PRA: The Government’s Million Dollar Survey?

Yes, I am talking about the Paperwork Reduction Act (PRA) of 1995. I would like to share with you my personal reflection and observations around the PRA. For those of you unfamiliar with the PRA, in summary it is a law that was created to reduce the paperwork burden to the public while maximizing the benefit of the information being collected to inform/utilize government programs. Therefore any form, survey, and basically anything that asks direct questions to more than nine non-federal employees by law has to go through the PRA approval process. This process takes anywhere from 6 to 12 months. Each one of these PRA packages consumes 100’s to 1,000’s of government and contractor employees hours to prepare. The lengthy process also directly burdens programs since the data takes so long to obtain and quality issues could result since the programs need to be released to the public in a timely manner. Did I mention this process is applicable to voluntary data collection as well? So where is the problem (or maybe you have already figured that out)? I 100% agree with the intent of the law; however, the way it is currently written and interpreted creates one of the most frustrating processes that federal employees and government contractors face every day. Here is a quote from one of the employees who has been helping me to understand the PRA system.

“The PRA process is literally a speed bump (a very large one) at a time when we have no time to spare. We can’t do our programs without them! The longer the process, the longer it takes to get to quality improvement. It is really that simple! We can’t even enlist volunteer providers without one, if the number of volunteers is greater than 9, yes NINE. Healthcare improvement via horse and buggy when we need lear jets.”

Having read that quote, here is my real life example. As I was planning my first Kaizen (Continuous Improvement) event back in January I was told that I was going to violate PRA because I would be asking targeted questions during my event which had more than 9 external participants. I didn’t really understand PRA but it was lawyers and other folks whom I looked to for guidance informing me of this; so I didn’t do due diligence in further checking it out as I was strapped for time and was just thrown another roadblock. The only way I was told I could hold this event and not violate the law, was to hire a contractor to do a task that I was already going to do myself. In turn, this added cost to the government and utilized approximately 200 hrs of my time figuring out how I was going to get this approved and coordinated with the contractors. Not to add, it increased my stress level and caused a lot of unnecessary angst in my life, but there is happy hour to deal with that. I then later found out, because of my lack of knowledge that I was not in violation of the PRA because in essence I wasn’t asking any specifics – we were literally collaborating on fixing a process. I’m guessing that I am not the only one who this has happened to. In the end it was just a variation of interpretation of the PRA and the result of taking the most conservative approach in order to not be in violation of a law. Which I cannot argue to say this was right, wrong, or indifferent.

I have actually been avoiding writing this post because it seems a bit controversial. When I saw a recent article talking about the pain the public feels if a PRA violation happens I kind of got inspired, as the author failed to present the other side of the PRA process lacking a representation of what really happens holistically. I felt it was my duty to share. I do not promote violating the law and can’t speak to the details of the data being collected as this was not included in that particular article. I believe the public only seeing one view is what continues to hinder the US government from updating the law to allow us to work in a more lean/agile environment and provide the highest of quality programs to the American people while keeping the original intent of the law and meeting Congress’s deadlines. This is a classic case of bad systems beating good people. I hope this post can give you a more realistic view of what really happens from both sides of the fence to help form your own opinion.

Another example of an unintended consequence of the PRA is when we develop our quality measures, which are essentially pieces of software code that are built into EHR’s (electronic health records). As part of lean and general product development you want to build from the customer’s perspective. One of the most effective ways you can do this is by observing how your customer interacts with your product and getting feedback on what they customer finds valuable. This type of an approach enables you to be agile in your development by quickly iterating based on how it is working from the customer’s end and integrating their input before launching the product. Where the PRA hinders us is that it makes it difficult to build in an agile environment because we have to wait the 6-12 months to get approval to collect the data/feedback from our customers. Ultimately, if we do not incorporate customer feedback, we end up potentially spending up to millions of dollars doing re-work internally and also externally affecting 1,000’s of care providers by putting out a flawed product.

Now I am guessing that if we offer the providers a voluntary opportunity to test our measures before they are finalized they would jump at the chance. Yes, this may mean that a provider might be burdened for 20 hours of data pulling but if that was me I would jump at spending 20 hours or even 1000 hours to avoid the downstream effects of having a poorly tested product. We have testing in simulated environments, but if you have worked in a development position you know these environments have a lot of assumptions built in, and are nowhere near the quality we can obtain by doing testing in the true customer environment. You may also argue all of this can be avoided if you plan ahead since you know it takes 6-12 months to get the PRA package approved. Agreed, and we do, but we still have the issue of not being able to work in an agile environment as we wait and continue to spend 1000’s of hours of contractor and federal employee’s time on something, that in this instance, is voluntary and gives citizens an opportunity to help their country develop good programs, or opt out if they choose to.

While the law was written with good intentions, this is a classic case of how a bad system is beating good people. Please feel free to comment and give your thoughts, share your stories, and opportunities to improve. Internally, we are currently working on what we control within my group to standardize our part of the process so we can make a repeatable 6 month approval process but ultimately there are more opportunities that lie within updating the law to, in the end, benefit the public.

Mindy is one of our External Entrepreneurs working on the Accelerating Clinical Quality Measures Project. Mindy is an innovator in lean methodology. Prior to coming to federal government, Mindy was the Technical Program Manager for Strategic Lean Programs, Intel Corporation, a key contributor/innovator to the development of two successful start-up products a customized lean methodology applied to business and clinical value streams. She identified business needs and developed target metrics, such as automating clinical access tools and virtualizing our custom lean methodology . Prior to her work with lean, she was a Process Engineer with Intel Corporation for Logic Technology Development.