The Three Rules of Obamacare's Trauma Team

Time has a an article on the Trauma Team that rescued Obamacare.

Monday, Mar. 10, 2014

Obama’s Trauma Team


Last Oct. 17—more than two weeks after the launch of—White House chief of staff Denis McDonough came back from Baltimore rattled by what he had learned at the headquarters of the Centers for Medicare and Medicaid Services (CMS), the agency in charge of the website.

McDonough and the President had convened almost daily meetings since the Oct. 1 launch of the website with those in charge—including Health and Human Services Secretary Kathleen Sebelius, CMS administrator Marilyn Tavenner and White House health-reform policy director Jeanne Lambrew. But they couldn’t seem to get what McDonough calls “actionable intel” about how and why the website was failing in front of a national audience of stunned supporters, delirious Republican opponents and ravenous reporters.

One excellent point are the three rules that most of us know work well for an effective team.  In this case it was the Trauma Team to make Obamacare work.

Dickerson quickly established the rules, which he posted on a wall just outside the control center.

Rule 1: “The war room and the meetings are for solving problems. There are plenty of other venues where people devote their creative energies to shifting blame.”

Rule 2: “The ones who should be doing the talking are the people who know the most about an issue, not the ones with the highest rank. If anyone finds themselves sitting passively while managers and executives talk over them with less accurate information, we have gone off the rails, and I would like to know about it.” (Explained Dickerson later: “If you can get the managers out of the way, the engineers will want to solve things.”)

Rule 3: “We need to stay focused on the most urgent issues, like things that will hurt us in the next 24—48 hours.”

Can you imagine the disruption of the chain in command?  An example is the executive Zients who chooses to use the Apollo 13 analogy.

Zients isn’t a techie himself. He’s a business executive, one of those people for whom control—achieved by lists, schedules, deadlines and incessant focus on his targeted data points—seems to be everything. He began an interview with me by reading from a script crowning the team’s 10-week rescue mission as the White House’s “Apollo 13 moment,” as if he needed to hype this dramatic success story. And he bristled because a question threatened not to make “the best use of the time” he had allotted. So for him, this Apollo 13 moment must have been frustrating—because in situations like this the guy in the suit is never in control.