Bryan Sivak: Chief disrupter at HHS

Mission is to turn the culture on its head to bring about big changes in healthcare
By Tom Sullivan
10:31 AM
Bryan Sivak

The term disruption is perhaps a bit overused in the technology and healthcare sectors these days, but if there is one place where it’s needed most, that just might be the federal government.

In his role as CTO at the Department of Health and Human Services, Bryan Sivak is looking to inject innovation into his department, and others, drawing on experience gained in both the public and private sectors to bring about a culture change. Prior to HHS, Sivak was chief innovation officer of Maryland, CTO of the District of Columbia, and a founder of software companies InQuira and Electric Knowledge.

Government Health IT Editor Tom Sullivan spoke with Sivak about HHS programs that aim to improve traditional practices within the federal government by bringing people in from the outside world and tasking them with solving complex problems quickly, what he’s anticipating in the imminent second round of HHSentrepreneurs, and his take on former HHS CTO Todd Park’s vision to transform the department into the NOAA (National Oceanic and Atmospheric Administration) of healthcare.

Q: One of the HHSentrepreneurs told me that the program is, and I quote, “disrupting the traditional model of getting things done inside the federal government.” So what are the most disruptive aspects?
The key element is that we’re bringing people in who have very different sets of experience than your typical government employee but only giving them 12 months to execute, at the maximum. And because they’re coming in to solve some really interesting and somewhat difficult problems and they have such a limited timeframe they almost by definition have to do things in a different way. We’ve been seeing that across almost of the projects in the first round. To me, personally, it’s been very fascinating to see the roadblocks they’ve been running into and how they’re overcoming them. It’s been actually kind of wonderful.

[See also: Florida practice catches HHS attention.]

Q: What’s the most innovative example particular to the HHSentrepreneurs program?
I have a whole bunch. But just off the top of my head, one of our projects, with CMS and ONC, basically they have a joint program where they are determining clinical quality metrics. The idea is to take all this electronic data that health records are collecting and figure out ways to combine that data, generating algorithms, for example, that spit out measures of quality for various types of procedures and services. So the process itself is pretty interesting. When we started the project it took between 3 and 5 years to develop a metric because it's a relatively complicated process and there’s all kinds of documentation, different stakeholders, and other things. There’s this one guy who works at ONC, he came from a health system, his name is Kevin Larsen and at the health system he participated in some lean efforts — you know, lean manufacturing type of stuff, Six Sigma, etc. — and saw some amazing improvements within the health system. In fact, he said this is really a process that we could apply lean mechanisms to make it much more straightforward and streamlined. And so this woman, Mindy Hangsleben, who’s a lean expert, she quit her job at Intel and moved to D.C. for this yearlong position. The first thing she did, the first thing you do in any lean effort is look across the entire process to identify what your error rate is to try and figure out what’s going wrong and how often it’s going wrong. And the first thing she discovered is that this process had literally a 100 percent error rate — there was error in every step of the process. Which, honestly, we think is a good thing because that means there’s only one direction you can go. She dove right in with a lean methodology and they actually just ran their first measure through the new process and it went from 3-5 years to three months, which is pretty amazing.

But what’s even more amazing to me and the whole reason we’re doing this program is not necessarily to — I mean we do want them to be successful in solving the problems they’re here to solve — but really what we’re trying to do is change the culture in some of the areas of the federal government. And when you look at the people she’s been interacting with in these organizations, it basically changed their entire mindset around this lean methodology, even to the extent that a woman at ONC came up to me the other day and said, “I’ve even optimized my grocery shopping based on lean methodology.” If that’s not having an effect, I don’t know what is. So it’s been pretty amazing.

Q: I have to ask: Will you be publishing quality measures for grocery shopping?
We can ask about that. We could all use that. But that’s just one example. Each of the programs has its roadblocks and interesting ways of getting around that.

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