WhatWentWrong@healthcare.gov

By Brian Lucas

This one is dedicated to Sally, “Di politica nunquam nos!”

“Truth never damages a cause that is just.” ― Mahatma Gandhi

By now most of America knows that the healthcare.gov website – one of the main delivery portals of the Affordable Care Act – was a disaster.  Even back on November 13th only 13% in a Slate poll[1] thought it was successful; and a week is a long time in a political hot potato such as this.  There are so many political sharks circling the water smelling blood on this issue that the last thing we need is another political commentary[2].   What can we ALL learn from this unfortunate debacle?  How can it be prevented in the future?

I am not going to engage in calling for U.S. Health and Human Services Secretary Kathleen Sebelius’s resignation; even though she continues to demonstrate that she either does not understand the true state of affairs or is deliberately reporting an unrealistically optimistic view of when the numerous issues are going to be resolved.  Nor will I levy blame at the White House’s chief technology officer, Todd Park.  Blaming is nonproductive at this point.  I am not even going to rip my shirt open to reveal my superman outfit and tell everyone how to solve the problem.  Instead, let’s look for root causes and learn what can be done to prevent such a disaster in the future.

So let’s ask the question; how can a “project” – not a natural occurrence like a flood or a hurricane – become such a manmade disaster?  One answer, that is undeniable, is an obvious failure of management.  Just look at the variable figures of cost for the overall implementation and the website separately.  Is it $600 million, $350 million, $125 million or $70 million[3]?  Everyone from the GAO on has a different figure. If this was managed successfully there would be no doubt as to the up-to-the-minute cost.  Before you jump to conclusions; I will readily admit far too few software projects are adequately managed.  Then there are the optimistic projected end dates that Kathleen Sebelius was providing.  Does anyone really believe they are going to be achieved?  Those are proof of a management system failure.

So the failure was an ineffective management system!  What caused the management system to fail?  Believe me; I am not calling for more government regulation.  Procurement is already a tedious and convoluted process.  At some point, the American people and the government have to realize it cannot legislate its way out of every crisis.  To understand this failure, we need to understand a fundamental similarity in the nature of the underlying forces of management systems.  These are the same forces that drive agile efforts.  Both run on two critical principles:

1.     Being able to tell truth to power.
2.     Being incented to accomplish the strategic vision.

Surprised?  You should not be!  These are problems that have plagued business management for centuries and software project management for decades.  Let’s look and the second factor first.  The best management system in the world will never run smoothly if people are not incented to achieve and understand the big picture.  In a large project, which uses many private vendors and has a distributed development structure, it is easy for things to slip through the cracks.  Contractors are only concerned with completing their statement of work so they are not liable for legal action and can get reimbursed for their efforts.  This puts the entire onus on the overall management team.  They need to first create a phenomenally detailed and accurate requirements definition.  Second, they must possess a superior knowledge of all the individual efforts so they can provide oversight.

Is there any surprise this fails as often as it does?  Instead, if the overall vision is a part of the requirement for each development team and the onus for technical coordination (not administrative management) is pushed down to the working level, everybody wins.  Teams know they must work effectively with the other teams or they won’t get paid.  If I develop my part to what I thought was the specification and you develop yours to your understanding and they don’t work together, we both fail.  That is often missing in government thinking.

Second, the most critical aspect of any operation – business, government, whatever – is being able to effectively tell truth to power without blame or retribution.  This is a documented problem as old as Sophocles’ fourth century B.C. play, Antigone.  The play is the source of the modern cliché, “shooting the messenger.”   The hierarchic management structure imbeds the chain of command and that is its greatest and often lethal weakness.   If you are down on the chain and actually doing the work (and seeing the problems) you have no way of escalating the issue past your direct manager.  If that manager chooses to cover up the problem because they feel it reflects poorly on them or they think that the executive management will not be receptive to criticism, failure is assured.

This is the greatest lesson that every executive should learn.  Have a real “open door” policy, and don’t shoot the messenger.  Furthermore, it doesn’t pay to treat these kinds of issues as finger pointing exercises.  You should instead understand them as process failures.  Then managers, who previously blocked bad news from coming up the chain, will have no motivation for repressing the truth even when the news is bad.  That is the biggest failure here and the reason that something can go live and be in as bad a shape as the healthcare.gov website was.

I must point out that this is not a failure of the current administration.  It has plagued almost every administration in my memory including the previous one.  From Watergate to Bob Woodward’s book State of Denial those who tell the truth are often crucified. It is not easy to implement successfully; or more administrations would have done so.  A telling truth to power mechanism is not the same as a whistleblower one.  The former is positive; the latter, though necessary, is negative.  Both must begin at the top; and that means the president.

Implementing truth to power and uniting former antagonists can be accomplished even in a large organization.  Just look at Alan Mulally’s success at Ford.   When Mulally arrived at Ford, it had one of the most caustic corporate cultures ever seen.  Executives put the advancement of their careers ahead of the company’s success – even its survival.  Mulally openly applauded executives in meetings who reported problems and showed each person they had a vested interest in seeing Ford succeed by tying their compensation to the success of the whole company[4].

It will be a slow process to repair the damage that was done to the Affordable Healthcare Act by this botched implementation.  The President himself will need to set the tone for change.  The question is; did the administration learn a strategic lesson, and will they change the underlying motivations of the government’s workforce and vendors to correct the situation and prevent future failure.

Did you?


[2] Since I am very apolitical, I am always amazed at how many people want to know my political affiliation and my political views.  It comes up in almost every talk I give.  I would like to think of myself as a business person, physicist and philosopher first and a seeker of truth rather than an opinionistic political taking facts or subversions of truth out of context to prove a zealously held belief.

[4] See American Icon: Alan Mulally and the Fight to Save Ford Motor Company by Bryce Hoffman.

About Brian Lucas

In his life, Brian Lucas has been a coach, farm worker, forester, health care advocate, life guard, general contractor, mechanic, mixologist, musician/singer (in a rock group), salesman and teacher. Brian has worked as a project manager, technical marketer, methodologist, manager, software architect, systems designer, data modeler, business analyst, systems programmer, software developer and creative writer. These efforts include over a hundred hi-tech initiatives in almost every business and industrial sector as well as government and military projects. Among them, he designed and developed a quality assurance system for the first transatlantic fiber optic communications network, a manufacturing system for a large computer manufacture’s seven manufacturing centers, a data mining system for steel production, an instrumentation system for cable systems, defined requirements for government’s information systems and designed and developed human performance management systems. Brian has educated and mentored many over the years, designing programs to discover and develop talent. He has also lectured extensively to a variety of audiences. Brian is currently devoting as much time as possible to the innovation of business agility and human capital management along with the next generation of agile software development. As an amateur theoretical physicist he is working on joining general relativity and quantum mechanics through a multidimensional time corollary on string theory and negating the uncertainty principle with Louis de Broglie’s wave/particle hypothesis. He is also an avid blue-water sailor and wilderness backpacker. He enjoys billiards, boxing, chess, cooking, famous battle reenactments and war gaming, fencing, flying, gardening, horseback riding, martial arts (particularly Ninjutsu), philosophy and psychology, playing musical instruments (7 so far), poker, rapid-fire target shooting, reading (he tries to read a new book every night), painting with oils, scuba diving, skiing and recently writing novels.
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13 Responses to WhatWentWrong@healthcare.gov

  1. Sally says:

    My god! I am so honored! I have never known a person who was better able to cut through the fog of complexity and get to the simple truth better than you Brian. It is unfortunate that the government probably won’t learn the lesson as you outline it here. I have shared your post with the executives I am working with on the conversion. To a person they are impressed with your understanding and your ability to communicate it. Each time I meet you I am more impressed than the last!

  2. Lynette says:

    Brian, this is so well-written. Thank you for your continued insight and sharing your knowledge.

  3. Jack says:

    Once again Brian you hit the nail right on the head. It is your ability to see truth through the fog of partisan politics that makes everyone want to know where you stand. Its too bad I fear your advice falls only on deaf ears in Washington. The smartest thing I ever did was open my door and listen to what was actually going on in my company. Thanks for all your great posts!

  4. mARTINg says:

    I agree 100%!

  5. Fran C. Zabrinski says:

    Brian when are you going to march down to Washington and straighten them out? I love how you don’t condemn or play the blame game. You are so amazing at seeing the BIG picture and making the complex easy to understand. How can anyone argue with what you have said! I have to meet you sometime. You are in the top 10 of my bucket list! – Your blog commenting friend Frannie

  6. Dr. Colin Baker says:

    This is an interesting, if simple approach to the problem of major initiatives failing. I approve of the author not descending into a stream of political rhetoric and performing a root cause analysis. I am sure if pressed, he would point out other failures. Vision, incentive and telling all the truth are so basic to a large complex endeavor that I agree if you are not able to establish both nothing else matters. From my part, I would like to see an exploration of how these things could be successfully accomplished in a government setting. Some examples were given of Ford’s return from the brink, but this is such an important subject it merits greater discussion.

  7. Lillian-Rose says:

    This was a refreshing and insightful exploration of the underlying problems without the usual political accusation. Thank you Mr. Lucas, I hope the government reads your blog and learns form it.

  8. Dory Kratzer, RN says:

    This is the only real sensible post I have seen on this subject

  9. Calvin Jackobson says:

    Brian what is your current opinion on the Obamacare offering? I’d like to get your perspective.

  10. Dr. Elliot Smith says:

    It is so hard to find an intelligent, impartial and informative article written on anything concerning the Affordable Care Act. I admire the non-accusatory nature of your post and the high caliber of your writing. I hope that you can expand on this subject with a commentary on the ACA itself. Thank you for being a voice of reason.

  11. Geninne Gerencher, NP says:

    I agree with Dr. Smith (oh my goodness that brought on a flashback to Lost in Space)! I would like to see an expansion on this subject. I am a nurse practitioner and the ACA has been the subject of so much controversy. I enjoy reading your blog Brian, but I get lost in the computer end of things. I wish you would write about more general subjects and certainly more often!

  12. arturo bonagura says:

    I would like too see this subject discussed as well!

  13. Irene Gottlieb says:

    I think there was so much more wrong with the ACA than this article implies!

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