Slim just left town: decisionmaking on an intensive care unit

The title of this paper comes from an incident that occurred while I was participating in morning rounds on the pediatric and surgical intensive care unit of a large, midwest tertiary care center. The patient under discussion was an eight-week-old girl who had been born without kidneys, and who had been cared for on the unit for seven weeks. In the previous week, the baby's condition had gone steadily downhill, as she experienced on medical catastrophe after another. One of the nurses asked the staff doctor who was leading rounds that morning, "What are the baby's chances?" The physician replied, "Her chances are slim." To which one of the young residents immediately answered, "Slim just left town."     

Assessing the results of public expenditure: program evaluation in the Canadian federal government

Abstract. In an attempt to tighten up its financial systems and improve control of expenditures, the Canadian federal government has set up a new office, that of the Comptroller General. One of this Office's responsibilities is to administer the Treasury Board's policy on program evaluation, which says that all government programs should be periodically reviewed for their effectiveness in meeting goals and for the efficiency with which they are managed. The paper describes the Office's approach to program evaluation, reviews program evaluation policy in three other countries and discusses the principles and practical problems which limit the application of evaluation research. Evaluation activity in Canada is endangered in its cradle by two threats: the tendency of proponents to over-exuberance; and the cynics' view that the activity is of such limited applicability that potential savings are negligible. A third problem is a tendency to fuse together policy-related and management-related assessment activity. Evaluation activity conducted from the operational management point of view which takes program goals for granted will surely result in sequences of small victories and economies. This is worth doing well. But the dramatic import of effectiveness evaluation as a ‘bottom line’ for judging the worth of whole programs — that is, as a policy tool — should not be allowed to generate false expectations about the scope for improvement in routine management of the public service. Sommaire. En vue de fortifier ses systèmes financiers et d'améliorer le contrôle exercé sur ses dépenses, le gouvemement fédéral canadien a créé un nouveau poste, celui du Contrôleur général. Une des responsabilités de cette function est d'administrer la politique du Conseil du trésor en matière d'évaluation de programmes. Cette politique exige que les programmes gouvernementaux soient évalués périodiquement afin de déterminer leur efficacitéà rencontrer leurs objectifs ainsi que la capacité de rendement de leur gestion. Ce document décrit l'approche du Bureau du Contrôleur général en matière d'évaluation de programmes; examine les politiques correspondantes dans trois autres pays; et discute des principes et des problèmes pratiques qui limitent l'applicabilité de l'évaluation en recherche.