Most of Ad Hoc’s daily work is focused on health care and Veterans, but I want to take a step back and look at government as a whole for a moment. I want to remind ourselves of the truly enormous number of public services it provides.
- Consumer safety
- Disability services
- Emergency preparedness and response
- Energy, renewables, efficiency
- Land management, natural resources, and parks
- Food and agriculture
- Health and health care
- Jobs and unemployment
- Courts and the justice system
- Commerce and small businesses
- Travel and immigration
- Voting and elections
Within each of these bullet points, there are many sub-services, and services under those sub-services. It is remarkable the breadth and depth of what government does.
Together, these public services constitute a kind of infrastructure, which could be called social infrastructure. Sociologists have referred to things like libraries and public parks as social infrastructure, highlighting the connective role these public resources play in our communities. At Ad Hoc, we take an expansive view of public services and their delivery as social infrastructure. Like physical infrastructure, social infrastructure needs to be designed and engineered effectively, operated by skilled technicians, continually maintained, periodically rebuilt, and expanded when necessary. Like roads and bridges, social infrastructure connects people to each other, and to other resources that improve their well-being, their sense of self and place in the community. We define social infrastructure as that which we collectively pay for and administer which enables people to live healthier, happier, freer, more fulfilled lives, as individuals and together.
We’re in the midst of a massive transformation from public services to digital services, and with that, a critical change in the country’s social infrastructure. Government has used technology to deliver public services for as long as we have had computers and networks, but until recently, it was mainly in service of the back office. Users interacted with paper forms, phones, and in-person public servants. Now, technology is consuming all aspects of public services and becoming the primary way the public interacts with government and the social infrastructure it provides. This is a substantial shift that should not be taken lightly. We’ve seen what can happen when government’s desire for digital service delivery is outstripped by its capabilities. It’s time for government to treat the digitization of the delivery of public services as the monumental endeavor it is. If we are going to rely on digital channels to support the weight of our nation’s public services, we need to approach building them with a commitment commensurate to the challenge, and with a humility commensurate with the risk of getting it wrong.
Ad Hoc’s work on the social infrastructure
Talking about this transformation in terms of social infrastructure helps put Ad Hoc’s work in context. Through our work to date on HealthCare.gov, Vets.gov/VA.gov, the Quality Payment Program, and others, we've helped create better experiences for users of government services. Piece by piece, we are incrementally improving the overall social infrastructure. We’re increasing the reliability, availability, and accessibility of public services, delivered through digital channels, so that people can depend on them.
Most of Ad Hoc’s work has been on public-facing applications, like HeathCare.gov and Vets.gov/VA.gov, services that are plainly part of social infrastructure. While these are critical services, there is a deep well of software, products, and processes supporting other vital services with differing levels of visibility to the average person. As an organization committed to improving social infrastructure, we must also put our research, design, product, and engineering skills to work on all aspects of public service delivery. Human-centeredness and better user experiences are still core to how we approach our work, but we're thinking more about the full life cycle of user experiences and how they’re impacted by numerous levels of government technology.
Last year, we began work on a project called MACFin, which is the financial reporting part of Medicaid and the Children's Health Insurance Program’s (CHIP) business information system. Building out MACFin is important for improving how budgets in Medicaid are managed, and how its financial reporting systems function. Medicaid is a critical public service that serves more than 70 million people, or roughly 1 in 5 Americans, largely from our most vulnerable populations. States and the Centers for Medicare & Medicaid Services (CMS) have to work together to accurately and efficiently share financial information, which is tied to budgets and ultimately to the ability of states to deliver health care to those eligible.
Ad Hoc has been using our front-end design and development skills to make MACFin interfaces user-friendly and effective for the state and federal Medicaid staff who work with the system every day. The goal is to allow CMS to better collect and use data to modernize and measure the Medicaid and CHIP programs. MACFin may not have a public-facing component like HealthCare.gov, but it is a crucial part of the social infrastructure, and therefore fits with the kind of work we want to do.
Taking the long view
We sometimes think of objects of technology as disposable, quick to be made obsolete by the next new shiny tool or app on the market. But the things we build, especially the services we build, have a way of being around for a while (see: mainframes). Today’s quick fix can become tomorrow’s critical infrastructure. We’re mindful while we’re shipping new features to consider our work in this broader context. At the same time we are creators of technology, we must be stewards of social infrastructure. This means building things with an eye toward longevity, which in technology often translates into being easy to change and as simple as possible to implement, without introducing extra complexity that could weigh down future maintainers (which may be ourselves). Being stewards also means taking care to build things well, with care and using best practices, so that they are worthy of the public programs they are in service of.
We also believe being stewards means collaborating well with others, and we bring this attitude to each of our engagements. Infrastructure by definition is something that connects people and things, and our services must play well with other systems and follow agreed-upon rules of the road. We also look to pitch in and help in adjacent areas and systems where we can be useful. While we may not own the products we work on, our teams are essential partners in helping government solve problems and deliver services. We strive to cultivate an ethos of stewardship as we participate in the ongoing digital transformation of public services.