December 12, 2010 — Health Care, Part 3


Well, that was a bit of a longer wait than I expected. I spent the past few weeks getting a novel ready to be uploaded to the Kindle store. Much time has also been spent in the wood shop preparing Christmas gifts. So the book is now available on Kindle (Hannah Sorpat's Eye – A Novel of Alien Abduction by Ward Wagher). The Christmas presents are nearly finished. So, it's time to look at IT Management once again.

In our last segment we talked about some of the necessary requirements to develop a workable healthcare plan for the United States, as an exercise in facilitation. Facilitation is largely a question-asking exercise. The goal is to drive the customer / user to the bedrock of requirements. It is also called “The Five Whys.” In other words, by persistently asking “why,” you should be able to come close to the real reason for anything.

This approach may be a bit simplistic for the health care question. We are dealing with an enormously complex system. The numerous project failures over the course of the history of the IT industry most often are the result of projects which became overly complex. The science of project management has evolved to deal with complexity, and the science of business process management (BPM) is now evolving to help businesses reduce complexity.

When a project manager or a business process analyst looks at the structure of the health care reform bill, the immediate conclusion is that this will never work. The structure was cobbled together without any thought to an underlying architecture, and clearly lacked a single architect. There are numerous contradictory rules and regulations. The attitude of the Congress, or perhaps more accurately the Democratic leadership of the Congress, was to get a bill, any bill, passed. Then they can go to work on cleaning it up. That's the way we used to do things in IT, and it never worked. One is tempted to wonder about the intentions of Congress.

So, when faced with this kind of an architectural challenge in an organization's business rules, the business process analyst or facilitator begins driving through to conclusion an entire series of questions designed to highlight the issues, difficulties, and contradictions in the business rules. All the while, the facilitator works hard to keep the overall goals in mind, and constantly reminds the team of these goals.

The analyst then works with the project manager to develop a set of deliverables for the project. Careful attention is paid to the "achievables." The process owner should have a set of goals for the overall project. The project manager and the analyst should share those goals, and also have a personal goal: to successfully complete the project.

Obviously most members of Congress are not stupid. I say "obviously" because I believe that our Congress critters are not far removed in intelligence from the people who elected them. I do believe, however, that they suffer from an institutional blindness. The accepted wisdom in Congress is that the legislative process resembles the making of sausage. The large omnibus bills are viewed as the only way to get controversial legislation passed.

Over the past two decades, experience has taught us that the only way to get projects completed successfully is to have the process owners onboard. In the case of healthcare the process owners include the Congress, the president, the courts, and most importantly the people. Once again the conventional wisdom tells us that it is not possible to gather a consensus. I do know this has rarely been tried. I do believe, and this is my personal opinion, that when things get serious enough in the economy, a consensus will somehow be found. The solution will occur when someone has gathered sufficient authority to push through real change. Something like this happened following the election of a Democratic president and Democratic control of both houses of Congress in 2008. The only problem was that no one believed it was a true solution.

Honestly, friends, this is as far as I can take the process. Those of us in IT have developed ways to align technology with business, and helped drive through significant change in these businesses. If our national leadership can be convinced to follow similar practices, I believe we can usher in a new period of prosperity and freedom for the country. If nothing else, I hope I have left you with something to think about.

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