Kathleen Sebelius: Failed IT Project Manager? - InformationWeek

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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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4/18/2014 | 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.
Thomas Claburn
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Thomas Claburn,
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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.
RobPreston
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RobPreston,
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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.
Shane M. O'Neill
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Shane M. O'Neill,
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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....
David F. Carr
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David F. Carr,
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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).
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.
Lorna Garey
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Lorna Garey,
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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.
Alison_Diana
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Alison_Diana,
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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. 
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.
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