healthcare.gov and project management

<preface explanation:

http://brucemctague.com/opinion-editorial-thoughts-shared-posts-are-behind-this-preface

  >

I will begin with the following thought:health care gov_logo

 

Damned if you.

Damned if you don’t.

 

I began with that because the healthcare.gov <for America’s affordable healthcare act online sign up> is one of the oddest discussions I have ever experienced.

 

Damned if you do.

I could begin by pointing out how cumbersome rules for procurement, hiring, and management are inside the government.

Several business people in the private sector have pointed out that their work was, in many ways, easier than Healthcare.gov’s.

They could start from scratch, did not have to coordinate with as many outside entities, and could hire anyone they wanted, and work in any way they liked. Everything about the way the government builds large technical projects contrasts unfavorably, from specification to procurement, to hiring, to management.

 

By the way.

We, the people, put the restrictions on how a government job can be procured. We often demand they cannot sole source. We demand that they must have a certain percentage of minority, small businesses, female owned business and a variety of their mandatories depending upon the size and the scope of an assignment.

This <most often> drives up total cost of a project particularly if you begin to have 10+ contractors/suppliers/partners.

This doesn’t mean that they cannot do it … just that we make it difficult for them to do it.

This doesn’t mean they shouldn’t do projects like this <because they should>.

This doesn’t mean they shouldn’t have some restrictions <because they should>.

This means that we should recognize they are doing what we told them to do.

 

 

Damned if you do.

The public scrutiny.

Sure.

Initially the website issues appears to be a management issue … not a technology failure.

One person should always be in charge.

But.

Other than maybe a general in the midst of a military campaign … I cannot think of another situation, in business, in which there is this much scrutiny on a major project on a daily, if not hourly <or minute-by-minute>, basis.

Most business leaders have their proverbial shit together and even in the midst of major problems … a leader stays out of the way and let people do their jobs to fix it.

In the midst of an issue is not when you want spotlights and discussions and scrutiny <with major finger pointing and blaming>.

 

In other words – let the frickin’ program unfold.

I struggle to think of any major business project that looked pretty and worked pretty from day one. And if someone judged me on day one of a project I imagine I would have been fired so many times I would look like swiss cheese.

A government program never has the luxury a private company has with regard to letting things just ‘happen’ and adapting … and then reporting.

 

A business truth.

 

What happens on day one … let alone week two … is not often an indicator of success or failure. I don’t know how to explain it other than that.

In a government program they are asked to explain it other than that.

I would fail if I were demanded to do so.

 

Damned if you do.

 

Public demands <with political scrutiny>.

It is pretty much a general rule in business that you should start small and build from there.

Like maybe get one state up and running first and then go from there <albeit I could argue Massachusetts was your one test market>.

Most robust technology systems are built by constant testing as you go and by teams who swap jobs frequently <hourly even>.

 

Well.

 

Could you imagine in a test program in this political environment?

It wouldn’t, and couldn’t, happen.

In this political environment you had to build it and launch it.

Let the chips fall as they may and deal with it.

 

 

Damned if you do.

 

Last minute changes are always bad. And they shouldn’t be allowed.

And we, in business, acknowledge this.

But you know what?

 

We do it all the time.

 

We do it all the time and jump through hoops and hope like hell it all works out.

And we do it on absurdly complex far reaching programs.

 

For example … let’s assume the Affordable Healthcare contract specifications were pretty clear … and communicated with … ‘more than 50 different companies, five government departments and 36 states were involved in building the website, which is designed to help millions of uninsured Americans find affordable coverage from private insurers’ … in addition … this project must have generated thousands <if not more> of change orders throughout the project.

 

Last minute changes?

Shit.

 

There were every minute changes.

 

And, yes, this happens in non government projects too.

 

 

Damned if you don’t.

 

Ah.

Results.

People are naturally hesitant to change. And change this big and confusing? They will naturally do something first … search for information <hence millions visited the site just to explore information and the site got overwhelmed>.

 

Millions did not purchase … and here is some news … they will not for quite some time.

 

In fact … they will not purchase until the deadlines dictate that they do so.

 

The overwhelming majority will not sign up until the last 45 days or so.

Bet on that <and I am surprised no one communicated that to anyone>.

 

Regardless.

Notice who is talking about this project and who isn’t.

Politicians are blabbing away nonstop.

Private sector business leaders, who have developed and implemented these types of initiatives, are silent.

There is not one business out there who looks at the scope and complexity of this type of project and is not laughing.

Laughing at all the people who are calling this a fumbled train wreck.

Because we in business have lived it … and still do.

All the time.

 

Just … well … Damned.

 

No good business person judges a project on its launch. They judge it on its final success or failure. Is month one an indicator? Sometimes.

Often not.

A government project is damned from the beginning not because of the project itself … the excruciating political scrutiny of minutiae.

 

This means I am suggesting that not only are any ‘government hearings’ on a healthcare website simply political theater <staged by people who could not run a business let alone a business project like this> but … well … unhealthy business practice.

 

Look.

I am not suggesting people shouldn’t be held accountable.

And that we shouldn’t expect better <or the best that can be done>.

 

But what is important is not who is to blame but rather fixing what needs to be fixed.

 

Personally I would throw the ‘train wreck analogy’ back at whoever uses it.

The train has already left the station.

You cannot bring it back.

Better figure out a way to get it on the tracks moving smoothly rather than run around trying to say ‘sorry … no more train.’

 

Ok.

Lastly.

Should someone should get fired?

 

I don’t know.

And I am a business guy who has painfully but necessarily fired people in the past.

 

Complexities of the project aside … it is what it is … and it always was … a complex project.

My gut tells me I would continue to let the team remain in place and follow improvements and follow results.

The truth is that most results will occur as the deadline nears. It is human nature for everyone to wait. Therefore we really cannot judge until then.

 

Healthcare website aside.

 

Health care, in the end, is about people.

Doctors and medical people around the world share a dedication and professionalism.

 

And in the end we will have millions of good and not-so-good stories no matter the system.

 

But I would like to note that even before the Affordable Healthcare Act figuring out what providers and procedures are in what plans, who is ‘in network’ and who isn’t, and the cost, and the guidelines, and … well …. It wasn’t simple.

 

You often received a doctor’s bill which you thought was covered under your plan … but  Doh! … the doctor <procedure> is only in some plans … but not yours.

 

The American health care system with its complexity and lack of transparency has always set it apart from systems in other wealthy industrialized nations.

 

It didn’t need to be simply changed … it needed to be fixed.

It needed to be broken in order to be fixed.

 

And as we know … breaking things hurts.

We may be in pain but blaming a website for our pain is ludicrous.

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Written by Bruce