The rocky launch of Healthcare.gov raised new questions about government efficiency and the Department of Health and Human Services is working on answers. Officials there are encouraging entrepreneurship and innovation through a model they hope can be exported to other agencies. But as many “re-inventing government” initiatives over the years have shown–and as many federals worker can attest–changing the culture in a federal bureaucracy can be tough. Kojo explores the challenges of making government more efficient and effective.

Guests

  • Elaine Kamarck Founding Director,Center for Effective Public Management, Brookings Institution; Creator of the National Performance Review during the Clinton Administration; author of "How Change Happens—Or Doesn’t: The Politics of U.S. Public Policy" (Lynne Rienner, 2013)
  • Bryan Sivak Chief Technology Officer, U.S. Dept. of Health and Human Services

Transcript

  • 12:20:43

    MR. KOJO NNAMDIThe bumpy launch of the new healthcare.gov website is raising questions about government efficiency. Are government bureaucracies too stuck in their ways to succeed at innovation and to insist on the same performance standards as the private sector? Some agencies are tackling those questions head on, trying to change a culture where it's sometimes best to keep your head down and where it's easier to get funding for continuing projects than for new ones. The Department of Health and Human Services is one such place, with an effort underway to encourage entrepreneurship and to pair private sector experts with government workers.

  • 12:21:18

    MR. KOJO NNAMDIBut a quick glance through history shows many attempts to reinvent government and make it more efficient sometimes met with limited success. Joining me to look at the federal workplace cultures, Bryan Sivak. He is chief technology officer with the U.S. Department of Health and Human Services. Bryan, good to see you again.

  • 12:21:35

    MR. BRYAN SIVAKGood to see you as well.

  • 12:21:36

    NNAMDIAlso in studio with us is Elaine Kamarck. She is founding director for the Center of Effective Public Management at the Brookings Institution, creator of the National Performance Review during the Clinton administration, and the author of, "How Change Happens or Doesn't: The Politics of U.S. Public Policy." Elaine Kamarck, thank you for joining us.

  • 12:21:55

    MS. ELAINE KAMARCKThank you.

  • 12:21:56

    NNAMDIYou too can join the conversation. Give us a call, 800-433-8850. Do you work in the federal government? What would make your department or your agency function more efficiently? 800-433-8850. Bryan, this is not a discussion about healthcare.gov, but given your position I have to ask you, how were you involved in creating the website and what's your assessment of what may have gone wrong?

  • 12:22:19

    SIVAKWell, you know, the Department of Health and Human Services is a very, very large organization with a pretty broad remit across many different areas of health, healthcare, public health, human services, etcetera. I sit in the deputy secretary's office. And my remit is because I sit in that office, my remit is actually very broad. The Center for Medicare and Medicaid Services, as you might know, had responsibility for implementing healthcare.gov. And so as a result I really wasn't all that involved in the actual implementation of the website.

  • 12:22:54

    SIVAKIt's, you know, it's been interesting to watch. I think everybody's learned some lessons from this. You heard the president stand up and say that, you know, we want to take a look at how we do IT procurement and delivery across the federal government. And I think this has really been a very interesting moment for us to step back and take a look at what we can do going forward to make things work better.

  • 12:23:20

    NNAMDIElaine, we've all heard about the problems with the new healthcare.gov website. You've said it's not a case of intrinsic government incompetence with technology, but of poor management. How so?

  • 12:23:31

    KAMARCKWell, I want to bring up the fact that in December, as the healthcare.gov sites were having terrible trouble, we had three astronauts taking a space walk outside of the space station miles and miles above the Earth. That's quite an amazing technology. Now, how does that happen? It happened from a partnership, government, civil servants working with contractors. Boeing runs the space station, as the prime contractor on that. There's a contractor who makes the space suits that lets the astronauts go outside. So the fact is that government is not intrinsically bad at doing technology actually, and there are some places where it's quite spectacularly good at doing technology.

  • 12:24:20

    KAMARCKBut there is a way to manage technology and this, I think the healthcare.gov experience was a management failure more so than anything intrinsic to the government.

  • 12:24:32

    NNAMDIBryan, the public perception of government is that there's a lot of red tape and frustrating bureaucracy. How would you describe the workplace culture inside the government? And how does it affect the ability to foster creativity and innovation?

  • 12:24:45

    SIVAKSo one of the things that I've seen now across all of the different levels of government that I've worked at, both local here in D.C., the State of Maryland and now in the federal government, is really that we -- the stereotype of the public sector bureaucrat is actually kind of a false stereotype. You know, I went into government -- when I first got there my impression of the public sector bureaucrat was I think the stereotype, you know, the clock-punching bureaucrat who's just riding out a pension.

  • 12:25:17

    SIVAKWhen I got there -- and this has really persisted throughout all of the different jobs that I've done -- I have found some of the most amazing people that I've ever worked with, who are there for the right reasons, who are all focused on actually doing the right things to advance whatever sector it is that they're working in.

  • 12:25:34

    SIVAKBut they're stymied often by red tape, by bureaucracy, by incentives that are sometimes set incorrectly, by a lack of freedom in terms of the way that they're allowed to experiment with new ideas. And so these are all the things that we're working on trying to change right now, is to provide an environment, to provide a new setting where people are able to have the freedom to experiment, to have the freedom to try new things, to make it okay if an experiment fails, as long as you learn from that experiment and fold those learnings back into the next iteration. And that's really a big focus of what we're trying to do right now.

  • 12:26:12

    NNAMDIWe want to get to the project you're working on specifically, but I need to get back to Elaine because the analogy you made is really a fascinating one, with the fact that we had astronauts dangling in space. You also I think mentioned the fact that we have drone strikes going on all over the world that are carried out…

  • 12:26:27

    KAMARCKSure.

  • 12:26:27

    NNAMDI…with some degree of efficiency. Do we in the public tend to make a distinction between the government and NASA, between the government and the intelligence agencies?

  • 12:26:38

    KAMARCKWell, we do. What happens when you ask these big broad programs, right, do you trust the government, etcetera, the government gets pretty bad marks. It gets bad marks because people don't like the IRS, etcetera, etcetera.

  • 12:26:53

    NNAMDIBut we love NASA.

  • 12:26:54

    KAMARCKBut we love NASA. When you break down the big government -- remember the federal government is 2 million people -- and if you put the federal government's real estate together they'd be about the size of Tennessee. Okay. So it's a big thing. When you break down the government people really like some parts of the government.

  • 12:27:11

    KAMARCKThey really like the Defense Department. They love NASA and the space exploration and all that stuff. And so when you break it down you get a different story. Even at HHS, when you do -- because the government does customer survey standards throughout the government. When you ask people about their experience signing up for Medicare, signing up for Social Security, guess what? They get great reviews.

  • 12:27:38

    KAMARCKOkay. They've got it down. So this image of all of government -- you've got to break it down a little bit because people really have different experiences and different evaluations with the parts of government.

  • 12:27:51

    NNAMDIIt's like the duplicitous feelings we experience between our letter carriers and the post office.

  • 12:27:55

    KAMARCKOh, that's precisely right. Although, you know, interestingly enough, the post office continually does really well in surveys. People like the post office.

  • 12:28:06

    NNAMDINot as much as we love our mail carriers.

  • 12:28:08

    KAMARCKYou know, but not as much as we love our individual mail carriers, that's for sure.

  • 12:28:12

    NNAMDIBryan, you've been working on a project inside the Department of Health and Human Services called the IDEA Lab. Tell us about that.

  • 12:28:18

    SIVAKSure. So we're actually launching the IDEA Lab sort of officially today. This, really the IDEA lab, the word IDEA stands for innovation, design, entrepreneurship and action. And each one of those things has a very specific meaning to us. Innovation, we believe is a direct result of the freedom to experiment.

  • 12:28:38

    SIVAKWe believe that this ability to experiment and to experiment effectively is incredibly important. The D stands for design. One thing that government tends not to do very well is good interface design, user experience design and things like that. Customer service is a great example of this. And so we believe that by focusing on this we can communicate ideas in a much more effective fashion.

  • 12:28:59

    SIVAKEntrepreneurship because obviously a spirit of entrepreneurship is required to actually try to do some of these experimental and innovative things. And then action. And to me this might be the most important one. We can sit around and noodle on ideas for a long, long time and deliberate and have meetings and have more meetings and have more meetings about those meetings, but until we actually sit down and do something we never get anything done. And so we are big believers in taking that first step, breaking things down into small increments and rapidly iterating over these ideas.

  • 12:29:31

    SIVAKSo the IDEA Lab then, in a nutshell, is really sort of considered a safe space for experimentation within HHS, consisting of a number of different pathways that are designed for different scenarios. So one might be if you're an individual contributor and you have an idea that is challenging to try out within the government, we want to give you the resources and the ability to rapidly experiment with that idea.

  • 12:29:58

    SIVAKMaybe you're a program that wants to try something different, but you lack the skills internally to do that. Well, we want to make it easy for you to bring somebody in from the outside world on a very limited basis in terms of time, who can help to execute this idea in a new a different way.

  • 12:30:12

    SIVAKAnd by the way, none of these things -- they might not be successful, and that's okay. We want to encourage this idea of experimentation, of the idea of people actually trying new things, and making it okay in some cases to have an experiment that does not go well.

  • 12:30:29

    NNAMDIMaking it okay and trying new things apparently means that it doesn't really matter what one's position is in the hierarchy. One of your goals is to place value in people's skills, as opposed to placing value on their position in the hierarchy. How do you do that?

  • 12:30:45

    SIVAKWell, you know, one of the hierarchical organizational structures are sort of an artifact of the late 1800s and early 1900s in terms of the way that corporations and organizations have been structured. And you're seeing a lot of new organizations -- some big ones and some small ones -- experimenting with new methods of organizing that actually get away from this sort of typical, organizational structure and move more into a structure that allows people to contribute based on their skills and based on the things that they find interesting, rather than a specific job description for a box on a (unintelligible) chart.

  • 12:31:25

    SIVAKOne of the best examples of that recently, actually, is the company Zappos.com. They recently announced a couple of months ago that they were implementing this new system called holacracy, which is a relatively -- it's a very new and somewhat interesting idea which organizes a company in what they call circles, circles of influence. And they have a sort of strict set of operating procedures around how these circles work.

  • 12:31:49

    SIVAKIt's an experiment and people are watching it very closely to see if it'll work. But we're trying to kind of accomplish the same thing without dramatically changing the bureaucracy or the organizational structure at HHS by empowering people at lower levels to try new things without having to, you know, get 18 different levels of approval, without having to, you know, get the lawyers to sign off on every crossed T and dotted I and things like that.

  • 12:32:15

    NNAMDIBryan Sivak, he's chief technology officer with the U.S. Department of Health and Human Services. He joins us in studio along with Elaine Kamarck. She is founding direction of the Center for Effective Public Management at Brookings Institution and creator of the National Performance Review during the Clinton administration. She's also the author of "How Change Happens -- Or Doesn't: The Politics of U.S. Public Policy." 800-433-8850 is our number. Do you think federal agencies reward innovation and entrepreneurship among their employees? Give us a call or not, 800-433-8850. You can send email to kojo@wamu.org.

  • 12:32:53

    NNAMDIElaine, what are the challenges for a government that has to serve everyone, as opposed to a private business that does not? How does that affect the ability to streamline operations?

  • 12:33:03

    KAMARCKIt affects it profoundly because, you know, if you don't want to buy books on Amazon, you don't have to. Okay. That's kind of your choice. You have some other options, big deal. Amazon does not have to serve everyone. The government has to serve everyone. And this of course is one of the big failures in the ObamaCare rollout, which is that it assumed a level of technical competence across the entire population. You know, it's sort of amazing. The IRS has been letting you file your taxes online for 20 years now. And most Americans do file their taxes online.

  • 12:33:47

    NNAMDIBut some don't.

  • 12:33:47

    KAMARCKNonetheless, you can still go into a post office and get tax forms. You can pick up the 1040EZ, you can download it from a computer and write it out by hand. There needs to be redundancy in government programs in a way that there doesn't need to be in the private sector. And you need redundancy because you have the obligation to reach 100 percent of the population, not just the percent of the population that's online. And so this, I think, is one of the biggest failures of this -- not just rollout, but the idea of customer service. Why wasn't there an option to have a form sent into a place where civil servants would scan the answers into computers and do that work?

  • 12:34:36

    KAMARCKAnd that, I think it's particularly visible in the Affordable Care Act, but I think it goes across government. Government needs to be able to reach people at every level. You can't just go online. You still have to have telephones, you still, in fact, have to have offices. Social Security Administration has online, it has phone service and it has old-fashioned offices where you walk in. And that's why the government is fundamentally different from the private sector.

  • 12:35:10

    NNAMDIBryan Sivak, one of the things you're doing is bringing in outside talent to partner with government employees on projects with a limited time frame. How does your HHS Entrepreneurs program work? And what are examples of projects that you've tackled through these public/private match-ups?

  • 12:35:27

    SIVAKSo the general idea of HHS Entrepreneurs is to essentially find what we consider to be high-risk/high-reward projects within the department, and bring people in with different types of skills that can help address some of the challenges that we have. But because they come in on a limited time frame -- 12 months generally speaking -- they kind of have to "break some rules." Right? I mean we're not going to officially break any rules, but they have to do things differently than what the typical public sector employee would do.

  • 12:36:01

    SIVAKSo a couple of great examples, last year in our first cohort of HHS Entrepreneurs we had a project that was working on changing the nation's organ transplant system. So this is something that HHS manages. And one of the challenges is that when you procure an organ from a donor that organ has to be labeled and transferred to the recipient.

  • 12:36:32

    SIVAKAnd currently the process for actually doing that labeling and transfer is relatively archaic. It uses Sharpies and stickers. And there are lots of reasons for that, but one of the things that HHS wanted to do was investigate ways of, for example, maybe tagging an organ with an RFID tag so that we could scan it on the departure from the operating room and then scan it in on the arrival and have all the information transmitted across.

  • 12:36:59

    SIVAKWhat was interesting about this problem as part of the HHS Entrepreneurs program is that we brought in a fellow named David Cartier who worked at UPS. He quit his job at UPS to actually come and do this. And he was all set to work on this idea of RFID tagging, you know, organs and figuring out that system would work. But he decided first to go and watch a few procurements and see exactly what happened.

  • 12:37:24

    SIVAKAnd what he realized was that the solution that we had prescribed to this problem was actually not the most fundamental issue to solve. The most fundamental issue to solve was to actually remove the requirement for docs to actually write with Sharpies on stickers, all of this information about these organs and these patients, and actually start doing that electronically so that all of that information was actually captured somewhere and could be sent.

  • 12:37:48

    SIVAKAnd what I really like about this is that he didn't just come in and say, okay, I'm here to implement RFID tagging. Right? He came in and said before I do this, I'm going to take a customer centric view of the problem. I'm going to look at what the actual issues might be. And, you know what, I'm going to propose a different solution that we can rapidly iterate on to see if we can actually solve the problem.

  • 12:38:10

    NNAMDISo UPS -- because he'd had the experience at UPS of doing what he did, he comes in with a different set of eyes, so to speak.

  • 12:38:18

    SIVAKExactly.

  • 12:38:19

    NNAMDITo look at the problem. On to the telephones now, we will start with Ann, in Arlington, Va. Ann, you're on the air. Go ahead, please.

  • 12:38:28

    ANNHi, Kojo. Thanks a lot. This is a great topic. I'm about to take my project management certification class because of my frustration as a contractor in this town trying to work and collaborate with, you know, on job sites with federal workers or other contractors. And I just want to say that, you know, good management is an art. And it's lost on a lot of people because basically there's a lack of accountability, lack of people taking time to allow new people they roll on time to adjust to internal processes and procedures. And really what you're dealing with in today's workplace is this balance of technology on one hand and people.

  • 12:39:17

    ANNAnd good managers, whether they're in the government or in the corporate, private sector, need to be able to manage both, technology where operating systems, different people on a project, maybe working with different operating systems or different versions of software. And there's often a real lack of sort of ramping everyone up and getting everyone on the same page.

  • 12:39:41

    ANNAnd the culture of federal worker versus contractor that I've seen acted out on government sites is really toxic. You know, contractors are resented and yet, have little job security when it comes to issue resolution and a lot of fed workers tend to feel threatened by somebody who might have an idea that's not theirs.

  • 12:40:01

    NNAMDISo you're really identifying two different sets of problems. The one is management as it applies to technology and people, and the other is a resentment of federal contractors. Allow me to have Bryan Sivak and Elaine Kamarck respond. Elaine.

  • 12:40:20

    KAMARCKI think that, Anne, you're bringing up a big problem these days. And if you look at what's happened over the last 20 to 30 years in the federal workforce, there has been a movement to use more and more contractors and fewer and fewer civil servants. Now part of this is a failure of reform in the civil service itself. So the civil service now is seen by many executives to be -- and by Congress to be too inflexible to get the job done.

  • 12:40:54

    KAMARCKAnd so they resort to contractors. There's also been a tendency to try and limit the number of people in the government that's driven by big political push, and so the money goes to contractors. The fact of the matter is that we lost the sense of balance over the core question, what is a core governmental responsibility? And we lost it -- I can tell you exactly when we lost it.

  • 12:41:25

    KAMARCKWe lost it in the first decade of this century when the Bush Administration proposed the famous OMB Circular A-76, which basically said it was the policy of the government to contract out work whenever possible. Well, guess what? The government took that to mean that we should contract over having civil servants do the work. And we are now seeing the results of that which is too much work has been contracted out that shouldn't have been, that should be in the federal government.

  • 12:42:00

    KAMARCKSo I'd say that what you're pointing to, Anne, is two problems, a problem of civil service that needs to be very much updated -- I mean, the legal structure of it -- and you're looking at a problem of too much work has been contracted out for really ideological reasons and not for the reasons it should be, which is asking whether or not it makes more sense from an efficiency standpoint to contract it out than to do it in-house.

  • 12:42:31

    NNAMDIBryan?

  • 12:42:32

    SIVAKSo I just want to add a couple of things to that. Anne, I couldn't agree with you more that good management is an art, and it's incredibly important to get it right in order to make sure that we do some of these things the right way. One of the things that's really struck me recently is that we tend to focus internally inside the government on -- and incentivize on following process rather than delivering outcomes.

  • 12:42:56

    SIVAKAnd delivering outcomes is really this key element that we need to get back to. We need to think about why we're doing something and work on actually rapidly executing on ideas and managing systems in such a way that we can actually see deliverables quickly and adjust them in real time so that we actually get to the right place. This is agile development in a nutshell.

  • 12:43:16

    SIVAKThe second piece, though -- and I think you sort of touched on this, which to me is maybe even more important -- is this idea of culture. And I believe that the culture is possible to shift. We've seen some examples of it. I'll give you another example from our HHS entrepreneurs program actually. We have -- one of the things that HHS does is develop quality metrics for physicians and for hospitals and things like that so that we can actually tell what the quality of the healthcare system actually is and the quality of the outcomes.

  • 12:43:46

    SIVAKThe process of creating a quality metric is actually relatively complex. There are a lot of different stakeholders in the process, a lot of different data inputs and outputs. Algorithms have to be created and tested and generated. But the process itself is very lengthy. It takes between three to five years to develop a single quality metric.

  • 12:44:05

    SIVAKOne of the folks at the Office of National Coordinator for Health IT and his counterpart in a specific group within the Center for Medicare and Medicaid Services recognize that, based on some of their past experience in the outside world, they could potentially leverage lean management techniques to kind of come in and redo some of these processes.

  • 12:44:25

    SIVAKAnd so we brought in this woman, Mindy Hangsleben, who again quit her job at Intel, moved across the country for 12 months, to come and work at HHS to solve this problem. And a few remarkable things happened. First of all, she was able to -- when she first sat down to do a study of the process that we have right now, she discovered that we literally had a 100 percent error rate.

  • 12:44:44

    SIVAKThat meant that there was an "error" in every step of the process which required rework or redoing something. I looked at that as a good thing because it meant that there was only one direction to go from there, and we could only get better.

  • 12:44:55

    SIVAKBut what happened when she got everybody together and started going through this lean process is not only was she able to reduce the time that it took to generate a quality metric from three to five years to three to five months, which is a massive improvement, but she got contractors and federal employees and outside third parties to actually, for the first time, understand what everybody else was doing, what their challenges were, what some of their unique issues were in terms of what they could and couldn't do or what they thought they could, couldn't do. And the reason she was able to make this massive change is because the culture shifted. And when I saw that, it really blew me away.

  • 12:45:32

    NNAMDIGot to take a short break. When we come back, we'll continue this conversation on boosting government efficiency. If you have called, stay on the line. If the lines are busy, shoot us an email to kojo@wamu.org. What's your prescription for how to make government more efficient? You can also send us a tweet, @kojoshow. I'm Kojo Nnamdi.

  • 12:47:34

    NNAMDISo much to say, so little time. We're talking about boosting government efficiency with Elaine Kamarck. She's the founding director of the Center for Effective Public Management of Brookings Institution. Also in studio with us is Bryan Sivak. He is chief technology officer with the U.S. Department of Health and Human Services. Elaine, during the Clinton Administration, you were involved in reforming both the Federal Aviation Administration and the Internal Revenue Service. What happened in those two cases?

  • 12:48:02

    KAMARCKWell, FAA was a particularly interesting case. They were using very, very obsolete technology. In fact, they were using something called vacuum tubes, which used to be in the back of our televisions when you and me, Kojo, were kids, okay?

  • 12:48:17

    NNAMDIYes.

  • 12:48:18

    KAMARCKAnd they -- in fact, then we went up to the Hill, and we said, look, this agency needs a real remake. And it needs a lot of flexibilities for its IT procurement, etcetera. We were initially met with a very cold shoulder. And then, lo and behold, someplace, somewhere in '95, '96, there was a real crisis in the air traffic control system with a couple near-misses going on at airports around the country.

  • 12:48:46

    KAMARCKThat woke everybody up. We got legislation through. They got a different procurement and civil service law that were unique to the FAA. And while there's certainly nothing perfect about the FAA these days, they're not using vacuum tubes. So things have improved a lot. IRS, 1995, '96, there was a terrible problem with people -- lots of, you know, sort of people complaining that the IRS was being really obnoxious to them and going after back taxes, etcetera.

  • 12:49:22

    KAMARCKWe got called in and kind of looked around and did some talking -- and going down to the grassroots and talking to people is not new. We did it all the time -- and discovered that IRS investigators were paid on the basis of cases closed. So, guess what, it was a lot easier to bully an old lady, a widow, into settling with the government than it was to get a medium-sized company or a large company with a lot of lawyers.

  • 12:49:51

    KAMARCKThat resulted in a big transformation inside of IRS, a new law in 1997, a transformation that allowed them to look at customers differently, not treat, you know, big corporations the same as widows. And while nobody loves the IRS -- and it certainly has had its share of scandals -- the fact is that, operationally, it has been working fairly smoothly since then. So those are the kinds of things that we did on an agency-wide basis.

  • 12:50:22

    NNAMDIBryan, we got a post on our website from Jack who says, "The comparison between NASA and HHS failed to mention a critical difference. At NASA, the government workers thoroughly understand the technology they're trying to manage and are in a position to sensibly evaluate the work of the contractors. At HHS, there's a deficit in the understanding of information technology, and the government workers managing the program are unable to participate in a meaningful dialogue about the work, much less evaluate it." What do you say?

  • 12:50:51

    SIVAKWell, my first reaction is that that's a pretty broad brush.

  • 12:50:55

    NNAMDIYes. The assumption that everybody at NASA is very technology hip may not be true.

  • 12:50:57

    SIVAKExactly. Yeah. Yeah. And in the, you know, converse, the fact that everybody at HHS is not...

  • 12:51:04

    NNAMDIIs not.

  • 12:51:04

    SIVAK...technology savvy. And so I think that in any large organization, you'll see both kinds, right? Now, I will also -- I will agree to a certain extent in that one of the challenges that the federal government has -- and actually many governments, not just the federal government -- is that, especially in this day and age of, you know, well-paid technology positions in lots of, you know, great places to live, it's -- we have to be competitive in areas that we're not necessarily competitive, from a financial perspective and others, that make it hard for us to get the right kind of people on board.

  • 12:51:39

    SIVAKYou know, we -- if we're going to hire -- if we want to bring in, you know, a top programmer in a modern language that we're going to competing with Google and Facebook and a whole bunch of other people on, we're going to have to figure out how to incentivize that person in many ways. Now we're not going to pay them the kind of salaries that Google and Facebook can. We know that. But there are other incentives.

  • 12:52:00

    NNAMDIBut you've said that every HHS employee should feel like creativity and innovation are rewarded. How do you create a culture that values those things?

  • 12:52:09

    SIVAKSo what we're trying to do is lead this by example, right? And we believe that if we can prove to people that it is okay to experiment, that it is okay to try your new ideas, that it's okay to push the envelope in different ways, that provides a very interesting incentive, right? Because one of the great things about working at HHS and working in the federal government is that you're doing work that matters, right?

  • 12:52:32

    SIVAKYou're doing things that have real impact on real people and can really help to move this country forward in a positive way. And so if you, as an individual contributor, feel like your ideas are possible to at least try to implement, then we will be able to actually have these right incentives in place to bring the right kinds of people on board.

  • 12:52:51

    NNAMDIOn to Selwyn in Laurel, Md. who wants to underscore, I think, a point you made earlier, Elaine. Selwyn, go ahead. You're on the air. Go ahead, please.

  • 12:52:58

    SELWYNHi. Thanks for taking my call, Kojo. I'm amazed -- and I have about 20 years' experience in information technology -- that they really tried to develop an application that should reach, I would say, technically 100 percent of the population in a year. You just cannot -- it's impossible to do that. It would take you about -- for such a large application, it has to interface with all the states and the healthcare industry.

  • 12:53:30

    SELWYNYou -- it would take you more than a year just to design the thing. So I was amazed when they said they were going to roll it out. And I said, that's not going to work. I was surprised it even came up (unintelligible) able to bring the application up.

  • 12:53:46

    NNAMDIWell, let me add something to that because that underscores a point that Elaine made earlier about the government having to serve all of the people and that all of the people are not necessarily online. But, Elaine, you've also said that the worst government bureaucracies are often the ones that run the most contested programs -- and obviously the Affordable Care Act is a highly contested program -- those that have been repeatedly amended in Congress, litigated in the courts. Why is that and what can be done about it?

  • 12:54:14

    KAMARCKWell, what happens is it goes to the culture that Bryan is trying to create. When civil servants are working in an area that is contested and unpopular and subject to partisan wrangling, which certainly healthcare is -- I mean, it's probably the most contested area of policy we've seen since the Iraq War. What happens is the natural human tendency, when both ends of Capitol Hill are shooting at each other, is to duck so that you don't get hit by any of the bullets.

  • 12:54:49

    NNAMDIMm hmm.

  • 12:54:50

    KAMARCKAnd so without really, really strong White House backing, without the protection of the president, without some serious congressional allies, it is actually difficult to -- and it's unrealistic to expect that your average civil servants are going to really take a lot of risks and stick their neck out. And so that's why you find in contested parts of the government -- Environmental Protection Agency is one of the ones that's been contested for a decade now -- you find that there is a withdrawal from innovation for obvious reasons.

  • 12:55:27

    KAMARCKFailure in something in the contested part of the government becomes an instant political crisis. It becomes a hearing on Capitol Hill. It gets on the front pages of the newspaper. Failure in an area of government where people are -- where there's broad political support, you know, it's folded into the process. And so that's why you do see different levels of innovation, depending on the program.

  • 12:55:55

    NNAMDIRunning out of time, Bryan, but you have said that you don't want the department to be a haven for the risk-averse but to be a place that attracts change agents. What are you looking for in the workforce of the future? And how do you compete with the private sector for a limited supply of the best and the brightest?

  • 12:56:12

    SIVAKWell, I mean, so, first, I want to react to something that Elaine said...

  • 12:56:14

    NNAMDIPlease do.

  • 12:56:15

    SIVAK...which is I totally agree in terms of having the sort of broad support. And one of the reasons that we're able to do what we do is because not only do we have the complete support of the secretary and the deputy secretary to do these things, but this also fits in with the president's innovation agenda and the things that he's talked publicly about in the past. And so we do have that sort of level of air cover, if you will, to go about doing these things which is important. In terms of...

  • 12:56:43

    NNAMDIWorkforce of the future.

  • 12:56:44

    SIVAKYeah. So, you know, what we need to -- you know, I saw an interesting statistic the other day which suggested that in the next few years a pretty significant portion of the federal workforce is going to be eligible for retirement, and this is actually true in both state and local as well. And what that means is that we're going to have to start looking to the younger generation for new employees, new public servants.

  • 12:57:05

    SIVAKAnd I'll tell you, I know a lot of Millennials, and they're not the ones who are going to love to come into these concrete bunkers that we've got and sit down in cubicles and be told what applications they can and can't use and what, you know, what they can do with their smartphones and what they can't. And these are the kind of mindsets that we need to start figuring out how to change and the types of things that we need to figure out how to enable so that we can bring in the best and the brightest of this new generation.

  • 12:57:29

    NNAMDIOnly have about 30 seconds left, Elaine. But from Al Gore's National Partnership for Reinventing Government to the more recent Government 2.0, lots of attempts over the years to make government function more efficiently, how optimistic are you that it's an achievable goal?

  • 12:57:44

    KAMARCKI think that if you look back, what the Al Gore's program did was modernize the government, brought it into the information age. Most of what we did 20-some years ago is now standard operating procedure in the government. And it's probably time that we do another government-wide review, take all the things Bryan was talking about, only expand them to the full federal government.

  • 12:58:08

    NNAMDIElaine Kamarck, founding director of the Center for Effective Public Management at Brookings Institution. Bryan Sivak is chief technology officer with the U.S. Department of Health and Human Services. Thank you both for joining us.

  • 12:58:18

    SIVAKThank you.

  • 12:58:19

    KAMARCKThank you.

  • 12:58:20

    NNAMDIAnd thank you all for listening. I'm Kojo Nnamdi.

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