Post-launch fiasco, followers of the Healthcare.gov experiment seemed locked in a pointless pattern of irrational expectations, finger pointing, witch-hunts, and spasmodic new deadlines (i.e., more irrational expectations). Fortunately, in the news this week, the situation seems to be turning around (although some are still skeptical). What’s to be learned sorting through the wreckage? The failed launch points to four common mistakes leaders must strive to avoid.
Setting irrational expectations. To expect anything as complex as this particular project to emerge fully functional on day one was the first (and perhaps most important) failure. I’ve seen this mistake numerous times in other industries — from a customer service fiasco by a major telecommunications company that launched DSL at too large a scale to NASA’s failure to recognize the implications of a foam strike in the Columbia shuttle tragedy.
Like these other complex challenges, the more we learn about the process of building Healthcare.gov, the more we understand why the initial launch failed.Communications between the Centers for Medicare and Medicaid Services (CMS) and the hired private IT company, Consultants to Government and Industry (CGI) were tangled and mistrustful, making simple requests for access and information cumbersome and time consuming. The two major players didn’t share priorities: CMS prioritized the October 1st deadline above operability. And the New York Times lists “weak leadership” at Medicare as another complicating factor.
Playing the blame game. The CMS monthly status reports leading up to October 1 (especially the report for August, 2013) reveal increasingly desperate language and blame shifting. Medicare officials, the New York Times reports, “began to suspect that staff members at CGI were intentionally trying to hide flaws in the system to cover up for their inability to meet production deadlines.” CGI staff members express barely concealed frustration with repeated requests for access and with constant heckling emails from CMS staff. Within CMS, Deputy CIO for IT Henry Chao’s group emails employed all caps and direct finger pointing, like this one dated 9/26: “I need Monique to get this in sync…ironed out now — I DO NOT WANT A REPEAT OF WHAT HAPPENED NEAR THE END OF DECEMBER 2005 WHERE MEDICARE.GOV HAD A MELTDOWN (THIS IS TO GET YOUR ATTENTION IF I DIDN’T HAVE IT ALREADY).”
Following old-fashioned buck-stops-here logic, post-failure investigations hoisted mangers like Kathleen Sebelius onto the chopping block, (unsurprisingly) failing to reveal any solutions for Healthcare.gov’s problems. Moreover, it’s simplistic (and just plain wrong) to seek a single culprit. As one computer expert with intimate knowledge of the project told New York Times reporters, “Literally everyone involved was at fault.”
Rolling out instead of cycling out. Healthcare.gov is a good example of the importance of learning small and fast, rather than rolling out a risky new product or service launch all at once. Cycling out in phases includes the expectation of early failures – and demands all hands on deck to learn from them along the way. A roll-out, in contrast, implies that something is all set, ready to go — like a carpet. All it needs is a bit of momentum to propel it forward. For complex initiatives, of course, this is simply not the case. Getting people motivated enough to change is not the real challenge; it’s getting them engaged enough to learn — to become part of a discovery process.
CGI and CMS, like countless organizations under pressure (deadline, bottom-line, or finish-line), employed an organize-to-execute mindset instead of an organize-to-learn mindset, which made it difficult for managers to change their approach, especially in the middle of a crisis. On-the-job learning is necessary to discover and use new answers simultaneously. Managers must make it clear that they understand that excellent performance does not mean not making mistakes — it means learning quickly from mistakes and sharing the lessons widely.
Losing sight of the big picture. Finally, in all of the hoopla over the website, many lost site of the original goal: affordable care for more Americans. For this goal, it seems there is reason for cautious optimism. In spite of the website fiasco, data released by the CMS Office of the Actuary in September, 2013 reveal significantly lowered per capita healthcare expenditures in all three payer categories (a growth rate of 1.3 percent vs. the long-term historical average growth rate of 4.5 percent).
These and other similar trends led columnist/economist Paul Krugman to predict improvements in healthcare spending, in part due to the Affordable Care Act: “The news on health costs is, in short, remarkably good,” he wrote. “You won’t hear much about this good news until and unless the Obamacare website gets fixed. But under the surface, health reform is starting to look like a bigger success than even its most ardent advocates expected.”
The predictable traps described above can be avoided with four leadership actions:
Set compelling, but realistic, expectations. Novel complex initiatives will encounter stumbles and falls along the way to success. Let people know to expect them. They’re an essential part of the learning process! The job is to work closely together to learn fast — and improve faster.
Identify lessons, not culprits. There’s always plenty of blame (i.e., factors contributing to a failure) to go around, and it’s almost always a poor use of time to seek out and punish culprits. Although satisfying to some, it distracts from the core work of learning and improving. Instead of “who did it?” ask, “What happened? What can we learn? What should we try next?”
Design learning cycles. For novel initiatives, design to identify intelligent failures (those that occur in novel territory at a small scale) quickly, then catch and correct them before the next cycle starts. Celebrate intelligent failures as a source of innovation. Recognize that the timeline for completion can be ambitious but it is necessarily uncertain; build in time for recovery.
Emphasize what’s at stake. Reminding people of the big picture helps them understand why it’s worth forging ahead through the trials and tribulations of learning.
Sometimes the best launch is a bit bumpy, a little less glamorous — and certainly more than a little frustrating — but, in the end, the best route to success.