Platforms such as data.gov represent initial steps in the direction of enabling data-driven governance. Much more can be done, however, to open-up data and for the agencies to become better consumers of data, to improve decision-making and scale up evidence-based governance. This includes better use of predictive analytics, more public engagement; and greater use of cutting-edge methods like machine learning.
  • Scale Collaborative Innovation: Collaborative innovation takes place when government and the public work together, thus widening the pool of expertise and knowledge brought to bear on public problems. The next administration can reach out more effectively, not just to the public at large, but to conduct targeted outreach to public officials and citizens who possess the most relevant skills or expertise for the problems at hand.
  • Promote a Culture of Innovation: Institutionalizing a culture of technology-enabled innovation will require embedding and institutionalizing innovation and technology skills more widely across the federal enterprise. For example, contracting, grants and personnel officials need to have a deeper understanding of how technology can help them do their jobs more efficiently, and more people need to be trained in human-centered design, gamification, data science, data visualization, crowdsourcing and other new ways of working.
  • Utilize Evidence-Based Innovation: In order to better direct government investments, leaders need a much better sense of what works and what doesn’t. The government spends billions on research in the private and university sectors, but very little experimenting with, testing, and evaluating its own programs. The next administration should continue developing an evidence-based approach to governance, including a greater use of methods like A/B testing (a method of comparing two versions of a webpage or app against each other to determine which one performs the best); establishing a clearinghouse for success and failure stories and best practices; and encouraging overseers to be more open to innovation.
  • Make Innovation a Priority in the Transition: The transition period represents a unique opportunity to seed the foundations for long-lasting change. By explicitly incorporating innovation into the structure, goals and activities of the transition teams, the next administration can get a fast start in implementing policy goals and improving government operations through innovation approaches….(More)”

Policy in the data age: Data enablement for the common good


Karim Tadjeddine and Martin Lundqvist of McKinsey: “Like companies in the private sector, governments from national to local can smooth the process of digital transformation—and improve services to their “customers,” the public—by adhering to certain core principles. Here’s a road map.

By virtue of their sheer size, visibility, and economic clout, national, state or provincial, and local governments are central to any societal transformation effort, in particular a digital transformation. Governments at all levels, which account for 30 to 50 percent of most countries’ GDP, exert profound influence not only by executing their own digital transformations but also by catalyzing digital transformations in other societal sectors (Exhibit 1).

The tremendous impact that digital services have had on governments and society has been the subject of extensive research that has documented the rapid, extensive adoption of public-sector digital services around the globe. We believe that the coming data revolution will be even more deeply transformational and that data enablement will produce a radical shift in the public sector’s quality of service, empowering governments to deliver better constituent service, better policy outcomes, and more-productive operations….(More)”

Counterterrorism and Counterintelligence: Crowdsourcing Approach


Literature review by Sanket Subhash Khanwalkar: “Despite heavy investment by the United States and several other national governments, terrorism related problems are rising at an alarming rate. Lone-wolf terrorism, in particular, in the last decade, has caused 70% of all terrorism related deaths in the US and the West. This literature survey describes lone-wolf terrorism in detail to analyse its structure, characteristics, strengths and weaknesses. It also investigates crowdsourcing intelligence, as an unorthodox approach to counter lone-wolf terrorism, by reviewing its current state-of-the-art and identifying the areas for improvement….(More)”

Smart Economy in Smart Cities


Book edited by Vinod Kumar, T. M.: “The present book highlights studies that show how smart cities promote urban economic development. The book surveys the state of the art of Smart City Economic Development through a literature survey. The book uses 13 in depth city research case studies in 10 countries such as the North America, Europe, Africa and Asia to explain how a smart economy changes the urban spatial system and vice versa. This book focuses on exploratory city studies in different countries, which investigate how urban spatial systems adapt to the specific needs of smart urban economy. The theory of smart city economic development is not yet entirely understood and applied in metropolitan regional plans. Smart urban economies are largely the result of the influence of ICT applications on all aspects of urban economy, which in turn changes the land-use system. It points out that the dynamics of smart city GDP creation takes ‘different paths,’ which need further empirical study, hypothesis testing and mathematical modelling. Although there are hypotheses on how smart cities generate wealth and social benefits for nations, there are no significant empirical studies available on how they generate urban economic development through urban spatial adaptation.  This book with 13 cities research studies is one attempt to fill in the gap in knowledge base….(More)”

How Technology Can Restore Our Trust in Democracy


Cenk Sidar in Foreign Policy: “The travails of the Arab Spring, the rise of the Islamic State, and the upsurge of right-wing populism throughout the countries of West all demonstrate a rising frustration with the liberal democratic order in the years since the 2008 financial crisis. There is a growing intellectual consensus that the world is sailing into uncharted territory: a realm marked by authoritarianism, shallow populism, and extremism.

One way to overcome this global resentment is to use the best tools we have to build a more inclusive and direct democracy. Could new technologies such as Augmented Reality (AR), Virtual Reality (VR), data analytics, crowdsourcing, and Blockchain help to restore meaningful dialogue and win back people’s hearts and minds?

Underpinning our unsettling current environment is an irony: Thanks to modern communication technology, the world is more connected than ever — but average people feel more disconnected. In the United States, polls show that trust in government is at a 50-year low. Frustrated Trump supporters and the Britons who voted for Brexit both have a sense of having “lost out” as the global elite consolidates its power and becomes less responsive to the rest of society. This is not an irrational belief: Branko Milanovic, a leading inequality scholar, has found that people in the lower and middle parts of rich countries’ income distributions have been the losers of the last 15 years of globalization.

The same 15 years have also brought astounding advances in technology, from the rise of the Internet to the growing ubiquity of smartphones. And Western society has, to some extent, struggled to find its bearings amid this transition. Militant groups seduce young people through social media. The Internet enables consumers to choose only the news that matches their preconceived beliefs, offering a bottomless well of partisan fury and conspiracy theories. Cable news airing 24/7 keeps viewers in a state of agitation. In short, communication technologies that are meant to bring us together end up dividing us instead (and not least because our politicians have chosen to game these tools for their own advantage).

It is time to make technology part of the solution. More urgently than ever, leaders, innovators, and activists need to open up the political marketplace to allow technology to realize its potential for enabling direct citizen participation. This is an ideal way to restore trust in the democratic process.

As the London School of Economics’ Mary Kaldor put it recently: “The task of global governance has to be reconceptualized to make it possible for citizens to influence the decisions that affect their lives — to reclaim substantive democracy.” One notable exception to the technological disconnect has been fundraising, as candidates have tapped into the Internet to enable millions of average voters to donate small sums. With the right vision, however, technological innovation in politics could go well beyond asking people for money….(More)”

Through the looking glass: Harnessing big data to respond to violent extremism


Michele Piercey, Carolyn Forbes, and Hasan Davulcu at Devex:”People think and say all sorts of things that they would never actually do. One of the biggest challenges in countering violent extremism is not only figuring out which people hold radical views, but who is most likely to join and act on behalf of violent extremist organizations. Determining who is likely to become violent is key to designing and evaluating more targeted interventions, but it has proven to be extremely difficult.

There are few recognized tools for assessing perceptions and beliefs, such as whether community sentiment about violent extremist organizations is more or less favorable, or which narratives and counternarratives resonate with vulnerable populations.

Program designers and monitoring and evaluation staff often rely on perception surveying to assess attitudinal changes that CVE programs try to achieve, but there are limitations to this method. Security and logistical challenges to collecting perception data in a conflict-affected community can make it difficult to get a representative sample, while ensuring the safety of enumerators and respondents. And given the sensitivity of the subject matter, respondents may be reluctant to express their actual beliefs to an outsider (that is, social desirability bias can affect data reliability).

The rise of smartphone technology and social media uptake among the burgeoning youth populations of many conflict-affected countries presents a new opportunity to understand what people believe from a safer distance, lessening the associated risks and data defects. Seeing an opportunity in the growing mass of online public data, the marketing industry has pioneered tools to “scrape” and aggregate the data to help companies paint a clearer picture of consumer behavior and perceptions of brands and products.

These developments present a critical question for CVE programs: Could similar tools be developed that would analyze online public data to identify who is being influenced by which extremist narratives and influences, learn which messages go viral, and distinguish groups and individuals who simply hold radical views from those who support or carry out violence?

Using data to track radicalization

Seeking to answer this question, researchers at Arizona State University’s Center for the Study of Religion and Conflict, Cornell University’s Social Dynamics Laboratory, and Carnegie Mellon’s Center for Computational Analysis of Social and Organizational systems have been innovating a wide variety of data analytics tools. ASU’s LookingGlass tool, for example, maps networks of perception, belief, and influence online. ASU and Chemonics International are now piloting the tool on a CVE program in Libya.

Drawn from the humanities and social and computational sciences, LookingGlass retrieves, categorizes, and analyzes vast amounts of data from across the internet to map the spread of extremist and counter-extremist influence online. The tool displays what people think about their political situation, governments and extremist groups, and tracks changes in these perceptions over time and in response to events. It also lets users visualize how groups emerge, interact, coalesce, and fragment in relation to emerging issues and events and evaluates “information cascades” to assess what causes extremist messages to go viral on social media and what causes them to die out.

By assessing the relative influence and expressed beliefs of diverse groups over time and in critical locations, LookingGlass represents an advanced capability for providing real-time contextual information about the ideological drivers of violent and counter-violent extremist movements online. Click here to view a larger version.

For CVE planners, LookingGlass can map social movements in relation to specific countries and regions. Indonesia, for example, has been the site of numerous violent movements and events. A relatively young democracy, the country’s complex political environment encompasses numerous groups seeking radical change across a wide spectrum of social and political issues….(More)”