healthcarereimagined

• Paul Leinwand
• Joachim Rotering

November 17, 2017

Summary.   

Research has shown that only about 8% of company leaders excel at both strategy and execution. But more and more, we need leaders who can do both. Leaders who master both strategy and execution start by building a bold but executable strategy, addressing the questions “What are we great at?” and “What are we able to achieve?” rather than coming up with lofty plans and asking functional and business-unit teams to do their best to execute. Next, leaders must ensure that the company is investing behind the change, which means linking the budget closely to the strategy. Finally, leaders need to make sure the entire organization is motivated to go the journey. Great leaders know that success stems from specific skills that come together in unique ways to do the challenging tasks in executing the strategy.

For decades, we’ve often thought of leadership profiles in unique buckets—two popular varieties were the “visionaries”, who embrace strategy and think about amazing things to do, and the “operators”, who get stuff done. We intuitively knew that there must be leaders that span these areas, but in fact, few do. According to a global survey of 700 executives across a variety of industries conducted by Strategy&, the strategy consulting division of PwC, only 8% of company leaders were said to excel at both strategy and execution.

You may think that success can be achieved by excelling at either strategy or execution individually—that great visionaries can change how we see the world, or that amazing operators can wind up outperforming competitors. But our experience and research suggests that the days of keeping strategy and execution as separate topics are ending: We need leaders that can create big promises to customers, and help their organizations deliver on those promises.

Take Starbucks: CEO Howard Schultz created a very ambitious aspiration for the company, far more than just being a seller of coffee. He wanted Starbucks to be a “third place” for conviviality beyond home and the workplace. Visit a Starbucks anywhere in the world, and you will find the same consistently comfortable and welcoming ambiance. But he didn’t get there simply by telling his staff to “be warm and friendly”.

Starbucks has been able to deliver on its promise because that promise is tightly linked to the company’s distinctive capabilities. The feel of Starbucks stores isn’t created merely by the layout and the décor—it exists because the people behind the counter understand how their work fits into a common purpose, and recognize how to accomplish great things together without needing to follow a script.

INSIGHT CENTER

• The Gap Between Strategy and ExecutionAligning the big picture with the day-to-day.

Over many years, Starbucks has built a capability to foster a relationship-driven, “employees-first” approach. It was Schultz who famously said “You can walk into [any type of retail store] and you can feel whether the proprietor or the merchant or the person behind the counter has a good feeling about his product. If you walk into a department store today, you are probably talking to a guy who is untrained; he was selling vacuum cleaners yesterday, and now he is in the apparel section. It just does not work.”

Schultz made sure that Starbucks would be different: Workers are called “partners” rather than employees, and even part-time staff (in the U.S.) receive stock options and health insurance. At the height of the global financial crisis, when other companies were cutting HR costs wherever they could, Starbucks invested in staff training, including coffee tastings and courses that ultimately qualified employees for credit at higher education institutions. Beyond employees, much of what you will see and experience at Starbucks has been well thought out to accomplish the company’s mission, from the music played to the furniture selected. Even the bathrooms are strategic at Starbucks, because they play a part in allowing customers to spend time in the “third place.”

Leaders like Howard Schultz don’t just have both the visionary and operator skills—they deeply value the connection between the two skill sets. In fact, they see them as inextricably linked, since a bold vision needs to include both a very ambitious destination and a well-conceived path for execution that will get you there. This is ever more important today, where differentiating your company is so difficult. Differentiation increasingly requires more innovative thinking, and the use of very specific areas of expertise (like Apple’s winning design, a capability that wouldn’t have been prioritized in most technology companies before Jobs).

Leaders who master both strategy and execution start by building a bold but executable strategy. Next, they ensure that the company is investing behind the change. And last, they make sure the entire organization is motivated to go the journey.

Developing a bold but executable strategy starts with making sure leaders have addressed the questions of “What are we great at?” and “What are we able to achieve?” rather than coming up with lofty plans and asking functional and business-unit teams to do their best to execute. Indeed, they spell out the few differentiating capabilities that the company must excel at to realize the strategy.

Ensuring that the company is investing behind the change means that leaders recognize that the budget process is one of the most important tools in closing the strategy-to-execution gap. Cost isn’t an exogenous variable to be managed—it is the investment in doing the most important things well. But rarely are budgets linked closely to the strategy. If your company is merely incrementalizing the budget up or down by a few percentage points, ask yourself whether the investments are really reflective of the most important tasks.

Motivating individuals is a hugely underleveraged tool to close the gap between strategy and execution. Great leaders know that success stems from specific skills that come together in unique ways to do the challenging tasks in executing the strategy. But today most employees don’t even understand how they are connected to the strategy. In a recent (not-yet-published) survey of 540 executives, managers, and non-managers by Strategy&, only 28% of employees said that they feel fully connected to the purpose and identity of their organization. Articulating the strategy in human terms—what capabilities the company will need to build, and what skills are required to do so—not only helps the company focus on how to develop the right talent, but it allows individuals to understand how their role fits into the overall strategy, and allows them to see their work in a much more fundamentally connected way.

How are you doing in combining strategy and execution? Below are some questions for you to think through that cover all three stages of the strategy-to-execution continuum. Getting these three areas right allows leaders to make a big step forward toward closing the gap between strategy and execution:

1. Build the strategy.

• Are you very clear about how you add value to customers in a way that others don’t, and about the specific capabilities that enable you to excel at that value proposition?
• As strategies are being developed, are you using the classic approach of “build the strategy, then think about execution,” or are you asking yourself the question, “Do you have the capabilities needed—or can you build the capabilities needed—to execute the strategy?”
• As you’re dealing with disruption, are you shaping the world around you with your given strengths, or are you waiting for change to happen, and therefore playing by someone else’s rules?

2. Translate the strategy into the everyday.

• Are you diligently following through on what you have decided? You need to be very clear about what the strategy is and what it takes to succeed—and to communicate it so that everyone in the organization understands what they should be doing.
• Are there visible programs (for example specific new technologies, new processes, or training programs) to build the key capabilities your organization needs to win with its strategy?
• Are you building specific connections between strategy and the budgeting process so you’re reallocating funds to where they matter most? And do you have mechanisms in place that translate the strategy into personal goals and rewards for managers and employees?

3. Execute the strategy.

• Are you motivating employees every single day to understand how what they’re doing connects to the important strategic levers that you have focused on?
• Are you enabling employees to work together across organizational silos to tackle the cross-functional challenges that allow the company to win?
• Are you keeping track not just of your performance, but of how you’re building and scaling up those few key capabilities that enable you to create value for customers in ways that others cannot?
• Is your management team engaged in how you are executing the strategy—not just by measuring results, but by constantly challenging the organization and supporting it in improving its key capabilities? Are you setting your team’s sights high enough for what they need to accomplish, and by when?

We believe there’s a tremendous upside for companies that can succeed at strategy through execution. The leaders who are able to be both visionaries and operators, and switch between these two mindsets, are the ones who can turn their organizations into super-competitors.

Paul Leinwand is the global managing director for capabilities-driven strategy and growth at Strategy&, PwC’s strategy consulting business. He is a principal with PwC US, an adjunct professor of strategy at Northwestern University’s Kellogg School of Management, and a coauthor of several books, includingBeyond Digital: How Great Leaders Transform Their Organizations and Shape the Future (Harvard Business Review Press, 2021) and Strategy That Works: How Winning Companies Close the Strategy-to-Execution Gap(Harvard Business Review Press, 2016).

Joachim Rotering is the Strategy& Global Leader as well as the Europe, Middle East and Africa Leader. He is a Managing Director with PwC Strategy& Germany and works primarily with clients in the oil, chemicals, and steel industries.

Article link: https://hbr.org/2017/11/how-to-excel-at-both-strategy-and-execution?

By KIRSTEN ERRICKSEPTEMBER 26, 2022

The Government Accountability Office highlighted deficiencies in common data standards, interoperability and public health IT infrastructure.

In light of public health emergencies like the rapidly-evolving COVID-19 pandemic, the importance of health data and the ability to share it is critical, according to a Government Accountability Office report released Thursday.

The watchdog found that public health entities do not have the ability to share new data and other important information in real-time, hindering the ability to respond to health crises quickly. 

GAO stated that there are numerous challenges to the way the government manages public health data. In particular, the watchdog noted three deficiencies that the government must address: common standards for collecting data, interoperability and public health IT infrastructure.

Common data standards are “requirements for public health entitles to collect certain data elements, such as patient characteristics (e.g., name, sex, and race) and clinical information (e.g., diagnosis and test results) in a specific way.” A lack of such standards can make it difficult for federal agencies to compare data across different states, a challenge the Centers for Disease Control and Prevention faced in collecting information on the COVID-19 pandemic.

Interoperability is “the ability of data collection systems to exchange information with and process information from other systems.” GAO noted that the lack of interoperability during the early days of COVID-19, made health officials and hospitals to manually input data into several systems, affecting the CDC’s ability to make timely decisions.

Lastly, public health IT infrastructure refers to “the computer software, hardware, networks and policies that enable health entities to report and retrieve data and information.” Not having a public health IT infrastructure can hinder the timeliness and completeness of information shared during public health emergencies. For example, during the early stages of the COVID-19 pandemic, some states manually collected, processed and transferred data, which increased the likelihood of errors. 

While the Department of Health and Human Services launched the HHS Protect platform in April 2020 to provide a centralized source of information reflecting COVID-19 numbers, public health and state organizations questioned the completeness and accuracy of the data.

The report noted that federal law requires HHS to establish a national public health situational awareness network with a standard data format that provides secure, real-time information to help detect and respond to infectious diseases. However, this has not been implemented nor have previous issues identified by GAO been addressed. According to a previous GAO report, HHS Protect does not satisfy all of the legal requirements for this network. As a result, the watchdog states that the legally mandated requirements for this network do not currently exist. 

Specifically, the report stated, “We agree that HHS has implemented several systems related to public health situational awareness and biosurveillance [including HHS Protect]. However, the law called for a near real-time electronic nationwide public health situational awareness and biosurveillance capability through an interoperable network of systems to share data and information. This capability was to be made up of interoperable systems that would enable the simultaneous sharing of information needed to enhance situational awareness at the federal, state, local and tribal levels of public health. This capability does not exist today.” 

According to GAO, “having near real-time access to these data could significantly improve our nation’s preparedness for public health emergencies and potentially save lives. Without the network, federal, state and local health departments, hospitals and laboratories are left without the ability to easily share health information in real-time to respond effectively to diseases.”

GAO stated that it previously made several recommendations related to the three challenges, but these have not been implemented.

For common data standards, GAO recommended that HHS establish an expert committee for data collection and reporting standards and for the CDC to define specific actions and a timeframe for its data modernization efforts. 

To address the issue of interoperability, GAO recommended that HHS ensure that its public health situational awareness network includes how interoperability standards will be used. 

For public health IT infrastructure, GAO recommended that HHS prioritize developing the network by establishing actions—both near- and long-term—to show progress, for the agency to identify an office to oversee the network’s development as well as to identify and document challenges to information sharing and lessons from the COVID-19 pandemic.

The most recent report did not include how the agencies responded to GAO’s recommendations. However, the previous recommendations were met with mixed agreement by HHS.

Article link: https://www.nextgov.com/analytics-data/2022/09/public-health-data-still-facing-challenges-despite-previous-recommendations-watchdog-says/377665/

by Thomas Sumner , Simons Foundation

Using artificial intelligence, physicists have compressed a daunting quantum problem that until now required 100,000 equations into a bite-size task of as few as four equations—all without sacrificing accuracy. The work, published in the September 23 issue of Physical Review Letters, could revolutionize how scientists investigate systems containing many interacting electrons. Moreover, if scalable to other problems, the approach could potentially aid in the design of materials with sought-after properties such as superconductivity or utility for clean energy generation.

“We start with this huge object of all these coupled-together differential equations; then we’re using machine learning to turn it into something so small you can count it on your fingers,” says study lead author Domenico Di Sante, a visiting research fellow at the Flatiron Institute’s Center for Computational Quantum Physics (CCQ) in New York City and an assistant professor at the University of Bologna in Italy.

The formidable problem concerns how electrons behave as they move on a gridlike lattice. When two electrons occupy the same lattice site, they interact. This setup, known as the Hubbard model, is an idealization of several important classes of materials and enables scientists to learn how electron behavior gives rise to sought-after phases of matter, such as superconductivity, in which electrons flow through a material without resistance. The model also serves as a testing ground for new methods before they’re unleashed on more complex quantum systems.

The Hubbard model is deceptively simple, however. For even a modest number of electrons and cutting-edge computational approaches, the problem requires serious computing power. That’s because when electrons interact, their fates can become quantum mechanically entangled: Even once they’re far apart on different lattice sites, the two electrons can’t be treated individually, so physicists must deal with all the electrons at once rather than one at a time. With more electrons, more entanglements crop up, making the computational challenge exponentially harder.

One way of studying a quantum system is by using what’s called a renormalization group. That’s a mathematical apparatus physicists use to look at how the behavior of a system—such as the Hubbard model—changes when scientists modify properties such as temperature or look at the properties on different scales. Unfortunately, a renormalization group that keeps track of all possible couplings between electrons and doesn’t sacrifice anything can contain tens of thousands, hundreds of thousands or even millions of individual equations that need to be solved. On top of that, the equations are tricky: Each represents a pair of electrons interacting.

Di Sante and his colleagues wondered if they could use a machine learning tool known as a neural network to make the renormalization group more manageable. The neural network is like a cross between a frantic switchboard operator and survival-of-the-fittest evolution. First, the machine learning program creates connections within the full-size renormalization group. The neural network then tweaks the strengths of those connections until it finds a small set of equations that generates the same solution as the original, jumbo-size renormalization group. The program’s output captured the Hubbard model’s physics even with just four equations.

“It’s essentially a machine that has the power to discover hidden patterns,” Di Sante says. “When we saw the result, we said, ‘Wow, this is more than what we expected.’ We were really able to capture the relevant physics.”

Training the machine learning program required a lot of computational muscle, and the program ran for entire weeks. The good news, Di Sante says, is that now that they have their program coached, they can adapt it to work on other problems without having to start from scratch. He and his collaborators are also investigating just what the machine learning is actually “learning” about the system, which could provide additional insights that might otherwise be hard for physicists to decipher.

Ultimately, the biggest open question is how well the new approach works on more complex quantum systems such as materials in which electrons interact at long distances. In addition, there are exciting possibilities for using the technique in other fields that deal with renormalization groups, Di Sante says, such as cosmology and neuroscience.

Article link: https://phys-org.cdn.ampproject.org/c/s/phys.org/news/2022-09-artificial-intelligence-equation-quantum-physics.amp

The White House released new guidance this week ordering federal agencies to create a full inventory of the software they use within 90 days. 

In a letter to all heads of executive departments and agencies, White House Office of Management and Budget (OMB) director Shalanda Young said a wide-ranging cybersecurity executive order handed down last May by President Joe Biden directed the National Institute of Standards and Technology (NIST) to publish guidance on how the agencies can better protect government systems through more secure software. 

Now that NIST has finished creating its guidance, the OMB wants all agencies to implement it for any third-party software used with an organization’s computer systems. The rules do not apply to software developed by agencies themselves. 

One of the key tenets of the NIST guidance is having agencies ask the producers of software to show they have followed a “risk-based approach for secure software development,” and agencies are now banned from using software that does not comply with the NIST guidelines. 

The software vendors will need to send agencies a “self-attestation” letter about the product’s security features, recent changes and more. The vendors also have to attest to following “secure development practices.”

In addition to the 90-day deadline for creating an inventory of all software used, agency chief information officers have 120 days to build out a process for communicating the new requirements to software vendors. Within 270 days, agencies need to collect letters from vendors about “critical” software. Agencies will need to have letters from vendors about all software — critical and otherwise — by next September. 

The letter gives agency CIOs one more task: they have six months to train employees to validate what the software companies claim in their letters. Any extensions to the timelines need to be applied for within 30 days of the deadline.

Chris DeRusha, Federal Chief Information Security Officer and Deputy National Cyber Director, said it is important for agencies to embark on this process because they handle “everything from tax returns to veteran’s health records.”

DeRusha specifically cited the SolarWinds scandal as one of the reasons why the effort was paramount for agencies, noting that the 2020 incident saw several federal agencies and corporations compromised by malicious code that was added into SolarWinds software.

The small change created a backdoor into the digital infrastructure of federal agencies and private sector companies.

“This incident was one of a string of cyber intrusions and significant software vulnerabilities over the last two years that have threatened the delivery of Government services to the public, as well as the integrity of vast amounts of personal information and business data that is managed by the private sector,” DeRusha said.

He added that the goal of the effort is to ensure that “millions of lines of code that underpin Federal agencies’ work are built with industry security standards in place.”

Young, the OMB director, said these tasks are part of a larger effort to get agencies to regularly use NIST guidance when choosing what software to use. 

Young also outlined a process where the “self-attestation” letters from vendors can be supplemented or replaced by a third-party assessment provided by a federally-certified organization or government agency. 

The letter to agencies adds that they can require a Software Bill of Materials (SBOMs) — an ingredient list of parts that make up a piece of software. 

In recent months, the Cybersecurity and Infrastructure Security Agency (CISA) has led an industry-wide pushto make SBOMs a common part of releasing any piece of software, with the hope that the practice will make it easier to find potentially vulnerable features. Cybersecurity experts and lawmakers say that SBOMs would make it easier for organizations to deal with issues like the Log4j vulnerabilityuncovered in December 2021, because it would help identify whether they’re at risk and how to mitigate the threat.

OMB is working with CISA and the General Services Administration to create a centralized repository for software attestations. CISA was also given a range of tasks to complete over the next year that include creating some of the guidelines agencies will need to follow going forward. 

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DeRusha explained that the guidance released this week was created with input from the public and private sector as well as academia. It will make it easier for federal authorities to quickly identify security gaps when new vulnerabilities are discovered, he added.

“Not too long ago, the only real criteria for the quality of a piece of software was whether it worked as advertised,” DeRusha said. “With the cyber threats facing Federal agencies, our technology must be developed in a way that makes it resilient and secure, ensuring the delivery of critical services to the American people while protecting the data of the American public and guarding against foreign adversaries.”

“Long Overdue”

Rick McElroy, principal cybersecurity strategist for VMware, told The Record that while the timeline “seems aggressive,” all of the goals listed in the advisory are “worthy and long overdue.”

He added that it will have a major impact on any provider of technology services or software to governmental agencies, noting that suppliers will now need to be prepared to respond to the requirements outlined. 

Additionally, because the government spends billions of dollars on software, the requirements might have a downstream effect — software developers might decide to offer these features to regular customers.

Immersive Labs’ Kev Breen explained that executives’ focus on rapidly shipping new products to market means that cybersecurity is not always the top priority, potentially exposing companies to millions in lost revenue and damaged brand reputations.

Former Obama administration cybersecurity commissioner Tom Kellermann told The Record that software supply chains are now under siege thanks to a deluge of cybercriminals and spies specifically targeting software development, integration, and delivery infrastructure.

“Given the sophistication of recent software supply chain cyberattacks, ensuring software integrity is paramount to protecting Federal systems systemic cyberattacks,” he said. 

DeRusha said the software changes are part of a larger effort by the Biden-Harris Administration to modernize agency cybersecurity practices, improve detection and response to threats as well as “quickly investigate and recover from cyberattacks.”

“The guidance released today will help us build trust and transparency in the digital infrastructure that underpins our modern world and will allow us to fulfill our commitment to continue to lead by example while protecting the national and economic security of our country,” he said.

Jonathan Greig 

Jonathan has worked across the globe as a journalist since 2014. Before moving back to New York City, he worked for news outlets in South Africa, Jordan and Cambodia. He previously covered cybersecurity at ZDNet and TechRepublic.

Article link: https://therecord-media.cdn.ampproject.org/c/s/therecord.media/white-house-u-s-agencies-have-90-days-to-create-inventory-of-all-software/amp/

By EDWARD GRAHAMSEPTEMBER 22, 2022

But leadership at the agency pushed back against projected cost overruns and delays moving forward.

Senators pressed officials from the Veterans Affairs Department to address cost and usability issues hindering the rollout of VA’s multi-billion dollar Oracle-Cerner Millennium electronic health record system during a Senate Appropriations Subcommittee on Military Construction, Veterans Affairs and Related Agencies hearing on Wednesday.

Dr. Shereef Elnahal, VA’s undersecretary for health, said he has “deep concerns about the system as it’s functioning for frontline employees and service to veterans,” noting that he visited the VA Central Ohio Healthcare System in Columbus earlier this year following the medical center’s EHR deployment and “saw folks struggling with this system deeply.”

“Among the most concerning things that I saw was a phenomenon whereby our frontline clinicians, when they put in an order or were trying to interface with the system, they were not confident in many cases and in many clinical settings that those orders were actually getting where they needed to go,” Elnahal said, adding that the experience led to a broader review within VA of how workflows and the configuration of the EHR system could be improved.

Sen. Martin Heinrich, D-N.M., who chairs the subcommittee, reiterated his support for VA’s EHR modernization efforts, calling it “an extremely important effort to solve a decades-long problem.” But Heinrich expressed concern about VA’s transparency throughout the EHR deployment process, citing cost overruns that were not initially conveyed to Congress when the program was launched and an implementation process that has been hindered by delays and functionality concerns. 

“I am glad VA is not rushing deployments until there’s more confidence in the likelihood of success, but the department needs to be straightforward with Congress about what is reasonable and achievable,” Heinrich said.

VA signed a $10 billion, 10-year contract with Cerner in 2018 to implement new, interoperable EHR software across the department’s national network of 171 medical centers, replacing its legacy system. The EHR system rollout, however, has been plagued by software outages, logistical delays and patient safety issues that have hampered the deployment process. A highly critical watchdog report released by the VA Inspector General’s office in July found that the EHR system deployed at the department’s initial rollout site—the Mann-Grandstaff VA Medical Center in Spokane, Washington—routed more than 11,000 clinical orders for veterans to an “unknown queue” without alerting clinicians. 

Sen. John Boozman, R-Ark., the subcommittee’s ranking member, noted that approximately $8.5 billion has already been appropriated to launch the EHR system over the past five years, and that VA is seeking another $1.75 billion for the program for fiscal year 2023. 

“At the outset, we were told that this program would cost no more than $16 billion and would be complete in 10 years,” Boozman said. “In the years since, VA has deployed the new system at only a small handful of sites, and those rollouts have been challenging, to say the least.”

VA’s beleaguered EHR deployment has garnered bipartisan criticism from lawmakers, who passed legislation—the VA Electronic Health Record Transparency Act—earlier this year requiring that the VA Secretary submit reports to Congress on cost, performance and patient safety issues related to the system’s deployment. President Joe Biden signed the bill into law in June. The Senate subcommittee hearing was held one day after lawmakers on two House Veterans’ Affairs subcommittees faulted VA for its major acquisition failures, including its EHR system deployment. 

Sen. Jon Tester, D-Mont., who chairs the Senate Veterans’ Affairs Committee, criticized VA’s lack of progress deploying the new EHR system and said “I don’t know if we’ve got a return on investment to speak of at all.”

“We’re into this damn near five years—it’ll be five years in May—and we still haven’t done a damn thing,” Tester said. “I mean, we’ve implemented, and it’s been a trainwreck, in my opinion.”

The VA had rolled out the EHR system at five medical sites, before announcing in July that it was postponing future deployments of the software until next year. VA initially delayed a planned EHR rollout at Boise VA Medical Center in June, before indefinitely postponing the site’s rollout in July after an assessment determined that “more could be done to ensure a safe and successful deployment.” VA’s EHR deployment schedulecurrently has the software slated to go live at 25 medical sites, including Boise, in fiscal year 2023. 

VA Deputy Secretary Donald Remy said the department is “looking closely at the schedule” and that “there are issues that need to be resolved before we can go live.”

Remy said that VA uses a site readiness checklist—which includes issues related to training, infrastructure and patient safety protections—to determine whether or not the EHR system is ready for deployment. That review process, he said, will largely guide future rollouts. 

“As we’re working with a site for potential deployment, we work through these issues to make sure they have them covered,” Remy added. “An example of the effectiveness of that checklist was Boise recently, where we determined we weren’t going live as we went through the checklist.”

A cost estimate provided to Congress by the Institute for Defense Analyses—or IDA—in July estimated that the lifecycle cost of the EHR system’s implementation would be more than $50 billion over 28 years, with the EHR deployment process at all of VA’s medical centers taking 13 years. As was noted during the hearing, VA has not yet allowed IDA to publicly release its cost estimate. 

Dr. Brian Rieksts, a research staff member in IDA’s cost analysis and research division, said that VA’s 10-year, $16 billion implementation and cost estimate did not take into account assumed productivity losses at medical centers deploying the EHR software, as well as sustainment costs needed to keep the EHR systems operational. And Rieksts told Boozman that IDA’s additional three-year deployment estimate was based on risk analysis.

“We estimate a range of one to five additional years over the 10-year period that will be required, and that’s based on both looking at historical programs and the challenges that they’ve had, and then events that have happened with the current program that have led to delays that don’t indicate that this program would behave differently than historical programs,” Rieksts said. 

Remy said, however, that VA still believes it can accomplish the EHR rollout within the 10-year contract period—although he added the caveat that the department is committed to doing so in a “safe, effective manner for our clinicians and our veterans.”

“If that needs to go beyond 10 years, we’re working through the process of determining what that time period might be,” Remy said. 

Mike Sicilia, executive vice president for industries at Oracle, told the senators that proper implementation of the EHR system was Oracle’s “most important” priority and added that the company has moved 2,000 employees onto the project to complement the existing Cerner team. Sicilia said Oracle—which acquired Cerner in June—still believes it “can deliver this system within the budget envelope and without the need for any additional funds.” 

Sicilia cited Oracle’s recent partnership with Accenture to “evaluate the current training program,” as well as the launch this week of a new dashboard “that catalogs our to-do list and progress being made” on the project, as examples of the company’s commitment to ensuring the success of the EHR system’s deployment moving forward. 

“As we have examined the underlying causes for these delays and challenges, our conclusion is that we have found nothing that can’t be addressed in reasonably short order to get us back on a workable schedule and within budget,” Sicilia said. “We know we have a lot to prove with deployments next year at larger, more complex sites. We view the next year as a key window for building momentum and turning the corner.”

Article link: https://www.nextgov.com/it-modernization/2022/09/va-official-has-deep-concerns-about-agencys-ehr-deployment/377508/

Fast Facts

For over a decade, VA has tried with little success to implement a framework for managing and overseeing how it purchases goods and services. We added VA acquisition management to our High Risk List in 2019.

VA plans to implement a new framework but hasn’t:

• Identified major acquisition programs subject to the new framework
• Addressed acquisition workforce needs

If VA takes steps to address these and other challenges prior to implementing the new framework, VA could acquire goods and services more efficiently to support veterans.

We recommended VA take steps to address challenges before implementing the new framework.

Skip to HighlightsHighlights

What GAO Found

For over a decade, the Department of Veterans Affairs (VA) has worked to implement a framework for managing how it purchases goods and services, with little success. GAO found that VA has not used its Acquisition Program Management Framework, its current framework, which has been in place since 2017. This framework includes features—such as phases, key documents, and identified decision authorities—that could provide standardized management and oversight of VA’s major acquisitions. These features generally align with GAO-identified acquisition leading practices. However, VA’s major acquisition programs that GAO reviewed instead use program-specific approaches that vary widely in robustness.

VA plans to implement its proposed acquisition framework—the Acquisition Lifecycle Framework—in 2022. Plans for the new framework include features and processes similar to those of the current one. However, VA and its acquisition programs are not well-positioned to successfully implement the new framework because VA plans to implement it before addressing challenges that hindered adoption of its predecessor. For example:

• Identifying programs subject to the framework. VA has yet to develop a list of major acquisitions that would be subject to increased oversight within the framework because it lacks a mechanism to collect and monitor acquisition program costs. Without such a mechanism, VA will struggle to identify acquisition programs subject to increased oversight within the framework.
• Assessing acquisition workforce needs. VA identified gaps in its acquisition workforce that affected programs’ ability to implement the existing framework. Since VA has yet to assess its current workforce to determine whether gaps still exist, it will not know if current staff levels and skillsets are adequate to effectively support the new framework.
• Aligning the framework with other processes. VA planned to align its current framework with IT program and major construction project management processes, but it issued potentially confusing guidance as to which processes to follow. VA has yet to provide clear direction to integrate the new framework with its IT and other management processes, increasing the risk it will not be implemented effectively.
• Ensuring framework compliance. VA identified that the lack of a mechanism to ensure that acquisition programs adopt its framework was a weakness when it implemented its current framework. But VA has yet to establish and communicate a mechanism to ensure program compliance with its new framework, risking a repeat of limited adoption.

VA’s current plans to implement the new framework in 2022 do not provide the department time to address these challenges. If VA does not take steps to address these challenges prior to implementing the new Acquisition Lifecycle Framework, then VA will face increased risks of another unsuccessful implementation that does not achieve meaningful improvements in management of its major acquisitions.

Why GAO Did This Study

Over the past 10 years, VA’s contract obligations nearly doubled in size to $38 billion in fiscal year 2021. The increase was driven in part by key program growth and efforts to modernize VA systems. GAO added VA’s acquisition management to its High-Risk List in 2019 due to numerous challenges to efficiently purchasing goods and services, including medical supplies.

GAO was asked to examine how VA manages major acquisitions, which Office of Management and Budget guidance identify as requiring special management attention. This report assesses the extent to which VA acquisitions are following the current acquisition management framework and the extent to which VA is positioned to implement its proposed acquisition framework, among other objectives. To conduct this assessment, GAO reviewed relevant VA policies and guidance; analyzed VA program documents for a mix of IT modernization efforts and service acquisitions; and interviewed VA officials.Skip to Recommendations

Recommendations

GAO is making seven recommendations. These include establishing a mechanism to collect and monitor program costs, assessing workforce gaps, aligning the proposed framework with other agency processes, identifying a mechanism to ensure compliance, and ensuring these steps are taken before implementation of the new framework. VA agreed with GAO’s recommendations.

Recommendations for Executive Action

Department of Veterans Affairs The Secretary of Veterans Affairs should ensure that the Chief Acquisition Officer addresses challenges that pose risks to the Acquisition Lifecycle Framework’s success prior to its implementation. These risks include collecting cost data to enable identification of programs subject to increased oversight within the framework, addressing acquisition workforce needs, aligning the framework with other processes, and ensuring program compliance with the framework. (Recommendation 1) 

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.Department of Veterans Affairs The Secretary of Veterans Affairs should ensure that the Chief Acquisition Officer establishes a mechanism to collect, maintain, and monitor program costs and cost estimates necessary to identify programs subject to increased oversight within the Acquisition Lifecycle Framework. (Recommendation 2) 

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.Department of Veterans Affairs The Secretary of Veterans Affairs should ensure that the Chief Acquisition Officer and the Assistant Secretary for the Office of Human Resources and Administration conduct an enterprise-wide workforce assessment to identify any gaps that could limit effective adoption of the Acquisition Lifecycle Framework, such as in roles related to program management. (Recommendation 3) 

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.Department of Veterans Affairs The Secretary of Veterans Affairs should ensure that the Chief Acquisition Officer determines, documents, and communicates to programs how the Acquisition Lifecycle Framework should be used in conjunction with existing project management frameworks and processes, such as the Veteran-Focused Integration Process, VA Construction, and VA’s Project Management Framework. (Recommendation 4) 

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.Department of Veterans Affairs The Secretary of Veterans Affairs should ensure that the Chief Acquisition Officer identifies and documents a mechanism to monitor and ensure that applicable acquisition programs adopt and comply with the Acquisition Lifecycle Framework processes and decisions. (Recommendation 5) 

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.Department of Veterans Affairs The Secretary of Veterans Affairs should ensure that the Chief Acquisition Officer establishes key measures for the performance of the Acquisition Lifecycle Framework, collects and analyzes data related to these measures, and reports results. (Recommendation 6) 

Open

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.Department of Veterans Affairs The Secretary of Veterans Affairs should ensure that the Chief Acquisition Officer establishes a documented lessons learned process to consistently collect, analyze, validate, archive, and share lessons learned related to implementation of the Acquisition Lifecycle Framework. (Recommendation 7) 

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

SEE ALL 7 RECOMMENDATIONS

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Article link: https://www.gao.gov/products/gao-22-105195

The Department of Veterans Affairs (VA) has faced acquisition management problems – placing it on the Government Accountability Office’s (GAO) High-Risk List – but agency officials on Sept. 20 said they are looking to chart a new course in VA acquisition, one that may require an enterprise-wide approach.

During a House Committee on Veterans’ Affairs hearing, Michael Parrish, chief acquisition officer, and principal executive director at VA’s Office of Acquisition, Logistics, and Construction, said the agency has made “considerable progress” to address GAO’s concerns.

“I am personally involved in ensuring that we show GAO and others how VA is properly monitoring and demonstrating progress across the enterprise,” Parrish said. “In its most recent report regarding VA acquisition management, GAO noted substantial work has been done to develop our acquisition lifecycle framework.”

However, lawmakers and Shelby Oakley, director of contracting and national security acquisitions at GAO, said VA has a long way to go until VA’s acquisition management will be able to successfully meet the needs of veterans.

Lawmakers pointed to the VA’s troubled Electronic Health Records Modernization (EHRM) program, which the agency initially estimated would cost $10 billion over 10 years. The new cost estimate is closer to $56 billion, with $39 billion for implementation of the EHR system over 13 years, and then $17 billion to maintain the system over 15 years.

The committee also noted the VA’s struggles to acquire a modern medical supply chain management system, which the GAO has also reported on several times. As Rep. Chris Pappas, D-N.H., warned, “the supply chain modernization failures resulted in hundreds of millions of dollars in cost overruns and years of delays,” according to GAO’s findings.

Chairman Rep. Mark Takano, D-Calif., stressed that the committee has seen a “fundamental lack of planning, budgeting, and adherence to contracting best practices by VA and its contracting centers.”

Notably, Oakley said one of the biggest challenges GAO has seen regarding VA’s acquisition is “VA’s even ability to develop a credible cost estimate. You know, we have a lot of concerns about the capacity within the organization to do that.”

Oakley said that while she is encouraged by “the time and attention” Parrish has invested into improving acquisition management, the agency needs an enterprise-wide effort.

“The sustainable, repeatable progress that his office is seeking requires much change across the VA enterprise – not only in the organizations that he directly manages but also in other parts of the department, which manage substantial acquisition programs,” Oakley said. “Without a coordinated and persistent enterprise-wide effort, the improvements VA seeks to meet the needs of veterans will be elusive.”

Parrish acknowledged and agreed with GAO’s concerns and said he considers the agency “to be a force multiplier helping us to improve our processes.” 

“Broader acquisition reform within VA is essential to our ability to survive and flourish in these dynamic markets such as healthcare and technology,” he said. “Systemic reforms and new tools such as other transactional authority will allow us to fuse acquisition with innovation to create that cradle-to-grave force multiplying effect.”

Article link: https://www.meritalk.com/articles/va-in-need-of-new-acquisition-management-approach/

The U.S. NSA, CISA and ODNI created the Securing the Software Supply Chain guide to focus on the software development lifecycle.

By Chris Hughes

CSO

SEP 15, 2022 2:00 AM PT

Software supply chain attacks are on the rise, as cited in the Cloud Native Computing Foundation’s (CNCF’s) Catalog of Supply Chain Compromises. Industry leaders such as the Google, Linux Foundation, OpenSSF, and public sector organizations such as NIST have provide guidance on the topic over the past year or so.

The U.S. National Security Agency (NSA) alongside the Cybersecurity and Infrastructure Security Agency (CISA), and the Office of the Director of National Intelligence (ODNI) now join that list with their publication Securing the Software Supply Chain: Recommended Practices Guide for Developers. The announcement of the publication emphasizes the role developers play in creating secure software and states the guide strives to help developers adopt government and industry recommendations on doing so. Subsequent releases from Enduring Security Framework (ESF) will focus on the supplier and the software consumer, given the unique role each plays in the broader software supply chain and its resilience.

At a high-level the document is organized into three parts:

• Part 1: security guidance for software developers
• Part 2: software supplier considerations
• Part 3: software customer recommendations

The role of developers, software suppliers and customers

The guidance notes the unique role developers, suppliers and customers play in the broader software supply chain ecosystem.

Software providers and their development teams may end up in the dichotomy of speed to market, versus secure and resilient software or software-enabled products.

As noted in the image above, each of the three roles has respective security activities it can and should be doing. These activities span the gamut from initial secure software development, composition and architecture all the way through security acceptance testing and integrity validation on the customers’ end.

Secure software begins with a secure software development lifecycle (SDLC) and the guidance cites many options teams can use, such as the U.S. National Institute of Standards and Technology’s (NIST’s) Secure Software Development Framework (SSDF), Carnegie Mellon University’s Secure Software Development Lifecycle Processes, and others such as the recently announced OpenSSF Secure Software Development Fundamentals courses.

How to develop secure software

The guidance stresses not just using secure software development processes but producing tangible artifacts and attestations that are used for validation, both by the software producer and consumer to have assurances related to the security and resiliency of the software. These processes and activities include best practices such as threat modeling, SAST, DAST and pen testing but also using secure release activities such as digitally signing, a notable example being the increased adoption of Sigstore, which is a standard for signing, verifying and protecting software. The adoption and use of Sigstore is also cited in the OpenSSF’s Open Source Security Mobilization Plan as a method to deliver enhanced trust in the software supply chain.

Threat modeling gets a significant mention, recognizing that during product development and delivery teams should be examining the potential threat scenarios that can occur and what controls  could be put in place to mitigate them. Teams should also have established security test plans and associated release readiness criteria to ensure unacceptable vulnerabilities are not making it to production environments or getting to customers.

Mature product teams have established support and vulnerability handling policies as well. This includes having a system where product vulnerabilities can be submitted and an associated incident response team that is in a position to respond and get engaged should an incident occur. Given the impact developers can have on producing secure or insecure products, formalized assessment and training must occur. Determine what training is required and who is required to take it at a specified frequency. The OpenSSF’s Open Source Software Security Mobilization Plan lists upskilling developers on secure software development as a key objective that is recognized as an industry-wide necessity. Training topics include secure software development, code reviews, verification testing and using vulnerability assessment tools during development to drive down vulnerabilities that make it into their end products.

The activities and practices discussed above, such as secure development training, threat modeling, security test plan and developed security policies and procedures, are mapped to activities in the previously mentioned NIST SSDF, which will be a requirement soon for software vendors to self-attest to when selling software products to the U.S. federal government.

Secure code development has many aspects, including selecting programming languages that could mitigate vulnerabilities from the onset. There is also the need for organizations to address insider threats, which might be a compromised engineer or simply poorly trained engineers. Organizations can mitigate these threats by having codified source control processes with appropriate authentication, running static and dynamic tests on code, as well as looking for exposed secrets.

Organizations should also implement nightly builds and security regression testing to recognize and address flaws and vulnerabilities. Development efforts shouldn’t be ad hoc and should be mapped to specific system requirements with associated security testing to avoid feature creep which can introduce risk.

Code reviews should be prioritized, especially critical code to ensure fundamentals such as cryptography are in place and there are requirements for privilege escalation and access protection for resources. It isn’t just the code that must be secured but also the development environment. There has been notable incidents such as SolarWinds where the development environment can be compromised and poison downstream consumers so systems, such as developers endpoints, source code repositories and CI/CD pipelines, should be threat modeled and have vulnerability assessments conducted.

Open-source software (OSS) introduces its own unique risk and the guidance recommends using dedicated systems to download, scan and perform recurring checks on OSS components that internal development teams can use. This concept is also advocated by NIST in its Improving the Nation’s Cybersecurity executive order guidance for Section 4 and has been dubbed as continuous packaging.

Another practice emphasized is securing the developer environment, using secure development build configurations and secure third-party software toolchains and libraries. Development systems should be hardened and only used for development purposes, without internet access, and only with pre-approved tooling and software. The guidance recommends vetting third-party modules for CVEs against the NIST National Vulnerability Database (NVD). Tooling and automation can help facilitate this process and can even be done as part of the integrated development environment (IDE) using security dependency analyzers and similar tooling to identify vulnerabilities.

Hardening the build environment is critical, including the developer network, enterprise network and internal build environments. This mitigates threats being introduced from the internet and external malicious actors as well as integrity and validation measures to validate that malicious activities have not occurred to compromise products.

Software components should be sourced from known trusted suppliers that meet organizational requirements and validated through methods such as SPDX or CycloneDX SBOM formats as well as the suppliers responsiveness to vulnerabilities with established methods for vulnerability reporting.

Securing the Software Supply Chain’s guidance goes beyond hardening the build environment to make recommendations such as using hermetic reproducible builds as well. This means fully declared build steps, immutable references, and no network access, as well as identical outputs and artifacts regardless of variable metadata changes to things such as timestamps.

Software should be delivered securely, including an SBOM of final composition to the customers. As part of package validation customers can use binary analysis outputs to ensure only intended software components are in place. To address compromises of software packages and updates, both product and components can make use of hashes and digital signatures for product distribution, components and upgrades. Organizations should also take steps to mitigate compromises of the distribution system itself. This can include applying security measures to repositories and package managers as well as using secure transport layer mechanisms.

Other resources for securing the software supply chain

The guidance includes a crosswalk among various scenarios with developers, suppliers and customers to specific practices outlined in SSDF. It also includes a mapping of dependencies and artifacts that exist among the supplier, third-party suppliers and the end customer.

A mapping to the SLSA framework shows how specific recommendations in the guidance map to the various levels of SLSA, ranging from L1 to L4. Lastly, there’s a comprehensive list of artifacts and checklists to be used throughout the SDLC and a list of informative references such as the cyber executive order, DoD and NIST documentation as well as industry organizations such as OWASP.

This secure software supply chain guidance is a critical resource that will undoubtedly be adopted by the industry as a go-to reference for organizations looking to bolster their software supply chain practices for both software producers and consumers. With this document taking a developer-centric focus, the industry would be well advised to look for the subsequent guidance, which will focus on software suppliers and consumers.[ Learn how to track and secure open source in your enterprise.

Article link: https://www-csoonline-com.cdn.ampproject.org/c/s/www.csoonline.com/article/3673233/u-s-government-issues-guidance-for-developers-to-secure-the-software-supply-chain-key-takeaways.amp.html

• Deborah Ancona
• Hal Gregersen

April 16, 2018, Updated April 20, 2018

Summary.   There’s a new kind of leadership taking hold in organizations. Strikingly, these new leaders don’t like to be called leaders, and none has any expectation that they will attract “followers” personally — by dint of their charisma, status in a hierarchy, or access to resources. Instead, their method is to get others excited about whatever problem they have identified as ripe for a novel solution. Having fallen in love with a problem, they step up to leadership — but only reluctantly and only as necessary to get it solved. Leadership becomes an intermittent activity as people with enthusiasm and expertise step up as needed, and readily step aside when, based on the needs of the project, another team member’s strengths are more central. Rather than being pure generalists, leaders pursue their own deep expertise, while gaining enough familiarity with other knowledge realms to make the necessary connections. They expect to be involved in a series of initiatives with contributors fluidly assembling and disassembling.close

In front of a packed room of MIT students and alumni, Vivienne Ming is holding forth in a style all her own. “Embrace cyborgs,” she calls out, as she clicks to a slide that raises eyebrows even in this tech-smitten crowd. “Really. Fifteen to 25 years from now, cognitive neuroprosthetics will fundamentally change the definition of what it means to be human.”

She’s referring to the work that interests her most these days, as cofounder of machine learning company Socos and a visiting scholar at UC Berkeley’s Center for Theoretical Neuroscience. (“So — can I literally jam things in your brain and make you smarter? If you’re curious, the answer is unambiguously yes.”) But the talkhas covered a lot more than this, as Ming has touched on many initiatives and startups she’s been involved with, all solving problems at the intersection of advanced technology, learning, and labor economics.

She’s an entrepreneur, a CEO, and a teacher — all leadership roles — but when we ask her about her leadership style, she demurs. “What I’ve learned about myself as a leader, as an executive, is — I’ll be blunt — I’m a pretty mediocre manager. I try to do the right things, but I’m much more focused on problems than I am on people, and that’s not always that healthy.” While she’s utterly confident in herself, she just doesn’t identify as top management. She’s happier to think of herself as a data scientist, a computer geek. She loves talking about hacks she’s pulled off — like the alterations she made to her diabetic son’s medical devices, so she could merge all their data to produce a predictive model. Now, she gets an alert an hour in advance if a spike or drop is coming in his blood glucose level. This is an unprecedented, and highly valuable, thing. “Turns out, it would have broken several federal laws if I had done this with patients as a medical device company,” she laughs.

Ming is a tech optimist, believing that all kinds of previously intractable problems will be able to be solved as the tool kit for addressing them is developed. And she’s decided her best way of contributing to that progress is to keep honing her individual-contributor skills. “For a long time, I tried to be the whole package. I put a lot of energy into making certain that I was shepherding everyone along, doing all the right things for my teams. Then I realized: You know what? If I can get some people that are really good at the things that I’m not, then I can focus on my strengths. And my strengths are in creative problem solving — all the way down to writing the code myself.”

The attitude she’s espousing doesn’t really map to the traditional image of the enterprise leader, or to what typically gets taught in leadership development programs. Yet there is no denying that truly awesome stuff gets done thanks to Ming’s abilities to see possibilities and assemble talent. There’s a reason she’s been invited by the MIT Leadership Center to speak. We think her approach to taking on big problems will resonate with this crowd.

Over the past year, as faculty director and executive director of the MIT Leadership Center, we have been trying to put a finer point on a distinctive style of leadership we keep seeing all around us. We weren’t sure if it was because we spent so much time with MIT-trained people, or if there was a much more widespread shift under way, but the people we saw driving impactful, world-changing initiatives just didn’t look like old-school leadership material — and didn’t seem to want to. Cautiously, we called it problem-led leadership, and launched into all the interviewing, case studying, and literature review that goes into a leadership research project.

To make a long story very short, we found several common threads in the work of problem-led leaders. Most striking is that none of these leaders has any expectation that they will attract “followers” personally — by dint of their charisma, status in a hierarchy, or access to resources. Instead, their method is to get others excited about whatever problem they have identified as ripe for a novel solution. Having fallen in love with a problem, they step up to leadership — but only reluctantly, and only as necessary to get it solved. As Ming says about her entrepreneurial ventures, “The only reason I do it is because it is an amazingly effective way to have an impact on the world.”

From this “problem-led” beginning, other differences follow. Leadership becomes an intermittent activity as people with enthusiasm and expertise step up as needed, and readily step aside when, based on the needs of the project, another team member’s strengths are more central. Rather than being pure generalists, leaders pursue their own deep expertise, while gaining enough familiarity with other knowledge realms to make the necessary connections. No one assumes that the life of a team, or even organization, will be prolonged for its own sake. They expect to be involved in a series of initiatives with contributors fluidly assembling and disassembling. It’s a key leadership talent, then, to know how to put together a team. To tackle a problem, they need to find the right talent and to convince others that their project offers the chance to be part of a breakthrough. (Talented people always have other options, after all.)

Back to Vivienne Ming. In an interview after her talk, she is pressed again to describe the role she plays in her ambitious projects and she pauses to reflect. “I lead by leading,” she begins, and then quickly worries that this “sounds a little self-aggrandizing.” She clarifies what she means. “I get out there, and I solve problems. And I hope that motivates my colleagues to do the same.”

It’s the leadership that dare not speak its name — we’ve heard this discomfort with the term expressed so many times that we now call people like Ming “anti-leadership leaders.” But while we started out thinking it was “MIT style,” we now believe it is a style that is generally trending in the world, at least in settings where a premium is placed on innovation. People like Vivienne Ming can be found in many places, getting focused on opportunities, getting others energized and organized, and getting problems solved. Call them what you want, but what they’re doing is leading.

Article link: https://hbr.org/2018/04/the-power-of-leaders-who-focus-on-solving-problems?

Editor’s note: We’ve updated this article to clarify that Vivienne Ming did not actually break any federal laws.

• Deborah Ancona is the Seley Distinguished Professor of Management at MIT’s Sloan School of Management and the founder of the MIT Leadership Center.
• Hal Gregersen is Executive Director of the MIT Leadership Center, a Senior Lecturer in Leadership and Innovation at the MIT Sloan School of Management, a Thinkers50  globally ranked management thinker, and the founder of the 4-24 Project. He is also the author of Questions Are the Answer: A Breakthrough Approach to Your Most Vexing Problems at Work and in Life and the coauthor of The Innovator’s DNA: Mastering the Five Skills of Disruptive Innovators.