Legislative leaders expressed frustration over an outside review of the Department of Health and Human Resources, characterizing it as expensive milquetoast.
“I’ve been around since 2002 and I’ve watched us go over and over and over the concerns, regardless of party or who was running the administration, and we’ve gotten the same results over and over from doing exactly the same thing,” said Senate President Craig Blair, R-Berkeley.
“From what I can interpret here, you’re saying throw more money and throw more time but keep doing the same thing. This is what I’ve read into your report so far. Frankly, it looks like this is a million-dollar waste of our taxpayer dollars.”
Toward the end of a Sunday meeting, Blair wrapped up by saying “We’re finished with that million-dollar nothingburger. Let’s move on to other business.”
Lawmakers weighed in on the report on Sunday during legislative interim meetings at Cacapon State Park in Berkeley Springs. The report was in the spotlight during a meeting of the Legislative Oversight Commission on Health and Human Resources Accessibility and also during a meeting of the Joint Committee on Government and Finance, which consists of legislative leaders from both parties.
The big picture 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.
Earlier this year, a bipartisan spectrum of West Virginia lawmakers concluded that DHHR, 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.
The result was an outside assessment by the national consulting firm McChrystal Group. The resulting report that was released late last week rejected splitting the agency, but did conclude that 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 assessment of the agency “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.”
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.
Partners with the consulting firm clarified on Sunday that this report was the final product.
Senator Blair was not impressed.
“Top-to-bottom, to me, means ‘all encompassing.’ This does not all encompass,” Blair said on Sunday. “Your own responses do not reach the goal of the title. Would you agree?”
Senate Finance Chairman Eric Tarr, R-Putnam, questioned the consulting firm briefing DHHR’s top leaders about the report’s initial findings in late September without looping in legislators and the public until now. Blair also questioned that.
DHHR Secretary Bill Crouch responded by saying the review had been conducted at the direction of the executive branch. “We didn’t release it to anyone until we had time for the Governor’s Office to review it, the governor to review it,” Crouch said.
Blair fired back, “We represent the taxpayers’ dollar” and said the report should have been shared much sooner for legislative review.
As the findings were publicly released Thursday afternoon, the governor said he has directed Crouch and his leadership team to immediately implement the McChrystal Group’s recommendations.
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.”
House Majority Leader Amy Summers, an emergency room nurse, found many of those findings too abstract.
“As a worker, I need to know how I do these things. When I read your thing: People don’t have phones, people don’t have the internet, people don’t have the tools to do the jobs they need to do. They don’t have enough help,” said Summers, R-Taylor.
“Those are the things I’m worried about that you didn’t even look at because we spent all this time developing a strategic plan that I could have put together in five minutes. So how do you get into that deeper part that we’re worried about instead of just telling us we need to add two more layers of management?”
Meghan Bourne, who presented the McChrystal Group’s review, responded that much of the firm’s focus was on whether DHHR’s leaders share a focused strategy.
“I agree. You can write a strategy on a piece of paper in a few days. The challenge is assessing leadership alignment around that strategy,” she said.
“Whether it’s a hospital or a department — large, complicated department — assessing whether or not leaders across that department are in alignment with it. And we did find that we got to alignment and leadership across DHHR was aligned very quickly on the top three. Once we got to the objective level, that’s where we saw a little bit of what we would call misalignment.”
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.”
Summers, toward the end of Sunday’s meeting, asked Crouch several times what he had learned from the report that he wouldn’t have known already.
“We are just disappointed in the meat of the report, and I’m trying to figure out how I’ve benefited,” said Summers, who described spending several days trying to analyze the review. “I’m gaining nothing from this. And I’m just trying to figure out how to move forward, and I’m just asking you what did you learn that cost a million dollars? What did you learn that you didn’t already know?
Summers concluded by telling Crouch, “It just seems like they stated that we needed ‘bold change,’ and I’m just trying to figure out what those bold changes are. And I think they would have popped out at you right away. I’m sorry. I’m sharing my frustration.”