Using Business Process Improvement to Address Procurement Challenges in Guam

ROBERT JOHNSON:
This is Public Health Review. I'm Robert Johnson. On this episode, leaders in Guam work to improve the process of managing public health procurement.

JON JUNIOR CALVO: I think that this should be considered a top priority for other governments and other agencies.

BERTHA TAIJERON: This is the first time that we've come together as a community. That Guam agencies are trying to address a problem, right, or a challenge on procurement.

ART SAN AUGUSTIN:
The hope is that this model can then be replicated and used at other governing Guam agencies that do small purchase procurement.

JOHNSON:
Welcome to Public Health Review, a podcast brought to you by the Association of State and Territorial Health Officials.

With each episode, we explore what health departments are doing to tackle the most Pressing public health issues facing our states and territories.

Today, business process improvement. Words that can apply to many things in government or business. In Guam, it's the approach leaders there have taken to make sure federal dollars are spent where needed, looking at the way they handle small purchase procurement to avoid sending money back to Washington, D.C.

Arthur San Agustin is an ASTHO alum, the retired director of the health department in Guam, and now a special assistant to the governor and lieutenant governor there. Bertha Tyrone is in the health department. She's a program coordinator. They're along shortly to give us their take on the journey to improve Guam's small purchase procurement process.

But first, John Jr. Calvo, Chief of Staff to Guam's Governor and Lieutenant Governor, explains why the administration decided to reform the process.

CALVO:
Yeah, you know, as we learned from the pandemic, you know, specifically to public health, they played a critical role as the public health agency in response.

And so, one of the challenges we experienced was procurement. The procuring of goods and services in the government, not including RFPs, request for professional services. So, you know, one of the challenges is that procurement is a very complex process, but it doesn't have to be for everyday things that an agency, public health would consume.

And so, utilizing ASTHO to go through this business process improvement was extremely beneficial to getting the agency on board to better understand how procurement works and how we can achieve our goals in expanding federal funds and the local funds that have been entrusted to the agency to provide services to the people.

JOHNSON: 
And it really does have a couple of objectives, right? You want to do a better job of spending the money that you get, making sure that's done right, but you also don't want to send money back.

CALVO:
Absolutely. I don't think any government or any agency, particularly for our administration, um, has been kind of a mandating that we do not return federal funds.

And since taking office in 2019, we've been able to prove that. We've increased our federal spending. Despite also receiving additional or increases in federal funds to support our various programs. And so this process was critical again to ensuring that the agency uses both an upstream and downstream process to kind of streamline a lot of our acquisitions.

Johnson: It's been underway for a while now. From your perspective, how has the process been so far?

CALVO:
You know, it's been a very long one. You know, I think one of the early steps that we needed to take was getting the buy-in from the employees that are going to be involved in this process from step one to completion.

And so, We've had tremendous support from the leadership team, we've had tremendous support from the office of the governor, as well as the agencies that are affected, particularly the General Services Agency, the Department of Administration, and the Bureau of Budget Management and Research, who all play critical roles and have broad areas of responsibility in the procurement processes.

JOHNSON:
What should people know if they haven't engaged in a process like this? What's easy? What's difficult? What do you wish you had known before you started that you now understand?

CALVO:
One of the initial steps is establishing your cross-agency leadership team. And these are going to be what I would call the decision makers, identifying the people who are going to be responsible for taking the lead and making sure that whatever happens throughout this process, they're not only implemented, you know, they're practiced, they're consistent, but they're also audited, right, to make sure that everything that we've decided that we're going to implement is actually taking place.

Be clear about the goals and objectives. You know, we're not going to change this process overnight. It's going to take time. There is going to be a learning curve, but there has to be, again, like I said earlier, buy in from the people who are going to be part of the process. And communication. Managing the expectations and making sure that we're going to be able to see deliverables throughout the entire process every step of the way.

JOHNSON:
Has it been worth it?

CALVO:
Absolutely worth it. In fact, we're again, going back out to see if we can get additional technical assistance in other areas. And I think that this has been. It's a very good model for the Department of Public Health and Social Services, but it's also going to be a good model for other agencies to kind of adopt.

And I, and I'm hoping that's what we're going to be able to see in the next couple of months or even years as we implement other areas of government work, whether that's going to be human resources, whether it's going to be training, leadership development, et cetera.

JOHNSON:
When you gave the green light for the department to move ahead on this were you expecting that it might end up being a project that could be applied across all of government in Guam?

CALVO:
Yeah, that was one of the expectations. Um, even though we did have a limited pool of funding to get this going, the idea was that, from my vantage point, kind of like the 30,000 foot view, was that, how are we going to be able to utilize this process in other agencies?

This is not for me. And from my vantage point, it wasn't going to be a one and done type of scenario. I think that we've invested a good amount of money in this. We've had a lot of professionals come in and we've expended a lot of time and resources to kind of bring this all together. And it's not a cookie cutter approach to processes, right? It's something that we are able to kind of pick up and just kind of say, well, how can we use this process here? How can we make some changes that are specific to your agency or to your division or organization and how will it benefit you at the end of the day?

JOHNSON:
Should other government agencies take a look at a process like this?

CALVO:
Yes, I think that this should be considered a top priority for other governments and other agencies and if there's an opportunity to engage, to learn from what we've learned as best practices, um, or even setting up the foundation to go through this type of process, I would highly, highly recommend and, you know, on behalf of the government of Guam and public health, we're happy to, be a part of that process wherever it may be.

JOHNSON:
Arthur San Augustin led Guam's public health department during the pandemic, taking over as director in October 2019. He's since retired but remains a trusted advisor to the governor and lieutenant governor. San Agustin says the project to change procurement processes will have a lasting impact on the department's work.

SAN AUGUSTIN:
What it means to the Department of Public Health and Social Services, wherein this project is embedded, is it means that they would be able to have a map, a model laid out, job aids that would assist current employees, future employees, that is process based to process and move forward with procurement, small purchases. And the whole impetus behind this is that the department identified two key areas that were always a constant challenge, and into today, still through today, it is still a challenge, and that challenge is procurement and recruitment.

JOHNSON:
Was that approach slowing you down, or were you worried that you wouldn't be able to do as good a job if you didn't address these issues?

SAN AUGUSTIN:
Well, you know, I think that's what part of the process was. In working with AASHTO, they were able to map out the process and just in being a part of that conversation, you heard varying perspectives. Just when should you start procurement? How soon should you start procurement? We were not all on the same page.

There was good conversation about just where do we start that procurement process. So it was critical that the people understood that we're all on the same page. There was clarity, direction, and vision moving forward in terms of the procurement efforts for public health and social services.

JOHNSON:
What is the timetable for this work?

SAN AUGUSTIN:
That is a good question. I say that because there's six divisions within public health and social services, and the approach was to work with the Division of Public Health. And that was based on an assessment, perhaps more from just conversations, that the Division of Public Health probably passed the most number of requisitions.

So, it's somewhat of a pilot concept in which we're going to work through with one division, identify are there any challenges, any kinks in the system that need to be addressed, need to be clarified, need to be refined. And once that step in that process is completed, it will then be used as a model for other divisions.

In a time frame, it's probably going to be a month, a year, looking at the requisitions, testing them through the process that has been laid out, reworking any processes that need to be reworked, retraining, making sure everybody that was initially trained gets the updates, and then engaging the other divisions. There are six within this department, Department of Public Health and Social Services, to all be trained up.

This model can then be replicated and used at other Governing Guam agencies that do small purchase procurement. So that's the big picture, let's get it working, let's get it smooth, let's get that system in place with the Division of Public Health. Once that is done, let's look at the other five divisions, train them up, let them use it.

JOHNSON:
You had to work outside public health to get this done. How has that collaboration been going?

SAN AUGUSTIN:
Well, you know, during the mapping and discussion phases, it seemed that there were intermittent engagements and depending on, I think a lot of people's workload, a lot of people in the department and the governor of Guam is just short staffed.

So this is multiple agencies sitting at the table, talking through the process. And I believe in the end, my observations are all sharing the sense of, I appreciate what you do. We didn't realize what your role is and what you do for us. And it's just, we don't talk with each other normally. It's send the paperwork in.

There's no person behind it. And we do say we're process based, right? It's what we're driving for. But that person behind it does make a difference in that human factor. And so, there was enough engagement for us to move forward and complete the project.

JOHNSON:
It sounds like the simple notion of sitting down and talking about the process has really helped.

SAN AUGUSTIN:
Oh, absolutely. Yes. I mean it was it was that aha moment sometimes for people. We're like, oh, wow I didn't know you did that. It's like, oh just call me. It's like, okay and so there was that receptiveness to be process based but then you also develop relationships, working relationships that are critical because when they say hey call me, you know you're going to call them.

JOHNSON:
What kind of an impact do you think this will have when it's done? What are you hoping will come from it? What'll be the big upside from all of this?

SAN AUGUSTIN:
Well, the big upside, I think, is by providing the training, we'll have a competent, confident, self assured staff to execute the work that they were hired to do and to do it with a sense of confidence in that they're not wondering, did I do this correctly, who do I need to call? And, then in the end result of doing what they do, we would be able to procure goods and services that then translates to those goods and services being provided to the community for improved health outcomes.

JOHNSON:
What do employees at the department think about all of this? How do they feel?

SAN AUGUSTIN:
When we first started, there was a degree of skepticism because we had done mapping before and we were looking at, I believe it was also procurements. So, there was initially that sense of, hmm, are we really going to finish it this time? And we did. This time they did complete the manual. They completed the job aids training is being scheduled.

And so the staff, I think after knowing that there was a real commitment this time around to complete the business process improvement for small purchase procurement, I felt that they were feeling a sense of satisfaction. Like it's not just conversation. We didn't have a bunch of meetings, a series of meetings, and we didn't just talk about it and share our concerns and our stressors and our understanding.

It turned into a final product that can be, well, it's going to be tested and then eventually refined and that can be used for small purchase procurement within the department. And again, the hope is beyond the department that this, model can be used in other Governor Guam agencies under the 25,000 procurement marker.

JOHNSON:
Would you recommend this process to others in public health?

SAN AUGUSTIN:
Many of us have had challenges with recruitment and procurement and depending on their organizational structure, some are able to move procurement even sooner than recruitment. But what I would say is that definitely if you have an opportunity to map out your process If it's a challenge for you and you map out your process and you have a committed, dedicated team to walk the system through, develop the process, the job, it's looking at Guam as a version, could be a reference. It could be a toolkit to look at to not have to reinvent the wheel.

JOHNSON:
Bertha Tyrone is a program coordinator inside Guam's health department and right in the middle of this project. She tells us how it's been so far.

TAIJERON:
It definitely has been an interesting process. It's also been very eye opening, and the reason why I say that is because this is the first time that we've come together as Guam agencies to try to address a problem, right, or a challenge on procurement. And ultimately, we're trying to improve gifts and services, and of course, this impacts the people of Guam, right, because this is who we serve, so having agencies come together to try to address and improve the process, try to develop new processes, was helpful because we were able to learn firsthand and hear from the other agencies, some of their challenges, and some of the ways that they can help us to improve the process.

So, working together, trying to strategize and brainstorm. To help improve this process, develop a new process, and test that process with something that we've never done before. So, I felt that this has been definitely something that our department needed for so long, and um, having the support across the entire Guelph Guam agencies that were involved in this project with technical assistance from ASTHO helped us understand the process and come together and just try to improve services for our island community.

JOHNSON:
And you've been working with these other agencies. What has gone well?

TAIJERON:
I think what has gone well is the fact that we come together. There's commitment from the top. And when I say from the top, I'm talking about leadership, right? I'm talking about GovGuam agencies who definitely want to help us improve this process and there's just commitment.

Um, there's this long term commitment, there's this support all the way up to our governor, right? So, our governor is aware of this process. She shared her commitment to prioritize our procurement process. And so with the support from our agency leadership and, of course, key staff coming together to try to improve this process.

It has gone well, and we're still continuing to try to improve this process, to try to support each other so that we can try to improve services.

JOHNSON:
Well, let's get into your impressions of the project as someone who is involved. What about the experience stands out to you?

TAIJERON:
So, what stands out to me is the commitment, right?

The dedication of staff who want to improve the process. Um, we've been at this for quite some time now. And my thing is, I never give up. Always know that there's always room for improvement. And just continue to push forward. Try to work together with your external partners to try to improve processes.

Because ultimately, the people of Guam is who we serve. So, I'm having that commitment and support from the top down is definitely helpful knowing.

JOHNSON:
What you know today, thinking about that in the context of getting all of this going two years ago, has it been what you expected or were there things that were unexpected?

TAIJERON:
I think looking back these past two years working across agencies, working even within our own department across the six divisions, just working together, coming together, and trying to improve this process, what stood out to me is that even within our department, we have different ways of managing procurement.

So, having a standardized process. It's a benefit just understanding some of the challenges that we face as a department as well as some of the challenges our external partners face and how we can work together to minimize those challenges and try to we've developed forms, we've developed SOPs, um, which definitely will be helpful moving forward so everybody has a standardized, consistent process of procurement.

JOHNSON:
So, just a couple of more questions here for others who are thinking about getting involved in a project similar to this. What would be your advice to them?

TAIJERON:
My advice would be to just keep the momentum going. Continue working on improving the process. Keep talking, keep communicating. Don't stop. Hopefully, you know, we know, we realize that this is a long-term process.

On improving our procurement, but I think the commitment, the dedication, just making sure that staff understand the reason why we're doing this, right, would be important and key to this long term goal of improving procurement across only the department, but across the entire Guelph Guam agencies.

JOHNSON:
How does a process like this benefit public health in Guam?

TAIJERON:
It allows us to spend our dollars in a timely manner. One of the things we're trying to do is return those federal funds and so it will increase our staff productivity because staff will be able to provide services to people, to their constituents. So there's a lot of benefits to this procurement process and I think, again, ultimately the goal is to improve services to our island community.

JOHNSON:
Thank you for listening to Public Health Review.

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We cover news like this every day. Look for the link to the show in the notes for this episode and let us know what you think. This podcast is a production of the Association of State and Territorial Health Officials. For Public Health Review, I'm Robert Johnson. Be well.