In 1943, the philosopher Jean-Paul Sartre published a screenplay based on the common casino gambling expression; “the bets have been placed” or “Les Jeux sont faits!” The plot concerns two characters, Pierre Dumaine and Ève Charlier. They are predestined to be soulmates, but this destiny is prevented by their premature violent deaths, and they do not meet until passing into the afterlife. For Broward Health, it is the promise of what could be for our community in this life that appears to be in the throes of a violent death from Broward Health’s increasingly intransient miss-management spaghetti and their missteps that continue to compound the problem.
The November 2018 elections will bring a new Governor to office who, regardless of party affiliation, will be saddled with the mess from the largely unsuccessful attempts of Governor Scott to monetize Broward Health for his political and personal benefit. Scott’s Broward Health’s record of malfeasance, misfeasance or outright neglect includes his refusal to appoint a full competent Board, a legacy of his crass political board appointments, his ‘trumped’ up – still pending Florida Inspector General and FDLE investigations among so many of his outright neglect or interference with Broward Health. The new governor will have the opportunity to suspend Broward Health’s criminally charged CEO, Corporate Counsel, and one current Board member. The new governor will certainly, at the very least, appoint Board members to fill the currently vacant seats and may, also, may ask for the resignation of all current Board members while giving them the opportunity to reapply for an appointment. (I should note that some current Board members, frustrated by so many easily corrected management actions have privately mused at resignation – and who could blame them?)
Then, of course, there are the pending ethics “investigations” into the CEO and one Board member. As heard around the street – a probable imminent bar complaint against Broward Health’s Corporate Counsel Lynn Barrett regardless whether the State Attorney makes a Bar referral in connection with Barrett’s criminal Sunshine law charges.
I have been told, that the newly elected Governor – again, regardless of who it is, will move expeditiously to close the pending Florida Inspector-General and FDLE investigations with a public report and push for a resolution or action on the pending ethic’s investigations.
All this, possible and according to some – probable within the next few months! Broward Health: “Les Jeux sont faits!”
So how does Broward Health avoid or delay their day of reckoning? The first law of holes or the law of holes states that “if you find yourself in a hole, stop digging.” Perhaps Broward health might consider the following steps:
- Board Oversight
The Board must embrace its public oversight role and take control of its meetings, it’s agenda, and it”s senior staff. While the Board is on the dais, senior staff are not their friends or colleagues – but highly paid professional employees who have jobs to do. - Partner with the Public
Broward Health must embrace the public, not hide from it.- Broward Health plans to implement a live streaming video program for all Board & Committee meetings; create a public cloud service to host these videos together with a knowledge base with all agenda and backup material appropriately redacted. Having a separate cloud service for this purpose will preserve inviolate the internal Broward Health network.
- Except for public record 119 requests that involve on-going litigation, public record 119 requests need to be primarily an administrative, clerical function and not an issue for expensive outside attorneys. Most public entities follow this practice including Broward Health until Lynn Barrett became Broward Health’s Corporate Counsel. Now, only Broward Health refers all its public records requests to outside attorneys. It is noteworthy that one of my more basic early public records requests for a copy of the CEO’s calendar cost Broward Health an outrageous $ 120,000.00.
- Board and Committee minutes are the current This problem emanates from agenda and Board governance problematic meeting procedures. With the addition of live streaming and your public meeting video library, there is no reason to have verbose meeting minutes. Transactional minutes together with the audio and video recordings are not only sufficient but overkill!
- Board Policies
Broward Health governs itself through policies. Currently, according to a recent public records request, there are over 4,000 active policies. While every one of the over ten thousand employees of Broward Health must abide by Broward Health’s policies, it would be impossible for any of them even to be aware of the policies that might affect them. Noteworthy, I have been ‘tipped’ that some ‘policies’ have been administratively changed (not by current managers) to fit a particular behavior. It should be no surprise that past practice is for some policies retroactively be established to justify otherwise questionable management activities. Governance requires that only the Board enact policies, procedures can be enacted by others to enact Board policies. Without wasting resources on a needless investigation into the provenance of any given policy, The Board needs to direct a comprehensive review, cataloging and public publication of Broward Health’s policies. - Governance
Currently, governance issues are a Broward Health mess. The job of the Board is to provide public oversight. The job of everyone else at Broward Health is to carry out the policies and mission of the organization. Senior leadership including all board reports each have primary responsibilities but in addition to responsiveness to Board policies – each must not only define problems in need of Board action but also recommend alternative administrative solutions for board consideration. Unending and unfocused Board discussions are the direct result of board reports failure to adequately define problems and recommend alternative solutions for the board. Further, board reports infighting, turf-protecting, and a complete lack of either professional courtesy or meaningful communication among the Board reports is a direct result of the Board’s failure to perform its oversight responsibilities. Given the critical nature of the recent Corporate Compliance Agreement, the so-called “CIA”, and the importance of conduct becoming the importance of each of the Board reports, the Board must enact some clear guidelines for their senior staff, including but not limited to candor, honesty, and cooperation by and between all the Board reports.
These are some “easy” steps the Board could take to help the district climb out of the hole in which they find themselves. More difficult, and more interesting would be an open discussion and public discussion of the system’s anemic utilization trends, its eroding HCAPS (Quality) scores particularly in relation to the competition, and a favorite of mine – “fair market value (FMV)” or “Commercial reasonableness (CR)”. (Currently, there is a policy – I think, that any Health related service contract (think physician or physician group) that pays more than 75% of the FMV or CR must come before the Board for approval. Why? Why wouldn’t Broward Health be willing to pay 100% of the fair market value for a physician’s service? I don’t get it.)
Broward Health: so much to do, so little time to do it. “Les jeux sont faits”
‘