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Healthcare.gov: a management issue

Much of the blame around the Healthcare.gov website—a web-based insurance marketplace established by the 2010 Affordable Healthcare Act—has focused on the fact that the site couldn’t handle the amount of traffic it received. Essentially, it wasn’t scalable. But look beyond the headlines and it becomes clear that there are bigger issues around the website: not only is it not scalable and therefore not accessible to the thousands of Americans hoping to use it, but it also has some user design flaws.

Both of these issues—accessibility and user design—can be attributed to a reported lack of testing. According to The Washington Post in “Full Testing of Healthcare.gov Began Too Late, say Contractors,” testing on the site began a mere two weeks before its hard and firm go-live date of October 1, 2013.

A combination of 47 contractors and multiple agencies were involved in designing and building the website. Between the level of complexity involved in the site, the number of technologists designing and building the site, and the large numbers of “managers” involved in the process, the overall place to put blame is on the management of the project. Someone—or, more likely, many people—along the way did not do or manage the proper level of accessibility and usability testing. And in a recent management shakeup, the official who supervised the launch of the health care site left for the private sector.

A June article in The Atlantic, “Healthcare.gov: Code Developed by the People and for the People, Released Back to the People,” gives a good overview of the complex technology and processes used for the site. And while it’s hard to know what may have changed between when the article was written and when the site was live, one can assume the level of complexity remained the same, or increased.

Healthcare.gov Website Management Challenges

Managing technical professionals presents unique challenges; they have different goals and incentives than those of other employees. Managing large numbers of technical professionals requires a deft hand. The MIT Sloan Executive Education program, Managing Technical Professionals and Organizations, details strategies that are crucial to any organization–such as the “organization” that built Healthcare.gov—where research and development, engineering, and/or computer-related technologies lie at the core of the business.

“Ultimately, to carry out the requisite technical work, professionals have to assume many different roles and work together in different kinds of groups and teams,” said Ralph Katz, Senior Lecturer at MIT Sloan. “How do managers create the kind of environment and innovative culture that is highly motivating and stimulating for the professional? What are the managerial options for encouraging creative individual contributors to work together, and how can managers maintain the vitality of their technical workforce over time?”

Had these questions been asked at the beginning of the Healthcare.gov initiative, it’s possible that the overall management of the project might have been better. And, that might have led to more success in the accessibility and usability of this critical website.

Ralph Katz is a Senior Lecturer in Technological Innovation, Entrepreneurship and Strategic Management with MIT Sloan School of Management. He is also the Faculty Director for MIT Sloan Executive Education’s Managing Technical Professionals and Organizations program.