Toward the end of 2009, I was hired to be a GS manager for a government agency (defense-related). Three of the four members of the office had suddenly left, and there was some hinted turmoil as I walked into the job.
My job was to clean up a million-dollar renovation project. I won’t go into the vast details of the mess....but the general issue I came to after four weeks of review (figuring how to restart the project and complete it)...was that the director and staff were continually changing the requirements after we’d noted the requirement and budgeted the project. We were three months behind, and had wasted a quarter of the budget already by redoing portions of completed work.
I simply sat there at every subsequent meeting and refused to change anything. It was....as is. There was arguments, but in the end....nothing else changed, and a year later, we completed all of the projects.
The thing about project management...you lean toward thinking over the completed image...write the requirements...and double-check it before you budget the money and sign contracts. After that point....unless a wall fails, a pipe bursts, or termites are discovered...you don’t change nothing and complete everything as-is.
I will also offer this wisdom in life...when you sign on to build yourself a house....you do the same strategy...no changes in the scheme of the house or redesigns in the middle of the construction.
People need to think long-term and know the consequences of continual changes. Nothing is free, and once you squander your budget....you are screwed. In this case....$400 million is gone, with nothing to show for it. I’d personally fire the IT manager and project manager over this database platform. Neither are competent to withstand pressure from above, and neither did their job.
Note: I quit the gov’t job at the end of June because of continued incompetence that I saw within the government. Between that and sequestration...it’s a ship run by a bunch of fools...bound and determined to hit some iceberg. Nobody can practice budget control and project management.
They can’t do market-based human resourcing either. If you bid out a contract to lowest bidder, then the high skilled workers don’t apply or incumbents flee when they cut their pay! DUH! That’s a big reason the gubmint is FUBAR.
You know the entire game is screwed up when there are “open seasons” and “closed seasons” for any changes in enrollment.
I generally agree with your assessment in Construction project management as it takes as much time to change the scope of work in a change or mod to the contract as it takes to write a new contract. Those scoping the work need to focus on usably complete finite projects instead of fixing everything as it comes along.
The healthcare industry is much more complicated.
It has at least 7 major components, in which the primary transaction parties never really complete their transactions between themselves, i.e. Dr and Patient.
Dr gets paid by the Drs Group, which authorizes a Pharmacy and Lab to work, who bill both the patient and the insurance company and the Drs Group pays to a Hospital for space and services and requires their records from Admissions, Emergency Rooms, and secondary labs and Pharmacies.
Some people think a single payer system will solve many problems, except it builds in bureaucracy where the model is overly complex already because everybody wants to be in charge of a larger system helping everybody.
Here is what is funny about the model.
It boils down to the patient and the doctor. You can double the salary of the Dr and not change the cost of healthcare by even 1%. Generally speaking, the Patient never directly pays the doctor. Many Doctor’s offices treat copays like petticash for the receptionist’s slush fund.
Each of the above entities operate and may be modeled, luckily in one relational database. Grouping them together, you need to migrate about 7 RDBMS into one system, which takes about 6mo to 5 years and half a mil in effort per hospital in a regional area, say a municipality or about the size of a county, say about 1 mil people.
These projects are not scalable.
Working in parallel, you might be able to get the entire nation working in parallel in about a decade as a goal, but realistically, you will have pockets of gross impropriety to complexity scattered on a national map, looking somewhat like election results.
It would be easier to purge all healthcare from the US, begin with a Doctor’s Corps, and start from the bottom up, than to implement the beast they seek to tangle. (no I don;t favor that approach,...govt needs to stay out of it, or confine themselves to a small part of the market,...like say,...Oh, Medicaid and Medicare.)
From concept to design to development to construction/manufacturing, the cost of a change goes up 10x with each life cycle state.
That they kept changing it in development and construction/manufacturing is poor change management and poor management overall.