By Timothy Hoff, Associate Professor of Management and Organizational Development, Healthcare Systems and Health Policy at Northeastern’s D’Amore-McKim School of Business and School of Public Policy and Urban Affairs.
Even the best ideas can be implemented poorly. That’s the message of a recent New York Times piece about the federal government’s development of the now highly criticized health insurance exchange system portal at the heart of allowing millions of uninsured Americans to sign up for health insurance under Obamacare. What is this story about? Delays, ignored warnings, system failures and consumers unable to shop or sign up for insurance are all signs that it is never enough for leaders to provide only a strategic vision of what must be done, or simply the broad strokes of how a new idea should be implemented. It is not enough to believe that the logic of an idea can override the complexity involved in putting that idea into practice. Careful adherence to proven implementation science principles is also needed. Here is where the field of management has something to offer.
As the Times piece notes, steps such as rolling out the health information exchange system portal in stages, gathering evaluative data, using that feedback to identify failure points and valuing this information for the purpose of continuous improvement — all validated parts of a systems approach to effective design and implementation — were not done. In addition, Federal leaders did not consider the development of the insurance exchange system portal as a “high reliability” organizational situation in which complexity and uncertainty around the production process are so high that a specific implementation approach is required — one characterized among other things by an ongoing, sincere commitment to problem-solving, deferring to expertise and maintaining an open dialogue with those on the front lines who are most involved in the everyday work of the innovation. The early history that will be written of Obamacare’s health insurance exchange system portal is one of preventable failure because proven management interventions were never implemented. Sadly, it is a history many other organizations have written for themselves over the years. But with our modern understanding of the right way to design and implement business initiatives, it is one that no longer should occur.