Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What leaders can learn from the failure of Healthcare.gov

Amy Edmondson
Policy
December 9, 2013
36 Shares
Share
Tweet
Share

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.

Prev

Why the independent payment advisory board is a good idea

December 9, 2013 Kevin 11
…
Next

Are we making progress in the fight against childhood obesity?

December 9, 2013 Kevin 0
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Why the independent payment advisory board is a good idea
Next Post >
Are we making progress in the fight against childhood obesity?

More by Amy Edmondson

  • a desk with keyboard and ipad with the kevinmd logo

    What distinguishes a sincere apology from the rest?

    Amy Edmondson
  • a desk with keyboard and ipad with the kevinmd logo

    Doctors need to stop working 24/7

    Amy Edmondson

More in Policy

  • Pediatricians grapple with guns in America, from Band-Aids to bullets

    Tasia Isbell, MD, MPH
  • Health care wins, losses, and lessons

    Robert Pearl, MD
  • Maximizing care amidst provider shortages: the power of measurement-based care

    Tom Zaubler, MD
  • Unveiling excessive medical billing and greed

    Amol Saxena, DPM, MPH
  • Chronic health issues and homelessness

    Michele Luckenbaugh
  • The impact of certificate of need laws on rural health care

    Jaimie Cavanaugh, JD and Daryl James
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Doctors and disability insurance: Protecting your income

      Amarish Dave, DO | Finance
    • Emergency care nightmare: the urgent need for experienced nurses

      Rachel Basham, RN, CCRN | Conditions
    • Physicians have no autonomy. Here’s how to change that.

      Diane W. Shannon, MD, MPH | Physician
    • Understanding intersex health care [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Report: Persistence of Gender Inequalities in Cancer Care, and a Call to Action
  • Cancer Risk in NAFLD Higher With Early Disease Onset
  • FDA Displeased With Companies Purposely Adding Sesame to More Foods
  • COVID Vax Appointment Cancelled? New Shot Rollout Faces Challenges
  • Medical Residents Receive 100+ Job Offer Contacts, Survey Shows

Meeting Coverage

  • New Schizophrenia Treatments Are Coming: Don't Panic
  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Doctors and disability insurance: Protecting your income

      Amarish Dave, DO | Finance
    • Emergency care nightmare: the urgent need for experienced nurses

      Rachel Basham, RN, CCRN | Conditions
    • Physicians have no autonomy. Here’s how to change that.

      Diane W. Shannon, MD, MPH | Physician
    • Understanding intersex health care [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What leaders can learn from the failure of Healthcare.gov
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...