An outside review of West Virginia’s Department of Health and Human Resources has rejected a legislative proposal to split the agency, but concludes changes are urgent to knock down silos and improve results.
“To improve West Virginia’s health and human services outcomes, the status quo is not an option; DHHR requires bold organizational change,” wrote consultants for the McChrystal Group.
“However, creating two separate departments is not the change required, as doing so would divert time, funding, and leadership’s focus away from serving West Virginians.”
The context is West Virginia’s low performance on the most challenging health and societal issues. Consultants noted that West Virginia ranks lowest for life expectancy, highest for rate of drug-related deaths, highest for percentage of minors in foster care, second highest for food insecurity and 35th for access to care.
An assessment of the organization designated to meet those challenges “shows a compassionate and committed workforce forms the cornerstone of DHHR. At the same time, current Department operations are not driving long-term improvements in state-wide health and human services outcomes. As such, indicators and outcomes in West Virginia continue to rank among the lowest in the country.”
West Virginia officials selected the national consulting firm McChrystal Group for a top-to-bottom review of DHHR in May in reaction to legislative dissatisfaction with the agency’s performance.
A bipartisan spectrum of West Virginia lawmakers said experience had taught them the state’s largest agency is just too unwieldy to get a handle on its operations or finances. DHHR’s total annual budget is $7.5 billion to handle a wide range of health and societal issues.
Gov. Jim Justice vetoed a bill that would have divided the agency, saying a restructuring needs a longer, more careful examination. The governor called for a top-to-bottom review.
McChrystal Group provided a cost estimate of $503,648 for the organizational assessment of DHHR and $578,770 to develop a strategic plan. The national consulting firm named for retired U.S. Army Gen. Stanley McChrystal reached conclusions after analyzing a survey of all DHHR employees, conducting 65 interviews, reviewing agency documents and reviews by subject matter experts.
As the findings were released Thursday afternoon, the governor said he has directed DHHR Secretary Bill Crouch and his leadership team to immediately implement the McChrystal Group’s recommendations.
“They will do so in an effective and efficient way and will ensure there is no lapse in any vital support or services for the West Virginians who rely on the DHHR. I will also work closely with the Legislature on changes to laws or funding that may be necessary to implement these changes.”
McChrystal’s report says the agency’s executive team should focus on a strategic plan and then further develop and communicate its direction.
“The objectives in this plan are large challenging issues that will not be simple to address. Achieving them will require consistent focus and support from teams across the department,” the consultants noted.
“Therefore, detailed action plans are needed to identify key strategies, initiatives, performance measures, and milestones.”
Right now, the report concluded, communication throughout the agency too often falls short to be effective: “The Office of the Cabinet Secretary – including all administrative offices – rarely seeks proactive input from the bureaus, which impacts decision-making and service delivery.”
Lack of broad strategy across the agency results in fumbled priorities, the review concluded. “The lack of a department-wide strategy also results in over reliance on key leaders, further limiting collaboration and hindering teams’ abilities to effectively deliver services.”
The report describes silos.
Senior leaders in the Office of the Cabinet Secretary are primarily communicating within their own group,” the report concludes. “That is, these individuals name very few sources of good information outside of their own office. While the senior leaders and Cabinet Secretary are referenced in some instances as good information sources, many others do not reference them, indicating that they are disconnected from the center of the network.”
West Virginia legislators are scheduled to hear from a representative of the McChrystal Group about the findings during interim meetings on Sunday.