On Nov 19, 2013, 50 days after launch of Healthcare.gov, a ‘red team’ report by McKinsey was made public.
The (undated) red team report, was apparently briefed to White House,
HHS, and CMS officials in April. The briefing addressed several areas of the project, but one set
of observations in the 14 page briefing that struck my interest is the part that compared an ‘ideal situation’ for
projects of this type to the ‘current situation’. The current situation was
described as having:
- · Evolving requirements
- · Multiple definitions of success
- · Significant dependency on external parties/contractors
- · Parallel “stacking” of all phases
- · Insufficient time and scope of end-to-end testing, and
- · Launch at full volume
In the systems engineering world, these are among the deadly
sins of projects:
- · No technical target (specification ambiguity)
- · No project goals (scope creep and confusion)
- · No single authority (managerial chaos)
- · No proven methodology (technical chaos)
- · No time (mandated 'big bang' date)
- · No live testing (everything must work for everybody on day 1)
So, what happened in the five months between the red team’s
diagnosis and launch? One politically
oriented notion is that those closest to the President understood the risks and decided to ignore them or not raise
attention to them. A technically oriented notion is that they didn’t understand these serious risks,
or anyone’s ability to actually mitigate them. In either case, 'everyone' involved seems to
have suffered critical, if not fatal, cases of Irrational
Optimism: a belief based on something other than rational thinking. This kind of magical thinking
includes hoping that the diagnosis
was overly critical, hoping that the
teams would "fix it", and hoping
that history would not repeat itself.
What else could make the apparent optimism even more
irrational?: The need to service, organize, interface and/or manage:
- · 17,000,000 users
- · 55 contractors
- · 9 government agencies
- · 36 states depending on the federal system
- · 14 states building their own exchange
- · 170 insurance companies
- · 4,500 insurance plans
On December 1, 2013 we will discover whether this system
development project team can redeem themselves of the MAJOR DEADLY SINS committed. Can they ultimately avoid being added to the
list of FEDERAL FAILED SYSTEMS PROJECTS?
We’ll be watching, analyzing and reporting.
There is an interesting article by Nancy Gibbs in the December 2nd issue of Time Magazine. This is some of the content of the article: POTUS was briefed on the recommendations of the McKinsey report following the 14-slide presentation to senior officials. In April, Max Baucus, Senate Finance Committee chairman, told Kathleen Sebelius, HHS secretary, "I just tell ya, I just see a huge train wreck coming down". In July, Henry Chao, deputy chief information officer of the Centers for Medicare and Medicaid Services, told a colleague in an internal memo "I just need to feel more confident they are not going to crash the plane at takeoff". All this time POTUS's top aides were saying, publicly and privately that they had the project in hand. I think one of the many lessons is that POTUS has to run the government. Elaine Kamarck, Brookings Institution, says "The President has never surrounded himself with people who have deep experience in managing government". As you say above, we'll see if POTUS can fix it.
ReplyDeleteI've read a lot of the internal documents, including the McKinsey red team report and some of the emails during the summer/fall. Some of these emails had 40-50 addressees, so it wasn't a closely held secret. Some of the other documents from the main contractor (CGI) indicate that they knew (and told) that they couldn't/woudln't finish on time. I've also watched most of the Congressional hearings. I haven't figured out who these "top aides" are, or why they'd be optimistic. Nobody else was optimistic. I've also read the memo written by David Cutler back in May 2010 with all kinds of warnings around CMS's ability to manage the whole program, not just the website/system. So whoever the politicos around him that didn't understand what the "BLEEP" they were facing need to be ferreted out and sent packing after a good ole' pubic humiliation. POTUS isn't in a position to fix anything. All he can do is stand and watch, yell, and hope….then fire people after they get things working better it (or not) after Dec 1.
ReplyDeleteThe article did not specify who these "top aides" are - you are the expert in this matter, and I defer to you.
DeleteHere is an excellent comprehensive article about who was involved at the WhiteHouse and HHS and CMS. It looks like they were trying to hide a bunch of details from the GOP attacks. Looks like they hid a bunch of critical information from themselves http://www.washingtonpost.com/politics/challenges-have-dogged-obamas-health-plan-since-2010/2013/11/02/453fba42-426b-11e3-a624-41d661b0bb78_print.html
ReplyDeleteMy reading of it says that Nancy-Ann DeParle, Michelle Snyder and Jeanne Lambrew at one time or another were the White House leads. The article talks about how they were really POLICY types who helped get the legislation crafted, but certainly not technical or management types. There is a guy NOW involved from the WH named Park (last name). He's something like a technology advisor and seems very smart, well spoken etc… the question is what the BLEEP else was so darned important that he wasn't keeping an eye on O-Care systems progress?
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