July 2021. GrowthPolicy’s interviewed David Eaves, Lecturer in Public Policy at Harvard Kennedy School and Director of the at Harvard’s Ash Center, on the future of digital government, COVID-19’s impact on technology, and healthcare IT.
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David Eaves: We live in an exciting time in which government systems, services, and processes are increasingly digitized. This means leaders’, managers’, and public servants’ ability to manage the quality and capacity of many public goods is increasingly dependent on some knowledge of the risks, opportunities, and limits of “digital.”
Oxford University’s sums this up in one of my favorite quotes: “IT systems often limit policy-makers’ discretionary action in particularly fixed and non-tradable ways. … (I)f some goal A is non-attainable within an existing IT system, then there may not be a feasible way policymakers can achieve A, short of redoing the IT systems in a new investment, which may take years.” This is a remarkable observation of the constraints digital puts on the actions of public leaders. Something both they, and the public at large has become acutely aware of—like, say, when a vaccine-registration website doesn’t work.
In response to this reality, the goal of a public administration or policy school can’t be to turn current and future public leaders into computer programmers. Rather, my efforts have been focused on ascertaining what is the minimum viable knowledge public leaders need to have in order to be successful.
David Eaves: First, the student appetite for this material is enormous. They are acutely aware that they live in a digital era. They see governments and public institutions (as well as many private and non-profit organizations) struggling to adapt, and these students want to be skilled, effective, and prepared for their careers. Paying attention to that demand is worthwhile.
But I also think we’ve framed teaching in this space incorrectly. Courses on “digital government” are widely confused with courses on “innovation”; or, these courses are widely perceived to be about peering into the future. The key reframe of is in the last part: “in the digital age.”
This work is about teaching about the future, so my own journey on this has been coming to recognize that much of what I teach is simply straight-up public administration, but public administration that reflects, as would say, digital-era culture, practices, processes, and technologies that are needed to meet people’s raised expectations.
GrowthPolicy. In what ways has the COVID-19 pandemic revealed the fault lines at the intersection of technology and public healthcare delivery systems? What would be your recommendations to prepare for any future global health crises of similar scale?
David Eaves: COVID-19 revealed a number of fault lines in the public sector. First, it has been interesting to observe how governments that invested in not just IT but in Digital—that is, the practices of quickly adapting and iterating services, focusing on user needs and incorporating digital-era-design thinking— outperformed those that did not. For example, governments with dedicated digital teams were often more able to offer new services and communicate online more effectively. What’s more, once the pandemic hit, governments were simply overwhelmed with too many problems (like facilitating working from home) to have the bandwidth to develop new digital capacities. As a result, governments without these capacities fell even further behind.
COVID-19 also revealed how a failure to think about digital infrastructure—not only in terms of government tools, such as enabling online-collaboration tools, but also in terms of more traditional issues such as broadband access—have revealed fault lines in equity and justice. Wealthier and more privileged communities have fared better than others, and there is a direct link to not having nurtured digital-era leadership or making the right investments. I remain haunted by the photo early in the pandemic of two very young girls “going to school” on laptops in a Taco Bell parking lot because that was the only way they could access the internet.
Now to healthcare. The challenge in the healthcare space seems less about the need for new digital technologies than managing those we already have in better, more efficient ways. There are huge opportunities to be found by focusing on the perhaps boring but essential and complicated subject of scalable interoperable standards. Core to what caused our world to be transformed digitally is the emergence of common, open standards—for the web, email, and other digital services—that make moving and sharing information easier. Before the internet there was no lack of networks, but the key was making those diverse networks interoperable.
The same is true in the healthcare space. There is certainly no shortage of healthcare information generated; neither is there a lack of significant opportunities to leverage data and information. We need to find the leadership and/or authority to drive more standards across players that may not have commercial incentives to do so. This won’t be easily achieved in a market system wherein data silos protect incumbent healthcare providers and IT companies.
I did some governance work earlier this year for the , which is attempting to delineate more scalable standards in one part of the healthcare space. It is exciting work with enormous potential, but the inertia of existing systems and players is considerable. Enormous enough that even a global pandemic has not so far triggered a conversation that has penetrated into the public consciousness. That’s a window into how hard this work will be.
David Eaves: Yes, the opportunity for private-public collaboration will be enormous. I’ve enjoyed immensely that served the public sector. It was rewarding both to us and our clients to help them serve the public more effectively. It’s one of the reasons I’m focused on building capacity in the public sector: It is important to boost the public sector’s capabilities, but it is also critical so that they vet and engage the private sector responsibly. As digital engulfs a greater number of sectors of the economy, and shapes the provisioning of public goods, governments will need to develop greater capabilities in building and supporting eco-systems built atop of standards, data, or services.
Internally, much government work with technology, to date, has been about automating existing services or processes. There real opportunities lay in rethinking what services and—more ambitiously—what institutions might look like in a digital era. This is why I watch places like India and Estonia so closely. They have done more than others to identify and standardize core pieces of data—like a digital ID—and activities—like payments—and create interoperable standards to enable them to work at scale across government, and at times across society at large. By not requiring each agency to build duplicate systems or databases, these approaches can radically lower the costs of delivering public goods. It can also increase efficiency across society by simplifying “Know your Customer” (KYC) processes. These systems often work in support of, or even in collaboration with, non-profit and for-profit partners.
As much as I want to increase government capabilities, the reality is that the private sector is going to play a massive role in enabling governments to realize their full potential in a digital era. But for that to happen, government leaders will need to be able to understand the ecosystems they both create and/or are embedded within, as well as manage critical standards, datasets, or services. Indeed, the best thing for the private sector would be a more digital-era-capable government as it will make better decisions and be a more capable and enabling collaborator.
GrowthPolicy. Take our readers to the year 2050. What would be your predictions and forecasts about how technology will change the way government services are both accessed and delivered?
David Eaves: I have several hopes for 2050. The first is that we’ve gotten right the emerging “foundations” of digital-era public administration. That means digital IDs that allow citizens to access services seamlessly, and maybe enable governments to predict and proactively enable services for which these citizens are eligible. A set of core, interoperable standards around key pieces of data and services, so things like credentials or healthcare records are truly portable and both serve to empower individuals and create new markets and services. That the digital architecture of government is robust enough that administrations are able to launch new services, or adjust existing services easily to reflect to policies desired or seize on new opportunities. And that we are able to monitor services to see if they serve citizens well, identify biases and whom we are excluding so we can adapt and serve them better.
In short—referring back to the Margetts quote above—can we ensure that digital is more of an enabler of public-good creation than a constraint on public leaders?
But the second hope is more important. Everything I’ve talked about will dramatically increase the capacity of government. And here we need to be enormously careful about not enabling the leviathan. So what I’m most concerned about is that we: (a) continue the ongoing negotiation of the social contract to ensure that the public has trust in and is safe using, government services, and (b) using the words of the authors of the , “shackle” the government to ensure that these new capabilities support and don’t undermine the liberal democratic norms, particularly the capacity for dissent, that are essential in a free society.