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Testimony to Select Committee for the Modernization of Congress

Thank you for the opportunity to submit testimony regarding the need for impartial scientific/technology analysis in Congress, and regarding potentially reestablishing an office to provide members, committees, and staff with analysis of complicated scientific and technological issues. My name is Allan Cohn, I have been a Quality Leader for over 30 years, designing and implementing new processes and achieving meaningful improvements in a wide range of industries and functional areas including Manufacturing, Research and Development, Call Centers, Information Technology, and Healthcare. In March, I retired after an outstanding ten year run as Quality Director of Pediatrics for the Cleveland Clinic. In this next chapter of my life, I am devoting a significant amount of my time to support efforts to improve government effectiveness and accountability. Using evidence and impartial data should help Congress rely on “facts” to support legislative content and maximize the effectiveness of resulting legislation. However, I don’t believe that data and analysis alone will achieve your objectives. In order to maximize the impact of this work, I want to suggest broadening the scope to incorporate Quality Improvement methodology to improve the lawmaking process. Such an approach was first used in manufacturing and has spread to service industries such as insurance and healthcare. Based on the proposed scope change, I have included some considerations in the potential establishment of an office that would provide analysis to members of Congress and their staff and utilize Quality tools to produce world class legislation. (Congressional Office of Quality and Process Improvement) World-class quality improvement (and legislation) requires a clear definition of the problem, identification of root causes, and interventions to address the root causes. Using “Improving the Lawmaking Process” as an example, the first step would be to define the problem you’re trying to solve. A hypothetical problem and aim statement would be “Over the past ten years Congress has identified twenty priority pieces of legislation per year, with only a 5% success rate of legislative priorities being passed and implemented. Objective of Improving the Lawmaking Process and Evidence Based Legislating is by 2025 to achieve a 50% success rate for priority legislation.” Applying the methodology used in manufacturing, healthcare, and other service industries to improve quality, reduce cost, and increase worker and customer satisfaction, possible next steps would include: 1. Document and analyze current legislative processes to systematically identify failure points · Similar to documenting all the steps in establishing an accurate list of medications prior to discharging a patient and determining where in the process errors occur, a Quality expert would review the steps involved in past legislation and identify points in the process where legislation stalled or failed.

2. Prioritize failure points for impact and ease of resolution · Quality experts frequently use an impact/effort matrix to help prioritize interventions. For example, in trying to improve first call resolution in an insurer’s customer service call center (percentage of time a customer’s problem can be resolved on their initial call), the Quality expert would list recurring failures on a matrix that shows the impact of the failure and the ease of addressing the failure. This would help prioritize areas of focus based on which failure has the most impact on first call resolution and is the easiest to address. · Working with legislators and congressional staff, a Quality expert could rank all causes of legislative failures for the impact and frequency of each failure and the ease of revising each part of the process to help determine initial areas of focus. · The ninety-seven recommendations of the Select Committee on the Modernization of Congress could be placed on an impact/effort matrix to help prioritize the recommendations to try to implement first.

3. Perform root cause analysis of high impact/high priority failure points · A hypothetical example – Why are 50% of manufactured products arriving late to the store? Because they shipped late. They shipped late because they weren’t ready for shipment on time. They weren’t ready for shipment on time because the batches were completed late. The batches were completed late because they were started late. The batches were started late because the raw materials weren’t available on the scheduled start date. The root cause of this manufacturing problem is that raw materials need to be ordered earlier. · Quality experts can help legislators and staff drill down to root causes to ensure that legislation addresses the source of the problem rather than a symptom of the problem.

4. Conduct benchmarking analysis to identify best practices and possible interventions · Healthcare benchmarked the aviation industry to implement pre-operative checklists to prevent surgical errors, similar to how the aviation industry uses a pre-takeoff checklist to prevent plane crashes · Legislative benchmarking could look at states, municipalities, and other countries; or look at other industries. See considerations in the potential establishment of a Congressional Office of Quality and Process Improvement below, for more information on benchmarking and analysis

5. Pilot interventions (i.e. testing process modifications for one or more pieces of legislation) · Using the call center example above, the prioritized intervention might be tested on insurance sold to one state or group of customers (e.g. 16 to 25 year old drivers), so the intervention can more quickly be deployed and the success of the intervention can more quickly be determined · An additional advantage of piloting this approach for a relatively small piece of legislation is the ability to more easily overcome resistance to change if it is very limited in scope, with limitedrisk to those agreeing to the change

6. Analyze impact of process modifications · This step involves determining whether the modification achieved its objective and whether it is feasible and practical for continued use

7. Make adjustments and/or implement as a standardprocess for all future legislation · Options at this step would be to try something different, proceed with another small piece of legislation, or adopting the revised process for all future legislation Considerations in the potential establishment of a Congressional Office of Quality and Process Improvement: 1. Team could focus on both the quality of the legislative process and on supporting the development of optimum legislation through data analysis, benchmarking (other industries, best practices in states and municipalities), process design and documentation, and development of success metrics

2. The ideal office would have a small team of Quality experts that could each lead three to five legislative projects, and a small team of Analysts to support both the Quality experts and congressional staff

3. Using the pilot concept noted in item 5 above, you could start with one accomplished Quality expert (hire or consultant) to initially focus on legislative process, build credibility, and ultimately build the Congressional Office of Qualityand Process Improvement.

4. It will be very critical in this era of conflicting information and “fake news” to include provisions to ensure analyses have credibility and can be trusted by members of both parties. The Office will need to establish guidelines for properly designing and scoping out analyses. Assumption is that the Analysts in the Congressional Office of Quality and Process Improvement would frequently rely on outside experts and data to produce reports for congressional staff and the Quality practitioners. A key part of the Analysts’ job would be to validate and interpret data for the Office of Quality and for congressional staff.

I greatly appreciate the opportunity to submit testimony regarding this very important work. Please contact me if you would like additional information and/or if there is anything else I can do to support this committee.

Respectfully submitted.

Allan L. Cohn

Submitted to Select Committee for the Modernization of Congress June 25, 2021

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