As a healthy, fit US citizen, I am aware of the importance of healthcare reform that is drastically needed. It is going to occur in the next few years, giving hope to many people that our system may finally be "bettered". To think a system as large and uncontrollable as healthcare could reach the goal of being anything better than ok is a dream...an unlikely one. However, an iterative approach, with a well thought out plan may allow us to achieve a system that is always in a state of  "continuous improvement" , thereby delivering over the long haul, a great system. Seems like an easy thing to do. Many companies have this type of mindset in their businesses, and it delivers great results for them. They focus on improving processes, streamlining and automating them for the best efficiency, all for the sake of the customer, delivers a great value proposition.

So, why can't this work for the healthcare system? Because the "company" trying to overhaul it is the government and if you ask a hundred people how well the government is run, they will tell you "poorly".  How then, can the government "fix" the healthcare system if they haven't been able to fix themselves. They can't. Can they make it incrementally better in some areas? Maybe, but the issues are more than just the insurance companies and the doctors and hospitals. The issues also include lobbyists, politicians, party lines, and future elections. Think corporate politics on steroids.

We all know how horrible the result is going to be once bills start to get passed and policies begin to change....frankly, I have nightmares thinking about it. In reality, this is the largest Change Management  project the world will ever see, and it will take a strong Change Management plan, along with Vision, Communication and Metrics to track progress. Let's breakdown how the government might be able to actually make a difference suing a process called DMAIC.  I won't talk about politics, maybe it's because my parents always told me not to discuss politics in public and frankly I hate when people talk about it to me.  Talking won't solve anything, rational action will. 

A Systemic Plan: Define
The first thing in Change Management is a vision, created by stakeholders from all facets, in effort to ensure there is buy in and therefore, the changes will be accepted. To do this, we need to Define what the issues are. It's the first step for the govt, and the American people need to see this draft strategic plan outlining the issues defined, and be given the opportunity to provide feedback. The plan, although in Define, should also be futuristic and show the future state at the end of 10 yrs., because that's how long it will take for real benefit to be realized and appreciated. It should be presented in a simple manner in terms and language everyone can understand. I don't want to see thousands of pages of policy changes until I know how they will integrate together to form change in a holistic systemic manner. Maybe 10 pages at max, with an appendix for areas you want to dig into with facts and data. 

Next, have a website that will allow people to provide feedback. But here's the thing, it can't be people providing feedback in open ended questions, it must be in a survey form that allows them to give "yes'  and "no" answers, or a weighted 1 to 5 point scale from "agree" to "disagree".  The 1 open question would be on Recommendations to solve a problem. To limit the number of rants, make it short, like Twitter.  Someone should be able to get their point across in one short paragraph. If it's a good idea, it will be given to the solutions team to expand upon and get more information on the recommendation.

Based on the input from the survey, the draft plan should morph into a formal plan that incorporates the CUSTOMERS feedback of the healthcare reform. 

Measure and Analyze

Now you have all the input to develop a formal strategic plan, it's time to create the solutions that will drive towards the future state. The problem the government has is they are looking at "fixing" the system, which is not the right approach. There are things that are ok in the system that don't need to be fixed. The goal should be to have an end state that is optimal, but takes several phases to get to. Using processes in Six Sigma (DMAIC, DFSS, Lean, TOC, etc), a prioritization process must take place, and each independent issue must have thorough analysis completed. Define what the measurements are and analyze the root cause issues.  To do this, experts in Six Sigma are required, each with a team of Subject Matter Experts (SME's), and stakeholders like doctors, nurses, administrative types and most of all, customers. Drilling down into the issues and conveying the issues in a scientific way with data, will give the government credibility that it needs to make the change happen. And during this entire time, a communication plan must be in place in order to let the American people know "where" in the process they are and what the "progress" is.  This could be through local politicians, but it would be more accepted if there was a "Network of Change Advocates", everyday people in the local cities who represent their town and are responsible for delivering the updates at weekly town meetings, newspapers or other venues. The government also needs to set up an Internet site completely separate from any other govt site, that is inviting, compelling....cool, not political. It would be great if someone like Google would offer to host it for free and supply resources to help with this, because if the government does it, it's going to be....dull. Now that the issues have been measured and analyzed, and we know what the root causes are, we can begin to look at solutions.

Improve

The hardest part of any change management program is the execution and implementation stage. This is where the rubber hits the road. We have the plan, the analysis and roadmap of the changes to occur. But how will it be executed. Using a PMO (Program Management Office) with standard tools and processes, and a team of subject matter experts(SMEs). Also, Steering Committees, not filled with politicians, rather, the stakeholders, should be formed. The Steering Committee should be for every project, given the size and importance of the decisions that need to be made. One overall Steering Committee can be formed, that the individual Steering Committees report their progress into, or if there are decisions that require their approval, like funding, investments, etc.In general, a cadence must be followed, like any other project, whereby a decision making body guides and is not "held up" by politicians and lobbyists. 

Given the expansive change taking place, the govt needs to have the best talent possible to execute. Pulling people from the private sector is my recommendation. Get the smartest, brightest and hardest working people you can find. The teams should have a cadence similar to those at large corporations when big initiatives are being rolled out.  Implementation is the one thing that will take the longest and is at most risk if things go wrong. The govt should hire professionals to manage the project plans (which there will be many) and the resources. And the teams needs to be formed by conducting interviews, just like the private sector. Appointments should not be an option.  In addition, rewards should be in place for the teams, but only on final execution, not during. Just like corporations, executives don't get bonuses unless they hit their targets (well, most corps, not BofA). 

At the same time the actual improvements team is executing, a Legal/Compliance/Risk team should be managing the policy changes. The new policies need to be simple in nature, versus long, cumbersome language that no one understands and puts you to sleep. Obviously the PMO would manage the changes in policies along with the implementation, knowing there will be interdependency that will need to be managed. The Risk experts should be tracking any risks that arise and develop mitigation or contingency plans in order to be preemptive in nature vs reactive.

Control

Now that they are executing, they need to build a metrics scorecard that will be communicated to the American people on a weekly or monthly basis. Whatever the reporting communication rhythm is, it needs to be focused and tell the people "how the changes are progressing." As I said earlier, a Continuous Improvement mindset must be in place, therefore a Continuous Improvement team must be ever present, and always be improving the system annually. This will become the balanced scorecard once the govt transitions to a another entity that will manage the process going forward. A govt running this does not seem feasible or realistic. It's not their core business, and they can spend time and money doing things that is their core, like protecting me and my family.