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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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David F. Carr
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David F. Carr,
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4/11/2014 | 3:43:28 PM
Could you have done better than Kathleen Sebelius?
Second guessing politicians and government officials is always fun, but it's also easier to criticize a failure in hindsight than to prevent it. Would you want the job Kathleen Sebelius had? What would be your approach to managing the layers of bureaucracy involved in steering a large government IT project like this.
Alison_Diana
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Alison_Diana,
User Rank: Author
4/11/2014 | 3:50:22 PM
Re: Could you have done better than Kathleen Sebelius?
I, personally, couldn't but I think the error of government lies with its belief that government is good at doing what are, for it, one-off projects. Instead, it would have been more successful if HHS had done better due diligence and partnered with a solution provider whose very livelihood depended on making Healthcare.gov a success from Day One and had a say in creating a realistic deadline. InformationWeek alone is full of stories of past failures -- and successes in the multi-millions of dollars. She was right to resign/get fired, especially if the much-touted 7 million number isn't accurate once payments are due. 
Lorna Garey
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Lorna Garey,
User Rank: Author
4/11/2014 | 5:31:38 PM
Re: Could you have done better than Kathleen Sebelius?
Exactly Alison. I heard that Ellison offered to build the site for free. Now, that would have its own pitfalls, but it was folly for the government to project manage this effort. As for Sebelius resigning, I agreed with the Target CIO resigning, and I agree with this. The buck needs to stop somewhere.
BruceB093
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BruceB093,
User Rank: Strategist
4/12/2014 | 10:26:28 AM
Re: Could you have done better than Kathleen Sebelius?
I managed IT projects for 20 years in the government as an Air Force Officer.  What happened on healthcare.gov is fairly typical of many, if not most, projects.  The key here was this was a very visible project and so just muddling by was harder to conceal. 

There are always plenty of indicators that things are going wrong.  But because this is "normal" people who point them out or who try to change things are considered problems and don't fare well. 

If instead one takes on a project and does it well, delivers on time with good quality, then inevitably that person had to do things very differently. That "very differently" pretty much guarantees that you've made a lot of people unhappy.  Early in my career, after a hugely succesful IT project, I was told "they liked what you did, but not how you did it."  My performance review was "average" which was of course the kiss of death for future promotions.

The bottom line to all this, in my observation and experience, is that those folks who rise to the top in this environment are rarely managers who have experienced successful projects (IT or otherwise).  Therefore the notion that they will, suddenly, successfully manage a huge megaproject or be able to provide senior executive oversight to such a project is fanciful. 

"It is better to fail conventionally, then it is to succeed unconventionally" -- generally works well in government, unless it is on an externally visible project.

Shameless plug:  pmtoolsthatwork com a-successful-manager-but-never-a-successful-project - talks more about this subject.

 
danielcawrey
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danielcawrey,
User Rank: Ninja
4/12/2014 | 3:20:32 PM
Re: Could you have done better than Kathleen Sebelius?
Government operates differently than the private sector. I think there area a lot of loops to jump through in order to make a technical project like this work.

Sebelius in this case is being used as a scapegoat for something many of us are aware of: Some government projects falter and go through a lot of issues before they are ready for primtetime. 
satneosen900
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satneosen900,
User Rank: Apprentice
4/13/2014 | 4:06:02 PM
Re: Could you have done better than Kathleen Sebelius?
'Completely agree that the failure of healthcare.gov was attributable to a failure if leadership and Sebalius should own up and seek a better fit. But the other clear failure was Obama's. I'm always confounded by poor operators who blame their underlings for what they are responsible to deliver. Any good operator/manager would have been able to deliver - especially with the resources that were available. Any other explanation is simply politics.
Shane M. O'Neill
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Shane M. O'Neill,
User Rank: Author
4/14/2014 | 10:29:21 AM
Re: Could you have done better than Kathleen Sebelius?
I can't help but feel that Sebelius is a scapegoat, and got in over her head in a beauracratic position for which she was not qualified. It sounds like communication up the chain of command was terrible, and that's on her. But Obama put a politician in charge of the construction of a really, really important website and it became a quagmire early on. That's on the president.

Like other commenters have written, HHS should have partnered with an experienced solution provider from the beginning.
jries921
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jries921,
User Rank: Ninja
4/14/2014 | 10:51:51 AM
Re: Could you have done better than Kathleen Sebelius?
Two terms as governor of a state strikes me as good preparation to being a federal cabinet officer.  Both the political and the management skills acquired should be helpful in managing a large bureucracy like HHS (Mrs. Sibelius' executive background is much stronger than is President Obama's).  But it does appear that the whole project was badly managed and in the end, that suggests one of two people fell down on the job: the Secretary of HHS or the President that appointed her, was responsible for directing her, and to whom she was responsible.  And per the sign on the desks of Presidents Truman and Carter, the buck stops in the Oval Office.

 
Shane M. O'Neill
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Shane M. O'Neill,
User Rank: Author
4/14/2014 | 11:25:11 AM
Re: Could you have done better than Kathleen Sebelius?
My comment could have been clearer: Sebelius was qualified to be head of HHS, but I don't think she was qualified to lead the healthcare.gov monster IT project. But that was part of the gig. It just should have been managed differently. I would love to know more details of her communication with Obama. If she pumped up the project with rosy reports to him, her resignation is more just. But if she tried to warn him and he waved it off, well....
jries921
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jries921,
User Rank: Ninja
4/14/2014 | 12:20:11 PM
Re: Could you have done better than Kathleen Sebelius?
Good point, and that's one of the things I wonder about.  Another thing that occurs to me is that a couple of the things Mrs. Sibelius would have been expected to bring to the table given her experience as Governor of Kansas were the abilities to negotiate with the opposition, and to explain policy initiatives in terms that opposition voters can understand and might even accept (Kansas is a Republican state and has been since the Civil War).  I saw very little evidence of that in any aspect of the Obama Administration's health care reform initiative and it's the biggest reason why the ACA is still a highly partisan issue.  She should have been the Administration's principle spokesman on the issue from day one and actively involved in the effort to put a bill together.  Instead, the initiative seemed to have been run almost entirely from the White House (with little involvement from the most experienced politician present, Vice President Biden) and once the Republicans decided they didn't want anything to do with it, the focus was on getting enough Democrats behind it to allow it to pass on a party line vote.

 
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.
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.
jries921
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jries921,
User Rank: Ninja
4/12/2014 | 3:52:25 PM
She's a politician, not a techie, but...
...as an ex-governor she does or should have understood that an executive is responsible for what her people do and don't do, even if it's outside of her area of expertise.  It was her job to make it work and she and her President are responsible for the successes and failures of implementation (the President and Congress are responsible for the law itself).

 
BruceB093
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BruceB093,
User Rank: Strategist
4/14/2014 | 9:55:01 AM
Re: She's a politician, not a techie, but...
Not a techie, but most senior managers have managed projects (she was an insurance commissioner and then governor for 2 terms) and should have the ability to detect and assess when she is getting good and bad information.  

Again, this only works well when the senior manager has had successful projects -- which is hard to come by in government.  She recently said: "Clearly, the estimate that it was ready to go Oct. 1 was just flat-out wrong. ... If I had a magic wand and could go back to mid-September and ask different questions based on what I know now."

Mid-September?  That is only about two weeks before the launch.  The only thing someone can generally do just 2 weeks before a major deadline is to delay the deadline.  If a senior manager is unaware that they have a bad project and it is two weeks from deadline, then they either probably have no clue (she seems a lot smarter than that) or else they've been ignoring all the bad evidence and been just listening to what they wanted to hear -- which in my experience is fairly common.

Most projects that don't deliver on time and are buggy, again in my experience, will clearly show critical problems before half the schedule has passed.  Intermediate milestones are missed and quality measures are way behind (functionality working, defect counts, etc.).  Few mega-projects suddenly fail just two weeks before the final deadline.

Actually, the evidence that it may be working (at least as to signing up) is heartening, suggesting that it might be actually useful one day. Three to six months late is not too bad even by corporate standards (which is a sad state of affairs).  It could have gone the way of the FBI's Virtual Case File where we are out over $100 million with not much to show for it. 

 
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
4/14/2014 | 8:50:58 AM
Could I Have Done Better?
I probably could have raised awareness regarding some of the site's architecture.  From the beginning, it seems the site was tasked with a massive set of requirements that were trying to be fulfilled in real/near real time which, in my opinion, was a huge red flag.  However, I seriously doubt whether or not such advice would have made any difference.

The problem with this task is it was wrong-headed from the very start. That is, bad initial decisions were made regarding the single fed exchange.  The fed never should have tried to create a single exchange for all the states that didn't want to create their own.  Once it became obvious a lot of states were going to opt out of creating their own exchange, they should have figured out a way to incent most/all of those states to build their own.  Granted, this might have higher initial costs but when this started we were in the midst of the worst-ever recession.  Although I'm sure there would have still been a few hold-outs, the right financial incentives would have convinced most that the potential economic stimulus is more important than their principles.

I also agree with another post regarding why the government wanted this at all.  The government should have told the insurance companies they need exchanges and, again, incented them to build them rather than a single, massive and failed fed site.
David F. Carr
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David F. Carr,
User Rank: Author
4/14/2014 | 10:33:17 AM
Re: Could I Have Done Better?
Given how many states had problems trying to field their own healthcare exchanges, I'm not sure a more decentralized approach would have been better. Nor would offering more incentives have been likely to make a difference for the states, some of whom had governors and legislatures making the decision on partisan grounds. I wouldn't be surprised if some state IT directors also saw this project coming and set off alarms over schedule, budget, and complexity.

In full arm chair quarterback mode, I've been thinking it might have been better to centralize efforts on one website (or one common codebase for the core system) and work like hell to get it right.

You also suggest having the insurance companies build the exchanges. I'm not sure how that would have worked. There were, however, some private health insurance exchanges that might have served as a model or even licensed code to the effort. The relatively successful California state exchange was built partly on code licensed from a firm called GetInsured (see GetInsured Wants To Be Cloud Provider To State Exchanges).
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?
jcarlini601
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jcarlini601,
User Rank: Apprentice
4/14/2014 | 1:52:56 PM
TOO MANY POSERS IN GOVERNMENT
I cannot believe some of the comments here.  She was the project executive.  If she did not have the skill sets of understanding the Systems Process for a major IT initiative, she should have had someone on her staff who had those skill sets.  For all the money a department gets within the Federal government, that department should have skilled IT people on staff.  Evidently, they didn't.  With this project being so critical, you would think they would want people who understood the compexity of this endeavor.  OR - maybe they thought IT projects are easy.  More evidence of people not knowing the complexities of IT and real-time systems.

 

ALSO- no one is questioning who the contractor was and what their qualifications were.  Was this a project thrown to a friend rather than a qualified contractor?  Better look at ALL the entities on this one, you might be surprised.

 

As to getting people back to work, this project should have been viewed as part of the Stimulus package and developed as a "keyboard-ready" project where they could have employed the 1000s of out-of-work IT professionals that were US citizens rather than throwing it to a foreign firm.  It could have been a positive jolt to our failing economy and maybe even had a better success story if done by Americans. 
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.
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. 
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.
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
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. 
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