Lessons from the Healthcare.gov Project Meltdown

In the fall of 2013, the meltdown of Healthcare.gov, the consumer website for the Affordable Care Act, otherwise known as Obamacare, suggested that what the government needed was an IT doctor. Running late, missing features, and simply not working for millions of people, the launch was embarrassing, left people unsure of what to do, and caused huge political problems.

In any large-scale project using project management skills is the best first step.

If you work in health care management, this should be a warning. Information technology is rocketing in toward health care providers. Many organizations will need to quickly come to speed with electronic medical records, mass data integration, news software packages, automation, and tricky project management. These days, an MBA in health administration should include a grounding in managing technology adoption. The website rollout was a disaster because it “violated every principle of sound project management.”

That includes the following:

  1. unrealistic project goals of automating an entire complex insurance and government regulatory interaction;
  2. ridiculous complexity involving dozens of contractors and hundreds of insurers in 36 different states;
  3. fragmented decision making and authority; 4. inadequate testing in the face of aggressive roll-out goals.

Even more of a problem, people at the bottom didn’t talk and people at the top didn’t listen. There were early signs that the project faced problems, only people did not want to address them, as the New York Times noted:

Some people intimately involved in the project seriously doubted that the agency had the in-house capability to handle such a mammoth technical task of software engineering while simultaneously supervising 55 contractors. An internal government progress report in September 2011 identified a lack of employees “to manage the multiple activities and contractors happening concurrently” as a “major risk” to the whole project.

Outside of the Department of Defense, most government branches don’t have the deep experience monitoring, coordinating, and integrating all the separate aspects of a project to have something that works at the end. No one rolled out the project in pieces; it was all supposed to work fine on day one. Months before the opening day crash, people inside and outside of government were warning about the rapidly approaching brick wall.

Many companies and government bodies will also have to implement large-scale projects. The biggest single piece of advice, if you are part of such an effort, is to prepare the necessary software project management skills:

  • No matter what the pressure, set design and implementation goals that are realistic for the organization. Over-promising and under-delivering can lead to disaster.
  • Have experienced project managers run things.
  • Test results early and often.
  • Roll out systems in phases and avoid an all-or-nothing strategy.
  • If you must outsource, have someone in charge who knows how to integrate work of multiple teams.
  • Communicate goals, progress, and problems clearly.
  • Ensure that communications runs from bottom to top as well as top to bottom, so that the observations of people on the front line receive adequate attention.

Chances are that whatever health care project your organization takes on will be only fractionally as large or complicated as the healthcare.gov website. But don’t let relative safety lull you into complacency. The minute you think things are safe is about the time that they will blow up.