How Simplicity Principles Could Fix Obamacare

How Simplicity Principles Could Fix Obamacare

To be successful, leaders need to focus on reducing complexity rather than amplifying it

As everyone now knows, – the $394 million website that was supposed to enable millions of Americans to shop for health insurance – is experiencing some initial technical failures. Critiquing the troubled rollout is easy, but not helpful considering that the current framework is the law of the land. So, what should the administration do now to right the ship?

To answer this question, we have to think about the Affordable Care Act not as a piece of legislation that needs to be implemented, but as a complex organizational transformation effort – similar to a large-scale company turnaround. To be successful, leaders need to focus on reducing complexity rather than amplifying it. Here are four “simplicity principles” that can help to do this, and how they might be applied to Obamacare.

Make someone explicitly accountable for end-to-end implementation. Complex processes need a leader with a larger perspective. We saw a similar situation in our recent work with a technology company, in which the executive team complained that major quality initiatives impacting multiple business units had fallen through the cracks. Everyone acknowledged that quality needed to improve and busied their teams with improvement initiatives, but there wasn’t any single person responsible for collective results. In the same vein, who’s responsible for the end-to-end challenge of implementing the Affordable Care Act? (Not just the launch, for which Health and Human Services Secretary Kathleen Sebelius is clearly now taking the blame.) Whether it’s business, politics, or running a book club, there needs to be a single person on the hook for success.

Begin a series of rapid cycle experiments to solve long-term issues. Getting up and running is a good thing, but it’s not a complete turnaround strategy. Take, for example, the problem of attracting young, healthy Americans to get insured. For the longer-term problems, setting “unreasonable”, tightly bound 100-day goals – like attracting 50% more people under 25 in Pittsburgh to buy insurance – would help get some early results and inform how to scale up successes nationwide. The short, 100-day time frame ensures that problem solvers are working on the most critical problems in the leanest possible ways.

Engage unusual partners. Complex transformational challenges usually benefit from injections of fresh thinkers, who can challenge the way things have been done in the past and look for simpler or better alternatives. For example, in 2011, GSK announced an unexpected partnership with the McLaren Group, a British racecar company who could offer the pharma company a fresh perspective on innovation, analytics, and decision-making. We now know that a standard mix of government contractors built, with reportedly some light help from Microsoft. But now there is a tremendous opportunity to involve a much more diverse group of stakeholders. What if part of the website surge included a hackathon with a select group of Silicon Valley’s best programmers? What if health insurance leaders were invited to collaborate with the government on customer development plans to attract new buyers to the market? What if customers were invited to weigh in on what Obamacare needed to deliver via crowdsourcing, sandbox testing, and good old-fashioned face-to-face conversations?

Embrace transparency. Nothing amplifies complexity more than a lack of information. In fact, much of the firestorm about the Obamacare website was caused by the fact that the issues were never fully explained or even communicated ahead of time. However the development team did not wake up on launch day and say, “Wait, there may be some problems here!” They spent months fretting about potential issues, likely in denial of their dire consequences. Yet the public heard not a peep about what to expect. So either the feedback loop broke down, or there was a conscious decision to withhold bad news. But now is the time to introduce openness into the Obamacare communications and development process, however difficult that may be for an organization like the government. Being clear about snags in rollout plans will not spare those responsible their share of criticism. However, it will position them to respond to it more effectively.

It’s dangerous to rush to judgment when it comes to transformational change. The success or failure of Obama’s healthcare policy will play out over years, not weeks. Still, we now have an opportunity to step back from the finger-pointing frenzy of Congressional hearings to say, “How do we make this big, complicated, messy thing work better?” As any leader worth her salt will tell you, accountability, experimentation, involvement, and openness will all help to cut through the complexity to achieve better results for the country.

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Ron Ashkenas' blog post on Harvard Business Review. Join the discussion. (This article was cross-posted on Forbes.)

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