Healthcare.gov – Yes, Yes, and Yes

Yes, Yes, and Yes

Healthcare.gov was rolled out on October 1.

Since then there has been lots of bashing of the site and fingerpointing betweeen government overseers and contractors executing it.

Some have called for improvements down the line through further reform of government IT.

Others have called for retribution by asking for the resignation of the HHS Secretary Sebelius.

Publication after publication has pointed blame at everything from/to:

– A labyrinth government procurement process

– Not regularly using IT best practices like shared services, open source, cloud computing, and more

– An extremely large and complex system rollout with changing requirements

And the answer is yes, yes, and yes.

Government procurement is complex and a highly legislated functional area where government program managers are guided to hiring small, disadvantaged, or “best value” contract support through an often drawn-out process meant to invoke fairness and opportunity, while the private sector can hire the gold standard of who and what they want, when they want, period.

Government IT is really a partnership of public and private sector folks that I would image numbers well in the hundreds of thousands and includes brand name companies from the esteemed defense and aerospace industries to small innovators and entrepreneurs as well as a significant number of savvy government IT personnel. Having worked in both public and private sector, I can tell you this is true–and that the notion of the government worker with the feet up and snoozing is far from the masses of truth of hardworking people, who care about their important mission serving the public. That being said, best practices in IT and elsewhere are evolving and government is not always the quickest to adopt these. Typically, it is not bleeding edge when it comes to safety and security of the public, but more like followers–sometimes fast, but more often with some kicking and screaming as there is seemingly near-constant change, particularly with swirling political winds and shifting landscapes, agendas, lobbyists, and stakeholders wanting everything and the opposite.

Government rollout for Healthcare.gov was obviously large and complex–it “involves 47 different statutory provisions and extensive coordination,” and impacted systems from numerous federal agencies as well as 36 state governments using the services. While rollouts from private sector companies can also be significant and even global, there is often a surgical focus that goes on to get the job done. In other words, companies choose to be in one or another business (or multiple businesses) as they want or to spin off or otherwise dislodge from businesses they no longer deem profitable or strategic. In the government, we frequently add new mission requirements (such as the provision of universal healthcare in this case), but hardly ever take away or scale back on services. People want more from the government (entitlements, R&D, secure borders, national security, safe food and water, emergency response, and more), even if they may not want to pay for it and seek the proverbial “smaller government” through less interference and regulation.

Is government IT a walk in the park, believe me after having been in both the public and private sectors that it is not–and the bashing of “cushy,” federal jobs is a misnomer in so many ways. Are there people that take advantage of a “good, secure, government job” with benefits–of course there are some, but I think those in the private sector can look in the offices and cubes next to them and find quite a number of their colleagues that would fit that type of stereotype as well.

We can learn a lot from the private sector in terms of best practices, and it is great when people rotate from the private sector to government and vice versa to cross-pollinate ideas, processes, and practices, but the two sectors are quite different in mission, (often size and complexity), constituents, politics, and law–and not everything is a slam dunk from one to the other. However, there are very smart and competent people as well as those who can do better in both–and you fool yourself perhaps in your elitism if you think this is not the case.

Are mistakes made in government IT–definitely yes. Should there be accountability to go with the responsibility–absolutely yes. Will we learn from our mistakes and do better in the future–the answer must be yes. 😉

Finding Better Ways

Why_do_we_do_it_that_way

Saturday Night Live had a funny skit last week about people in the future looking back at us in 2012 as “digital pioneers”–and how silly many of the things we do today looks from the outside.

Here are some examples that may resonate with a lot of you:

– Driving–We drive 1-4 hours a day and “are okay with that.”

– Email–We boot up our computers, go to the Internet, log unto to our accounts, and send an email and think that “was so easy, fast, and convenient.”

– Clothing–We get dressed in underwear, shirts, pants, belt, socks, shoes, tie, and wrap it all under a jacket and feel that it’s “not way too many pieces.”

– Bathrooms–We have bathrooms in our homes and have it close to where we eat and that “seems smart to us.”

There were other examples making fun of us eating fruits and vegetables, keeping domesticated animals in our homes, and thinking that living to the age of 91 is old.

While we don’t know exactly what the future will look like, when we look at our lives today “under the microscope”–things really do sort of appear comical.

I believe that we really do need to look at ourselves–what we do, and how we do it–with fresh eyes–and ask why do we do that? And are there alternatives? Is there a better way?

Too often we believe that the way things are–“is simply it”–when if we would just think how this would look to someone 100 years from now, perhaps we would be quicker to open our eyes to other options and innovations.

It reminds me of the story in the Torah (Numbers 22) where Balaam is sent to curse the Jewish people but ends up blessing them. In this story the donkey that he is riding on refuses to proceed, because it sees an angel in front of them. Balaam does not see the angel and beats the donkey thinking that was the right thing to do. G-d then miraculously gives the donkey the power of speech and the donkey complains about the harsh treatment from Balaam, and G-d opens Balaam’s eyes to see the angel, at which point he understands that the donkey really saved his life.

This Biblical story is similar to our lives where we go along sort of blind to the realities right in front of us, and not only that but we keep pushing forward along the very same route not seeing the obstacles or other alternatives that may be better for us.

While we (generally) don’t have donkeys talking back to us with feedback or the ability to see angels, I think by sensitizing ourselves more, we can open ourselves up to question the status quo and break the paradigms that we just take as givens.

So when we do get to the next 100 years out–it’ll truly be a lot better than today and without the traffic! 😉

The Done Manifesto v2

The Done Manifesto with 13 principles of getting to done has been circulated since 2009 (and recently reprinted in LifeHacker). It was made into a poster and creatively illustrated with Rubik’s cubes.

 

Below are the 13 principles revised and presented as The Done Manifesto Version 2.

 

Done_manifesto_v2
(Copyright: Andy Blumenthal)

 

Of course, there is a 14th principle that could also be considered–I remember this from a poster that I first saw in the local newspaper and candy store in Riverdale–it was illustrated with a little boy on a toilet and a roll of toilet tissue and had a caption that said “No Job is

How Leaders Can Imitate Art

Mental Floss (July-August 2011) has an article on the awesome art of “Christo and Jeanne-Claude.” Their pieces are large, imposing, and environmentally-based. Some examples are:

1) The Umbrella (1991)–Installed 3,100 umbrellas across a 12-mile stretch in California and an 18-mile stretch in Japan.”

2) The Gates (2005)–Erected “7,503 steel gates, each with a giant rectangle of orange fabric flowing from it.”

3) Surrounded Islands (1983)–“Surrounded 11 uninhabited islands in Biscayne Bay with 700,000 square yards of pink fabric.”
4) Wrapped Reichstag (1995)–Wrapped the German parliament in “119,600 square yards of shimmering silver fabric.”
What I like about their art is the duality of on one hand, magnitude of the projects–they are huge!–and on the other hand, the utter simplicity of it–such as using a single color fabric to just line up along, spread over, or surround something.
Further, I really like their use of contrasts whether it is the colors of the blue water and green islands with the pink ribbon or the lush green valley with the blue umbrellas–it is in every case dynamic and spell-binding.
Each work even in a microcosm would be beautiful, but when done on a massive scale like with the entire German Parliament building or on multiple continents simultaneously, it takes on an air of magic, almost like Houdini.
Jeanne-Claude passed away in 2009, but together she and Christo created “20 gargantuan works of art, and Christo carries on the “couples’s 45 years of collaboration” with new works today
To me, Christo and Jeanne-Claude are incredibly inspirational:
1) They were highly productive and developed a multitude of magnificent works of art.
2) They defined a sense of beauty in both urban and rural settings that combined the natural surroundings and augmented it with human interventions to complete the creative process. 
3) They took on monumental tasks, “funded all the projects themselves,” and would obsessively plan all the details to get it right. 
4) The were truly collaborative–Christo was the artist and Jeanne-Claude his encouragement and manager, yet they considered each other “equal partners in the creative process.”
Their work reminds me of floating in virtual reality like in Second Life, but in this case, it’s the real thing. And it’s incredibly important because it teaches us that we are partners in the creative process and can do enormously great things in simple and beautiful ways.  Similarly, true leadership is about being one with our surroundings, at peace, and yet envisioning how to improve on it and make the good things, spectacular. 
(Source Photos of Umbrella and Gates: Wikipedia, and of Islands and Reichstag: Here)

Feedback, Can’t Live Without It

Feedback

Whether you call it feedback or performance measurement, we all need information on how we are doing in order to keep doing better over time.

Wired (July 2011) reports that there are 4 basic stages to feedback:

1. Evidence–“behavior is measured, captured, and stored.”  
2. Relevance–information is conveyed in a way that is “emotionally resonant.”
3. Consequence–we are provided with the results of our (mis)deeds.
4. Action–individuals have the opportunity to”recalibrate a behavior, make a choice, and act.”
The new action (in step 4) is also subject to measurement and the the feedback loop begins again.
Feedback plays a critical role in helping us achieve our goals; according to psychologist Albert Bandura, if we can identify our goals and measure our progress to them, we greatly increase the likelihood that we will achieve them. 
Thus, feedback is the way that we continually are able to course correct in order hit our targets: if we veer too much to the right, we course correct left; if we veer too much to the left, we course correct right. 
Feedback loops “can help people change bad behavior…[and] can encourage good habits.
From obesity to smoking, carbon emissions to criminal behavior, and energy use to employee performance, if we get feedback as to where we are going wrong and what negative effects it is having on us, we have the opportunity to improve
And the way we generate improvement in people is not by trying to control them–since no one can really be controlled, they just rebel–instead we give them the feedback they need to gain self-control.
These days, feedback is not limited to having that heart-to-heart with somebody, but technology plays a critical role. 
From sensors and monitors that capture and store information, to business intelligence that makes it meaningful in terms of trends, patterns, and graphs, to alerting and notification systems that let you know when some sort of anomaly occurs, we rely on technology to help us control our often chaotic environments. 
While feedback can be scary and painful–no one wants to get a negative reaction, criticized, or even “punished”–in the end, we are better off knowing than not knowing, so we have the opportunity to evaluate the veracity and sincerity of the feedback and reflect on what to do next. 
There are many obstacles to self-improvement including disbelief, obstinance, arrogance, as well as pure unadulterated laziness. All these can get in the way of making necessary changes in our lives; however, feedback has a way of continuing to come back and hit you over the head in life until you pay attention and act accordingly.  
There is no escaping valid feedback.

>EA Can Do It

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A number of weeks ago, I was at a CTO Event in DC and got to hear from colleagues about their thoughts on various technologies and IT trends. Overall the exchange was great, and as always, I was deeply impressed with the wisdom and experience of these IT leaders.

However, one particular set of comments set me back in my chair a little. And that was on the topic of Enterprise Architecture. Apparently, a number of CTOs (from a relatively small number of agencies) had not had great success in their organizations with EA and were practically questioning it’s very existence in our IT universe. Yikes!

I believe some of the comments were to the effect (and this is not verbatim—I will put it euphemistically) that these individuals had never seen anything valuable from enterprise architecture—EVER—and that as far as they were concerned, it should be discontinued in their organizations, altogether.

In thinking about the stinging comments from some of the IT leaders, I actually felt bad for them that they had had negative experiences with a discipline like EA, which is such a powerful and transformative planning and governance framework when implemented correctly—with the value proposition of improving IT decision making and the end-user as the focal point for delivering valuable and actionable EA information and governance services—generally what I call User-centric Enterprise Architecture.

Right away after the negative comments, there were a number of CTOs that jumped up to defend EA, including me. My response was partially that just because some EA programs had not been successful (i.e. they were poorly implemented), did not mean that EA was not valuable when it was done right—and that there was indeed a way to build an organizations enterprise architecture as a true beacon for the organization to modernize, transform, and show continuous improvement. So please hold off from dismembering EA from our organizations.

Recently, I was further reassured that some organizations were getting EA, and getting it right, when I read a blog by Linda Cureton, the new CIO of NASA who wrote: NASA CIO: How to Rule the World of IT through Enterprise Architecture.

In the blog, Ms. Cureton first offers up a very nice, straightforward definition of EA:

“Let me step back a bit and offer a simple definition for Enterprise Architecture that is not spoken in the dribble of IT jargon. In simplest terms, it is a planning framework that describes how the technology assets of an organization connect and operate. It also describes what the organization needs from the technology. And finally, it describes the set of activities required to meet the organizational needs. Oh, and I should also say it operates in a context of a process for setting priorities, making decisions, informing those decisions, and delivering results called – IT Governance.”

Further, Ms. Cureton draws some parallels from a book titled How to Rule the World: Handbook for an Aspiring Dictator, by Andre de Gaillaume, as follows:

“· It is possible to manage IT as an Enterprise.

· You can use the Enterprise Architecture to plan and manage the kinder, safer, more cost effective IT world.

· Transformational projects will successful and deliver desired results.

· IT can be a key strategic enabler of NASA’s [and other organizations] goals.”

Wow, this was great–an IT leader who really understands EA and sees it as the tool that it genuinely is for–to more effectively plan and govern IT and to move from day-to-day organizational firefighting to instead more strategic formulation and execution for tangible mission and end-user results.

While, I haven’t read the dictators handbook and do not aspire to draw any conclusions from it in terms of ruling the world, I do earnestly believe that no organization will be successful with their IT without EA. You cannot have an effective IT organization without a clear vision and plan as well as the mechanism to drive informed decision making from the plan and then being able to execute on it.

Success doesn’t just happen, it is the result of brilliant planning and nurtured execution from dedicated and hardworking people.

Reading about NASA’s direction now, they may indeed be looking to the stars, but now, they also have their eyes focused on their EA.

>Tech is Threatening to Some and A Savior To Others

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As technology advances and supplants the “old ways” of doing things, some people are threatened that they are being put “out to pasture” and others find opportunity in the emerging technology—they find in it something new to learn and grow with, perhaps an opportunity to shine and become the resident subject matter expert at work or at home.

As we get older, it’s natural that some people may not be as flexible in “starting over,” learning something new, or changing the way “we’ve always done things.” It’s reminiscent of the sort of unflattering old saying that “you can’t teach an old dog new tricks”—a saying by the way that I don’t really believe (you should see my Dad on email, Internet, and so on—he’s great!). But at the same time, people, as do all things, have a life cycle, and our strengths and weaknesses go through peaks and valleys at various points on the cycle. For example, “with age comes wisdom.” Years ago, getting the chairman or CEO to use email was a corporate challenge. Now, young people are migrating to Social Media for communications, and email is the technology dinosaur. It’s a constant technology transformation.

In November 2009, the Wall Street Journal reviewed a new book by Sci-Fi author Cory Doctorow, called “Makers”. “This novel is set in a not-too distant future when the creative destruction of technological change has created an economy so efficient, with profit margins so thin, that traditional companies can hardly stay in business.” In this book, the inventor “uses three-dimensional printers to produce copies of machines and most anything else at close to no cost.” Now “good ideas are copied so quickly that they become commodities. Every industry that required a factory yesterday only needs a garage today.” Where this leaves us is in a time with “competition and invention getting easier and easier—it’s producing a kind of superabundance.” And the result is widespread unemployment and stress.

As we are presumably heading out of a major recession now with unemployment topping 10% (and some would say the real figures, including the underemployed and those that have stopped looking for work, at closer to 20%), we must but wonder whether the recession/unemployment is due to the financial crisis alone or is there some element that is due to our new high-tech economy, where everything in the manufacturing sector has either been tech-enabled or outsourced to Asia. And where we are left in a primary “services economy—pushing papers and flipping burgers? Is there a time coming when we become so technologically advanced, like in the Makers, that there is a very real threat of leaving hundreds of millions of people behind, while the few technology mavens “have it all”?

Interestingly enough, with the advancement of technology, the income disparity between rich and poor has grown where the top 1% of Americans own more than a third of the wealth, compared with a fifth of the wealth in the 1970s (according to Robert Reich).

I think it is critical that smarts and performance be rewarded (i.e. performance-based), but that we cannot let things get out of control and unjust. Billions cannot starve while the ultra-rich hop from rural mansion to Park Avenue condo and from private plane to recreational yacht. Technology must be used to level the playing field and not abuse it. Some like Bernie Madoff used systems developers and technology to create and issue phony financial statements to Ponzi-scheme clients showing trades that never occurred. Instead, we need to use technology to educate, communicate, share, and advance the opportunities for all and overcome the technology divide through amazing advancements here and yet to come. To do this, we must focus on continuous innovation and application of technology to the challenges we face—whether alternative energy, health care, world-hunger, global warming, and so much more. There is no shortage of issues for us to apply our minds and technology to—there is plenty for everyone to contribute to.

>Leadership: Fight or Flight

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When we are confronted with difficult situations, people tend to two different responses: fight or flight.

Generally, people will stand and fight when they are either cornered and have no other option, when they will suffer undue harm if they just try and “let it go”, or when the issue is something that they really believe strongly in (like a principle or value such as equity, justice, righteousness, etc. that they feel is being violated).

In contrast, people typically will flee when they feel that they can get out of a bad situation mostly unscathed and their principles will not be violated (such that they can live with their personal and professional dignity intact). Often, people consider fleeing or a change of venue preferable to “getting into it” when it’s possible to avoid the problems that more direct confrontation can bring.

There is also a third option not typically addressed and that is just “taking it,” and letting it pass. In the martial arts, this is akin to taking someone’s best shot and just absorbing it—and you’re still standing. You go with the flow and let it go. This is sometimes feasible as a less dramatic response and one that produces perhaps less severe consequences (i.e. you avoid a fight and you still yield no ground).

Harvard Business Review (December 2009) in an article called “How to Pick a Good Fight” provides some guidelines on when as a professional you should consider standing up and fighting, as follows:

  1. “Make it Material”—Fight for something you really believe in, something that can create real value, noticeable and sustainable improvement.
  2. Focus on the Future”—Don’t dwell on the past or on things that cannot be changed. Spend most of your time “looking at the road ahead, not in the rearview mirror.”[This is actually the opposite of what 85% of leaders do, which is trying to figure out what went wrong and who to blame.”
  3. Pursue a Noble Purpose”—Make the fight about improving people’s lives or changing the world for the better.” I’d put it this way: stay away from selfish or egotistical fights, turf battles, empire building, and general mud slinging.

“The biggest predictor of poor company performance is complacency.” So leaders need to focus “the good fight” on what’s possible, what’s compelling, and what’s high impact. Great leaders shake things up when the fight is right and create an environment of continuous improvement. Leaders create the vision, inspire the troops, and together move the organization forward to greater and greater heights.

As for fleeing or “turning the other cheek” those venues are best left for issues of lesser consequence, for keeping the peace, or for times when you are simply better off taking up the good fight another day.