Healthcare // Leadership
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4/11/2014
02:55 PM
David F Carr
David F Carr
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Kathleen Sebelius: Failed IT Project Manager?

Sebelius didn't write the code for HealthCare.gov, but she is paying the price for failing to oversee those who did.

It's time for Kathleen Sebelius to polish her resumé, but I doubt she will be seeking work as an IT project manager. After overseeing the rollout and reboot of the federal government's HealthCare.gov health insurance exchange website, I suspect she will stay as far away as possible from any further venture that hinges on the success of an IT system.

Sebelius is resigning as Secretary of the US Department of Health and Human Services, the federal agency that includes the Centers for Medicare and Medicaid Services, which more directly supervised the construction of the federal website. That website was critical to creating an efficient shopping experience for citizens seeking individual health insurance plans. It turned out to be far from the Amazon.com for healthcare that President Obama promised.

Kathleen Sebelius (Source: Wikimedia Commons)
Kathleen Sebelius (Source: Wikimedia Commons)

At its Oct. 1 go-live, HealthCare.gov barely functioned at all, certainly not on the scale that it needed to serve most of the nation. For months afterward, the site struggled (maybe not as much as the people trying to use it).

By early 2014, after a heroic turnaround effort, the website rose to the level of being at least minimally functional. People could actually sign up. By the March 31 deadline for open enrollment, the remaining site slowdowns and glitches could at least be blamed on legitimately heavy traffic rather than unsafe-at-any-speed technical incompetence. Signups ultimately cruised past the 7 million mark, a target that at one point seemed unreachable. Never mind the politics of whether that should be considered a success -- to whatever extent it was a success, it was one achieved despite the website rather than because of it.

Was all this the fault of Kathleen Sebelius? Some Republicans in Congress had been calling for months for her to be fired. According to the account in The New York Times, she approached President Obama to discuss whether it was time for her to resign. Whether she jumped or was pushed scarcely matters. The lead on the Reuters story reads, "US Health and Human Services secretary Kathleen Sebelius is resigning after overseeing the botched rollout of President Barack Obama's signature healthcare law, a White House official said on Thursday." I doubt the White House official said it was because of "the botched rollout," but that's the prevailing story and probably more true than not.

The Times also noted that Obama previously defended Sebelius, saying in an interview with NBC News that she "doesn't write code; yeah, she wasn't our IT person."

No, she didn't write the code, but neither do most people with responsibility over an IT project. Even the most technical project manager is not a master of every discipline involved in the success of a complex project. Far from writing the code, he or she might not be able to read or understand it. The CIO doesn't know everything the project manager knows, even though his neck is on the line if a major tech project fails. The CEO knows less than the CIO, even though a major enterprise project failure could send the company as a whole into a tailspin. At each level, managers depend on their subordinates to behave responsibly and report problems up the chain of command so they can be dealt with.

Good leaders know that will not always happen. They are skeptical of good news. It probably makes particular sense to be skeptical that a massive IT project, created amidst great regulatory complexity and on a compressed timescale, could come together smoothly. Pessimism is good in that case.

What could Kathleen Sebelius have done differently? She could have asked for the real story, the worst-case scenario, and pressed her subordinates to check with their subordinates on whether the project really was on track. She could have insisted on more checks on the process, or taken the audits that were done and raised red flags more seriously. For that matter, the same criticism applies to President Obama, as well as governors in states like Oregon and Maryland that implemented their own exchanges with websites that failed to rise to even HealthCare.gov's eventual level of success.

There's a whole other blame game to be played about poor work by contractors and how those contracts were awarded, but that still boomerangs back to management oversight. There are always plenty of people to blame when an IT project craters. If you don't want to be one of them, pay closer attention to the chain of command reaching all the way down to the people who really are writing the code.

Download Healthcare IT in the Obamacare Era, the InformationWeek Healthcare digital issue on the impact of new laws and regulations. Modern technology created the opportunity to restructure the healthcare industry around accountable care organizations, but IT priorities are also being driven by the shift.

David F. Carr oversees InformationWeek's coverage of government and healthcare IT. He previously led coverage of social business and education technologies and continues to contribute in those areas. He is the editor of Social Collaboration for Dummies (Wiley, Oct. 2013) and ... View Full Bio

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asksqn
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asksqn,
User Rank: Ninja
4/18/2014 | 9:29:43 PM
Don't Cry for Kathleen
Get real.  As Secretary of HHS, Sebelius didn't have to write the code of the epic fail HHS dot gov site in order to get slammed for it.  As the person at the top of that particular pyramid, she rightfully fell on her sword.  But I personally won't be shedding too many tears for Kathleen as she will most likely end up as a multi-million dollar lobbyist for the same industry she was tasked with watching. 
MedicalQuack
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MedicalQuack,
User Rank: Moderator
4/18/2014 | 3:45:58 PM
Re: Let's go back to 2009...
Thanks for the kudos but I'm no genius in that department just wrote about what I saw.  Maybe it's that hands on background with writing an EMR years ago and integrating it with billing software that does it for me:)  I call it "data mechanics" and I'm just by nature, logical, the scariest thing walking around is a logical woman:)  Coding even accentuated it for me in my views.  I just visualize and of course I read a lot as well.  I spent a couple years at a doctors' office and was a great fly on the wall too as I studied their work flow so I could understand better to design a tool for them, not me:) 

I had already been following some great people though in what they were doing as well such as Dr. Halamka at Harvard who's really a good guy and should really even get more credit that what he does.  Heck I said he should have been nominated somewhere in a post back then.  He gets it and he's grounded with "the real world" and that's what makes him so valuable.  Logic and and real world values combined with any tech and coding skills, very hard to find in one person.  As a matter of fact we have too many that are in the "gray" area out there today.  I had to eat plenty of my dog food and I just learned a lot earlier as everything I created was now the crown jewels either:)  Thank goodness everything wasn't trash either on the other side (grin). 

Sure numbers could have been higher but still a success but now the real works begins after enrollment, fixing all those algos that have to work together with government, insurers, doctors, etc. otherwise you can be enrolled but if you don't get care, what have we done?  Now it's time to deal with all the killer algorithms that were created along the way too as there's a lot of code brought together here that was never connected like this before either. 

http://ducknetweb.blogspot.com/2014/03/obamacare-one-big-attack-of-killer.html
David F. Carr
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David F. Carr,
User Rank: Author
4/18/2014 | 3:00:46 PM
Re: Let's go back to 2009...
@MedicalQualk,

Interesting that you called it that the HHS Secretary job would prove to be "all about health IT." I suspect she came into office thinking the job was alll about healthcare policy, with IT as a detail that others would be responsible for worrying about. Yet the lack of management for IT had very direct consequences for undercutting the policy. Even with the latest enrollment #s trending above expectations, I can't help believing the numbers would be higher if not for the website embarrassment. Certainly, the political fallout was immense, undercutting the whole notion of competence in government.
5Tool
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5Tool,
User Rank: Strategist
4/16/2014 | 9:08:25 PM
Re: Could you have done better than Kathleen Sebelius?
If you ask all your subordinates if the project is "really" on-time, someone along the line will ask for more time and an IT project will never get done.
Thomas Claburn
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Thomas Claburn,
User Rank: Author
4/15/2014 | 7:28:20 PM
Re: She's a politician, not a techie, but...
>She's a politician, not a techie, but... 

I wondering how long it will be feasible to manage technology projects without really understanding the technology involved. Executives who don't realize what they're getting into technologically seem destined to experience this problems again.
rradina
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rradina,
User Rank: Ninja
4/15/2014 | 10:16:36 AM
Re: Could I Have Done Better?
Granted, there were many political motivations for states dumping their resident's problems on the fed but it isn't like all states had to build their own.  By removing the federal exchange option and forcing this down to the states (funded of course), each state would have the freedom to collaborate and figure out if it's own makes sense or if several neighboring states could team up and share responsibilities.  I guess my thoughts turn to transportation.  Each state has it's own transportion department and the fed typically provides 85% of the funding for "interstate" type projects.  Obviously this is an oversimplification but from an administrative perspective, fed pays billions to state to fulfill a need.  Whether it's healthcare or transportation, why would we want this responsibility vested in a single source rather than deferred to the states?

Regarding incenting the insurance companies to do this... insurers already have all the SMEs regarding what they need to sell a policy.  The only missing piece is funding (the rules around income and the level of government subsidies.)  Guessing here but I suspect the funding piece is fairly standard.  There might be regional cost factor adjustments for COLA and medical cost variances.  Plus, why wouldn't insurers be interested in doing their own thing and keeping the fed out of their business?
SaneIT
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SaneIT,
User Rank: Ninja
4/15/2014 | 8:02:23 AM
Re: Not a Barbarian
Part of the problem here is that we don't really know if the numbers have been reached.  How many people were dropped from other plans or how many have completed the registration process and will actually pay for the plans they selected.  I don't think we'll really know how that last minute push really went for another year as those registered users either start making payments or drop off of the map.  This issue is twofold, yes the health care issue is a big one and I think you'll be hard pressed to find someone who says that acquiring health care in the US shouldn't be made easier but the issue we are addressing isn't the availability of health care it is the train wreck of a highly technical project that many people saw going wrong very early on.  I can't say that I would have wanted to be responsible for that project but there were enough signs early on that it was not going smoothly that it frustrates those of us who do this every day.
MedicalQuack
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MedicalQuack,
User Rank: Moderator
4/14/2014 | 6:05:59 PM
Let's go back to 2009...
Back in 2009 before Sebelius or Deparle took office, got my head bit off for these two posts:0

http://ducknetweb.blogspot.com/2009/02/kathleen-sebelius-kansas-governor-for.html

http://ducknetweb.blogspot.com/2009/03/nancy-ann-deparle-and-kathleen-sebelius.html

This was before either one stepped foot in office.  If you know what I call "data mechanics" and looked at where things were moving at that time and how fast, then it was obvious that insurers and others with their groves of Quants and other module building experts were going to tromp on them and someone was going to get duped and I guess they did.  DeParle knew when to get out of Dodge and now sits on the board of CVS but Sebelius could have maybe left sooner with dignity, but we all know that didn't happen. 
cumulonimbus
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cumulonimbus,
User Rank: Strategist
4/14/2014 | 5:47:53 PM
Not a Barbarian
The criticism here seems a litte harsh given that she made the numbers in the end. Perhaps this is more of a political statement. People are resistant to change even if it is perceived as life-saving? Go figure.
RobPreston
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RobPreston,
User Rank: Author
4/14/2014 | 4:27:45 PM
Re: Could you have done better than Kathleen Sebelius?
The buck stops with her, plain and simple. The failure of the biggest technology project (and probably any other project) in the history of the HHS is her legacy as the chief executive of that organization. She's not a scapegoat. She was the chief executive.
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