September 24, 2013
Practice What We Preach

The federal government doesn’t sing the praises of its employees enough. I came to federal government a little over a year ago. I am continually impressed with how mission oriented and hard working federal employees are. They are passionate about their work and see their jobs as service to the people of our country.

However, the systems of government often do not let them do their best work. Like most large organizations, government has evolved over many years, with lots of layers, processes and requirements. What we call in engineering “control steps” places along the way to assure adherence to rules and procedures. Too often these control steps have become a bureaucracy that wastes the time of federal employees hampering their ability to live out this service to Americans.

I have had the pleasure of witnessing the tremendous transformative power of lean in government. I have been amazed at how quickly tfeds have taken to lean and how effective they are at leveraging it. I was surprised by this, as I have worked in organizations in the past that have embarked on change use lean. In those places it took longer for success and culture change.

One reason is that our HHSentreprenuers project is working with the teams that oversee federal programs in health care quality improvement. These people believe in quality, believe in change and have rich prior experience in quality improvement. In some ways, the lean transformation is using their quality improvement expertise in things like root cause analysis and plan, do, study, act models on their work in government.

Another reason is the terrific team doing this work- the leadership has been terrifically supportive in giving the teams the freedom to discuss issues, identify waste, collaborate and change. Mindy, as our lean HHS innovation fellow, is fantastic in the way that she is adaptive with lean, streamlining it to each purpose. She is also a gifted teacher and coach- very patient with us.

However, the greatest reason lean is so successful here at HHS; it’s giving a path for the dedicated, intelligent, mission focused government employees to fix the issues that get in their way. Lean gives them a framework to analyze their work, a process for group decision making, a platform for managing up and a way to continually iterate. Lean gives the tools and structure to unleash the innovator in all of us for in the work we actually do day to day.  Our mission driven federal employees can now focus more time on the parts of their work that truly matter and less time cutting red tape.

April 11, 2013
Mr. Potatohead meets the Secretary!!!

By Mindy Hangsleben (@MindyHangsleben), External Fellow for the Clinical Quality Measures Project

Last week the other entrepreneurs and I had the opportunity to brief Secretary Sebelius on our progress.  I normally don’t get ultra nervous before speaking, after years of teaching, but this time it was a little different.  I am guessing that most of you have had some sort of performance anxiety when it comes to public speaking.  Mine usually manifests into a red face and a shaky voice, good thing I put on extra deodorant. We had 5 min to present and then 5 min of questions from the Secretary.  I was most nervous as to how we could summarize and give a good picture of what we are doing in this small amount of time. 

When the Secretary entered the room she walked around doing personalized introductions, it was quite surprising and nice.   As the other entrepreneurs presented I was surprised by the interaction and engagement the Secretary provided.  She really knew all of the subject matter well and was very motivating in how she responded to the projects.  By the time my group was ready to go I became a lot more comfortable and lost my red glow.  Thank god we were last!   We presented our results thus far along with future plans to really integrate the lean culture into CMS and ONC in hopes to infiltrate all of HHS and possibly the rest of the federal government.  That being said, we re-iterated the importance of having senior leadership support to empower the employees and make lean a priority.  If you don’t have this, lean will definitely become the flavor of the month.  I find that this is one of the questions/challenges I get every time that I start to teach lean to a new group.  The Secretary gave us good feedback and even called me by my first name which I didn’t even notice until my colleague pointed it out.  How cool is that? 

As far as the details of our results that we presented out on, they were not only from the Kaizen but also from standardizing business processes that are totally within the control of the first line managers.  Some of our recent successes that came out of the Kaizen include developing a measure within 3 months versus the recent process which took anywhere from 1-5 years depending on the type of measure.  We reduced the contracting process from 6-8 weeks down to 2 weeks. The list goes on but these are just a few of the many successes that continue to come from the Kaizen groups.  In one of our business process improvement value streams we looked at how we track issues with our Meaningful Use measures.  After we removed as much waste as we could in the first future state we saved approximately 37.7 weeks of one full time employees time, issue resolution went from an average of 2 months down to around 1 week, we had great feedback from those reporting the issues and also gave better transparency, ownership and collaboration.  We are continuing to do these smaller scoped business processes in parallel with the large Kaizen events.  The big challenge is now to keep the culture change moving and build the sustaining model.  This will be the most difficult part of our journey.  I have faith that with the senior leader’s engagement, the internal lean experts driving the processes, and the employee’s motivation that this will be a huge success.    image

February 27, 2013
Community Resiliency

By Frank Sanborn (@seattle_guy), External Entrepreneur for the Health Resilience Technology Project

Wow..  How time flies by..  My name is Frank Sanborn, I am the External Entrepreneur (InnovationFellow) working on Community Resiliency and Smart Medical Devices.  My Fellowship has been bit like drinking from several fire hoses at once as I have been learning the culture and workings of both ASPR (Assistant Secretary of Preparedness and Response) and FEMA (Federal Emergency Management Agency).  I was the first Fellow to come on board here at HHS, starting Oct. 9th.  And it has been a fast ride from the very beginning… 

 I spent the first few weeks learning about ASPR by meeting with different departments and groups within the organization.  I found ASPR leadership incredibility capable and is an organization of action, responsibility and of accountability.  Every person I have met and worked with are incredibility passionate about their role to accomplish the mission of ASPR which is to make the medical community prepared for any type of disaster. 

 After a few weeks I joined up with my FEMA team, which includes the FEMA Think Tank.  My first meet up I got spend some time with Deputy Administrator Rich Serino and then with the Administrator Craig Fugate.  I was excited to learn the vision for the future of FEMA and how my core values and experiences matched incredibly well.  FEMA is undergoing a transformation to be more open and to make sure the whole community is being served and supported.  The first task was reading, reading, and more reading…. 

Just before heading back to Seattle, Hurricane Sandy hit the East Coast.  I spent a bunch of time in Health and Human Services SOC (Secretaries Operation Center) and the NRCC (National Recovery Coordination Center) learning about the storm and watching the Federal Government get ready to help the impacted states.  It was amazing to see both HHS – ASPR and FEMA get mobilized.  One of my tasks was to help figure out how to get supplement bandwidth to DRC’s (Disaster Recovery Centers) so they could deploy disability IPad’s to each location so people with hearing impairments and other disabilities could receive translation and other services.  We partnered with National NGO’s and Satellite providers to bring in supplemental bandwidth. 

Through the course of the dialog we quickly realized that not only did the DRC’s need bandwidth but so would the general public, especially at Community Shelters and other locations.  As we worked all worked hard to put the pieces in place to provide the infrastructure to serve these locations. 

On Thursday with some trepidation I returned home to spend time my family.  It had been a long 3 weeks and we were all missing each other.  After returning home, my work on Sandy did not stop…  On Saturday, I joined a local hack-a-thon (Geeks without Bounds) working in Seattle working on supporting Sandy recovery.  On Sunday I got a call from the lead of the Think Tank asking me to join the FEMA Innovation Team Deploying to NY.  I talked with Dr. Nicki Lurie, Assistant Secretary for Preparedness and Response, and we arranged for me to fly out that evening to meetup with my Fellow Innovators in Brooklyn at 8 AM. 

Under the direction of Rich Serino, FEMA deployed a on the group of people from Federal, NGO, Industry Trade Associations, and Academia be on the ground bridging the gap between the formal government organization and informal organization and other groups supporting and helping people recovery.  Our Mission?  To see where the system broke down and to problem solve issues that were effecting survivors ability to recover after Sandy and into the future.

Here is a link to an article written by a documentarian I met in Red Hook while setting up community computers at IKEA.  Mashable also picked up the story.

February 11, 2013
Innovation: Living Social Process

By Chris Lunt (), External Entrepreneur for the Infrastructure of Medicaid & CHIP Project

"How many of you are ENTPs?" asked Will.  A few hands went up around the room.  When my wife and I were engaged to be married, we’d seen a premarital counselor on the advice of a friend, and he’d given us the Meyers-Briggs test.  Suspicious of oversimplifications, I’ve always looked on personality tests with a jaundiced eye, but I vaguely recalled that I was an ENT-something.  I left my hand down.  "ENTPs are natural innovators," continued Will, a Georgetown grad student.  He went on about some of the methods they hope to use to identify innovators at HHS, but my attention drifted back to the beginning of his report, when he’d asked, "what does an innovator look like?"

When I started at the university of Michigan, I wandered through my dorm, meeting the people who made a point of leaving their doors open, so you could see their posters, and hear their music, advertisements for their readiness to make new friends.  Some posters seem evergreen to me, I suspect you might still find posters of Einstien, Audrey Hepburn, and Mozart.  Others are more people of their time, athletes, pop stars and business leaders.  Some of the beliefs and desires these icons suggest seem obvious and natural.  Others strike me as alien, and even perverse.  But most of all, they strike me as naive.  I don’t think you’ll find anyone who worked directly for Steve Jobs with a poster of him.  Not only because people who are close to where innovation happens recognize that it’s messy, and that its actors are human, but also because it’s never one person.  Innovation is social.  Ideation, packaging, selling, implementing and nurturing a new idea rarely come from one person.  Although the conductor is likely an ENTP, that person won’t be successful without the right team, organization, and culture.

I approached Will at the end of the innovation council meeting and asked him if he thought that “innovation is as innovation does”? Part of Will’s goal is to identify the people who were not yet innovators, but could be.  That begs the question, once you find them, what do you teach them?  There’s an industry built around that (you could claim that is the raison d’être for college), and I won’t add to it here, so suffice to say that Innovation is a process.  A teachable process.  For ideation, I’ve found nothing more effective than synthesis.  But that’s just ideation.  After that comes that packaging, selling, etc, and you need both people with those skills, and a fertile environment.  

Beyond that, innovation is a living organism.  It survives in an organization to continually improve processes, or it withers by starvation (or dies by predation).  I wonder if you can over-water innovation?  At the end of a two hour meeting about it, you begin to think so.

February 4, 2013
The Lean Virus has hit the Federal Government….Kaizen!!!

By Mindy Hangsleben (@MindyHangsleben), External Fellow for the Clinical Quality Measures Project

We just finished an amazing, exciting, empowering Kaizen (continuous improvement) Event focusing on leaning out the electronic clinical quality measurement development cycle.  Stakeholders gathered from all parts of the process to “map it like it’s hot” for a full 5 days…and believe me they mapped it like it was hot.  The event included folks all the way from federal employees to EHR Vendors.  With over 100 attendees, most of which had never participated in an event like this, we had 8 different scopes where we mapped out the current state of process, defined our ideal state, and then built our future state.  The current process timeline takes anywhere from 3-5 years and is filled with defects with our future state we hope to knock this down to 1 year and a large reduction in defects.  Throughout the process we were excited to uncover the horrors of our waste which included crazy amounts of re-work and multiple layers of sign-off causing significant wait time.  Not only did we uncover the horrors, we also learned about different roles throughout the process.  Many folks commented about how they didn’t realize that the other person had the same inefficiencies within their processes.  In Lean we always say bad systems beat good people, most of the time we don’t understand what others processes are and we tend to blame the people before looking at the system.

Throughout the event we shared our a’ha moments with our Senior Leaders.  It was a true reflection of how folks from different strokes can come together and really make things happen.  A couple that really resonated with me was when the HHS CTO joined us and a contractor stood up and shared how empowered she felt and the excitement around collaborating to enable the future state process.  Another external participant shared how for five years she has been dealing with enormous amounts of waste and frustrating processes and she finally felt like she was heard and now there is hope that it will be fixed.  Can you imagine working in an environment where change seems so impossible that you are always stuck banging your head against the wall?  Believe me, I have never worked in a place where I have felt so landlocked by restrictions and policy that even doing the smallest things like trying to hold a meeting with external stakeholders took me two months of very, very persistent follow-up and trying to  get approval even when the funding was ridiculously minimal.  Remember no free lunch with the government like the private sector. image

Personally, I could have never held this event without the support of Senior Management at CMS, ONC, the Secretary’s Office and the two Lean expert trainees.  Out of the senior leaders, two of them, who are very dedicated to this process, spent all week with us mapping and busting rocks.  That being said five days is a huge time commitment and this really shows how all parties involved are ready for change and are committed to making it happen.  In addition, the two lean experts were phenomenal and saved me quite a few 12 hour work days.  Last but not least the participants were amazing and so open to learning the process and working to remove waste. 

There was so excitement and energy from the group.  Usually these events are so draining that most people are dragging by the end of the day…not this bunch! 

On our final day of the Kaizen we held an optional networking lunch before folks flew back home.  It was crazy how many people showed up, I thought most would have been drained from the 5 days but they still had a ton of momentum and energy.  As I sat at lunch I observed how many relationships had been built over the week and could feel the empowerment.   I even had one group approach me with a picture of a mapping they had put together when they were out one night.  They were working on Leaning out one of the participants dating process.  How funny and touching at the same time…in the back of my mind I was asking myself is everyone was carrying around mapping supplies after hours, what have I done to these people???  There goes the virus spreading again, hopefully it moves as fast as the flu.  One by one folks continued to approach me and share their excitement and feelings of empowerment.  I believe this is the first time in the federal government that anyone has taken on such a task.  If any group can get er done I believe it is this one.  I can’t wait to implement all of the great work everyone did.  I will leave you with one final note never underestimate the power of the post-it!!!  Great job everyone!  If you attended please share any stories or reflections by selecting the comments below.

January 29, 2013
Innovation 101

By Zac Jiwa (@HITManZac), External Fellow for the Infrastructure of Medicaid & CHIP Project

in·no·va·tion noun \ˌi-nə-ˈvā-shən\

1: the introduction of something new

2: a new idea, method, or device : novelty

From <http://www.merriam-webster.com/dictionary/innovation>

Over the last several weeks, I have found myself challenged to be INNOVATIVE as an Innovation Fellow.  Sure, the job is challenging and figuring out the complex equation that is a MAGI eligibility determination shared service for state Medicaid agencies is not trivial, but that is not what I mean.  In this case I struggle with what it means to be innovative. 

First of all, INNOVATION is an overused buzzword, especially in government circles.  I do not mean to be negative or to take away from all of the good work being done by the  Innovation teams here in the Fed, but, if I had a dollar for every time that I heard a reference to innovation…well, you get where I am going.  It’s hip and cool to be seen as innovative, to “think outside the box”, to be “disruptive” or to be a “change agent”.  But what does it really mean?  And who decides?  And what if the obvious answer is notinnovative?

I suppose the reason that I struggle with it is, with regard to our project, the RIGHT solution, the OBVIOUS path does not seem all that innovative.  The best answer to our problem is staring us right in the face, has been exclaimed by many others before us and is not hard, not a new idea and is not novel as Merriam-Webster defines innovation.  Earlier this month, when meeting with Bryan (Sivak) to discuss our project, I made this observation to him.  That “I struggle with the natural solution to our equation because it is not really innovative.”  To which, he challenged my own definition (and Merriam-Webster’s for that matter), that it should be a “new” or “different” idea. 

Bryan’s rebuttal gave me a brief flashback of my early work in Louisiana.  In late 2010, I landed right off the train from Microsoft R&D and found myself in the midst of public sector sludge at Louisiana’s Department of Health and Hospitals.  It was my first job in government and I found myself very frustrated at the slow adoption of technology.  They were still using Windows XP on the desktop, most of the backend systems were ancient mainframes and introducing anything modern was met by a myriad of excuses.  I was used to working with tools that made it easy to communicate, collaborate and get things done and now I had to hunt people down and wait hours, sometimes days for an interaction that I was used to having over a quick IM conversation.  Compared to the “eat-your-own-dogfood” environment at Microsoft, I had gone from Disney World to Dicken’s World (for the reference http://www.dickensworld.co.uk/).  Soon I realized something very cool about this situation, though.  By making incremental advances that, to me were obvious and had marginal benefit, I was able to gain trust to make even more impactful changes.  I was sometimes seen as an innovator although I did not believe that what I was doing was all that innovative.  It was the opportunity to work in the private sector at one end of the technology curve and then step into the public sector at the other end of the curve that allowed me to be “innovative”.

Later, Chris (Lunt) and I were chatting further about the definition of innovation and he came up with another really great definition.   He defines innovation as “the ability to have one foot in one world while having the other foot in a different world and leveraging lessons learned across the divide.”  What a great observation!  We have seen examples of this many times over, whether it is crossing over from the consumer market to enterprise market, the automobile industry to the banking industry or the banking industry to healthcare, some of the greatest innovations of the last century can be resolved by this definition.

In the present case for me, I am able to bring my experience from a State Department of Health/Medicaid perspective and cross the divide to implementation at the Federal level.  Certainly it is a similar case for Chris who has spent his career in consumer internet technology.  The divide he is straddling is certainly wider than mine and that gives him a completely different lens in terms of innovation.  Where some of the challenges that we face may seem daunting or of questionable value by some of my colleagues at HHS, the answers are more obvious and unquestionable to me.  Whether that is innovative or not, I will let others decide, but it has certainly helped clarify my present dilemma.  I’m interested, How do you define INNOVATION?

And now for my quote of the day:

"Nothing is so embarrassing as watching someone do something that you said could not be done." - Sam Ewing

January 2, 2013
You Don’t Track What?

By David Cartier, External Fellow for the Organ Transplant System Project 

OK, as of last Friday, my feet are somewhat back on the ground…As you might have guessed, I wasn’t in the blogosphere as this is my first post!  I have been quite busy doing instant emersion in the world of transplantation and the problem and requirements are starting to come together. 

First of all, I would never have thought I would be working for the government…ever!  Slow, stodgy…the antithesis of innovation.  That was my perception until I saw the post looking for Innovation Fellows using the words…“External Experts”, “Entrepreneurs”, “Innovative Approaches”, “Rapid Iteration”, “Risk Taking”.  Seriously?  Even if the government was serious about innovation, how could they even go there with a government mentality and infrastructure?  Did it make sense to put my current start-up plans on hold?  It only made sense if it was the perfect fit and…a chance to impact the lives of people…literally.

My initial perceptions were wrong.  I am excited and surprised by the changing mentality in regards to innovation especially in HHS.  I was also surprised and impressed by the dedication of people I am working with and for at the Health Resources and Services Administration (HRSA) and the Department of Transplantation (DoT).  The people here have a sincere desire to make a difference.  I was fast tracked and on board in days thanks to the efforts of George Smith and leadership in HRSA and HHS.  My travel plans have been coordinated by Passy and Tammy late at night and on the weekends!  I was not expecting this “get it done” attitude.  My experience has not been without challenges but quite honestly, I was expecting many more

The project?  This project addresses vulnerability within the labeling, packaging, and tracking system currently used to identify, transport, and monitor organs moved through the nation’s organ transplant system—the Organ Procurement and Transplantation Network (OPTN).  Tell anyone that we don’t track the organs and you get the same response…”You are kidding…right?”  I will say that the entire process is complex, very complex but more on that in another post.

The stakeholders involved have thought about this problem for years.  They have some great ideas and are working hard to help me understand as much as possible.  Did you know that you shouldn’t say “harvest organs”?  That is, unless you are procuring organs from unwilling participants!     

Before I wrap up, here is a little background on me.  I started my 24 year career at United Parcel Service (UPS) in Arizona and had opportunities to work in many functions and capacities during that time.  I completed my BS and MBA at Arizona State before relocating to Atlanta as a Senior IT Analyst in UPS e-Ventures, a UPS incubator subsidiary.  I continued my UPS corporate career with roles in; Package Operations Support, Industrial Engineering, Package Center of the Future and as a Region Director of IT Implementation and Support to name a few.  I more recently worked as a consultant and entrepreneur in healthcare providing Electronic Medical Record Systems (EMR) product selection, implementation, support and reporting for medium and small sized ambulatory care facilities. 

Oh!  One more thing.  I had the unfortunate experience to have first-hand knowledge of using the OPTN.  On September 27th, 2004, a truck ran a red light t-boning the jeep my 38 year old brother was riding in.  I immediately jumped on a plane from Atlanta to Phoenix for what would be the most emotional time in my life and, unfortunately, is easily replayed.  Not all of it is completely clear though.  When the Organ Procurement Coordinator met with my parents and I to discuss Dan’s wishes to donate his organs, it is kind of a blur.  We all knew he would want to give.  That was just Dan.  We explained that to the coordinator.  The fuzziness comes in on the exact details and timing of things.  During the next seven days, there were three separate times where we thought he would die but didn’t.  Each time things turned around, we all had hope he would pull out of it.  He was strong and might just make it. 

I have no idea when we actually spoke to the coordinator.  I do remember being concerned that they seemed more concerned about getting Dan’s organs than they were about saving his life.  Despite the assurances of the nurses and the OPO Coordinator, I was still skeptical.  I didn’t trust them.  As sweet and professional as the coordinator probably was, I didn’t like her.  The fact was, she was getting her organs for my brother’s life. 

After seven long days in a coma, my younger brother, Dan past away.  They whisked him away to recover what they could.  We were mentally and physically wiped out.  We headed back to my brother’s house.  We found out a few days later that they were able to recover his heart, liver and two kidneys.   Four people would live because of him.  Although that was nice…it didn’t mean very much to me at the time.  It did however begin to resonate when I was preparing the eulogy.

As the numbness of the moment wore off, we began to appreciate the gift of life.  We are truly thrilled that four people had a chance at life because of my brother’s gift.  He continues to live through others.  Three of the four donor families contacted my parents, thanking them and telling them how it changed their lives. 

Fast forward eight years later, to today.  I am blessed to be involved in the first of its kind External Innovation Fellow project that will truly change and save people’s lives.  I have the privilege of working with really smart people who know the system, its faults and know we can do better.  The skepticism and anger I had in the hospital although natural, was unfounded.

I could not possibly have seen how my transportation, healthcare, education and personal experience would come together in a more meaningful way.  Two weeks ago, we received another letter from one of the kidney recipients again confirming the value of organ donation, the process and the people involved.  

December 28, 2012
Map it Like it’s Hot!!

By Mindy Hangsleben (@MindyHangsleben), External Fellow for the Clinical Quality Measures Project  

As I head back to MN to celebrate Christmas with my family I have more than just the holidays to celebrate!  This week we experimented with bringing together CMS and ONC to do some pre-Kaizen Event activities.   For those of you who are unfamiliar with lean, a Kaizen Event is where you basically overhaul a process by getting everyone together in a room and map it like it’s hot.  This visually represents the process and allows an objective view point to make sure your future state process is more efficient and higher quality.

We were trying to move fast as you all know this is government and I only have 12 months to make a difference.  With the organization being mostly new to the lean concepts I knew if we waited until the big Kaizen Event at the end of Jan that it would be more of me teaching and not a lot of process re-design happening.   I was very nervous as this would be the first place where I could get a good idea if the lean thinking culture shift was going to be a difficult one or rather smooth.  One of the key things to creating a culture shift is that your management has to be on board not only them saying it but also demonstrating presence and commitment. I only slept 3 hours the night before the event.  

One of the biggest challenges I personally face is teaching to new organizations.  It’s hard for me not because I don’t know the material but because I want to make sure that everyone gets something out of what I am teaching.  Unfortunately, you will usually run into some nay-sayers that don’t believe lean will work and I have a hard time not trying to spend extra time on them to try shift their thinking.   I was surprised it was awesome!   Out of the 25 people that we taught lean to, all of them were excited and willing to learn, at least that is the impression that I got! J  

During the event we mapped out the current state process of the quality measure development.   I call this mapping it like it’s hot.  The team did a great job, it really opened everyone’s eyes to how much opportunity there is to eliminate waste!  I think one of the big ‘a-ha’ moments was two steps one right after the other that had the same 4 approval loops…not to mention all the wait time for these approvals was taking anywhere from a day to a week.  That being said just the approvals could take up to 4 months…WOW…painful J

On a side note we had exceptional participation from the CMS senior leadership. They were supportive by demonstrating their commitment through their presence and willingness to look honestly at the waste.   They even reviewed a list of what we called out Big Hairy Audacious Goals (BHAG’s) and committed to helping us out with them.  I already received emails that are getting the ball rolling on a few of them.   More to come!  Happy Holidays   

December 17, 2012
Welcome to the Federal Government!

By Mindy Hangsleben (@MindyHangsleben), External Fellow for the Clinical Quality Measures Project  

Where to begin, as I am very behind on my blogging…I promise to be more diligent in the future!!!   Also I would like to fully disclose that I went to engineering school because English and creative writing was not my forte.  If there is a place for public comment I am guessing my brother-in-law will help correct my grammar errors. J

A little background on myself, I am originally from the Minnesota/North Dakota border just an hour south of Canada, so yes you may read this with a strong Midwest almost Canadian accent.  I earned my Bachelors degree back in 2005 in Chemical Engineering from the University of North Dakota…”Go Sioux”.  Since college I have been working at Intel Semiconductor in Oregon.  I started as a Process Engineer working on the production line making computer chips for 5 years and then over the past 2 years I had the amazing opportunity to work on two Lean start-ups.  One of them I traveled around the world training Product and Test Development Engineers in the assembly test factories, and the other working with our Healthcare Marketplace Collaborative in Oregon.  For those of you unfamiliar with Lean in essence it is a set of tools used to remove waste out of a system to deliver the most value from a customer’s perspective.  

When my upper management approached my group with the HHS Innovation Fellowship opportunity I knew that it had been written for me!  This fellowship would enable me to work on my top two passions, one creating pay for value healthcare in the US, and the other, leaning out systems empowering employees to make their work environments better!!   About a month ago I packed up and moved out to DC leaving behind my 8 week paid sabbatical that was scheduled to start the day I left Oregon.  Some say I am crazy for giving that up but what would I do with 8 weeks of time off when I could be changing the world? 

The DC area is great.  I left my truck back in ND so I am vehicle less which is a huge change for me.  I now spend extra time and enjoy the atmosphere when I go to Target because of the 3 hour transit it’s kind of like the excitement that my niece and nephew have when they get a piece of candy.   In addition, I am one of the few people here who insist that 40 degrees is not cold, they have since quit asking my opinion on the weather, I guess I steered them wrong a few times.  As much as I could go on and on about my personal experiences I am guessing you want to hear about the fellowship.

The first couple of weeks I was introduced to a lot of challenges and immersed in a very different culture then where I came from, not to mention I went from Jeans to Suits…which yet again was one reason I originally went into engineering.   One of my first experiences at the federal government which has taught me to cringe at the word policy was when I received my new PC a few days into the fellowship.  Exciting times, right?  I saw the Windows7 sticker and was excited because I knew this would bring me all sorts of tools… but…. I quickly realized it had been downgraded back to Windows XP.  I asked the Why and if I could get some of these tools downloaded on my PC and was told it had to do with some sort of Policy/approval process that needed to happen.  Also, as Zac mentioned in his blog the difficulty with the IT infrastructure is like fort Knox.  One of my personal struggles is when trying to work across the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) which are both on separate IT systems but yet both part of the HHS; it’s impossible.  As part of my fellowship we are working to lean out the electronic Clinical Quality Measures (eCQM).  About 30% of the eCQM’s are developed by ONC and the other 70% at CMS so you can see why we need to collaborate on our lean efforts.   With the current IT infrastructure, in order to communicate, we have to do everything through email or over the phone, as you can imagine this is a nightmare for document control and makes it hard to know who’s on first and who’s on second. 

Fortunately as part of the fellowship we have a great support system from the Secretary’s Office.  I highlighted to the CTO for the Secretary who is sponsoring our fellowship that these tools would greatly impact the success of my fellowship.  He immediately scheduled time to meet with the other fellows and myself to help address our IT needs and was able to provide a solution path and connect me to the right folks to hopefully get a solution in place soon!!! 

A couple weeks later I ran into yet another policy obstacle trying to get approval for holding a Kaizen Event with feds and non-feds to create a defect free and streamlined eCQM process.  This is a non-trivial task in the private sector but not so much in the government.  Due to multiple policies in place there are certain rules and approvals that need to be completed.  This would take months to get through everything and I only have 12 as part of my fellowship.  Even if we wanted to hold a meeting where we pay for nothing this still is a violation of policy…I won’t bore you with the details but I do need to mention that every meeting hosted by the government I have never had breakfast or lunch provided as part of the meeting/conference.  This is the exact opposite from what I experienced out in the private sector.  This isn’t a huge deal but it was an “a-ha” moment for me as I was always under the assumption that the government spent money on frivolous items such as this.  I was definitely wrong on that one!!

I am happy to say that I believe that we have found a way to get the approvals and necessary documentation by working diligently with management in CMS/ONC and the Secretary’s Office to make this happen.  I have been very surprised and grateful for all the support I have received thus far. 

I am going to close on this note as I myself am starting to feel that this blog post is long enough.  I still have so much to share and am planning to blog again soon to talk about the beginning of integrating Lean into the CMS and ONC culture and also publish some of our initial Lean activities.  It’s going to be an exciting year and I have the pleasure of working with a ton of talented folks who are passionate about making change thus the being the main reason for why they took government jobs.  They even gave me a Minnesotan boss so we can exchange our hotdish recipes. 

Please email me if you would like to give me feedback on my blog or if you have any questions.  mindy.hangsleben@hhs.gov  Thanks for taking the time to read this. 

December 12, 2012
What a Picture is Worth

By Chris Lunt (), External Fellow for the Infrastructure of Medicaid & CHIP Project

Standing outside the Secretary of Health and Human Services’ office, people clustered nervously in small groups, waiting to be ushered in for the photo shoot.  Unlike the rest of the Hubert Humphry building, the anteroom is carpeted and wood-paneled, and I was self-concious of my lack of a necktie.  I don’t even own a tie.  The organizer called my group.  A set of awkward dances followed as we made our way past the exiting group, and were positioned for the photo.  Secretary Sibelius shook our hands and made some encouraging comments about our project, we smiled politely, and the photographer rescued us.  On our way out, I turned to one of the other fellows and whistled a bit of the circus song.  Is there anything more pointless than meeting the head bureaucrat just for the sake of a photo?

Later that day, we met a group who participated in prior government innovation projects.  They shared their understanding of what creates success and failure in changing an organization of this size and momentum.  When you’re introducing change, you must find a way to win over the loyalists and conservatives: people who believe in working within the hierarchy.  When asked to do something new, people will look up to their supervisor to see if the supervisor has bought in.  If not, no go.  

You’ve seen other changes fail—are you going to risk being connected with that failure if your boss didn’t like it in the first place?  What about your boss’s boss?  Peculiar to government is the regular replacement of leadership through political appointment.  People who believe in the mission of the organization want to stay there, and if you’re proposing something new, new equals risky, and their attitude may be, “I can wait you out”.

Now I understood the photo.  This was physical proof of buy-in at the top, and I appreciate it.

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