What leaders can learn from the failure of Healthcare.gov

It’s lonely at the top. The buck stops here. I take full responsibility.

Noble sentiments. But the idea that one person, at the top, or elsewhere in an organization, is solely to blame for a complex failure in novel territory is as unhelpful as it is limited. In fact, the blame game is less useful today than ever before. Consider Healthcare.gov.

The idea that a project as complex, new, and large as the Healthcare.gov website would work smoothly right off the bat, or that one or two people are to blame now that it hasn’t, or that once we identify the bad guys we can all have easy access to affordable health care is simple, elegant, and wrong.

Post-failure damage control: The credibility gap

No matter how you slice it, it’s clear the White House won’t meet the projected enrollment of 464,920 in the first month. In a recent New York Times article, Sheryl Gay Stolberg and Susanne Craig cited numbers released by the Centers for Medicare and Medicaid Services on the botched Healthcare.gov rollout: 26,794 have chosen their health plans using Healthcare.gov, while 76,319 signed up through 14 state-run marketplaces.

In the same article, Dan Mendelson, policy advisor to President Clinton, referred to the cultural fallout from the failure as a “negative communications climate.” It’s not just about technology, Mendelson stressed, broken trust and lapsed credibility are now part of the mix preventing effective implementation of the Affordable Health Care Act.

Recently, James Furbush reflected on the Healthcare.gov fiasco and provided excellent take-away, post-failure lessons for leaders of health care organizations: Admit failure, course correct, insist on transparency, create a solution with speed and agility, manage and meet expectations, and stay ahead of the curve.

But, fixing a culture that relies on the blame game in lieu of real solutions is a much thornier problem than fixing a broken website. As one member of the Healthcare.gov program put it earlier this week, “literally everyone involved was at fault.”

Managers in most of the enterprises I’ve studied over the past 20 years — in pharmaceutical, financial, telecommunications and construction companies, to name a few — genuinely wanted to help their organizations learn from failures to improve future performance. In some cases they, and their teams, had devoted many hours to “after action reviews,” “postmortems,” and the like.

However, merely conducting after-action reviews doesn’t preclude falling into the same old patterns: fail, reflect, blame, take responsibility, eat crow, run the bad guys out of town, promise to avoid similar mistakes in the future, review, report, distribute.

Worse, too often, the lessons learned are superficial (“procedures weren’t followed”) or self-serving (“The market wasn’t ready for our brilliant product.”) And, the fundamental belief that failure is avoidable doesn’t change. The role of failure in innovation isn’t acknowledged and celebrated.

The crucial barrier to learning from failure in organizations is the perception that failure and high standards for organizational performance cannot co-exist. Failure is seen as incompetence, not opportunity. Innovative organizations necessarily blend high standards with failure tolerance. And when a single person, leader or otherwise, takes “full” responsibility for the failure, it perpetuates this belief! Instead, leaders must take responsibility for their part, be willing to apologize for their part, and then highlight the lessons learned, and how they’ll be put to good use to improve.

When times get tough, aim higher

The White House response to the website failure was to lower expectations. Too little too late. White House Press Secretary Jay Carney told reporters “We will not have a perfect website.” In mid-November,President Obama told a crowd in Dallas: “We are working overtime to get this fixed. The website is already better than it was at the beginning of October. And by the end of this month, we anticipate that it is going to be working the way it is supposed to, all right?”

In a post titled “Now Obamacare has to bat 1000,” Washington Post blogger Jennifer Rubin asked readers to imagine the burden on the White House to get it right. The White House can “madly try to lower expectations — only 80 percent of the people will get through on Healthcare.gov by Dec. 1 — but in fact it’s run out of slack and one more noteworthy event is likely to send the Democrats running for the hills. In other words, the gang that got practically nothing right now has to get virtually everything right.”

The best way for a leader to bridge a credibility gap and build post-failure trust is to remind the team of the beauty and importance of the shared goal, not to promise to nail the culprits. The shared goal makes it easier to take the risks and suffer the pain of working hard in a demanding environment where nothing is a sure thing. Aiming high also means stretching beyond what seems initially feasible.

Learn faster

Reflecting together on what happened, what was learned, and what could be tried next is a crucial step. Do this fast and do it openly, sharing insights widely, so as to ensure that others in the organization don’t recreate the same failures. The purpose of reflecting is ultimately to come up with the next experiment, which means being willing to confront the next failure, and the next honest reflection session. The secret to organizational learning and innovation is that the learning cycle never stops.

When intelligent failure (those that occur in new territory, and are integral to innovation) becomes part of the expectation, many of the steps traditionally taken post-failure — the blame game or retrenching to lower expectations, for example — can be skipped and the real work can begin that much sooner.

Amy Edmondson is the Novartis professor of leadership and management, Harvard Business School. This article originally appeared in athenahealth’s Health Care Leadership Forum.

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  • buzzkillerjsmith

    Uh, I thought this was a medical blog. What’s with the business patter?

    If we wanted win-win-situations and synergy we’d go somewhere else, maybe howtoconfusepeoplewithunintelligiblejibberish.com. But I guess it is what it is, in a six-sigma way of course.

    • Dr. Drake Ramoray

      As the title says buzz. “Leaders” we are but lowly humble “health care providers” this article is not intended for the peons or masses otherwise the author wouldn’t bother have dispensed it from on high from Harvard in the first place.

      My summary. Top down controlling healthcare is hard. Don’t blame any one person in management. Other people in management say don’t blame any one person in management. Oh and when management fails at a complex task then the best strategy is for management to aim high for a more complex task to screw up than the one they failed at in the first place.

      The author may excel at Harvard but after this piece I wouldn’t hire her as my office manager.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    I don’t know…. This is a Government, not a company that makes widgets. When Governments fail, people suffer and die. Sometimes lots of people suffer and die. Failure is not a learning opportunity for Governments, because Governments are not about market innovation. Not everything in the universe is about markets. Governments are about incredible responsibilities. Responsibilities that cannot be diffused by “teamwork”. When you are the President of the United States, then, yes, the buck stops on your desk. Not because it’s your personal fault, but because you are responsible for all faults. It’s in the job description.

  • Jess

    Obama took credit for killing bin Laden even though he can’t even pronounce “Navy Corpsman”. He campaigned on it constantly, and so did his acolytes.

    If Obamacare had been the shining success he claimed it was going to be, you betcha he would have claimed full credit for it.

    The failure of the Iraq War was absolutely blamed 100% on George Bush, the substandard response to Katrina was blamed 100% on him too, and his father’s failure to follow through on his “No New Taxes” promise was likewise 100% his father’s fault.

    I can’t think of any reason to hold Obama to a different (lesser) standard of responsibility than we have held other Presidents.