Leadership Lessons from the Flawed Affordable Care Act (ACA) Implementation

Leaders are responsible for any stakeholder communication that is used to evaluate an implementation.  Therefore, anyone who is responsible for an implementation’s marketing campaign, updates, and issue resolution must ensure that all project communication is clear, concise, accurate, and timely.  Otherwise, stakeholders may believe that information is withheld, feel misled, question future updates, and/or revolt against the implementation activities if there are significant issues.

The implementation issues with the Affordable Care Act (ACA) launch provide opportunities to learn some valuable lessons:

​* ​Implementations Should Not Be Politicized – Elected officials, news reports, and citizens refer to the ACA by its politicized name “Obamacare”.  By using politicized or personal references (e.g., ‘Bob’s project’ instead of the ‘billing system project’), any failures will most likely be attributed to an individual versus an issue being associated with the implementation itself.

* Don’t Publicly Communicate Things You Won’t Do – Any communication to stakeholders which advises that actions will not be done for one’s on purposes should be minimized.  An alternative approach is to document any issues that might be a challenge to implement.  Then, there should be open discussion(s) related to the implementation issues to provide stakeholders with an opportunity to provide input.  This will allow stakeholders to be involved in the process to resolve issues versus communicating through one’s actions that the stakeholder’s concerns don’t matter, will not be considered, or are not wanted.  By engaging stakeholders in the resolution process and also allowing them to express their concerns without restrictions, stakeholders are partners in the process to resolve any issues — even if the stakeholder’s position(s) are not used.

* Expect Issues – Seldom do things happen exactly as planned.  Therefore, leaders must be prepared for and truthfully communicate any issues.  This does not mean that stakeholders should expect major issues, but instead stakeholders should be ready to address any issues if things are not implemented as planned.  Leaders must understand that contingency planning is a critical part of any implementation.

* Leaders Must Accept Responsibility and Accountability – Organizational leaders are figureheads and as such these leaders must take responsibility and accountability for any organizational issues and/or challenges.  Furthermore, anyone under a leader’s command should know that their organization will protect its resources.  This type of cultural environment will lead to the development of a learning organization that is not afraid to make informed decisions to accomplish work tasks without
concerns about any ramifications due to missteps taken in good faith.

* Apologize Immediately for Delays – The ability to immediately apologize to stakeholders for a missed deliverable may not be difficult; however, giving an apology too late can be very uncomfortable.  The reason is that stakeholders may be more willing to forgive a missed date or a troubled implementation if the apology is timely and also includes an honest and full disclosure about the issues.  This type of action can lead to figureheads being considered effective leaders who will take ownership, responsibility, and accountability for any delays and/or issues.  Otherwise, late apologies may not be received as well or may not be believed to be sincere.

* Don’t Over Promise and Under Deliver – Stakeholders may not always pay attention to communication that provides implementation updates; however, stakeholders will be loud-and-clear if their expectations are not met.  Therefore, updates must be accurate and must not provide any information that is not confirmed to be true.  The reason that advance information validation is important is that stakeholders will hold executives and the implementation team responsible for any inaccurate information or missed promises, which can lead to concerns about other issues as well — known or  unknown.

* Support Implementation Leaders During Difficult Times – Organizational leaders must visibly support implementation leaders – especially – during difficult times, as there is often a rush to blame others for any errors.  The sole focus should be directed toward issue resolution without an attempt to associate blame.  This type of approach will allow an organization to focus on the issues and not waste time in any attempts to identify someone to blame.

* Acknowledge Issues Immediately – Any implementation issues should be acknowledged immediately, documented, and a
plan of action created to resolve them.  Furthermore, a defined and communicated status update schedule should be used to provide subsequent information to stakeholders.  If a planned update schedule is not provided to stakeholders, there can be additional issues created based on the lack of information because some individuals will associate silence with additional
issues and/or a cover-up.

* Engage Stakeholders in Issue Resolution – Issues should be identified, discussed, and resolved with stakeholder involvement.  Communication and engagement are important during implementation; however, both are even more
significant during troubled implementations.  Therefore, stakeholders should be core participants in the process and activities to resolve implementation issues.

* Refrain from Too Quickly Setting a Fix Date – At times, a leader’s initial reaction to an issue is to dictate and/or communicate a fix date without fully understanding the issues that created the implementation challenges.  As an alternative, the implementation team and stakeholders should be given an opportunity to develop a managed strategy to
resolve any issues before leaders provide any committed resolution dates.  The reason for this approach is that any
solutions to fix issues may be implemented in phases, utilize interim workarounds, remove requirements, or include other mutually agreed upon solutions.  This strategy can also help to prevent worst case scenarios that can emerge due to a rush to set a date to fix any issues and then miss an implementation date again.  Furthermore, stakeholders will be less forgiving of any subsequent missed dates — along with potential impacts to stakeholders’ views about an organization’s capability, leadership, and/or technical abilities to implement future implementations.

Any major system, process, and/or conceptual changes can be a significant undertaking, which can be complicated by any stakeholder communication that is not completely accurate or related to the implementation’s benefits, status, and/or impacts.

The initial release of the Affordable Care Act (ACA) system is just a single example about the importance of a documented and managed communication strategy, which includes a proactive plan to address any implementation issues.

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