41 Health Care Innovation
We sit down with [Shannon Sartin](https://twitter.com/sartin_shannon), to learn about their path to becoming a leader in the health care technology space. We'll learn from her experiences, chat through strategies for running teams, and more.<br><br>### Resources and Shoutouts:<br>- [USDS](https://www.usds.gov/)<br>- [Article with Cobol story](https://www.govexec.com/management/2018/09/meet-executive-bringing-digital-savvy-health-and-human-services/151171/)<br>- [CMS](https://www.cms.gov/)<br><br>##### Music Credit: [Tumbleweeds by Monkey Warhol](http://freemusicarchive.org/music/Monkey_Warhol/Lonely_Hearts_Challenge/Monkey_Warhol_-_Tumbleweeds)
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Transcript
Hello. I'm Ryan Cook, and this is Civic Tech Chat, a podcast about the civic technology movement. We seek to harness the power technology has to improve the delivery of public services to people everywhere. Shannon, thank you so much for joining us here on Civic Tech Chat. Could you introduce yourself and tell us a little bit about what you do?
Thanks so much for having me. So I'm Shannon Certain. I'm the former executive director of digital service at HHS and CMS, a former member of the United States Digital Service. And I have spent the last four years showing up in the federal government to help make the services that the various agencies offer work better for the American people.
One of the things that we try to start with on Civic Tech Chat is this idea of why. And in this case, personal why. So for Shannon, what would that be for you? You know, what's that thing that drives you to get out of bed each day and do what you do?
So my why is definitely rooted pretty deep inside me, probably all the way down to that DNA level. I come from a family with a strong history of public service. My mom was a physician for the Indian Health Service who turned into an informaticist after working in the clinic that actually beta tested the first one of the first EMRs that we had, in health care in this country. And I was part of this family that just shared this consistent commitment to showing up for under underserved populations for being part of policy making, working for federal agencies. We were definitely taught from an early age that you should try to work hard to leave the world a better place than when you showed up. And so that's a that's a big part of my initial driving why, and I think how that's continued for me later in life is I have a wonderful amazing daughter who's 12. And I think a lot about the importance of being a part of that same process to set an example for her, but also really wanting our our government to work for her when she is, you know, coming into an age where she's gonna be critically dependent on on government services in some way, shape, or form, whether that's just through submitting taxes to the IRS or eventually also being on Medicare. So, that's a little bit about my why.
I I appreciate you sharing that why. As you're no doubt aware that we're only a little bit removed here from the holiday season. And as we're kinda, like, talking about this the subject of what you do, I I imagine that you have to you know, you have small talk with folks, and they'll ask you that that very question. I'd be curious, like, how do you tend to describe your practice to folks that are asking you that in, like, a social situation?
Yeah. This is such a hard question sometimes because the people that ask you what you do run a pretty broad range, right, of people who understand how government and policy making at the federal level works all the way into people who are so disconnected that they don't totally realize what's happening at these federal agencies or the way that that's impacting them as individuals. And so I typically start out at a really high level of just talking about the importance of having technical talent in government to help make decisions. So a little bit of bringing I tend to bring up healthcare.gov. It's a great starting point that typically people remember and recognize. You know, when you talk about the critical failure of a service that people saw firsthand, they tend to immediately connect into why having technical talent inside government is important. They tend to connect into how that may impact them, and they also then connect into that story of there being, a team that showed up to help make that service help stand that service back up and make it better again. And so, I typically talk about the work that I'm doing in terms of general credit general services to the federal government and then also tend to lead a little bit down into health care and the specific projects that we're working on with health care, talking about things like running a team at the Centers for Medicare and Medicaid who's helping to ensure that every individual can get access to their health record and their critical data that they need to make decisions, and also talking about projects like rebuilding infrastructure for payment processing at a place like Medicare that processes $500,000,000,000 in payments a year.
And can you tell us a little bit about the path you've taken here that's now led, to where you are now?
Yeah. So I touched a little on kind of those really, really early days of my past, which I would definitely consider to be part of what pushed me in this trajectory, right, of having a mom who worked for a federal agency in, public service. And so initially, I actually started out my career in government at the Indian Health Service. I was brought in in, 2009, 2010 to work on thinking through how we can contract better for technical services. And so, I was lucky enough that at the time, I was living in Seattle. I had been working for Bungie on the video game Halo, so I knew a little bit about software development, kinda migrated into this space in the government, learning how to just pull together these massive contracting vehicles or, actually, at that time, it was pull apart pull apart these big contracting vehicles and rethink the way that we contract out for services. And so I started to do that for the Indian Health Service and ended up leaving when my I kinda hit, like, I hit a ceiling. I think that a lot of ambitious young people in the federal government maybe definitely at that time, maybe still now, would just kind of hit a place where they felt like they were plateauing in their career. We don't really tend to embrace ambitious individuals. And so I hit that I hit that ceiling and ended up leaving to go work for a small start up in Tucson, Arizona, which is where I'm from, who had raised some money and was interested in in bringing their product into the federal government. And my theory at the time was I can figure out how to be a great buyer on the government side, but if there aren't great contracting companies to actually award the contracts to, then I've only solved one half of the problem. And so, I ended up doing that and finding this amazing niche and helping companies think through product development, think through building out sales and marketing into the government. And, I spent some time in that space before applying to the US Digital Service one on a whim day, where I ended up on the US Digital Service website when it was still just part of I think it was, like, white house dot gov slash u s d s at the time
and ended up applying. And it's kind of all magic after that. One of the things you mentioned there in that story was the this this feeling you said you had of hitting a plateau. And I imagine that's a thing that perhaps folks, like, listeners out there may relate to as well. Could you tell us, like, a little bit more about what what that experience was like and and how that, like, drove you to then wanna make a change?
Totally. So for me, when I hit that plateau, there were a couple different things happening. The the first and probably most important one was that I had been on a team of myself and two other individuals. And as of two other people who were both brilliant and amazing humans left to go and pursue other opportunities as people do, their positions weren't backfilled. And so I was a number of pay grades beneath them, and here I inherited all of their work as they left. So I went from being, an entry level individual on a team with mentorship and support and people doing carrying a large portion of the work alongside with me to just carrying all of the work. And there was no financial reward for it. There was really not even an acknowledgment by other people that I was now taking on all of this additional work, and I am the kind of human who just shows up and just does the work. And I just kept showing up, and I kept doing it. And I anticipated that at some point in time, somebody would recognize it, and they would make sure to figure out that I had some sort of forward trajectory in my career. But it ended up kind of being the opposite. I the person that I'd worked for at the time ended up retiring, and his replacement was somebody who came in and really just tried to shut me down in a way that, thankfully, it's the last that I've ever experienced like that, but, took away some of my promotion opportunities and other things because they were not impressed with that, that what we had been brought in to do, which was to think about contracting in a very different nontraditional way. And so I really struggled with that. And, I'm not gonna lie. When I decided to leave, I actually didn't have another opportunity lined up, but I knew that I could not sit and struggle under those circumstances. And so I left, and I love to think that in many, many ways, my story and my leaving and thankfully, I ended up back in the federal government, but I am kind of the example in a lot of ways of what not to do when you've got smart, ambitious people that want to show up to serve the federal agencies. So it's definitely it drives me a lot to think about ways that I can support and, ensure that people around me are getting the attention and acknowledgments that they need. I spend a lot of time outside of the digital service role doing that with people and agencies because I think it's really important.
It's I think what I'm hearing from you is that, like, I mean, it sounds like that's a rather impactful experience you've had, like, something that would kind of stick with you. Is that something then that you're now carrying as you make choices about in in, like, in this realm as well?
Absolutely. Definitely. For me, it having had that experience, when I meet individuals who are bright and who want to make a difference and maybe they're a voice in a room who's behind you know, who's sitting in the back bench of the meeting and they clip up with one one little comment. I pay I pay so much attention to that, and I have had this tendency to kind of reach down and grab people out of different offices and ask them to come work on projects because I know what it's like to be stuck in a federal agency, and I know how hard it is to move forward. And I, I am only one person, so that is what I can do. I hope to, you know, eventually work to make some broader systemic change when it comes to the way that we hire and retain and recruit people, especially in management. But def it definitely has had a a heavy impact on the way that I think about being a leader and the way that I think about supporting other people around me.
In the realm of change and kinda like being a change maker, that's something I gather is a is a thing you've been in the health care space as well, in your role. And I imagine that's a thing that requires being rather skillful at managing relationships whether it's, like, within or without, government. Could you speak a bit to the role that, like, that relationship building plays in your in your daily activities?
Yeah. So I am pretty fortunate that my ability to I don't wanna say the word network, so that's not quite right. But definitely, like, build relationships, maintain relationships, understand the importance of talking to people has just something that's come to me a little bit innately. Maybe it's from my very, very social dad. But that's something that I've just kind of always been able to do and have. And for me, it's been really important in those getting things done in government and understanding how to have an impact when you're in government trying to work on health care because the decisions that are made around health care within the federal government tend to not actually have quite enough external voice in them. We tend to not always listen to people who are in the outside world. This is a problem that we have in policy making generally across government. So I'm not gonna say this is just a health care problem. It's that's just the space that I know. But it definitely having those relationships, understanding who's working on what, keeping up with who's building what cool new tool, who's thinking about how to do health care differently, who's seeing cool new results, and just consistently meeting with people, talking with them, engaging them, making sure that they feel heard, making sure that they feel like there's an open door. I think a huge part of us being able to make change in government and definitely in health care.
I think one thing I I I heard you talk about there was, this sort of, like, finding of a landscape as far as, like like, who is responsible for what is interested in the thing. Are there any techniques you tend to employ in order to try to to get at that sort of information as you, like, first go into an initiative?
So for me, I spend a lot of time initially just listening, whether that be I walk into a small meeting or a big meeting. I pay attention to who seems to be the leading voice in the room, what other information I know from outside that room that I can connect in, to try to kind of piece together where all those moving parts are. It definitely is a lot of just constantly absorbing information, whether it be something that I read on Twitter three days ago that I'm now hearing about in a meeting or something that, I I heard about in a meeting and now I'm seeing it echoed in, like, five or six different places. But it it really definitely is about being able to identify from a people perspective who seems to be connected or a leading voice and then being able to also identify those trends coming from various places with different information.
In that work, I imagine that there are times where we end up needing to guide folks into things that might take them outside of their comfort zone, whether it's a career service person, an agency, they're being exposed to to some new thing, or on, you know, a group of technologists that are entering an unfamiliar domain. Are there any, strategies that, you know, you or your like, your go tos when you're trying to lead in that kind of circumstance?
There are so many. Many. The the number one for me is actually about empathy and personal experience. So one thing that I have learned consistently is that in in the realm of the changes that we're trying to make, say, at CMS or at other federal agencies, the one thing that can always change somebody's mind or bring them around is to tell them a story of individual impact. And sometimes it's not just storytelling, but it's actually taking people out to see. So for instance, doing site visits at clinics, for instance, spending time talking to patients or providers, creating that connection that's bigger than just words on a paper, but it's actually actually another individual that we are able to say, I, like, I see you. I empathize with you. I'm going to turn around and try to make a change in the way that I've been making decisions. And so that, to me, which is really about us incorporating and bringing in human and user centered design into all the conversations in government from policy to actual technology building, those pieces are so hugely important. And that's definitely something I've seen, have a have a have a really big impact on the that people make decisions. And data is the other one. Right? There's a lot of times where you can show up with just irrefutable data on the way that some that a decision may impact people, may impact a service, and that is something that's really helpful.
That last bit, you mentioned irrefutable data. Is there are there any, like, particular ways you go about presenting in that circumstance? I know, at times, folks can try to entrench, for example, when when they're faced with the thing that runs counter to a belief they have. I don't know if there were any strategies y'all use to get around that sort of, natural tendency.
Yeah. So the answer to that is actually there is not one strategy and there should probably never be one strategy because all of us absorb information and think about things differently. So for for me, the strategy always comes down to being really aware of who the person that I'm talking to is. What are the things that motivate them? What do they care about? How do they like information being presented to them. One person may love a white paper, another person may love a PowerPoint, another person may need a phone call, from somebody else that does not just need to say, hey. I I know you guys are thinking about this. Here's it. Here's my opinion. Because there is no one size fits all here, and that really comes down to the fact that we all come with our unique backgrounds and perspectives. And, it's really important to acknowledge that, not just in ourselves, but in the people around us. And so when when it comes to trying to present information to people, if you want to make a big argument or if you've got something that you just know you have to get this person on board with, it is not about how you want to present it present any of the information. It's all about how they need to hear it. I I think what I'm hearing from you is that that
portion also ties back to that, like, root empathy skill. You you talked about kind of early on in that answer as a root. That, I believe is is, like, something one can can train and, like, learn to be better at. Is is that's, like, a practice that that you find yourself having to be mindful of yourself? And if so, would you have any tips for someone who wants to be to be better?
That's a good question. I I don't know that I have anything that I consciously think about doing. That said, I do have a few people in my life. Ironically, all of them are designers. So, like, definitely take note. Designers tend to harbor, really amazing empathy that I try to harness on a pretty regular basis. And so I tend to get the practice that I need, I think, through connecting with people that exhibit skills that I wish that I embodied. So, you know, like I said, I've got I've got probably a handful of designer friends that I'll have regular conversations with that go a little bit deeper and I think push me to think differently about how I'm connecting with people, and, I think that a big portion of it probably comes from there.
And since we're we're on this idea of empathy, I imagine that something that's important in this sort of work is and and, really any sort of work, I suppose, is building, an atmosphere where there's trust and psychological safety, both, like, within a team itself and as well as the relationships it may have, with others. How do you approach trying to create that, and does the tour of service model that you have to that you kinda operate with have any impact on on that approach?
For me, the the first place in establishing trust is just listening. It's not showing up and being the loudest voice or the smartest person in the room. It's actually about showing up, being quiet, hearing what other people have to say, not just to be able to use that information to help you think through what your your next steps are, but also to really I think that that's, you know, again, building that empathy. I need to understand maybe a decision that from the outside I didn't agree with when I sit in a room with the five people that made it and they tell me all the additional context and constraint that they were under, all of a sudden, I'm gonna have a different view on that decision. And so that is definitely the first place that I start every single time. And I think after that, it is about making sure that whatever it is that you're walking into propose or whatever it is that you're walking in to try to work on has alignment with what the the career federal employees that you're likely engaging with or the career government employees that you're engaging with, that it aligns with their interests as well. I think that this is where the tour of duty service model does sometimes maybe rub this process a little bit longer because it tends to operate in a way that is folks coming in with more experience, a different experience. Not necessarily better, but, something that may sometimes immediately come come off with that sense of of of better than when you walk into a room, and so you're kind of fighting against that. And I think it also doesn't always give a lot of time to to listen. And so the more that we can make time to do that, I definitely think the better off we are.
It it sounds like perhaps, like, the tone that's set during, like, the onboarding process is probably pretty important. Is am I hearing that correctly?
A 100%. If you this is so interesting because I've been having these conversations lately as as, I transitioned into a new role at CMS, and one of the most important things is to be really, really thoughtful and careful about when you are a new person and you show up in an established environment that is likely resource constrained and comes with its own set of struggles, that that first impression, like, it will last forever. I still hear stories from people who, you know, four plus years ago, had some bad some bad run-in with the digital service in some agency. Like, those things, they they sit heavy with people, and so it is really important.
At times, I think back on something I built earlier in my career and ponder in horror about whether someone is out there using it today, and I imagine that I'm not alone in that. In fact, I I think there's a, government executive piece that, mentions, like, a team you used to run, finding some COBOL software that you'd come across and then had to to do some things with. I wonder, do you ever wonder if we're ourselves just at a stage of a similar cycle and maybe someone, you know, ten, twenty years down the road is gonna be writing something very similar, highlighting some old Python or Go software they happen to find somewhere?
Totally. A 100%. We are definitely just at the beginning of that cycle all the time. I am I am a big, big believer that a huge portion of our work is not necessarily about exactly what we are building, but instead is about how we are building it and how we are thinking about moving into both, from a government perspective, from a software development perspective, from the way that we're running our projects perspective, that all of that is moving to be a little bit more iterative and agile. I also sometimes wonder, though, if, like, does Iterative and Agile end up going out the door too. Right? Like, I feel like I am constantly questioning that. And, actually, a great story to tell around this is that my first it must have been, like, my first year first, like, three or four months, actually, at US Federal service. I got called in to work on I hear it was, like, maybe some policy at HHS. It was, like, something that I was digging through. And I realized that at the bottom of this policy, this signature was actually my mom's. And Wow. I remember thinking, right. Right. How crazy. Because at the time, this was when they were first trying to write to figure out how to bring iterative development into their software development life cycle. At the time, like, that was the most forward leaning thing that they could do. And that doesn't necessarily mean that, you know, maybe it wasn't what the private sector was doing or whatever, but it it that for me brought this thing, like, really full circle into thing into realizing and remembering that, like, this is all cyclical. All of it is all the time.
Yeah. Yeah. Definitely. Like, the phrase coming full circle, I I think, is almost an understatement in in that story you told. Yeah. So so, like, accepting that we are on, like, a cycle like that, do you have any, like, words of comfort for someone who might be worried about, you know, what what happens toward the the endpoint of one of these cycles and the work that's already here?
The one thing that is true here is that if you are optimizing for your end users and you are making sure that the policies and the delivery of those policies make sense for them, it doesn't matter what you're doing to get there so long as you can research that, build it in, and then test it. That is the most important part. We have to meet the needs of our end users. And if we are not doing that, then all of it fails. And if we are doing that, then that really is all that matters.
Out of curiosity, is there any media that you consume, whether it's a a podcast, video series, book, periodical, or some other thing that you found to be particularly inspirational, informative to your practice?
That's a good question. So, yeah, so in terms of media that I consume, I definitely try to spend some of my free time decompressing. So listening to whatever music I want to, reading trash novels. I recently my daughter has been challenging me every single week to read a new book. So this week, I'm reading The Hate U Give. And a couple weeks ago, I read some terrible horror novel that she didn't tell me was a horror novel. So I am actually of the mindset that for as much as I want to be consistently consuming things to improve my practice or my work, that I actually need to figure out how to find balance. And so I am doing that by trying to consume as little as possible related to work when I am not working. When I am during my work day, though, I do try to just pay attention to what's happening in, kind of some of the different federal news outlets. I love knowing what other people are working on, and I actually spend a lot of time getting my information from other people versus, any specific, place that I feel the need to stay connected to.
You know, I I I like that answer because I so something you point out there is, like, that I that thing of needing to have some some balance as a human between the work things and the not work things. And I do think that's really important. Actually, I wonder if I should, I may I may have to think about, the way I word that question in the future because, you might be aware this is, like, something that is, like, a reused thing. We we tend to ask, guests for, like, podcasts or video tips. Totally not just so I have a I have more content for the episode description, and have it, like, written by the guest for me. Totally not that at all. Nope. But, yeah, I I appreciate that answer. That's that's awesome. I'm told that you might have some personal news, and I think you mentioned this a little bit in answer. There's, like, a little little sneaky thing about a new role and and when and an answer, I think, a couple questions back. Are you able to preview that at all for us? Like, what's, what's this, like what's next for Shannon here coming up? Totally. So I actually have spent the last eight weeks on
kind of a mini personal vacation trying to figure out what would come next for me. I went and hiked the Grand Canyon, hung out with my family, spent more time doing those personal things. And I am now coming back to the Centers for Medicare and Medicaid as the chief technology officer, the Centers for Medicare and Medicaid Innovation. And for people who don't know, that's not just technical innovation. So we're not, that typical innovation office in a federal agency. We're actually a center that's focused on figuring out how you, pay for health care differently. And so I'm super excited about this journey. I have been a huge fan of CMMI's work for a long time, and I'm so excited at the opportunity to go over there and work with that entire team and bring, a little bit more emphasis to technology and the process of thinking through the future of health care.
That sounds like a really exciting and a and a and a big step in in your journey here. What what inspired you to wanna wanna go that direction and and and take on that responsibility?
As I was in the process of stepping down from my digital service role, I wasn't really sure what I wanted to do next, and I just kept having this feeling like I wasn't done. Like, the work is not done, and it may never be done when it comes to CMS, I think that it's really important to continue to be a part of decision making, continue to be a part of thinking through and supporting people while they're trying to figure out really hard problems. And so, yeah, for me, it was really just this you know, I felt like there was still so much work to do, and I am really fortunate that I've spent the last couple of years being able to get some cool stuff done at CMS. And I would love to leverage that experience and that knowledge to helping and working over at at CMMI.
First of all, congratulations on on the opportunity. And, I know there's probably a ton of folks out there that are excited to see, how that turns out.
Awesome.
One thing, we we tend to do, on here on Civic Tech Chat is we, offer some space at the end for the guests to monologue a bit to let us know what sort of things they'd like us to think about as we depart the podcast episode. So, Shannon, what sort of thoughts, do you have for us for that?
Yeah. So in the period of the conversation, I ragged a little on being both a federal employee and also the the tour of service model, but I really strongly believe that every single person should, if they have the capacity to show up and be a part of working on our government, This is something that belongs to all of us, that we are all a part of building and making and partially responsible for. And so I would just encourage anybody who's interested or has considered public service in some way, shape, or form. It does not have to be US Digital Service even though USPS is always hiring. It doesn't have to be at the federal government. It could be in your state and local government. It could be in some other service that's partially connected to it. But I would definitely just encourage everybody to spend some portion of their time or their life, being a part of those institutions because I think it is really, really important to to this country, and it is really important to our future.
Again, Shannon, I wanna thank you so much for taking the time out of your day to come on and share your insights, your experience, and your knowledge with us here on Civic Tech Chat. Thanks so much for having me. I enjoyed doing this. It was great. You can follow us on Twitter using the handle at civic tech chat. Visit us on the web at civictech.chat, or subscribe to us for content updates wherever it is you download your podcasts.
