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Wednesday, September 30, 2009

THE HEALTH CARE BILL - HOW I WOULD HAVE DONE IT


Like most Americans, I have been watching the wrangling over the Health Care bill carefully. Something that has bothered me from the beginning is how it was developed which, frankly, sounded like it was cooked up in some back room in typical lawyer fashion. I may not have the answer for solving the problem, but I most certainly would have gone about addressing it differently than the politicians did. Here's what I would have done:

1. Develop a Project Scope - I would have carefully specified the problem to be addressed and identified all of the parties involved. including what parts of the government are affected as well as the populace. In other words, who is directly involved, indirectly involved, and not involved at all. I would also clearly identify the existing system(s) to either be modified or replaced.

2. Study the current system(s) - this would involve interviewing a wide spectrum of people involved with the existing health care systems, such as insurance carriers, hospitals and clinics, physicians and health care workers, malpractice attorneys, etc. Basically, anyone associated with the Project Scope. From this, a "Current Systems Analysis" is produced specifying the strengths and weaknesses of the current mode of operation. This includes what works well, what is deficient, and what is truly broken. Also, consideration would be given to cheating and abuses of the system, not just that it occurs, but why it occurs.

3. Specify Requirements - detailing what is needed from a mandatory, strategic, and tactical perspective. This would include the requirements of the American public, the government, health care providers, etc.

4. Review - "The problem well stated is half-solved." Before we try to solve the problem, let's make sure we have the Project Scope, Current Systems Analysis, and Requirements properly and carefully defined. If this is wrong, any solution devised to satisfy it will be wrong.

5. Develop System Approach - to satisfy the requirements, consideration is given to proposed alternatives, including modifying and/or correcting deficiencies in existing systems, devising whole new systems, or both. This would include the sub-systems and infrastructure needed to support them. Because of the enormity and complexity of Health Care, it would be wise to develop multiple solutions in order to propose alternatives with a recommended solution suggested.

6. Prepare System Evaluation - for each approach offered, a cost estimate is prepared (not just development costs, but implementation and on-going support costs as well), along with how it is to be financed, including a cost/benefit analysis (consisting of such things as break even points and return on investment). From this, we can put a price tag on each proposed solution and consider which one we can afford.

7. Review - all of the material thus far is assembled into an organized report with an executive summary highlighting the major points. This would then be presented to lawmakers in Congress for their review and deliberations. The outcome from this would be to accept it as is, ask that it be revised, or discontinued completely.


What I've just described is called a "Feasibility Study" as used in corporate America on a daily basis. No, it's not cheap and can take some time to produce, but business people long ago accepted the fact that you must "look before you leap" into a major project. Yes, it would be tough to prepare, but I know nothing of substance that has ever been done without some sound research and planning, but as far as I can see, this has not been done by anyone, least of all Congress or the President.

Some politicians would argue that we don't have time for a proper Feasibility Study. Interestingly, I hear this same argument from programmers in the Information Systems world who also don't believe in the necessity of upfront planning and prefer hacking away at program code instead, leaving an ugly disjointed mess that never gets finished. The fact remains though, no amount of elegant programming or technology will solve a problem if it is improperly specified or understood to begin with. I contend we haven't got time NOT to do this vital upfront work.

If our Congress went through the motions of building a true Feasibility Study, it would promote cooperation through effective communications, thereby eliminating partisan sniping; it would produce a proper solution for the right set of problems, and; it would go a long way to improving the trust in the government by the American people, simply by assuring them that the "T's" were crossed and the "I's" were dotted (that it has been thoroughly thought through).

I guess what concerns me, as well as a lot of Americans, is not so much what is being presented to us as much as the process by which it was developed which, to my way of thinking, was in a vacuum. If Americans don't trust it, they will not embrace it and may even revolt against it.

Remember, it's Ready, Aim, Fire; any other sequence is counterproductive. Then again, our attorney/politicians don't know anything about management.

Such is my Pet Peeve of the week.

Keep the faith!

Tim Bryce is the Managing Director of M. Bryce & Associates (MBA) of Palm Harbor, Florida and has over 30 years of experience in the management consulting field. He can be reached at timb001@phmainstreet.com

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