Problem Identification:
Nearly 90 percent of the Department’s funding comes from sources other than the City’s General Fund, yet the Department is required to adhere to all of the City’s existing administrative rules that govern personnel, procurement, and contracting practices. These requirements sometimes impede the Department’s ability to effectively and efficiently pursue, manage, and expend grant funds.

Recommended Action:
Establish the Department as the subject of a 12 to 24-month ‘demonstration project’ where its executive leadership would be given increased autonomy in critical administrative areas such as personnel and procurement.

Cost Savings, Organizational, Revenue Enhancement, Service Improvement

Functional/Operational Area:
All Department Operations

Estimated Annual Impact:
Cannot be Estimated

Estimated Implementation Costs:
Not Determined

Barriers to Implementation:
Existing City policies and practices related to hiring, procurement, and information technology. Some of these operational impediments are rooted in the City Charter.

Projected Implementation:
1 – 2 years

Next Steps:
Conduct planning meetings with all impacted stakeholders; including, the Baltimore City Council and Comptroller, affected municipal unions, and members of the advocacy community. Constitute a group of these stakeholders to oversee this demonstration project in conjunction with representatives from the Greater Baltimore Committee/ Presidents’ Roundtable Management and Efficiency Review Health Department project team.

Existing City policies and procedures governing public sector personnel, procurement, and contracting processes have been established over the years as safeguards to ensure the appropriate expenditure of public funds. These processes represent important internal financial controls to which all City departments must adhere. While every City department will argue that its operations are ‘different’ from other City entities, the Health Department’s arguments are particularly compelling. Factors to consider include the Department’s highly specialized staffing needs (doctors, dentists, nurses), its need to respond quickly to rapidly emerging health trends (strains of highly contagious diseases, virus outbreaks), and the unique types of materials and supplies required to provide health services (medical supplies, vaccines, etc.). These specialized needs, coupled with the City’s sometimes cumbersome administrative policies and practices, have led to the creation of organizational ‘workarounds’ such as the Baltimore Substance Abuse System (BSAS) and Baltimore Mental Health Systems (BMHS).

Some parties have advocated completely ending the practice of having the Department provide direct services to the public, opting instead for a service delivery model where the only Department official would be a public health officer with a policy-setting role, and all direct clients services would be outsourced to third-party providers. This would represent a direct extension of the past efforts by the Department to disassociate its operations from the public sector control processes. While this was a solution considered for inclusion by the Greater Baltimore Committee/Presidents’ Roundtable Health Department project team as a potential recommendation, the ‘demonstration’ concept was viewed as a more viable alternative.

For the reasons stated above, the project team judged the Health Department as a particularly attractive candidate for a controlled experiment to measure the effects of providing municipal entities increased management and operational autonomy.

Conducting such a demonstration project would require a tremendous amount of operational and financial planning and necessitate the establishment of well-defined goals and objectives against which to measure the ultimate success or failure of the experiment. In the event the Mayor elects to pursue the implementation of this recommendation, members of the Greater Baltimore Committee/Presidents’ Roundtable Health Department project team have volunteered to play an active role in collaborating with the Department’s leadership to develop more concrete plans for the scope of the demonstration, establish measurable performance goals, monitor the implementation, and provide regular reports (monthly or quarterly) to the Mayor, City Council, City Comptroller, and other interested stakeholders.