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Dysfunctional With Government a Many Commi Twice Fixing Suggests City Report Portland and as Manager



  • Dysfunctional With Government a Many Commi Twice Fixing Suggests City Report Portland and as Manager
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  • Portland Commissioner Chloe Eudaly Grills Law Enforcement Officials Over Joint Terrorism Task Force. “How do Report Suggests Fixing Dysfunctional Portland Government With a City Manager and Twice as Many Commissioners. The City. Report Suggests Fixing Dysfunctional Portland Government With a City Manager and Twice as Many Commissioners A company that provides City Commissioner Chloe Eudaly, overseer of the Transportation Bureau, with weather forecasts. Willamette Week is Portland's favorite media company. Sign up for our daily newsletter: Portland Commissioner Chloe Eudaly grills law enforcement over Joint Terrorism Task Force. Her questions and . Embed Tweet. Report suggests fixing dysfunctional Portland government with a city manager and twice as many .

    Dysfunctional With Government a Many Commi Twice Fixing Suggests City Report Portland and as Manager

    May 5, In Arkansas, Huckabee Was a Believer in Big Government Mike Huckabee may be one of the more conservative presidential candidates, but as governor, he expanded government programs and increased taxes. May 1, Tracing Chris Christie's Fall From the Top Once considered a "master of disaster" and frontrunner in the presidential race, the New Jersey governor is now neither.

    May 1, Government Accountability? April 29, The Next Baltimore? Freddie Gray's death sparked the riots in Baltimore, but they reveal deep systemic problems that plague many American cities.

    Louis rejected tax increases to fund schools last week. History shows that large-scale protests are no guarantee for change. But the new governor has slowly and deliberately built bipartisanship in the legislature.

    March 19, College Cuts Clash With Calls for Better-Educated Workers At a time when Obama is calling for free community college and governors want better-educated workforces, some states are considering big cuts to higher education. February 18, Gov. Kitzhaber, who's now resigning, is just the latest politician in a controversy involving his significant other -- a phenomenon some say will grow in the era of dual-career households.

    February 11, Cities Confront Long-Neglected DNA Evidence in Rape Cases With about , untested rape kits nationwide, officials at the federal, state and local levels are devoting new attention and money to reducing the backlog. February 1, Do Cities Need Kids? February 1, U. January 26, 5 Reasons State House Speakers May Be Prone to Corruption Sheldon Silver, who lost his job as one of the most powerful political posts in New York, is the fourth state house speaker to face legal trouble over the past year.

    January 21, Obama State of the Union Addresses Domestic Issues Despite making frequent calls for bipartisanship, President Obama delivered a State of the Union address that was clearly, and unsurprisingly, a call to arms in favor of Democratic priorities. Gubernatorial pardons have been in decline since the s, but that appears to be changing as views evolve on rehabilitation and drug offenses. But budget constraints may temper their appetite for extreme policies in December 31, How Minorities Can Help America With the nation's share of Asians and Hispanics expected to double in 40 years, the changes these rising minority groups are making to politics and society are only beginning.

    December 26, Why American Politics Seem More Divisive In the last few years allegiance to political parties may have gotten stronger, making the work of governing much harder. Most oil states have money saved in permanent funds, but the drop in revenues is causing shortfalls already. December 8, California's 'Game of Chicken' over College Tuition Unlike nearly every other state, California lacks a central board that oversees higher education, pitting political leaders against university administrators.

    At issue now is a 28 percent tuition hike. December 2, The Governor's Race That Still Isn't Over Vermont's election was so close that the legislature must decide who wins when it convenes next year.

    Shumlin as expected, many question what he can accomplish with so many unpopular programs. December 1, Message to Lawmakers: Say What You Really Think A new study shows that when legislators make their stance on even controversial issues public, they convince people to join their side. They were both successful, but both lost their campaigns for higher office. November 21, Unions Rethink Strategy After Election Losses Most of the candidates public-sector unions spent time and money supporting this fall were defeated, prompting leaders to question the effectiveness of endorsing any candidates at all.

    November 12, U. Supreme Court to Decide Limits on Race in Gerrymandering The ruling in two cases challenging Alabama's legislative maps could have an impact on congressional and legislative maps across the country. Instead, Republicans pulled off some unexpected victories.

    November 5, Cities Embrace New Mayors, Liberal Policies Voters in a number of cities chose new mayors and supported ballot measures that were either green or worker-friendly. Republican Sean Parnell expected to be easily re-elected, but the joined forces of Democrats and Independents and his slow response to recent challenges have put him in jeopardy.

    Rick Scott and former Florida Gov. Charlie Crist has been one of the year's most negative, dominated by personal attacks and enormous advertising budgets. Pat Quinn, who carries clear liabilities on his record, has kept the contest a dead heat by attacking his opponent. October 22, Maine Gov. October 17, Recall Survivor Scott Walker Faces Toughest Challenge Yet in November The Republican governor of Wisconsin survived a recall election two years ago, but recent ethics scandals and attacks on unions may have wrecked his chances for a second term.

    A poor economy and tax increases in one of the wealthiest states have made the Democratic governor one of the most vulnerable incumbents in the country. John Hickenlooper's decisions that once seemed like triumphs or smart compromises have turned off many voters.

    Senate seat, is polling evenly in this year's race against Republican Charlie Baker. Unlike other competitive grant programs, anyone can apply. September 25, The Next State to Likely Turn Red Arkansas' outgoing Democratic governor is one of the most popular governors in the country, but his successor may be a Republican he's already beat.

    September 23, Rick Snyder Is in Trouble but May Win Anyway The self-proclaimed nerdy governor of Michigan has made some mistakes in the past few months that have turned his re-election race into a dead heat.

    This fall, they think they have a chance to beat him. September 5, Andrew Cuomo Is Going to Win but Not with the Landslide He Wants The New York governor is essentially guaranteed to win re-election but not by so much that he can secure his spot as a top contender for president.

    September 1, From Vacant to Vibrant: August 15, Leadership Lessons from Ferguson The chaos that erupted after a police officer shot an unarmed black teen showcases the need for strong leadership and how law enforcement can lead best in communities where life is already a daily struggle.

    But the battle between urban and rural politics is as big as ever -- and those out in the country may be winning. Meet Greg Abbott The Attorney General is poised to beat Democrat Wendy Davis in the state's nationally watched and heated governor's race, but most Texans know very little about him. January 1, Corporate Entrepreneurs Are at the Heart of Downtown Revitalizations Private-sector actors are reshaping the center of some cities in ways local governments no longer have the ability to do themselves.

    For more from Governing 's first-ever International Issue, click here. December 28, The Era of Divided Government is Over For the first time in a long time, one party holds both the legislature and governorship in 37 states. December 28, States Double Down on Incentives to Woo Companies In the wake of the recession and the long, slow recovery from it, state and local governments have been even more eager to offer incentives to the few projects they have hopes of landing.

    December 28, Teachers Rack Up Wins Against Reform Efforts Education reform ideas that have generally received widespread support are experiencing pushback in the states, including some surprising places. November 30, Rural Areas Lose More Legislative Representation With fewer state lawmakers representing rural districts, issues important to rural areas may go unheard.

    Governing interviewed Time correspondent Michael Grunwald, who argues in his new book that the stimulus has had more influence on domestic policy than any other piece of legislation in decades. October 31, One of the Most Segregated U.

    Cities Opens the Race Conversation Cleveland has started a yearlong series of forums on race relations to educate citizens and city leaders. For full election coverage, go to Governing 's Election Center. Many state candidates are asked less about their stance on issues affecting the state and more about federal matters they can do little about.

    August 31, Transportation Plan? August 31, Cloud Computing Taxes Up in the Air in States A dozen states are debating whether they should and how they could tax cloud computing services. Recalls have been on the rise. Scott Walker survived his election, two other high-profile recall attempts failed in Michigan and California.

    With 14 states still to hold their primary contests, already incumbent state legislators have lost their seats. August 9, Pension Plan Changes Pose Challenges for Lawmakers Lawmakers have become acutely familiar with the financial challenges caused by pension underfunding, and they're certainly aware of the political difficulties involved in trying to change pension formulas.

    But the legal hurdles involved in changing pension benefits can be formidable as well. July 31, Counties: An Outdated Concept or the Future? Hit harder by the economic downturn than either cities or states, counties are feeling pressure from all sides, leading many to reexamine county functions altogether.

    June 29, Los Angeles Transit Needs Taxpayers' Money to Rebuild Mayor Antonio Villaraigosa is asking voters to pay a half-cent sales tax longer so he can finish his plans to improve the highway and subway systems quicker. April 30, Governors Have 'The Best Job in Politics' In his new book, political scientist Alan Rosenthal professes that no one gets what they want more than governors. April 30, Caucus System Cracks Revealed During GOP Primary Season Several states were embarrassed by faulty counts in their caucuses, which are run by political parties rather than by public officials.

    March 30, Tuition? Chris Christie have started questioning how effective U. January 31, Downtown Revitalization During a Recovery: Great Idea or Huge Mistake?

    January 1, More State Workers Face Personnel Cuts With the ballooning cost of benefits, a poor job market and more lean-government advocates in power, states are cutting personnel more than they have in the past.

    This year, the conservatives want total control. November 30, St. Louis is the last big city whose force is still under state control. November 30, Governments Abandon Fingerprinting for Food Stamps Most states and cities stopped requiring that recipients be fingerprinted because it was costly and slowed the application process. New York City and Arizona are the last jurisdictions that still do it. An evolutionary biologist adapts his theories to help local officials plan parks and improve schools.

    October 31, States Cut Welfare Benefits -- Again At a time when people need it the most, states are tightening work requirements, lowering payments and setting time limits for welfare recipients.

    Several states are setting up independent commissions in the hope of removing bias from the line-drawing process. Nikki Haley has state employees sounding more chipper. September 30, Your Day in Court? As San Francisco County closes more than a third of its courts, local lawyers are trying to find ways to raise more revenue. The word "borrow" may be taboo still, but one economist says states and localities should take advantage of historic low interest rates.

    September 27, Billionaires in the Classroom Bill Gates and other philanthropists are reshaping public education policy with private cash.

    Can they succeed at making schools perform to their liking? States that are cutting their K budgets by billions of dollars can expect more lawsuits, but they may not have an immediate impact. June 30, Are the Unions Winning the Fight? Governors and mayors say their workers are demanding unsustainable benefits.

    Union rebuttals are not turning the tide. May 31, Fixing Bridges Or Not The lack of money for bridge repairs is symptomatic of a larger problem: Transportation projects in general are going to slip behind. Republicans say they're merely protecting the sanctity of the ballot. May 31, Pink Slips Affect the Future of the Teaching Profession Massive teacher layoffs have led to concerns that young people will shy away from entering the suddenly less-than-secure profession. Daley is a tough act to follow.

    But Rahm Emanuel is determined to make his own mark. April 29, New Governors Time Their Battles Unpopular governors have good chances of winning re-election -- as long as they push their most controversial policies early on. April 29, Detroit's Disappearing Population -- and Revenues With the loss of 25 percent of its residents, Detroit could also lose its ability to levy higher income taxes.

    April 29, Does the Popular Vote Matter? While some states offer extra protection for statutes enacted by popular vote, legislatures can still overturn ballot initiatives in most states. March 31, States Handing Off More Responsibilities to Cities States are asking cities to take charge of more programs, but they may not provide enough support.

    Things may get worse this year. February 28, The Immigration Enforcement Divide Legislators are trying to pass laws requiring immigration checks, but they're running into resistance from the people who would enforce them. February 28, School Vouchers Are In Again Different circumstances and a favorable political climate make school vouchers more attractive than before.

    January 1, The Increasing Opposition to the New Health-Care Law Attorneys general in several states are seeking to overturn the federal health-care law. Chris Christie is playing an extremely active role in local government affairs.

    June 1, Playing Dumb Liability rather than serendipity is the focus of playground design. Some are trying to change that.

    May 1, Death From Washington Federal prosecutors are increasingly eager to invoke capital punishment--even in states that don't like it. May 1, Greenhouse Shift By one vote, the U. Supreme Court has altered the politics of air pollution. May 1, Horrendous Honeymoon It's hard to imagine a worse start than the one Nevada's governor is off to. County supervisors have done something unusual--given up power voluntarily.

    State legislatures may not be as partisan as Congress, but they're getting closer. Right now, states try to answer that question in troublingly disparate ways. According to one recent federal study, a fourth-grade November 30, Bending the Law on Slots Gambling interests seeking permission to move into a state like to tell voters that neighboring states are already profiting from casinos and lotteries, so they November 30, California Voters and the Water Spigot California has just enacted a huge and enormously complicated package of bills meant to put an end to the state's longstanding water wars.

    November 30, Local Government and Recall Fever The printed agenda for meetings of the county board in Monroe County, Wisconsin, always reminds elected supervisors to wear name tags, because "it helps visitors. I'm a big music fan, but all my friends had iPods before I November 4, For New York's Mayor, a Surprisingly Narrow Win As the votes were counted in mayoral races across the country, the biggest shock of the night occurred in a race that turned out just October 31, Tribal Trouble in Tennessee Given the limited number of Native Americans, it would be natural to expect that today's tribes would welcome the recognition of any new group with October 31, The Search for Interstate Cooperation In desperate budget times, more and more local governments are turning to their neighbors, hoping to save money by sharing services and equipment.

    October 26, The United Not-States There's been a debate of sorts in recent days in the liberal blogosphere on the question of whether states should be eliminated. October 20, Dayton Foreclosure Update I wrote a cover story early last year on foreclosures, looking at Dayton, Ohio, to give a sense of what the effects were like in October 14, Hyperlocal New Jersey If you're following the news about the news, you've probably heard that many media companies are hoping to find successful niches in so-called October 14, Postcard From New Mexico I spent several days in New Mexico last week, speaking at the Council of State Governments' western regional meeting and enjoying much of the stunning That doesn't mean they have to occur in the same place.

    Anne Gannon, the tax collector in September 30, What is the Age of Responsibility? Justin McNaull grew up in a hurry. By the time he was 23, McNaull had graduated from college, married and gone to work for his local But it seems like at every turn, September 30, Disappearing Dues in Kansas Bankers, barbers and doctors in Kansas, who pay a fee to support the state organizations that monitors their professions, might want to take a close September 30, A Spending Spree in Kentucky Like governments everywhere, cities and counties in Kentucky seem to realize that the current budget environment requires them to keep a close watch on spending September 29, Polanski Case Deserves an Ending I'll admit to feeling some ambivalence about the Roman Polanski case, but my bottom line is that if he's extradited and serves time, No one told me how anti-government-work it is.

    September 17, Why Washington, D. Is Rich To live in Washington, D. And while talking to people I know September 15, Blogging Metros One of the positive developments in the fracturing of the media world is that real experts are now blogging on just about every subject, obviating In fact, I first heard about it on NPR' Although merging small districts is a problem everywhere, New Jersey's system is so August 31, Abdicating the Budget Role to the Governor Legislators in many states this year, faced with huge budget shortfalls and difficult choices, must have been tempted to just sign off on any plan August 31, In Memphis, a Plea for Regionalism The mayor of Shelby County, Tennessee, is one of the relatively few local officials in America who regularly conducts business across state lines.

    But that was before it shut down altogether. In April, a special committee July 31, Mind Your Meters Parking has gotten worse in Chicago, and many see Mayor Richard Daley's decision to privatize parking meters as the culprit. Daley has been a privatization July 31, A Succession Question South Carolina is one of the most Republican states in the country, but picking a successor to Governor Mark Sanford is going to be a July 30, Cash-Strapped Zoo: July 29, NCSL: The National Conference of State Legislatures' Grasscatcher blog, being a good sport, links to a Paul Rolly column looking at how legislators in Utah and July 14, Check Your Gubernatorial Scorecard Everybody who attends meetings of the National Governors Association wears a name tag imprinted with a photograph.

    Everyone, that is, except governors. Sarah Palin offers a sobering variation on the Peter Principle -- the idea that because talented people are usually promoted, they "rise July 2, Sanford Saga: No Crime Involved Saying his agency doesn't "intend to be used in a political battle about the governor," Reggie Lloyd, head of South Carolina's July 1, Under Pressure Always finding new ways to look bad, S. Mark Sanford is backing away from a promise to release financial records relating to his I do believe, however, that the Governor has lost the Mark Sanford to resign is up to 12, out of Mark Sanford hoped to quiet his personal controversy by laying out more of his past indiscretions, the strategy hasn't worked.

    June 30, Too Broke to Fix? Fiscal shortfalls in the tens of billions of dollars are virtually an annual occurrence in California. But this year, the state's voters seem even more June 30, Stalled Trains Transportation might seem like the one issue best suited for local, state and federal cooperation.

    No transit system is built without affecting the planning process He expressed doubts when civic leaders recruited him to run in , and ever since then, June 30, Shortfall Shock Given a climate of national recession, Maine's budget process went pretty smoothly in James McGreevey's good works: Mark Sanford said Tuesday that he "crossed lines" with a handful of women other than his Andre Bauer to profile the man and his career.

    Bauer confirms yesterday's news June 29, Sanford Lays Out Reasons for Not Resigning Mark Sanford has posted an open letter on his Web site offering apologies and offering a spiritual explanation for staying in office. John Lynch says he'd consider furloughing himself as part of the state's budget-cutting efforts. June 29, Sanford: Mark Sanford to resign. June 28, "Women?! Mark Sanford tells the Associated Press today that he has considered resigning but won't.

    June 27, NYT: A business associate of Mr. Sanford's Argentine mistress said Friday that private messages between the two lovers had been sent anonymously to Andre Bauer has issued a cagey statement that does not call for Gov.

    Mark Sanford to resign: However, do not look Mark Sanford wanted more time and meetings in Argentina during last year's trade mission, citing a state Commerce Department June 26, Will Sanford Survive? Here's a sure sign that the Sanford story may start cooling off: Andre Bauer tells The Associated Press in an interview this June 25, More Calls for Resignation I have to admit that when I heard the news about Sanford taking time out from an official trade mission to meet up with his June 25, Hunting for the Governor South Carolina state troopers didn't know where Sanford was during his absence and couldn't find out from staff, the Washington Post reports.

    June 25, Politico: Sanford Planned Day Trip Update: As noted earlier, Sanford went to Buenos Aires on a trade Mark Sanford cannot navigate a deep and painful personal crisis and lead the state through its economic June 25, A Previous Encounter?

    On the misuse of funds watch, here's a tidbit from CNN: Sanford visited Argentina in June as part of a state-funded trade mission, according June 25, Gov. Don't Resign Josh has a post over at Ballot Box suggesting that Sanford's viability, like that of any politician caught in a big scandal, depends on the depth of the reservoir of popularity and goodwill he may have enjoyed before getting caught out.

    That's a shot of a Mark Sanford and his lover since Mark Sanford, turning it into "how June 24, Don't Miss the Emails In case you're joining us late, another link to the emails between Gov. Sanford and "Maria" at The State. I apologize to my staff. I misled them about my whereabouts, and as a result the people of South Mark Sanford has been the type of politician to Sanford and Maria, the woman with whom he's had an affair.

    The paper has removed June 24, Sanford's Wife: We're Separated During his news conference, Sanford kinda sorta ducked the question of whether he and his wife Jenny are separated. South Carolina's first lady has If you were a reporter, he was always great Tom Davis and some of the other Sanford friends that the June 24, Sanford Fallout If you scroll down, you'll see that I tried to be a willing dupe for Sanford as long as I could.

    Here's video of Sanford's announcement, if you missed it: June 24, Live Blogging the News Conference 2: That's all we get Mark Sanford has spent the last several days in Argentina, he tells The State. Sanford said he had considered hiking on the June 23, Where's Sanford Been Hiding? Plenty of chatter questioning whether SC Gov. TPM has been on June 23, Governors Gone Wild: Mark Sanford had taken off without telling even his wife where he was -- and not letting Lt.

    When budget times are tough, you threaten to shut down the most visible and popular programs Stafford is president of the Mike Beebe, I visited Searcy, where he practiced law for many years.

    Earlier this year, both chambers of the state legislature quickly passed a new 3-cent This coming month may May 31, The Full-Count Press With the census less than a year away, cities across the country are gearing up fast. Although the census is a constitutional responsibility of the The question is whether they will be May 31, George Tiller Shot, Killed George Tiller, a Kansas doctor who was one of the few physicians in the country to perform late-term abortions, was shot dead today as he His first entry ponders where college grads, facing an uncertain Huntsman has been mentioned Not surprisingly, the news is pretty bad.

    According to the Center, April 30, Gay Rights: The Not-So-Lethal Issue Last month, the Iowa Supreme Court threw out a state law banning gay marriages, while the Vermont legislature overrode a gubernatorial veto to allow same-sex April 30, A Little Bit of Gun Control A flurry of gruesome shootings nearly always brings the issue of gun control back into public debate.

    That's happening again, in the wake of cop April 30, Slumping Slots Gambling proponents typically overstate the amount of revenue that lotteries and casinos will generate for state treasuries. But the numbers rarely fall as far short April 30, Virginia Firebrand Jeff Frederick won't give up. Ousted as chairman of the state Republican Party last month, he may seek the post again at the party convention April 28, Now, That's Harsh One of today's popular apocalyptic fantasies is to imagine the world without human beings.

    This premise has been the subject of a bestselling book Here's this week's early winner for the cheap irony award April 13, Weekend Reading The least surprising headline in yesterday's Washington Post was bannered across the top of the front page: March 31, Digging for Dollars It's boom time for grant writers. March 31, Tanks for the Memories The gas tax is, as you may have heard, about to run out of gas.

    It's not hard to see why this is happening. March 31, Wild West Budgeting It's like one of those thrillers where one thing blows up after another. Trying to patch big holes in the state budget earlier this year, March 31, Just Say No.

    A three-quarters majority is required to raise taxes in Arkansas, but the legislature has done it twice in the past year. How did that happen? House approved yesterday, to expand national service programs. The bill would boost the number of Multiple cabinet secretaries addressed the Supreme Court will hear a case tomorrow regarding conflicts of interest for judges. The case resolves around a West Virginia justice who March 2, Government Uncovered Yesterday's Washington Post was filled with stories about the decline of the newspaper business, with two stories touching directly on state and local government February 28, A Metro View I talked with Steve Heminger, head of the Bay Area's regional transportation agency and a member of a bipartisan commission that recommended overhauling the federal February 28, Austin's Surprise Speaker Everybody in the Texas House of Representatives knew Joe Straus was one of its brightest newcomers, but nobody expected him to become speaker this year February 28, Predators' Reprieve Congress passed the Adam Walsh Act in to create uniform national tracking standards for sex offenders.

    President Bush signed it amid White House fanfare. Much of the National Governors Association's winter meeting here in Washington this past weekend was devoted to discussions about infrastructure. The message out of Everyone knows it's politically difficult Pittsburgh Mayor Luke Ravenstahl found that, under the circumstances, he Ed Rendell has made infrastructure the centerpiece of his presidency of the National Governors Association and, along with California Gov.

    December 31, Reformer in Power If you want to understand how Joe Hackney operates as speaker of the North Carolina House, it's worth thinking about the other things that he December 30, Confronting Carbon California lawmakers are finishing another ordinary year.

    Once again, their budget is a mess, with lawmakers and Gov. Arnold Schwarzenegger arguing about how to close December 16, Splitting the Difference With Duncan Barack Obama managed to find someone acceptable both to teachers unions and the education "reform" crowd with his selection of Arne Duncan, the December 11, Tobacco Turns Into Porn The British government plans to force merchants to keep cigarettes and other tobacco products under the counter and ban their public display.

    November 30, Squeezing the Cops These days, even cops can't get immunity. Given state and local budget woes, governments are taking a serious look at cutting programs they'd rather hold November 24, The Curse of Corporate Sponsorship Unlike my colleague Chris Swope, I still am uncomfortable with the whole trend of corporate naming rights -- naming stadiums and high school hallways after November 21, Hometown Pride Daily City was featured in Life magazine in the s as a classic postwar suburb see image.

    November 20, Napolitano's Successor? I put up a very quick sketch on our other blog of Jan Brewer, the Arizona secretary of state who would fill Janet Napolitano';s House Energy and Commerce Committee.

    This has repercussions for state November 17, Weingarten Willing to Talk The election of Randi Weingarten as president of the American Federation of Teachers this past summer signaled a greater willingness from that union to accept that new ideas and education "reforms" are inevitable. October 31, The Stuttgart Solution If you want to see how regional consolidation works when it really works, you might take a look at Stuttgart, the manufacturing capital of southwestern October 31, Carnival of Democracy After this month's elections, President Bush is likely to end up with a large memorial in San Francisco to visit during his retirement.

    September 30, Blueburbs Jeanne Kirkton was out canvassing a few weeks ago along Lilac Avenue in Webster Groves, an old rail-line suburb 5 miles west of St. September 15, How to Pull Off a Convention Laudatory praise of the logistics seems to reflect consensus opinion about the Democratic National Convention in Denver. August 31, A Union 'Yes' Randi Weingarten likes to brag a little about the reading and math test scores posted this year at two New York City charter schools she August 13, Curious Quote for the Day U.

    Attorney General Michael Mukasey gave a speech Tuesday saying that people wrongfully passed over for Justice Department jobs due to the politicized hiring Palin has drawn criticism due to July 29, Is States' Rights a Cover?

    The Tampa Tribune has an article looking at various issues on which presidential candidate John McCain has, in effect, punted, citing states' rights. He wants them to kick the Federal prosecutors, investigating corruption in Alabama's two-year college system, have subpoenaed legislators by the dozen -- in some cases No matter how big the issue, he leaves it up to others in the legislature or May 8, Bookshelf: It's about pensions and although April 28, Govs Agree Cowgill Not Qualified Last fall, when I was working on a feature about how states are rethinking their approach to higher education, naturally I turned to Kentucky, which April 10, Department of Hidden Costs Prince William County, Virginia, is our region's hotbed of immigration policy as enacted at the local level.

    Immigration was a particularly hot issue in political April 9, Memories of All the anxiety about the Olympic torch passing through San Francisco today -- will it elicit the same kind of disruptive protests seen in London April 9, Wishful Thinking Here is a story that demonstrates the triumph of governmental hope over experience as well as anything I've come across in a long while. The Des Moines Register has a fascinating story about a Carole Migden and California's Fair Political Practices Commission will move formally into the judicial realm today, with March 31, The Cost of Blocking a Bill Plenty of committee chairs have killed legislation that they didn't like, but few have done so as publicly and boldy as Kathy Stein.

    March 27, Double Dipping: Caught in the Crossfire In the wake of Florida Sen. Evelyn Lynn's decision to forego a big salary from a university she'd sent earmarks toward, Mike Haridopolos is coming March 26, Psst Wanna Buy a Book?

    To the dismay of Hoosier booksellers, Gov. Mitch Daniels has signed into law a bill to fine businesses that sell sexually explicit material. March 26, Hiring From Outside This story in the Washington Post is about federal employment, but I'd be surprised if the same dynamics didn't apply in the states, which will Charlie Crist to a lucrative state post, withdrew in the face of adverse publicity, the Miami Herald reports.

    February 26, Would Montana Secede? With the Supreme Court ready to hear a gun rights case for the first time in decades, Brad Johnson, Montana's secretary of state, sends a The policy stuff isn't terribly compelling "Diversity is among our many strengths" , February 19, Advertising Everywhere Zach's post about TSA's latest experiments in crowd control reminds me that the other day, while flying through Denver, I noticed that the plastic bins February 11, Persistence Pays Off Last week, the Nebraska Supreme Court abolished electrocution, the state's sole method of execution.

    January 31, Recipe for Respect Each branch of the federal government is housed in its own palace in Washington. The White House -- always surprisingly small to visitors -- is January 31, Competition Out West One of the major ongoing political stories over the past couple of years, and certainly this year, is renewed two-party competition in the Mountain West.

    January 31, Full-Time Headaches Not surprisingly in tough budget times, the Michigan legislature is highly unpopular with the public. Voters there will decide on a ballot initiative this year Both are pro-business Republicans who have been able to find common cause with Democrats from Senate back in Does anyone even remember that one? January 29, The Battle for the 26th Illinois is the rare state that is holding legislative voting at the same time as its presidential primary.

    It was always an early-primary state. January 28, Flogging Two Dead Horses A Field Poll shows that only a quarter of Californians would consider voting for Michael Bloomberg for president, while two-thirds would "definitely not. January 25, One Way to Look at It Just out of curiosity, I ran the numbers to see how many states have elected women to major statewide office, which I'm defining as governor Reading this history of how we got into Vietnam certainly sheds instructive light on January 24, No Surprise Here Support is weakening for California's Proposition 93, which would change the state's term limits law.

    According to the latest Field Poll, "yes" and " January 23, Cold Brother With the U. Conference of Mayors in town, we were just treated to an interesting visit from Melvin "Kip" Holden, the mayor-president January 22, What the GOP Wants We're now mostly through the quadrennial discussion of why Iowa, New Hampshire and the other early voting states are not representative of the nation as January 22, Wrath of Aguirre Michael Aguirre, the city attorney in San Diego, has earned both praise and enmity for his frequent criticism of other city officials.

    January 19, Cassandra Moments In this year's presidential contest, we are once again seeing candidates punished for daring to tell the truth. The conventional wisdom holds that McCain lost January 18, The Inside Game Here's a story you've read somewhere before. January 9, All Hail Partisanship "The punditocracy has been humbled once again. But it won't work--you won't see much humility from them, now or ever! January 8, What Obama Says About Race Assuming Barack Obama wins the Democratic nomination -- not such a risky bet at this point -- we will have at least nine months of conversation and coverage about what his candidacy means.

    January 4, Thoughts on Iowa: Dems Obama looks like a winner. His big Iowa victory will remove lingering doubts from many minds about whether he is for real, whether people will GOP There hasn't been a Republican primary season like this in my memory.

    Even when Republicans haven't started with a clear frontrunner, as in , they quickly December 31, Private Instigator Indiana likes to fashion itself as "the crossroads of America," with 14 interstate highways moving people into and through the state.

    As in so many other December 31, Immigration Fizzle Immigration has emerged as a pervasive issue in this year's politics, a part of seemingly every state and local campaign and presidential debate.

    December 27, Easy Street Philadelphia Mayor John Street's Christmas present to himself is going to leave a bad taste in the mouths of his constituents. He has decided to Doing it in Trenton is a different story.

    December 1, Buyouts in the Balance The elusive savings of retirement incentives. December 1, The Wrong Message Governments shouldn't consider it inevitable that they will get bad press. December 1, Zoned Out D. Not everyone approves of that change. Now, he's coming in as an elder statesman. November 2, Support the Troops? November 1, Bridgeport's Burdens Is the city's problem bad election choices--or something deeper? November 1, Putnam's Paradox Diversity accomplishes many things--but it may not make us better citizens.

    November 1, Scheming Magnolias Republicans have most of the power in Mississippi. November 1, Fiscal Guardian Natwar Gandhi knows how to make red ink turn to black. This spring, he was approached by Amtrak, which hoped to lure him to erase an enormous deficit as he had already done as chief financial officer for Washington, D. November 1, Policy Fulcrum Fabian Nunez doesn't think compromise is a dirty word. California's Assembly speaker has played a classic legislative leadership role as the bridge between a Republican governor and a strongly liberal majority Democratic caucus, helping to forge and shepherd through a long list of impressive legislation over the past couple of years.

    October 29, Gambling Against Gambling I have a short piece in Governing's November issue about how the Kansas legislature this year passed a bill that will make theirs the first state to own its own casinos. Since then, I've noticed gambling is a topic of debate in a number of states. Which makes me wonder -- why? For both, their jobs have been made complicated by the fact that their predecessors were so controversial.

    October 18, A Huckabee Surge? Here on the 13th Floor, we have, unsurprisingly, paid more attention to the state and local officials running for president than the Washington types. October 18, Lethal Injunction There's a lot of speculation right now about whether the Supreme Court will rule that lethal injections -- by far the most common method of In the case of Hurley, South Dakota, this idea didn't work out too well.

    October 1, Diagnosis for a Disorder States step in to provide services for children with autism. October 1, Bart's Gamble For even the most popular officeholder, raising taxes is risky. October 1, How Clean Is Clean? Campaign reform laws yield modest but tangible results. October 1, City Hall Solution Can mayors really help schools by running them? October 1, Mighty Malcontent For nearly 40 years, Ernie Chambers has made his colleagues mad--and made them listen.

    October 1, Other People's Money Our readership, which is largely made up of public officials, might like to read this exchange from one of The Washington Post's regular political online September 19, Annals of Academic Freedom In Governing's September issue, I wrote about how the University of California is establishing a law school at its Irvine campus, over the objections of of some state policy makers.

    So far, the institution is off to a rough start. September 13, Releasing Sex Offenders If you've been following the flurry of state legislation in recent years to punish sex offenders and prevent their future crimes, you'll want to know September 11, A Pointless Exercise? Dan Walters of the Sacramento Bee has a characteristically smart column today about the end of California's legislative session, which looks like the usual mad September 10, Party vs.

    September 1, Electric Exuberance A commuter-train experiment in California may have big implications. September 1, Nothing But a Street For some functions of government, two Texarkanas may be one too many. September 1, A Regional Mess Cooperation can end in corruption. Iowa learned that the hard way. September 1, Rod Reeling Bashing the legislature is one way to get elected governor. It's a lousy way to govern. September 1, Suburban Strains In many legislatures, suburbs have the votes to prevail--if they can find a way to work together.

    September 1, Nothing but a Street For some functions of government, two Texarkanas may be one too many. August 31, Teaching Past the Test Anyone who shops online knows how one purchase can quickly lead to another. It's not just the ease of clicking on an item and having August 31, Higher Purpose California is home to slightly more nurses than lawyers, but that's about to change. According to state projections, there will be a glut of attorneys August 15, Wrong About Everything We sometimes entertain foreign guests on the 13th Floor, local officials from other countries who are touring our country courtesy of the State Department.

    August 14, Praying for Disaster Here's my nominee for worst column of the year. Some of them are lively, though, including one on he question of whether school boards should give way to mayoral control. August 8, Taking on Task Forces NCSL's annual meeting this week in Boston is dominated, as you would expect, by sessions covering issues such as taxes, health care costs and homeland security.

    August 1, Budget Band-Aid Increasingly, state and local governments are expecting their workers to pay a greater share of their own health care and prescription drug costs. July 31, Golden-Rule Charlie It's hard to imagine an entertainer anywhere in America more despised by the Republican right than pop singer Sheryl Crow. She's a boisterous supporter of July 23, Memorial Upkeep The Sacramento Bee has a story about the capital city's statue commemorating and honoring Mexican American soldiers.

    It's not in terrible shape but it could July 20, Stand for Something I just got off the phone with Jay Pfeiffer, the deputy commissioner of education in Florida. He mentioned a counseling program in the state called July 20, What's in a Name My colleague Chris Swope is an unabashed fan of naming rights -- letting corporations slap their names and sometimes logos on everything from stadiums to July 5, Freedom to Photograph I happen to live in Silver Spring, a Maryland suburb of Washington that has staged a successful revitalization of its downtown.

    Silver Spring landed the July 5, Pet Peeve Department Every once in a while, a word or phrase or rhetorical trope will spread throughout the writing world like kudzu. A few years ago, there July 2, Forget Public Financing Events of the past week have not been cheery for fans of campaign finance laws. July 1, Auditor In Charge Mark Funkhouser has to make the switch from pointing out problems to solving them.

    July 1, Rancor In Little Rock The city famous for civil rights turmoil is arguing over race in schools again. July 1, Shareholder Heaven If you own stock in a company, you might want it to move to North Dakota. July 1, Water Diplomat William Ruckelshaus has had lots of tough assignments. He's got another one now. July 1, Hackneyed Gab Politicians and the media "do democracy a disservice" by resorting to cliches. July 1, Little Mergers on The Prairie Although Iowa failed in its efforts to make municipalities consolidate, collaboration is happening at the grassroots level.

    July 1, Deal in Denver An 11th-hour compromise shores up an overburdened state retirement system. July 1, Down on The Gown The demand for fiscal accountability is graduating to the college level. July 1, Perks That Kill When voters think legislators are living too well at public expense, they pounce. July 1, A Need for Magic Cory Booker's gifts are such that his political future seems limitless.

    But to move on, he has to make a record in Newark. July 1, Graduation Time When the term-limit clock starts ticking for legislators, state jobs begin to look more attractive. July 1, Spitzer's Gamble Who's got more clout in a state--the governor or the attorney general? In New York, that's not an easy question.

    July 1, Summer School The old custom of starting class after Labor Day is gone in most of the country. Not everyone likes that. July 1, Trenton's Folly New Jersey's budget has been built on illusion for a long time. This year, reality intruded. June 22, Mr. Olympia View former Mr. Olympia Arnold Schwarzenegger on the cover of Muscle and Fitness magazine. June 11, What Florida Could Learn Starting tomorrow, Florida lawmakers will take a swing in special session at revising the state's dozen-year-old cap on property taxes, which has led to gross May 31, Gimme Coverage This year, lawmakers in Washington tried everything to extend health coverage to the uninsured.

    They earmarked money to cover more children, allowed small employers to May 31, The Return of Romneycare It's good to see Mitt Romney finally taking some credit for the health insurance mandate bill he signed into law last year as governor of May 31, You Know What Normally I don't publish off the record remarks, but this one is so charming and innocuous -- and I'll keep the person in question anonymous May 24, Portentous Idol? May 23, Will Mike Run? Chris Cillizza, the political columnist for Washingtonpost.

    May 14, Good Night, Tommy Tommy Thompson was one of the great governors of recent years and no doubt possessed the ability to have done great things as a Cabinet April 26, Dry Cleaning Disputes Early in my career at Governing, I wrote this feature about methods that courts were using in order to speed along their dockets. April 24, Frayed Nerves A student was waving a gun late Monday night outside the University of Virginia's engineering building.

    It turned out that his reasons were entirely innocent April 19, Guns and Dorms Stateline. April 16, Everything's Up to Date in Omaha About a year ago, I was working on a short feature about how cities are trying to promote their local scenes. Fritz Junker, the head Although his prognosis is good -- he says the cancer I use it every day. It offers me a much greater choice of music and downloaded radio shows aka podcasts to April 11, Clear Path to Corruption Last fall, I appeared at a conference hosted by the American Enterprise Institute about financing higher education.

    I spoke about campus financial aid offices and April 10, Nice Guys Finish First? April 9, Going Native I've been working on a profile of Rick Jore, who chairs the Montana House's education committee despite being the only representative in the state from April 1, Data?

    Again, no evaluation of the impact on safety was provided. Only a few frontline clinicians participated in this study because they were not familiar with incident reporting and often were not consulted about the feasibility and potential benefits of recommended solutions.

    This suggests that the IRS in both these hospitals had limited effectiveness at the micro level. Wong, Kelly, and Sullivan 67 described 15 changes to practice directly resulting from data specific to vitreoretinal patient safety incident reports at the Moorfields Eye Hospital, England, concluding that these changes had improved patient safety.

    Grant and colleagues 79 examined patterns of adverse events in an Australian hospital using data from an electronic record-keeping system.

    They found 2 problematic areas: Using this information, the anesthetists developed specific departmental guidelines for these procedures. Subsequently, the number of adverse events during these 2 procedures was significantly reduced. Ross, Wallace, and Paton 71 reported a reduction of medication errors from 9.

    The changes described included the removal of high-concentration heparin vials and daily equipment checks. The authors did not directly measure the impact of the IRS on safety culture, noting that because their project coincided with several other quality improvement initiatives, they were unable to attribute the changes in safety culture to any one initiative.

    Wolff and colleagues 87 reported a reduction in the number of falls resulting in fractures following the implementation of falls risk assessments, after the IRS identified falls as the most common adverse event. This was a cross-sectional study, so sustainability was not measured.

    Hospital-acquired hip fractures still result in poor outcomes, such as increased mortality and doubling of the mean length of patient stay and mean cost of admission, , suggesting that IRSs have made little impact on patient safety in regard to falls.

    The checklists included reviews of treatment parameters before each treatment step. The authors reported that the use of these relatively simple measures significantly reduced error rates related to wrong treatment site, wrong patient, and wrong dose in patients receiving radiation therapy.

    In a medium-secure hospital in Wales, Sullivan and Ghroum 90 analyzed data from an IRS to find the peak periods for adverse events involving violence, aggression, and self-harm. An improvement plan was implemented that included flexible patterns of staffing and the introduction of therapeutic treatment groups. As a consequence, the authors reported a significant reduction in reported adverse events over a 2-year period. The context for this study was relatively unusual in that because staff are often the recipients of violence and such adverse events are highly visible, they may be more motivated to learn from IRSs.

    A number of studies found data from the IRSs that indicated a need for staff training. Callum and colleagues 77 showed that educational sessions on preventing ABO-incompatible transfusions were ineffective, as the rate of adverse events remained unchanged.

    Similarly, Cooke, Dunscombe, and Lee 89 found no evidence that training improved processes of care or outcomes. Indeed, most respondents believed that the incidents they reported were not investigated.

    The findings by Cooke, Dunscombe, and Lee 89 and Anderson and colleagues 40 suggest a disconnect between the micro and the meso levels of organization. Many of the studies did not report the impact of training on improving the actual process of care and ultimately improving outcomes, even though this was one of the quality improvement methods used. The implementation of technology was the third most commonly documented change to practice in the studies we reviewed.

    Askeland and colleagues 95 reported on the introduction of bar code technology throughout the blood transfusion process in a US hospital in order to help prevent transfusion errors. They found that the bar code system was considered 3 times safer than the old manual system.

    Callum and colleagues 77 described the implementation of an IRS for transfusion medicine in a Canadian teaching hospital. Information from the system was forwarded to the Canadian Blood Services, which established implementation and expiration date labeling as priorities. Although Callum and colleagues 77 argued that this would reduce the errors associated with labeling of the expiration date, they offered no actual evidence.

    In addition, the hospital implemented a trial that mandated labeling at the bedside via a system using wristband bar codes and portable handheld data terminals and printers to allow easy bedside labeling. The authors reported an improvement as a result in blood group determination and antibody screens in the emergency room.

    Indeed, after this change was made, not one out-of-sequence treatment was reported. Finally, a significant reduction in reported prescribing errors was found by Jayaram and colleagues 91 following the introduction of an electronic system allowing pharmacists to page immediately any doctor who entered an incorrect order so that it could be corrected. In conclusion, these 35 studies found 3 types of micro- and meso-level changes prompted by IRSs.

    All 4 instances of the implementation of technology were reported as being successful, although the studies did not always evaluate the effectiveness of the changes reported for patient safety outcomes. For example, only 1 out of 12 studies that reported provision of training did so. Because only a few studies reported the outcomes of IRSs, evidence of the effectiveness of the changes ensuing from IRSs remains partial.

    Nine of the 35 studies reported on changes to practice at the macro level. Roughead, Gilbert, and Primrose analyzed the case of the antibiotic flucloxacillin in Australia. Wysowski and Swartz analyzed all reports of suspected adverse drug reactions submitted to the FDA from to During this period, numerous drug reactions were identified and added to the product labeling as warnings, precautions, contraindications, and adverse reactions. Furthermore, 75 drug products were removed from the market owing to safety concerns, and 11 had special requirements for prescription or restricted distribution programs.

    Similarly, two guidelines, one regarding the management of a suspected transfusion-transmitted bacterial contamination and the other regarding the process of transfusion in France, were published in Zhan and colleagues 22 analyzed voluntary reports of errors related to the use of warfarin in a large number of hospitals in the United States from to , and they mentioned a number of changes in patient care, including increased monitoring and alterations to protocols.

    They did not state whether such changes reduced errors. Grissinger and colleagues 73 analyzed errors involving heparin gleaned from data aggregated from 3 large IRSs. The 3 programs used different terms to categorize the areas where errors occurred, complicating the aggregation of this information at the macro level.

    Although this cross-sectional study found significant harm caused by heparin, it did not explore whether organizations learned from the IRSs and whether this reduced levels of harm. The authors found common patterns of events in all 3 IRSs, arguing that in the case of common events such as medication errors, additional learning about the origination and causes of errors can be obtained only if incident reports provide rich qualitative data on the event and the context in which it occurred, rather than aggregating quantitative data.

    The respondents reported numerous settings and process changes, including equipment standardization, new standards for medication prescribing and administration, and improvements in staffing level.

    The authors noted that the medical staff had a poor level of reporting; that improvements in outcomes resulting from changes implemented were difficult to ascertain; and that if the AIMS was to show outcome improvements in patient safety, the level of resources required should not be underestimated.

    In the United Kingdom, Hutchinson and colleagues contended that the NPSA gave hospitals feedback that enabled them to benchmark their performance against other similar hospitals. Conlon, Havlisch, and Porter 69 analyzed the IRS introduced in in 36 Trinity hospitals and affiliates in the United States, and they described numerous changes in practice as a consequence of learning from the IRS data. The authors conceded that it was difficult to attribute improvements solely to the IRS, as the organization employed various improvement efforts.

    Overall, there is some evidence of effectiveness for improving patient safety at the macro level. In essence, we focused on whether evidence was of technical and operational improvements single-loop learning or of changes in governing variables double-loop learning. The detailed results are shown in online Appendix C. First, we observed that the evidence presented by 33 of the 35 studies could be classified as single-loop learning, such as direct improvements to procedures.

    Examples are a new bar code system leading to the correction of errors and improvements in patient safety 95 ; new labeling 99 , ; and the implementation of new blood transfusion guidelines. Turning to double-loop learning, based on our review we discovered little conclusive or convincing evidence in the studies we analyzed that shows IRSs leading to changes in governing variables. As noted earlier, the absence of such evidence does not necessarily mean that IRSs are ineffective in this respect.

    There are several alternative explanations for this lack of evidence. First, it could be inferred from some studies that an effective safety culture already exists , ; if so, double-loop learning would effectively be redundant. Second, with the exception of Aagard and colleagues, 57 Cooke, Dunscombe, and Lee, 89 NHS QI, 88 and Nicolini, Waring, and Mengis, 76 the studies we reviewed made little explicit use of organizational learning theory and lacked theoretically informed conceptualizations of cultural change.

    In the absence of a theoretical framework, such studies inevitably struggle to capture convincing evidence of cultural shifts in patient safety. Third, those studies confined to investigating outcomes that ensue directly and immediately from an IRS may have failed to capture the more indirect and diffuse learning that social theories of organizational learning suggest could be present. Even given these reasons, it is an important finding that the studies reviewed are more successful at producing evidence of single-loop than of double-loop learning.

    Ten of the studies contain claims that could refer to double-loop learning. This information is routinely shared with management. This leads to a common understanding and helps to foster a consistent culture within Trinity Health. In most other instances, the studies imply that the safety culture has been improved.

    Not one of these studies, however, contains sufficient information about the action taken toward organizational learning, or sufficient evidence about the consequences of such action, to conclude that double-loop learning resulted from an IRS. Those studies using medical definitions of error may have contributed to the research agenda focusing on the micro level, thereby implicitly blaming individuals. Second, the emphasis on learning needs to be genuine rather than rhetorical or espoused.

    Four studies raise awareness of the need for learning to be the function or output of an IRS. Third, although rarely adopting a social perspective on organizational learning, many studies drew attention to its complex, emergent nature. Our review did not find one paper that explicitly examined the effectiveness of IRSs for identifying latent error—promoting organizational managerial factors such as decisions about resource allocation.

    Yet it is the accumulation of dysfunctional organizational processes that eventually result in adverse events. Several studies refer to the need for an IRS to be cross-departmental, multiprofessional, or interorganizational.

    We conducted a parallel review of studies comparing IRSs with other forms of reporting and of studies designed to measure the effectiveness of IRSs in absolute terms, in order to explore whether IRSs improve patient safety through organizational learning.

    The analysis of the former group of studies showed no strong evidence that IRSs perform better than other methods. Indeed, medical chart reviews may have greater effectiveness in identifying clinical incidents than IRSs do.

    Moreover, there was very little focus on resource utilization, with only 2 studies looking at this issue. There was also some limited evidence of changes to processes and outcomes at the micro and meso levels triggered by the dissemination of IRS data on adverse events arising from blood transfusions and the use of flucloxacillin. At the micro and meso levels of organization, few studies reported on outcomes and those that did acknowledged the difficulty of demonstrating a causal relationship between IRSs and safety improvements, as IRSs were often part of a wider program of safety improvement.

    Consistent with this, our review indicates that meso-level changes may have little impact at the micro level. At the intraorganizational micro and meso levels, where there is ownership of incidents and clinical commitment to safety improvement, settings and processes can be changed successfully using learning from IRSs.

    The imposition of changes generated at the organizational level violates norms of collegiality and self-regulation and creates distrust of managerial motives. Such communities have been shown to be nurtured by opportunities for interaction and communication and are likely arenas for the development of reciprocal ties, shared commitment to group goals, trust, and the psychological safety required for organizational learning.

    Notably, the absence of standard, agreed universal definitions of adverse events or near misses and the lack of clear definitions and measurement of outcomes make it difficult to compare, identify, and correct errors or to evaluate reliably the impact of doing so.

    Without a clear definition of what counts as an adverse event, assessing the effectiveness of IRSs is problematic. Our analysis showed that when definitions were clear, such as in studies of blood transfusions and macro-level drug reporting, IRSs were more likely to improve safety. In contrast, although anticoagulation is an area of high risk, because IRSs relating to anticoagulant therapy did not have agreed-on definitions of harm, the aggregation of information from various databases was problematic.

    Another factor impeding organizational learning was the absence of a feedback loop; staff did not always receive feedback about incidents reported. Our review identified both potential facilitators of and barriers to double-loop learning and indicates that in order to achieve it, an IRS needs to satisfy certain conditions. To deal with such complexity, an IRS needs to work across functional, organizational, and professional boundaries and to be contextually located and participative rather than imposed and managed hierarchically.

    IRSs should be tailored to local conditions to create a sense of ownership and involvement in efforts toward organizational learning. The resulting action is likely to require multiple, complementary interventions. Studies indicate that interventions used in isolation eg, training are unlikely to be effective. Hence, a more effective method might be the development of IRSs at the micro- and mesodepartment levels, provided they retain the main principles.

    Our review has relied mainly on formal research in academic journals. We have acknowledged that social theories of organizational learning may account for the way that organizational learning is likely to emerge through complex processes that involve multiple actors and multiple agencies. Accordingly, this is a promising area for future research. Overall, the studies we reviewed did show some evidence that IRSs can lead to single-loop learning, that is, corrections to errors in procedures and improvements in techniques.

    We found little evidence, however, that IRSs ultimately improve patient safety outcomes or that single-loop learning changes were sustained, although this may be a consequence of measurement difficulties 65 , and the need for agreed-on definitions for both adverse events and the types of incident that should be reported. In sum, one way of improving both the efficiency and effectiveness of IRSs might be to embed them as part of wider safety programs and devolve their control and management from centralized hospital departments to clinical teams.

    The results of our study suggest that health care organizations should consider carefully the opportunity costs of IRSs and whether they provide value for money. Further work on the cost-effectiveness of IRSs would shed more light on this issue. Finally, future studies designed to investigate the capacity of IRSs should be better theorized in regard to organizational learning.

    Conflict of Interest Disclosures: No disclosures were reported. We would like to thank Mark Saunders for his useful comments on earlier drafts of this article. Additional supporting information may be found in the online version of this article at http: Comparison of Systems Papers. National Center for Biotechnology Information , U.

    Journal List Milbank Q v. Published online Dec 2. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Context Incident-reporting systems IRSs are used to gather information about patient safety incidents. Methods Our systematic literature review identified 2 groups of studies: Findings In total, we identified 43 studies, 8 that compared IRSs with other methods and 35 that explored the effectiveness of IRSs on settings, structures, and outcomes.

    Conclusions The results indicate that IRSs could be more effective if the criteria for what counts as an incident were explicit, they were owned and led by clinical teams rather than centralized hospital departments, and they were embedded within organizations as part of wider safety programs.

    Incident-reporting systems IRSs are a method of error reporting to enable organizational learning. Despite their significant cost, however, little is known about their effectiveness for improving patient safety. Our systematic literature review found no strong evidence that IRSs perform better than other forms of reporting.

    In addition, although we show that IRSs can improve clinical settings and processes, we found little evidence that they ultimately improve outcomes or enable cultural changes. IRSs could work more effectively if the reportable incidents used are defined more clearly and the IRSs have clinical ownership and integration with wider safety programs.

    Incident-Reporting Systems IRSs The theory underpinning IRSs is that in order for organizations to improve their safety performance, managers must be aware of events in their organization and employees must feel confident about reporting errors and near misses without fear of recrimination. Methods Search Strategy Our search strategy was designed to find empirical studies about the effectiveness of IRSs as a method to improve patient safety.

    Open in a separate window. Data Extraction We identified 2 groups of studies: Changes made in the setting in which the process of care takes place, which refers to the structures that support the delivery of care. Data Synthesis Having extracted the data from both data sets, we used an interpretative and integrative approach to synthesizing the evidence.

    Findings Descriptive Analysis of Studies In total we included 43 studies in our analysis, the majority of which were conducted in the United States 16 , followed by the United Kingdom 14 , Australia 4 , Canada 3 , France 1 , the Netherlands 1 , Denmark 1 , India 1 , Switzerland 1 , and Japan 1.

    Studies Examining the Effectiveness of IRSs We turn now to the remaining 35 of the total of 43 studies that examined the impact of the IRSs themselves on settings, processes, and outcomes summarized in online Appendix B.

    Changes to Policies, Guidelines, and Documentation Frey and colleagues 99 reported changes to drug administration in a Swiss neonatal ICU, including the introduction of a standardized prescription form, compulsory double-checking for a list of specified drugs, and new labeling of infusion syringes. Implementation of Technology The implementation of technology was the third most commonly documented change to practice in the studies we reviewed.

    Macro-Level Changes Nine of the 35 studies reported on changes to practice at the macro level. Discussion We conducted a parallel review of studies comparing IRSs with other forms of reporting and of studies designed to measure the effectiveness of IRSs in absolute terms, in order to explore whether IRSs improve patient safety through organizational learning.

    Limitations of Our Study Our review has relied mainly on formal research in academic journals. Conclusions Overall, the studies we reviewed did show some evidence that IRSs can lead to single-loop learning, that is, corrections to errors in procedures and improvements in techniques.

    Supporting Information Additional supporting information may be found in the online version of this article at http: Improving the Safety of Patients in England. The limits of knowledge management for UK public services modernization: Applying the lessons of high risk industries to health care. Qual Saf Health Care. Stories from the sharp end: Organizational learning and knowledge in public service organizations: Int J Manage Rev. Evaluating the quality of medical care. To Err Is Human: Building a Safer Health System.

    National Academy Press; Seven steps to patient safety. Accessed October 16, Int J Nurs Midwifery. Organisation patient safety incident reports. Implementation of a patient safety incident management system as viewed by doctors, nurses and allied health professionals.

    Hospital incident reporting systems: Accessed October 17, Incident reporting and patient safety. Why is patient safety so hard? A selective review of ethnographic studies. J Health Serv Res Policy. Critical incident reporting and learning. Health at a Glance , Paris: Accessed June 10, How useful are voluntary medication error reports?

    A Theory of Action Perspective. Accessed June 9, Accessed September 10, J Eval Clin Pract. Counterheroism, common knowledge, and ergonomics: Accessed February 1, Barach P, Small SD.

    Reporting and preventing medical mishaps: ICU incident reporting systems. Violations and migrations in health care: The Stationery Office; The organizational and interorganizational development of disasters. Managing the Risks of Organizational Accidents.

    Can incident reporting improve safety? Int J Quality Health Care. A Behavioral Theory of the Firm. Organizational Learning and the Learning Organization: Developments in Theory and Practice.

    Aaron Mesh

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    The latest Tweets from Portland City Club (@PDXCityClub). form of government in #Portland leads to inefficiency and leaves many residents .. @ PDXCityClub's big report on the need to rethink Portland's Commission form of . We need skulled, professional management, not political juggling of bureaus and services.

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