Healthcare.gov as a Case Study for the Analog Digital Divide

Tuesday, October 29, 2013
by Kent AitkenRSS / cpsrenewalFacebook / cpsrenewalLinkedIn / Kent Aitkentwitter / kentdaitkengovloop / KentAitken


I find myself thinking about the launch of Healthcare.gov with a bizarre frequency. I think it’s fascinating as a case study and, I believe, emblematic of a broader unaddressed problem.


The Long Story Short

Healthcare.gov launched on October 1, 2013 to serve as a hub for US citizens seeking health insurance in those states that didn’t set up their own systems in response to the Affordable Care Act. It has been fraught with technical problems, rendering the website nearly useless at times. It appears that the cost will end up being $170M-$300M, double or triple original estimates.

David Eaves weighed in on procurement in general on Friday, suggesting that procurement was borked: that embedding core principles such as openness and transparency in government systems is at odds with how we currently develop and procure those systems.

He pointed to Clay Johnson's piece on Healthcare.gov in the New York Times,
Why the Government Never Gets Tech Right. Johnson also lampooned current procurement models, and noted the dismal (~6%) success rates for large IT projects.

Alex Howard's assessment of the failed launch mirrors Johnson’s: the current procurement model rewards companies that are good at bidding, not building. Their US examples find support elsewhere: in the UK, "70% of IT spending between 1997 and 2010 went to just seven (!) companies."


Proffered Solutions

Eaves, Johnson, Howard, and a few others - Mark Headd, CIO of Philadelphia and Merici Vinton, part of the stunning digital success story of CFPB - call for wholesale procurement reform. Vinton goes one further and calls for hiring reform as well, to allow "in house strategy, design, and tech", which is one of the other common threads: Howard and Vinton laud initiatives such as the Presidential Innovation Fellows and entrepreneurs-in-residence, and Headd calls for more "makers and hackers" in government as the path forward.

Johnson's take:
"The president should use the power of the White House to end all large information technology purchases, and instead give his administration’s accomplished technologists the ability to work with agencies to make the right decisions, increase adoption of modern, incremental software development practices, like a popular one called Agile."

Johnson and Howard noted the dissonance between Obama's massively successful data-driven and digitally savvy campaign and this IT flop. Two of the key figures in the campaign's success - Daniel Wagner and Teddy Goff - were in Ottawa last week with Canada 2020, and their most striking message at that event applies here: science is your friend.

The
Agile methodology that Johnson referenced is broad, but a key component is the scientific method: hypothesizing, testing, and adapting. Howard noted that Healthcare.gov's front end, built with Agile methodology and open source, works well.

Building on that, one of the major themes that these authors’ admonishments drive at is that we shouldn't pretend that we can establish clear requirements for IT at a singular point in a procurement cycle. Flexibility and in-house talent are essential for managing a world in which that assumption, rightfully, breaks down.

In sum, the messaging is this: don't invest in highways with no exits. (And make sure you have someone to tell you when you need to use them.)


The Digital Analog Divide

Healthcare.gov is a cautionary tale for government’s major IT projects, but I think it’s also a case study for more fundamental issues. There are several possible lessons, but principally I think it’s a symptom of an awkward, incomplete transition from the analog world to the digital one.

Many companies
failed to make the transition, and the Fortune 500 list looks very different now because of it. Government faced no such competition: it’s still standing, applying a procurement model that worked for furniture - with 20-40 year lifespans - to technology that becomes economically obsolete at least ten times quicker.

So the questions I'm bandying about, and will return to next week:
  • Do governments have the appropriate foundations for a technology-enabled world?
  • Have governments reached the limits to outsourcing?
  • To what extent are procurement and hiring models influencing governments' effectiveness?

Impossible Conversations: The End of Big

Thursday, October 24, 2013
by Tariq PirachaRSS / cpsrenewalFacebook / cpsrenewalLinkedIn / Tariq Pirachatwitter / tariqpirachaGoogle+ / tariqpiracha

Nicco Mele's The End of Big
I've been on a bit of a rant lately when I see or hear people making claims like "Distance is dead" or "Newspapers are dead". Partially, I'm annoyed that they're stealing from Nietzsche, who coined the phrase "God is dead". The trend is: pick a concept and add "is dead" to the end. We love predictions and there are plenty of folks out there who are happy to oblige.

The catch here is that in Nietzsche's case, he was examining a long history of spirituality vs. science. We, in many cases when it comes to social media and web, do not have such a long history to look at. It is almost as if we are assembling a long list of weak signals and using them as fait accompli predictors of the near future. (Dare I call it the Malcolm Gladwell effect?)

I'm skeptical.

That said, Nicco Mele's The End of Big is compelling. Mele described many instances of the disruptive nature of the Internet that were effectively tearing down systems. However, what caught my attention was the void that followed. The scary thought for me isn't the removal of old systems — it's the lack of knowledge, or complete inability to replace them. Both in real terms and sociological ones.

I think perception also has a role to play in some of the disruption Mele points to, where a group's strength is not found through traditional notions of power, but in their ability to mobilize quickly and be perceived as big. For example, the U.S. Congress backtracked on SOPA in response to 7 million online signatures condemning the bill. Is a petition of 7 million signatures enough in a country of almost 314 million? Should 2% be enough? I don't know the answer to that. But the perception by Congress of the situation was "big" enough to change their mind.

There are plenty more interesting examples that Mele offers and I suggest you take the time to read them. If I hadn't missed the Google Hangout with Mele, my question to him would have been: Are we really seeing the end of big? Or has the Internet just introduced a new way for many people to take on the role of a big, disruptive player on any given field of play?









George Wenzel — "Threats abound in this dystopian future..."
George Wenzel

The End of Big gives a far-reaching, albeit bleak, overview of the Internet and its impacts upon the news media, entertainment, government, and business. Nicco Mele's take on the impacts of 'radical connectivity' upon these areas create a comprehensive, albeit bleak, view of how the hyper-connected world is working today and might work in the future.

The book's author joined our discussion and admitted that early drafts were even more dark and bleak, with a draft subtitle describing the 'coming chaos'. Mele's editor wisely suggested a tone-down of the FUD.

Mele paints a picture of a world where individuals can bring down governments, cripple industries, and strike fear into the populace. Threats abound in this dystopian future. Mele gives several examples, but I do not share the author's worry that these events are bellwethers of a coming geek-driven apocalypse.

If you haven't read much about the impacts of technology on the world, this book is a good overview. Kudos go out to Mr. Mele for joining our discussion via Google Hangout and sharing some of his thoughts in a more personal way.



Nick Charney   " ... the book made me take a good hard look my propensity to adopt new technologies ..."
Nick Charney

Here's the rub according Mele: radical connectivity is radically reshaping society and the tools used to create our culture are coming to define it. If nothing else the book made me take a good hard look my propensity to adopt new technologies even as they erode the very institutions we work for. 

This isn't to say that one ultimately defeats the other (although that may be implied by Mele's subtitle) but rather that we are just starting to understand the tip of the iceberg; the book is a great introduction for the uninitiated and a solid recap for those following more closely.


Kent Aitken — "...there is no such thing as metaphoric dust settling on the scale of global change..."
"The average lifespan of a company listed in the S&P 500 index of leading US companies has decreased by more than 50 years in the last century, from 67 years in the 1920s to just 15 years today". (From BBC.)

I agree that the internet is changing our world massively. I'm more hesitant to buy into Mele's title thesis, which is that we've reached The End of Big. There are many amazing and illustrative examples of Davids upending Goliaths, and our assumptions about power should be shaken. But I think there'll be a lot of Big in the future.

I originally wrote "there'll be a lot of Big left when the dust settles," but it struck me that there is no such thing as metaphoric dust settling on the scale of global change. Definitely not anymore.

To be clear: Mele is dead-on about a lot here, and our assumptions about power should change. Governments should be scared into rethinking their role in this world. The principles are the same - manage public goods and services otherwise unfulfilled, nudge general welfare along, uphold laws - but the what (What goods and services? What's welfare? What laws?) may be very different.

Social entrepreneurs are improving public transit environments without government. The classical concept of GDP*, as a rough measure of welfare, ignores the economy of experience, philanthropy, and environmental amenities. And many laws are ill-equipped to deal with, say, the collaborative consumption economy (think AirBNB) or global, internet-based terrorism.

On the more reviewy side of things, it's a solid read. The case studies (for instance: Anonymous, Reddit, 3D printing, citizen journalism, etc.) may be familiar to some, but The End of Big is a great synthesis, and it'd be a good wakeup call for others.

*Prediction: We'll stop caring about and quoting GDP figures within five years.



John Kenney — "...The Internet redistributes power by design..."

John Kenney

In his book, The End of Big: How the internet makes David the new Goliath, Nicco Mele sounds the alarm that "radical connectivity - our breathtaking ability to send vast amounts of data instantly, constantly, and globally - has all but transformed politics, business, and culture, bringing about the upheaval of traditional, "big" institutions and the empowerment of upstarts and renegades."

Radical connectivity presents opportunities and challenges. Ideas and data can be disseminated quickly via networks and social media. People and resources can be mobilized with relative ease to address perceived needs (e.g. fixing a pothole, addressing climate change, or overthrowing a corrupt dictatorship). On the one hand, it opens up opportunities for citizens, governments, private and non-government actors to collectively address issues that in the past only governments typically addressed (see the emergence of the solution economy). This is exciting.

On the other, radical connectivity can be disruptive and unpredictable. "Our twentieth-century institutions, which seem as foundational or ahistorical as hereditary monarchy, are on the cusp of collapse - or, if not, outright collapse, of irrelevancy and anachronism." They are ill-prepared and unable to engage with the connected world effectively. The role of government, accountability for resources and results, ensuring public health, safety and security, and maintaining equitable service standards and equal opportunity are all murky at best, particularly if governments do not adapt.

I found myself pulling a few other books off the shelf while reading The End of Big. Our big political, economic and social institutions have been on the receiving end of constructive criticism well before we became radically connected. For example, in the face what he saw as large-scale, unsustainable and dehumanizing economic systems, E.F. Schumacher proclaimed Small is Beautiful (1973) and extolled the virtues of "technology with a human face." On the education front, Ivan Illich called for Deschooling Society (1971) and, more broadly, the need for Tools of Conviviality (1973). And Samual Bowles and Herbert Gintis argued for more participatory political, economic and social models that reflect democracy as being not just about choosing (i.e. purchasing and voting), but also learning (i.e. how preferences are formed) - see Democracy and Capitalism: Property, Community, and the Contradictions of Modern Social Thought (1983). It appears the inventors of the personal computer read those books too, or at least shared similar philosophies. The Internet redistributes power by design.

I was struck by the common threads running between the authors' recommendations above and Mele's conclusions, including "As individuals and as a society, we need to acknowledge small as our future" and "...we can learn to celebrate the creation of a radical new way of organizing the world, taking steps to align it with democratic values and with our need for social order." Back in the 70s and 80s, the proposed alternatives may have been dismissed as radical, utopian, or both. If Mele's right about the current context, big institutions won't have a choice but to adapt this time around.

I highly recommend it. Both the book and adapting.



Next up: Simpler: The Future of Government by Cass Sunstein. Interested in taking part? Send us an email, leave a comment, send us a tweet. You know the drill.

Positive-Sum Leadership

Wednesday, October 23, 2013

by Kent AitkenRSS / cpsrenewalFacebook / cpsrenewalLinkedIn / Kent Aitkentwitter / kentdaitkengovloop / KentAitken



I love this:


That's the concept art for a hypothetical public transit system described in a blog post by Elon Musk, Chairman of Tesla Motors.

The Hyperloop (or something similar) is, in my opinion, the right solution for the specific case of high traffic city pairs that are less than about 1500 km or 900 miles apart. Around that inflection point, I suspect that supersonic air travel ends up being faster and cheaper. With a high enough altitude and the right geometry, the sonic boom noise on the ground would be no louder than current airliners, so that isn’t a showstopper. Also, a quiet supersonic plane immediately solves every long distance city pair without the need for a vast new worldwide infrastructure.
Musk, described in one Wikipedia article as a "Serial Entrepreneur", essentially invented a mode of transport in his head, explored the technological assumptions, and explained how to do it. Then, he dropped the mic and left it for someone else, saying that he was too busy.



The idea of a Hyperloop is awesome on its own. But it's far more interesting for the philosophy behind the fact that he wrote about it, but didn't do it:
  • Even if you're good at what you do, don't run with every good idea. There may be others better positioned to do it, or there may be more important goals for you to pursue.
  • It's worth sharing your ideas. Take the time because it's low-risk and high-reward, even if that reward doesn't necessarily accrue to you. Do it just in case something amazing happens.
  • In a market economy world that many see as a zero-sum game - in which people win only when others lose - you can be the one that takes the first step, the leader that makes a small sacrifice to try to redefine the world as win-win. As a positive-sum game, in which we can make something greater than the sum of our parts.
Be deliberate about your goals, err on oversharing, and look for the win-win. And you’ll lose nothing in the long run.

Inverting Thoughts on Thinking

Friday, October 18, 2013
by Nick Charney RSS / cpsrenewalFacebook / cpsrenewalLinkedIn / Nick Charneytwitter / nickcharneygovloop / nickcharneyGoogle+ / nickcharney

Last week I quickly threw down a video from Geoff Mulgan at Nesta in the hopes that you'd watch it (See: Thoughts on Thinking).  At the time I had a bunch of notes sketched out on a pad of paper (yes I still use those!) but didn't have time to pull them together into something coherent.

This week I wanted to share what I took away from the video because, as I indicated previously, there are some great nuggets of information in there. Mulgan divides up policy process into three parts:

1) Creating Mutation

Mulgan starts his presentation by arguing that novelty is the purview of iconoclasts and radicals; it's an explanation that conjures up support for the innovator as trickster hypothesis (See: Book Review: Trickster Makes This World, Innovation is Tricky, Literally and Finding Innovation) given that, tricksters seem well positioned to:
  • Reassert old ideas and infuse them with new ones 
  • Apply a different lens altogether (e.g. carbon)
  • Ask new types of questions (e.g. can it be a market?)
Whereas, as Mulgan argues, conformist institutions aren't a good source of creative mutation given that new ideas, by their very nature, have no evidence to support them.


2) Selection Principles

Mulgan goes on to outline a number of selection principles that determine which ideas tend to make the cut and which ones don't. It's likely not a coincidence that he starts his exploration by naming political convenience and ends it with evidence and reasoning. While I'm not trying to situate the two on a dichotomous spectrum I did get the sense that his ordering is purposeful and informed by his experience.

In an ideal world there is obviously at least some synergy between these and the other factors coherence, 'appealingness', and the failure of alternatives that Mulgan names. He goes on to explain that one of the core challenges of the selection phase is the tendency to promote a particular narrative structure (that which fits the mould, sustaining, do more with less innovation) rather than on what evidence supports (that which breaks the mould, disruptive, do different with different innovation).


3) Replication  and Spread

According to Mulgan, policy ideas that make it through the selection process require translation by intermediary bodies to enter into the policy bloodstream and that alternative approaches more easily replicate in the wake of failure created by an excess of orthodoxy. In other words, a history of failure creates a climate more ripe for disruptive innovation rather than one that has even a modest history of successful incremental innovation.

What if we reversed their order?

While Mulgan presents the above as sequential stages (e.g. moving from creative mutation, to selection principals, to replication), I wonder what would happen if we simply reversed their order? If we stand Mulgan's explanation on its head, the path to policy innovation seems to be:
  1. Look for a policy area with a deep history of failure (because the ground is fertile) 
  2. Identify intermediaries with a vested interest in the solution (because they will help you)
  3. Identify solutions that meet selection principals (because decision makers will support it)
  4. Apply a new lens that creates the mutation (because it leads to innovation)

Flipping the process putting support first and ideation last looks like a faster track for policy ideas and I'm interested in hearing if anyone has any tangible examples that I can learn from that have put this type of approach into practice.



Note: I've decided to re-embed the video below in case you missed it.

Trust in the Age of Information

Wednesday, October 16, 2013
by Kent AitkenRSS / cpsrenewalFacebook / cpsrenewalLinkedIn / Kent Aitkentwitter / kentdaitkengovloop / KentAitken


Last week Bill Eggers from Deloitte was in Ottawa, explaining his view of The Solution Revolution: the idea that for-profit businesses and social enterprises will solve societal needs before government can, in creative, interesting ways. The question post-presentation was "How can government help this ecosystem of solutions?" One of the themes we hit on in response was that supporting such counter-intuitive approaches is a hard road.


The Triple Bottom Line

There's a common case study in business literature - whether it's about innovation or marketing - about Gilette's "safety razor." This is the standard now: you buy a handle once, and expensive disposable blades frequently.

But when introduced, it was a disruptive innovation, undermining barbershops' monopoly on shaving. From the marketing standpoint, it's a example of knowing what your customers want. As it turned out, they didn't want a steady hand with a straight-razor in a nice barbershop, they actually just wanted a clean-shaven face.

Or as Harvard's Ted Levitt put it: "No one ever buys a shovel. What they're buying is a hole."

But for governments, this level of disruption and slight counter-intuition doesn't go far enough. Government isn't looking for a shovel or a hole. It's more like government wants a vibrant environment in which kids can grow up. The hole is just for a post, which supports a volleyball net, which isn't even really for volleyball at all - in the long run, it's actually just an interaction device for the neighbouring kids, to build friendships and community.

So the savvy marketer, when approached by someone looking to buy a shovel, might then say "Are you sure you don't want a soccer league, instead?"

With so many stakeholders, this actually is the level of complexity governments are experiencing in their outcomes, whether or not they actively pursue it. Or even know it.

It's the idea of the Triple Bottom Line, taken to extremes. Former Clerk of the Privy Council Jocelyn Bourgon provides case studies from this future: what she describes as a New Synthesis of Public Administration. There is a fascinating common thread running through each case study. Not only do the programs she describes solve the short-term problem at hand, they actually work to obsoletize the government's involvement in that solution in the long run by building communities around the problem. That would be part of my True Bottom Line for Government.

(Another would be organizational learning being a core component of any approach to solving problems. For another day.)


The Sound Bite World

The problem is that this level of nuance is really - and understandably - hard to explain to taxpayers.

An example: a few months ago a House Committee in the US released a report detailing $50M in spending on conferences for the IRS between 2010 and 2012. Outrage, predictably, ensued. It seems extravagant until you take the step of dividing that figure by the three-year horizon and by the organization's 106,000 employees. All of a sudden they're spending about $157 per person per year on conferences. Which seems borderline paltry, especially if you compare that to what they spend on each of those employees.

To boot, the longer and more accurate story about conferences is that their key benefit is the interaction and relationship building between colleagues and industry partners, far in excess of the value of simply having ideas changing hands and minds.

Or for an analogous example, as Clay Shirky put it yesterday at the Code for America Summit:
"The product of a hackathon isn't running code. It's the social capital people created among the people in the room."
Or what about building civic awareness by gamifying recycling with rewards, which Eggers explained has raised recycling rates from 30% to 90% in some U.S. neighbourhoods?

These are harder ideas to sell. Why hasn't the information age changed this?


Trust in the Age of Information

Even fifty years ago, the machinery of government would have been largely opaque to many Canadians. But as the availability of information has increased, Canadians' trust in government has not. Today, I would posit, we're at an awkward point in this evolution where we have information without understanding; availability without transparency; content without context*.

But this situation may be a side-effect of The Connected World: that of radio, television, photojournalism, and globalization, which is giving way to a new one.


Which dotted line path will it be, as even more information becomes available? What happens to the trend in public trust in The Hyperconnected World? As the age of Open Government unfolds? Are we going to see an acceleration, or a slowing and reversing?

I don't know, and I think much hinges on it. But if government lacks the relationships, willpower, and evidence to pursue messy, complex outcomes - to return to my original analogy, communities, rather than holes - The Hyperconnected World will be characterized by a lot of getting the wrong things done, with stellar efficiency.



* Another link to come out of the Code for America Summit yesterday: Transparency is Not Enough, by Danah Boyd. Suddenly I feel bad for having partially rehashed a three-year old argument (I wrote this over the weekend (and to be fair, this is actually somewhat of a synthesis of a handful of themes I've already gotten in to)), but considering that we still haven't moved past weak transparency yet, I'm okay with it.


Thoughts on Thinking

Friday, October 11, 2013
by Nick Charney RSS / cpsrenewalFacebook / cpsrenewalLinkedIn / Nick Charneytwitter / nickcharneygovloop / nickcharneyGoogle+ / nickcharney

It's been a busy week and I've got a lot of different thoughts in the blender but since none of those thoughts are ready for prime time right now I figured I'd share this video from Nesta entitled "How Think Tanks Think".

It's 45 minutes of your day well spent. Geoff Mulgan goes over the process and conditions of ideas generation (novelty and mutation), outlines selection principals and addresses how these ideas replicate and spread; and he does so with a respectable bias towards action and a rich history of experience. I found his closing remarks about the wake of excess orthodoxy creating room for innovation particularly poignant yet deeply troubling.