“Product Management In Public Health: Fireside Chat With The U.S. Digital Service At The White House”: Itir Cole, Mary Moreno, and Purvi Desai with U.S. Digital Service (Video + Transcript)

March 26, 2024

Ever wonder what it’s like to be on a product team that revolutionizes efficiency and impacts millions? Our groundbreaking work has amassed over 40 million test results, saving an astonishing 852,000 work hours over 2 years – a testament to our dedication to transformative innovation. Join this fireside chat to learn first-hand from product managers at the U.S. Digital Service (USDS) who are detailed to the Centers for Disease Control and Prevention (CDC). During this session, you will learn how to tailor and adapt product management principles for the unique needs of government organizations, bridge the gap between product teams and government stakeholders, and get a glimpse into how product management thinking has had a positive impact on public health initiatives.


In this ELEVATE session, Product Managers Itir Cole, Mary Moreno, and Purvi Desai from the U.S. Digital Service discuss their experience applying product management in the federal government.

They emphasize the importance of building relationships, being resilient, and highlight the significance of open communication channels and repetition in fostering trust and ensuring effective collaboration. 

Itir Cole ELEVATE quote we work remotely but we work for the federal government

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Transcript of ELEVATE Session:

Itir Cole: Hi. Thank you for having us. We’re excited to be here, and excited to share with you our experience. My name is Itir Cole. I am coming to you live from New Jersey. I’m joined here by my colleague Mary, who’s calling in from Colorado, and Purvi, who’s calling in from Texas. That’s the beauty of USDS.

We work remotely, but we work for the federal government. To introduce our agency a bit more, we are with the U.S. Digital Service, which is a federal agency, and we report into the executive office of the president.

Our mission at USDS is to deliver better government services to the American people through technology and design. We do this by using our collective expertise and our unique position to do the most good for the most people in the most need.

We collaborate with public servants throughout the government to address some of those most critical needs on high priority technology projects, and ultimately deliver a better government experience.

We work across multiple agencies. The way that we work is we are a central hub of technologists, and we get detailed out to agencies as they have priority projects. We do this by bringing our best practices from our various disciplines.

Of course, we are here representing product management, but we also have engineers, data scientists, designers on all of our projects, and we also have procurement, talent, operations, and communications. So, we are interdisciplinary teams.

Today, specifically, we’re going to talk to you about our experience applying product management in the federal government. We’re going to be drawing a lot from our experience being detailed to the CDC and bringing our public health experience. With that, let’s get started. I’m going to pull up our questions.

The first question we had was around how we balance bringing in new approaches to product management in traditional, maybe more rigid structures in the public sector. So I’ll give you… Mary, do you want to take this one first, and we’ll pass it over to Purvi?

Mary Moreno: Sure, yeah. Itir, maybe it would make sense for us to also introduce ourselves really briefly too, just so everyone has a little bit of better background. Why don’t you go first, actually, and then I’ll introduce myself and answer the questions. Does that sound good?

Itir Cole: Sounds great.

Mary Moreno: Then we can hand it off to Purvi? Cool.

Itir Cole: Yeah, let’s do it. I mentioned my name is Itir Cole. I have been in product management for several years now. My experiences in database administration, that’s how I started. But my formal education is in urban planning.

I love studying systems, going macro and then diving back into details. That led me into GIS, Geographic Information Systems, studying spatial data, I really love that. That’s how I landed in database administration.

From there, product management naturally came about. I just saw that there was a need bridging the gap between leadership and the work that we’re doing on the ground. So I started to fill up that space as a product manager, and decided to more intentionally lean into that work. So, that’s me.

Mary Moreno: Thanks. I have a degree in chemistry in German, so I’m just going to double down on the weirdness of a variety of backgrounds. But I’m a product human definitely, through and through.

A lot of my experience prior to coming to USDS almost a year ago, which is crazy, is mostly in healthcare technology. So I got my sea legs in healthcare technology at Athena Health, which is a large electronic medical record company out in Boston, where I’m originally from. But I moved to the mountains at some point, so I’m a reformed East Coaster, but definitely health tech nerd through and through.

Newer to government, so I can answer the question about existing processes in government to a degree, but I certainly don’t have the breadth of experience in the federal government as Purvi does, who you’ll hear from in a moment. But my approach to existing processes is… Well, I’ll be frank.

I am generally allergic to process, I say a lot. I do not love process as a product manager, and the government has a lot of processes, there is a lot of red tape and bureaucracy. We have this concept at USDS called bureaucracy hacking.

This idea that there might be a way for us to be innovative in our approaches, or ensure that the process in place is the right one for the job to be done instead of just following the status quo and checking the boxes, because that’s what people before us have done. That’s something that I really love about USDS, so I take that approach with me to the CDC when I’m faced with a process that we have to follow, or a framework that is typically used.

One example recently is that we went through a security review for the product and team that I’m on, and that product and security review didn’t quite meet the needs of a true agile product development team, so we brought the team along with us. We had the IT department on the phone, and we explained, “We don’t actually track costs in this way in an agile environment. We don’t break out the cost per sprint, but here’s what we could do instead.” Here’s how I think about whether we’re on track or not. Squaring their circle on what the IT department expects and meeting them halfway, but also bringing them along for the ride on those processes. Purvi, why don’t you introduce yourself? I’m happy to-

Purvi Desai: Thanks, Mary. Thanks, Itir. Hey, everyone. My name is Purvi Desai. A quick intro. I’ll pile on. I like to tell people that I live a portfolio life, and I’ve done a little bit of a lot of things. My start actually is, I’m a Veteran. I went to the United States Air Force Academy and I was a commissioned Air Force Officer for about seven years. I’m also a military spouse, so if there’s any military dependents out there, you know how hard it can be to find jobs and keep up with your career as you move along with your active duty spouse. So, that was my first experiences.

After being active duty, I moved into more traditional program management. I’m an engineer by trade, so my master’s and undergrad are in systems and industrial engineering, so I did a lot of reliability work for large acquisitions, so think buying airplanes and airplane systems for the services. From that, is where I found my love for innovation, and moving into the DevOps and the product career fields. I really helped stand up a lot of the Air Force’s innovation cells and software factories, as you could call them.

I worked in something called BESPIN. BESPIN is an organization down in Montgomery, and they’re really focused on digital transformation and mobile application delivery for business systems for the Air Force. Then moved on to more infrastructure-related backend things, such as running a hybrid cloud platform for applications across the world. So, all over the place. But really, at the intersection, I’m really passionate about serving. So throughout most of my work, even when I was a consultant or worked for a private industry, we were supporting government contracts.

Service is central, and USDS is a great place to do that. Working at the CDC has just expanded the horizon of how unique each government agency can be. But, at the same time, a lot of those same problems manifest in different domains. It’s great to be able to see across them, and bring some lessons learned from different government agencies into other ones. Process, let’s talk about that. Bureaucracies aren’t inherently bad. Having a process isn’t inherently bad. They bring important structure, stability and compliance to projects, and sometimes you just can’t get away with it, especially working in the government.

I like to orbit the giant hairball. You want to stay as close to… You don’t want to be relegated off the island. But, you want to be sure that you could actually move and balance things in the right manner. Like Mary said, having a good understanding of what is in scope and an out of scope is important. You want to start really with relationships, I think, though. Anything you want to do, you want to make sure you have a valued colleague relationship, so you’re not that heretic with wild ideas.

When you come in and you want to bring the IT professionals, and the security professionals, and the product people all together on a phone call to go through this security review, that’s not going to be just wild. It’s going to be like, “Okay, let me hear you out.” So invest in that relationship first, focus on those shared outcomes. Everyone wants the security review to happen, and then let’s give the existing process a fair shake. That’s probably a different answer from Mary, who’s newer to government. I’ve worked most of my life in government.

I feel like a more iterative approach to change sometimes is the right way. You’ve got to bring those folks along, like Mary said, and you can’t… Lasting change sometimes takes a while. Humans are humans at the end of the day, and change is hard. So taking people along, having an iterative approach to changing process as well. Maybe you just tweak one or two things here, and you meet their needs and you assuage their fears, and you’re building that rapport while you’re going along. I think that can help play that long game a little bit, and bring that lasting change for a while.

I will say, an important caveat, sometimes there is things that you just need to address immediately, staying true to the values that we know are important. Balanced teams, empowered teams, having certain cultural things, you need to address those right away. But, there might be some things that you could give a little bit on. So it’s like with anything in life, it’s a give and take, it’s an iterative approach. Focus on the humans because, at the end of the day, that’s what we all are.

Itir Cole: Excellent point there. I will echo both of those comments. I think where I might add is, yes, relationships are super important. People need to see that you’re reliable if you want them to trust you. When you’re trying to bring an innovative practice, you’re really asking for culture shift, probably at the organization level. Showing people that you’re reliable and you’ve built that relationship, I think is really important.

Another piece in government, probably, is being resilient. You’re probably going to come across a lot of closed doors as you’re going through this process of changing behavior, changing processes. Staying resilient, and staying strong, and looking for… Being like water, find another way to get there. That would be my recommendation. Should we go to the next question?

The next one is around fostering open communication. Of course, we’re talking about building relationships, but how do you ensure that open communication channels are effectively established and maintained to foster that trust we mentioned, especially when you’re integrating a new problem-solving approach? Should we go backwards this time? Purvi, do you want to go, and then Mary?

Purvi Desai: Sure. Thanks, Itir. Effective communication is so important everywhere, but especially in government. You hit the nail on the head. It is critical to foster trust, implement any new approach and really meet those successful outcomes of that approach.

Working in the government, and then especially in public health, we have many different stakeholders and customers all with varying access to communication methods. They also have varying levels of a shared vocabulary, and then there’s varying levels of how comfortable they are, according to their own organizational cultures, voicing concerns, being curious, and then just plainly being engaged in a large and complex group.

The first problem usually to overcome is ensuring that we have a shared platform to communicate on. Once we have that shared platform, we could then foster the dialogue. There’s some great tools out there, Airmeet being one. But I would caution at introducing new tools when the stakes are really high. Less complexity is probably better, and you might want to spend that capital on harder problems to solve, rather than teaching someone how to use Slack. So, having a common platform is important.

The next thing I would say is, being an active facilitator is also crucial. We have so many different folks at different levels of government, from different perspectives in the CDC and public health. We deal with tech people like me, and Mary, and Itir, but we also have EPI’s in the mix, we also have procurement folks. We have a ton of folks. Being able to be a translator and drawing parallels is really important to keep the engagement going, and really spark the action that needs to happen.

You’ll have to go deep in your domain to make sure that you can identify those areas. Sometimes you see a connection, and folks might not engage on that. You might have to facilitate that connection and that communication to happen a little bit more. Once those floodgates open up, it’s a little bit easier to get going. I have a colleague actually at the CDC who loves to say, “Repetition doesn’t spoil the prayer,” and it’s so true.

Most of the time, I hesitate on repeating information, or messaging, or repeating a question and an answer, and I’m routinely corrected. There’s always people who are hearing it for the first time, or they’re just now understanding the complex nature of public health or the government, and they’re finally hearing the message in the right context. I’d say, don’t be afraid to share more than once or twice. I think that’s it. Back over to… Maybe Mary has some additional thoughts there.

Mary Moreno: I’m so upset I have to follow that answer, Purvi. That was so good. I was just clapping and saying yes the whole time. We have the same colleague that says, “Repetition doesn’t spoil the prayer,” I love that. I love that you used that quote. I so agree. I’m going to add to it and say that…

Saying things in different ways can sometimes be a really effective way to communicate how we’re solving a problem for the first time. What I mean by that, more tactically, is just because you’ve said the words doesn’t mean everyone understands those words in the way that you’ve communicated them.

Sometimes a slide is helpful. I’ve actually used this tactic a couple of times, where you bring up a Mural board or a whiteboarding technology of choice, and you have someone add stickies and questions, and they’re more actively participating.

Or you have a diagram or an architecture diagram, sometimes that’s an effective communication tactic. Then something that we say at USDS is, “Show, don’t tell.” Sometimes just telling isn’t enough. Sometimes you just have to be like, “Hey, I’m doing this,” and then you show the results of the thing that you’re doing.

What I mean by that is, recently, we were coming up with a way to basically slap a UI, a user interface, onto this very backend heavy piece of technology to demonstrate how… This is a meta example, now that I’m saying it out loud. But to demonstrate to users how this backend technology actually improved the visibility that they had into data, just generally speaking, and getting the excitement… Not everyone understood why that was so important.

But getting that idea out in front of some of our potential users, getting feedback and then showing that feedback back to our leadership team was really, really helpful in demonstrating like, “Listen, this idea is actually getting some traction. We have some data here that says so.” Sometimes that can be a really awesome way to double down on telling, is just showing. Then lastly, I’ll add, one tactic that I employ is a monthly session where I bring everyone together who’s even interested, semi-interested, in my project, once a month. I call it the Interested Party Session.

I have a look back over the last month, and a look forward over the current to next month, on how the teams are orienting themselves, and how we’re chipping away at objectives and outcomes. I make that more of a dialogue where people can ask questions. Or, “Have you thought about this thing? Have you thought about that thing?” It aligns everyone, even though they might not be super involved in the day-to-day of the project, to what it is that we’re doing.

Itir Cole: Such excellent points. I’m happy to wrap up our answers to this question by adding that, yes, repetition is incredibly important. You have to continue to manage up, manage sideways, manage down, get your information, get your message out there.

The great thing about being able to work within a group setting is that you don’t have to do that alone. You can be strategic on sharing that message across the organization through your colleagues, which is what we do. If a message needs to travel up and down the organization, we can say, “Okay, this is how we’ll split ourselves across the hierarchy, and everyone go and have this conversation, and then come back and report back. Let’s see what message actually traveled across.” I think that’s a great one.

And, knowing how to influence the people that make the decisions. Maybe you’re not influential, but someone else is. How can you get in front of those people to get your message across, and have them support you or endorse your idea as you’re pushing change across the organization? T

o then wrap up our session, we have one last question for us to answer for all of you. That is, what role does user-centric design and iterative development play in creating public health solutions that are both effective and user-friendly? Mary, do you want to start us off?

Mary Moreno: Sure. This is a really big question because, I think, if you’re a product manager, then you’re obsessed with user-centricity. Often I’ve been at companies in the private sector where product managers are considered voice of the customer even. We are so focused on users that we are the users themselves, and can often speak for them.

One of the things that I think has been helpful, as far as ensuring that the thing that we’re building is actually making an impact, is that the same person that Purvi and I both work with, who talks about repetition not spoiling the prayer, also talks about customer benefit. He’s a huge advocate of outcomes-oriented product work.

One of the things that we push to do within our division at CDC is basically benchmark where we want to hit outcomes for the projects that we take on before we even get to a point where we even know what it is that we’re building. For example, time savings, or cost savings, or number of touches. If it’s not intervened, there’s no introduction to human error or something on a process.

One of the ways that we’ve been able to tell the story about the impact of my project is by concentrating on a pre-workflow and a service design blueprint that explains what happened before at this specific user group, how they were using, or not using in this case, a specific data source, and how difficult it was to make sense of that data before this tool was introduced.

Telling the story in terms of the service blueprint, and then showing the after effect of having the technology in place, and what impact it had. Not just on the user flow, but as a measurement of time saving.

Being able to do that time study even in an analog environment where maybe we don’t have monitoring in place like we do in private sector, and being able to say, “Before, this was a really bad process, and it took users 20 hours to process this data. After, it took them two minutes, because we automated the entire process. That’s a huge time savings.”

Being able to tell that story and getting really deep into your user’s workflows and stuff is really, really impactful and helpful in storytelling.

Purvi Desai: Perfect. Mary, you chatted about user-centricity so well that I feel like there’s almost nothing to add. I will make a note on maybe just the iterative nature of how that’s so important as well.

Working in public health, or maybe in government in general, our problem space doesn’t usually require brand new innovation. It’s usually modernizing existing functions or improving capabilities. This was a common scenario that applications and systems faced in the last pandemic, when we needed our existing systems to be able to sense and respond that novel disease, and then respond to it at that impressive scale.

We just weren’t able to keep up, and there were a lot of workarounds that happened because we didn’t have that agile or iterative development model in place. Those changes that were required would’ve taken an impressive amount of work because the scaffolding to incorporate them just didn’t exist.

It’s so important right now to create that scaffolding, to create the ability to add new capability while you’re still executing the mission. The public health mission doesn’t go away in times of normalness, in times outside of a public health emergency. But, you want to have that ability to rapidly include things.

Having that capability not only in the actual architecture of your systems, but also the flexibility in those wraparound services. In our jurisdictions, you know a lot of our folks rely on third-party vendors to help them execute their work. Do you have flexibility baked into the procurement contracts that might allow that scale to increase, or the support that they give? So that iterative nature not only within the development of the actual system, but also the iterative nature and the agility and flexibility for all of that wraparound service and support.

Then I’ll just add one brief bit. Being user-centric, make sure that once we have this ability to sense and respond, that we actually sense the right thing. Like Mary mentioned, we’re actually measuring the right things and sensing those right things, and then responding in the right way, because we are the voice of our users. We are so user and customer-centric, that is inherently ingrained in us. So, plus one. It doesn’t matter what… I shouldn’t say it doesn’t matter. It matters what we do. But, the way we do it too is equally important.

Itir Cole: That was awesome. Thank you both. I do see some questions. I realize we’re down to three minutes, so maybe I’ll give us some of the questions to respond to. There’s one here from Patty who’s asking, “How do you get stakeholders to be committed to goals if many areas are incentivized in different ways? Or specifically, to commit space and mind space for the project?” I can give you a quick answer, and I’ll turn it over to our panelists too.

You stay persistent. You have to remind them that you’re not going to let go of the goal yourself. So what I would want to avoid is making the ask towards the goal, and then just letting the person do it on their own time. But going back and reminding them, “Hey, I’m still on this. I’m not going to give up. I’m going to keep coming back to this ask.” Reminding them of why it’s important, as far as which outcome, I think that’s really helpful. Mary? Purvi?

Mary Moreno: Do you mind if I go first, Purvi?

Purvi Desai: Please.

Mary Moreno: Okay. I would say that there are likely different ways to storytell so that it resonates with your audience. If there’s truly nothing uniting these audiences together, if you can’t figure out a way to pitch or storytell to an audience that might not directly see the impact on the face of what it is you’re doing, maybe they’re the wrong stakeholders for you.

But, if you really strategically think about what it is you’re trying to get done, and then put on your user empathy hat as a product manager, and you’re like, “Okay, if I were this person or I was this team, what would I care about? What are their goals, and how do I make it make sense to them in the framework of their goals, or their strategy?” That’s one of the hardest things that we do, as we’re leading up and across orgs.

Purvi Desai: I would just add, we have the luxury in government that we don’t have to win. It is not an individual win, it’s a communal win. The pressure of getting ahead or not…it’s really what Mary said. We have a shared common goal, and it’s really just looking at all those different perspectives of meeting that goal. It’s not winning individually, it’s winning collectively.

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