"Management" and the Affordable Healthcare Act

The implementation of ACA/Obamacare is a fiasco. PERIOD. It is so silly-bad that I’ve shied away from commenting on it—even though I’m supposed to know a bit about management. Well, I decided to “sorta” break my silence via Twitter. What follows is completely incomplete. It is not a theory or overall statement. It is merely a few thoughts on the topic of implementing the ACA. The original tweet is followed by a brief commentary in brackets [ ].


Because of tangles in legislation/existing regulation, not clear God could have implemented Obamacare. [Could it be impossible to implement? Maybe not a silly question. The law is the start—a unique hyper-complex hodgepodge, even by low legislation standards, in part because of the number of compromises made to get the votes needed for passage. Add to that the existing jungle of regs from hither, thither, AND yon that must be made to dovetail with the new legislation—this ain’t no
Social Security or Medicare/Medicaid implementation; those were largely greenfield efforts, this is maxi-muddyfield implementation.]

Obamacare implementation should have been out of OMB, not HHS. [“All” agree that this administration has singularly failed to get excited about management issues—especially reflected by appointments. Nonetheless, taking this out of HHS and putting implementation on the back of the “management” agency would have been a help. Obamacare is NOT an HHS issue—it is a national issue of the highest strategic order.]

Only human being I can think of who could have implemented Obamacare on time: Lou Gerstner. [The former IBM turnaround boss is a management genius, tough as nails, “accountability” is his first/last/middle name, insanely smart, tech-savvy, used to minefields, experienced at managing hundreds of thousands of people, not afraid to speak truth to power, a mechanic who gleefully dives in four levels down as much as a strategic thinker. Among other things.]

Day full-bore implementation of Obamacare should have begun: Morning after bill signing. [The magnitude of the management challenge should have been immediately acknowledged and addressed. Frankly, we’re still not there!]

Principal piece of “software” to guide implementation of Obamacare: Paper and pencil. [Of course a jillion lines of code are required, etc., etc., but the discipline of paper and pencil is to keep the top of the project management pyramid understandable.]

No acronyms at any level. [Talk English, not Bureaucratese. 100% of the time.]

Deadlines galore, at a micro- as well as macro-level. [Define/measure or bust.]

Obamacare project mgt should be: “Insane” on topic of rapid partial prototyping. Several demos demoed each week with top boss; repeat at every level of organization. [Keep it real. Keep it bite-size. Can be done, regardless of size/complexity of overall project. The bigger the project, the smaller the demoed bites.]

Implementing Obamacare: Any project’s master plan and goals and deadlines can be reduced to two pages. [I fervently believe this.]

Hierarchy rules! [Yes, I’m an avowed fan of far less hierarchy than has been the norm—major reduction thereof is not optional given the speed of marketplace change. Nonetheless, in this project “clarity” and “accountability” are the watchwords. We need to know who’s on first. Hence an org chart, no matter how frighteningly complex, is a necessity.]

Prime contractor should perhaps have had less rather than more government experience. Subcontractors should be minimized. [Subs on top of subs decrease implementation likelihood exponentially. I have the sense that the current contractor knows the Beltway too well. Frankly, I would have liked to have seen perhaps IBM as prime contractor.]

Daily Obamacare senior implementation review: No PowerPoint. No paper. Learn to reduce the hyper-complex to simple, Hemmingwayesque sentences.

Deadlines clear as a bell and readily definable/measurable and big consequences for missing them. [Penalty for inflating what’s been done: firing after one warning of those involved, and major contractor penalties.]

Implementing Obamacare: Lou Gerstner in charge. Office in West Wing. Weekly report to President modeled after President’s morning intel brief.

Project team main office on virgin turf. [Make this business-as-unusual. And keep it physically away from extant bureaucracies.]

The text here is also available in PDF format.

Tom Peters posted this on November 25, 2013, in Healthcare.
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