As the U.S. Department of Health and Human Services (HHS) continues its efforts to address the operational shortcomings of the Federal health insurance exchange, healthcare.gov, it is worthwhile to take time to revisit the basic principles of strong project management. Based upon our experience and observations of the exchange’s launch, it appears as though a number of fundamental project management principles weren’t followed or not followed well. Whether the change effort is limited in scope and impacting a small number of constituencies within an organization or one with the broad scope and functionality of healthcare.gov, the same principles apply in terms of increasing the likelihood of a successful execution effort. While it may be some time before we fully understand the drivers of the failed launch of the Federal health insurance exchange that debuted on October 1, 2013, there has been sufficient information provided around some of the challenges of the exchange’s launch.
Governance – One of the more misunderstood drivers to successful project execution is having a governance framework, process and organization in place prior to embarking upon the change initiative. An effective governance structure provides the staff working on the initiative access to the decision-makers and influencers necessary to quickly address resource issues, scope ambiguities, and organizational resistance and risk. Governance provides timely and clear direction to an initiative’s priority and planned business results.
Given the breadth and complexity of healthcare.gov, the Federal government divided the development effort into distinct sections that were then the responsibility of different parts of Health and Human Services and various external consultants. However, the government’s leadership didn’t establish a governance framework that could effectively monitor the progress of the individual development efforts as well as guide the overall exchange. While decision-making regarding the individual development efforts appeared to work effectively, the lack of an overall governance framework created barriers to understanding and addressing roadblocks faced by individual efforts and the eventual integration of these efforts to create a fully functioning exchange. This also resulted in an apparent lack of transparency in terms of understanding the effort’s progress, further complicating the ability to quickly identify and remedy roadblocks to the exchange’s development.
Leadership – Establishing a single experienced leader whose sole responsibility is to drive all aspects of a change initiative is critical to ensuring tasks, deliverables and milestones are coordinated and aligned to achieve the desired business outcome and within budget (both dollar and time). As an initiative increases in scope and complexity and is dependent upon the integration of multiple projects or work streams of effort, the importance of this leadership increases. With a change initiative involving concurrent efforts of multiple internal and/or external teams and contractors, this leader serves the role of a general contractor who oversees and drives the coordination and integration of the various efforts.
As mentioned previously, the exchange design and development effort was divided into multiple projects. However, there was no single leader whose day-to-day responsibility was driving the successful execution of the exchange’s build and implementation. It appears as though this single point of responsibility resided in the hands of the Secretary of HHS, a position too high in the organization and one that doesn’t allow the incumbent to devote 100% of their time to the exchange effort. Having this critical role filled with a day-to-day leader would have allowed him or her to deal with some of the shortcomings of not having an effective overall governance framework for the effort. Without this role, no one was focused on ensuring the eventual planned exchange was being developed to plan and that challenges to this plan were addressed in a timely manner.
Requirements – Clearly defined business requirements that outline the desired functionality are the foundation for all successful development project efforts. They represent the basis for prioritizing capabilities, creating the project work plan, identifying required resources (people and budget), and most importantly communicating the expected business results the effort will achieve. Clear and complete requirements drive the project’s progress forward. Unmanaged changes in requirements at critical times within the project’s lifecycle, especially near the planned go live, will adversely affect the team’s ability to be successful.
A number of Federal government policy and regulatory changes occurred during the summer months of 2013 that impacted the requirements for the exchange’s functionality. The project teams attempted to incorporate these late in the lifecycle with limited success, negatively impacting their specific project as well as inadvertently affecting the work of other concurrent projects. These changes in requirements then compressed the timeframe for the final, and most critical, phase of a development effort – testing.
Testing – Unfortunately, many individuals believe testing is a ‘nice to have’ as opposed to a ‘must have’ and will seriously underestimate the level of effort. Since an effective testing strategy and plan are backend loaded in terms of level of effort, it is often seen as a barrier to signing off on the completion of a project. Strong test plans include component, integrated and user acceptance phases at the proper times within the development life cycle. An effort as complex as healthcare.gov requires a strong integrated test effort to ensure that all parts of the effort built individually will work seamlessly when these parts come together to provide full functionality. User acceptance for consumers accustomed to the ease of retail websites such as Amazon and iTunes is absolutely critical to ensure adoption and use.
As the result of unmanaged requirements changes and the immovable October 1 ‘go live’ date, the testing phase was compromised. With time running out, testing of the individual development components and the more important integrated exchange website was significantly reduced to accommodate the calendar. In the end, critical integrated and load testing was not completed prior to the website’s launch.
Project execution requires adherence to a project methodology discipline proven to increase success. Efforts to ‘fast track’ complex design and build projects by underestimating and under committing the level of resources (people, money, technology and time) required will end in failure. In the case of healthcare.gov, a lack of governance and leadership resulted in a considerable level of effort to be expended in an undisciplined manner. Healthcare.gov launched without critical functionalities, including integration points with other Federal agencies and the private sector, and the ability to handle the volume of users that accessed the website. We believe the underlying tenets of project methodology would have made a difference in the success of the exchange’s launch.