Mistakes and Coverups and Crises Management

It has always amazed me that the Trump White House has never employed or utilized the skills of a Crises Manager. Every organization of any size or import and with half way decent management skills, minimally has a Crises Management Plan and most likely a consultant Crises Manager (usually but not always an attorney) for that fateful day when something goes terribly wrong.

I spent a good many years managing a small private non-profit agency. Over those years, there were many things that could and sometimes did go wrong. We were providing support 24 hours a day, seven days a week, 365 days a year to people with intellectual disabilities. Leading and managing a few hundred staff. People could and did die in the care of the organization, most of the time from natural and untoward incidents. But there was always the potential for that one terrible situation that could in and of itself bring the people and the organization to its knees. Life and death, personnel disasters, potential lawsuits and terrible public relations were always just around the corner.

There were many things I did and read to try to prepare for any such occasion. Workshops attended, policies written and approved, training myself, other managers and our Board of Directors. I'm certainly not the only one who has experienced this. Hospitals, schools and yes, government agencies have all had to learn and prepare for dealing with a crises. Honestly, mine were very small compared to anything I can imagine in terms of some of those larger organizations or running and administering an entire government.

But the principals are pretty much all the same. That's why I'm amazed that the Trump administration has absolutely no one to stand up and tell the President, "you have to do this, we need a plan for all to follow, for the sake of the country and perhaps for the world."

Lanny Davis, a fairly well known Democratic lawyer and spokesperson for many politicians, says it all in one simple line that cuts across all partisan lines. Here's what Davis says, "Tell it all, tell it early and tell it yourself". That's it. It sounds simple but no one in the White House seems to get it.

Mistakes are understandable under stress but can usually be corrected. Coverups on the other hand lead to nowhere but personal and administrative disaster. It's hard sometimes to follow the words of Davis. "Can't my PR person do it?" No. "Can't I fudge some of the facts?" Yes, but you'll regret it when you get caught. Never lie to the press - never. Say you don't have the information if you don't and get back when you do. But don't lie.

This is not a partisan argument but people need to understand that none of this is normal and we shouldn't want it to be. There is real damage being done to the institution of the White House and people working there.  The President should be measured on these mistakes and coverups. It should really scare everyone relative to the incompetence of handling what could have been an uncomfortable but honest discussion of a badly played personnel decision with many missteps. Blaming the FBI, or the White House Security and Personnel Office doesn't wash. The President, the Chief of Staff and the White House Attorney need to clear up the terrible decisions that were made and learn from these errors in judgement.

Redesigning Healthcare In NYS - Unintended Consequences

I recently realized that healthcare for pets is easier to access in NYS then healthcare for people. For some reason I was surprised. Back in July I was informed that my primary care physician was retiring. He deserves it so good for him. I was provided with a list of physicians within his system of care and he made a recommendation or two. Before I left his office, an appointment was made for January with one of the providers he recommended. So far, so good. But I have a number of health issues where things can come up. I did have some symptoms that needed some follow up in August. Naturally in my mind, I thought I could just call the new provider, get an appointment and go from there. No such luck and that's when I realized things weren't going to go well.

It turns out the new provider wasn't prepared for new referrals coming into his office even though a January appointment was already made/accepted. I called numerous times and couldn't get calls returned. When I finally was able to speak to a human, I got the distinct impression that the new guy was upset about the new referrals.

Next steps - after realizing I was on my own, I began shopping around. Should I stay in the same system or move on? This requires thinking through health records, distance, insurance coverage, etc. It also requires trying to find out how good a provider and their system is - a chore in itself. I began talking to other friends and acquaintances. Results were all over the place.

After three months, I've finally got an appointment for early November with a provider I've chosen but still don't really know. We'll see how that goes. I hope well.

The reason I've gone into detail on this is because NYS is involved in a major redesign of healthcare for the medicaid population. This is happening across the nation but New York is undertaking its largest effort yet to transform the state's Medicaid health care delivery and payment system through the Delivery System Reform Incentive Payment (DSRIP) program.

New York is one of six states that has a program designed to move its delivery system from a place that’s fragmented and overly focused on inpatient care in hospitals toward an integrated system that proactively focuses on patients and the community. Organizations and agencies are working together to address the same goals and to care for the same patients.

Sounds easy. It's been talked about for years but now, how people and health systems will be paid is tied to the reforms and redesign so hospital administrators and providers are taking it very seriously. Remember though, this is for Medicaid health care delivery. What about everyone else?

Having gone through what I have recently, here's my read. NYS has over reached again and I'm not sure if they even realize the impact of this.They've forced this down to the provider level. Hospital administrators, project managers and providers as well as community agencies are spending much of their time redesigning a massive system for the Medicaid population. All of their resources are going into this effort and few, if any, are home watching the store or how the rest of the system is operating. Medicare and private pay patients are being impacted by the redesign without any real thought as to why or how this is happening.

While I wait for my appointment, I'm told to use urgent care or the emergency room if anything comes up. These are the more expensive options that are part of the target of the redesign effort for the Medicaid population. Interesting.

So back to animal healthcare. Turns out I can call the vet and get an appointment for my dog with ease (within 48-72 hours), even though my regular vet is out on paternity leave. I think we all hope for positive results from NYS's latest effort at Medicaid redesign but there are unintended consequences that need to be watched and acted on.

Hey Governor, It Takes Money!

How do we or the 'state' value work supporting vulnerable people - people with disabilities, the elderly, infants and children? Most of these groups of vulnerable people are supported by either the state itself or by private, nonprofit organizations who are paid by the state to take on that responsibility.

The people who take on this mission are hard working people, mostly young, mostly women, many people of color. They go by different titles, Nurses Aides, Certified Nursing Assistants, Teacher Aides, Instructors, Direct Support Professionals, etc. They perform tasks that range from personal care like bathing, toileting and feeding to more complex support around behavioral issues, employment training, community inclusion and independent living. The work is hard both physically and mentally. Sometimes care and support is total and other times the work entails helping someone learning to do things on their own, or teaching new skills. Then there's the paperwork, every 15 minutes to an hour - documentation, documentation, documentation. The people paying the bills want to be sure of course that the money is being spent correctly and wisely. In addition, due to issues of the potential for abuse or neglect, there is monitoring and reporting that might result in lengthy investigations, loss of pay or even in the loss of employment.

So back to the original question, how do we value this work? We tend to talk a good game. We make sure these people are talked about as wonderful, committed and special people, doing God's work, etc., etc. None of it pays the bills however. In the nonprofit sector, these employees make anywhere from $9 to $12 an hour on average. Their benefits vary based on the organization they work for. The state of NY, like other states, also continues to have employees who perform some of these tasks. Salaries tend to be higher in the government sector, sometimes close to twice as much as the employees of the organizations that the state contracts with. What a way to show value!

So now we have Governor Andrew Cuomo identifying one sector, the food service industry, as needing a review relative to a minimum wage increase. He has painted the industry as piggish with CEO's income in some cases exceeding $20M. No one on his staff has seemed to remind him, that people who he is responsible for funding, through contracts and reimbursement rates to nonprofit entities, are making barely more than current fast food industry employees. As a matter of fact, these agencies have in some cases fallen behind the food industry. Right or wrong, that is the reality.

So again, how do we value these hard working people in NYS who are supporting vulnerable people? It seems not much or to put it more crassly, obviously not as much as the value of a burger or southwest salad. How would you feel if you were treated this way? How would you feel if your economic stress was ignored while expectations kept increasing? The answer seems pretty obvious wouldn't you say?

A number of years ago and as a result of news articles about excessive salaries of CEO's at a few nonprofit agencies, Governor Cuomo tried to blame low salaries of direct support professionals on the high salaries of executives and administrators. As a result, he and the legislature capped CEO salaries in the nonprofit sector. That card has been played. It can't be played again Governor. The real issue is and always has been money and the direct level of reimbursement to agencies that government hires to do it's work. Priorities need to reflect that. Representatives of human service organizations and those advocating for them need to begin speaking up quickly and firmly, letting the Governor and the legislature know that these workforce issues need to be dealt with head on and that we all need to truly value the work of supporting vulnerable people. This has become an issue of economic justice for a sector of the workforce that needs more then just a good word.

Gov. Cuomo Makes A Joke of Wage Issue

Governor Andrew Cuomo loves to be the first out of the gate. He seems to think speed equals being correct on progressive issues. Being first seems to be more important then being correct or truly leading.

Today he tried to get out front on the issue of a living wage. This is a huge issue and one that has to be addressed by political leaders on every level. He stood in NYC in front of unions and union members wagging his finger and belittling and shaming the fast food and restaurant industry about the paltry wages they offer to their employees in comparison to company CEO's. And of course he's right. There are CEO's at some of those companies making up to $23million a year. And yes, the average fast food employee may make about $16K per year. One of the Governor's arguments and where he showed real anger was when he discussed the fact that many of these employees had to take advantage of state and federal programs like Medicaid, food subsidies, etc. He was outraged that the state, yes government, was subsidizing these businesses by providing these benefits. So far he sounds pretty progressive, right? Standing up for the little guy. Beating up on those corporate scoundrels who are always taking advantage.

Cuomo has tried to get the NYS Legislature to act on increasing the minimum wage to a meaningful level but they've resisted. So he's trying to find a new way to accomplish it or to create the atmosphere for negotiations with the other branch of government. He announced that he's creating a wage board to review the issue of a wage increase for employees in the food industry. It will report, recommend and potentially act on a new wage structure for those employees in three months.

First, let's be clear. Those employees that the Governor identified and was talking about today do deserve better - much better - from all of us. But so do a lot of other people and the last thing we need, especially from a supposed progressive, is to create classes of employees. Those who get a living wage and those don't, etc., etc. Who'll referee that scenario.

In addition, the Governor should think and get some facts before he wags his finger at other people. There's a whole other group of employees that are possibly in worse shape than employees in the food industry and they are in that situation because of policies and funding issues developed and supported by the Governor and his administrative and executive staff. These people also, sometimes have to depend on benefits provided by the government and taxpayers. There are many, but let me identify some specifically. They're called Direct Support Professionals. They support some of the state's most vulnerable and important citizens - some of the people they support are pretty independent but some need total support. They support people with many different types of disabilities, some physical, some developmental and some behavioral. These support staff are hired by nonprofit agencies who are paid by NYS (the Governor) to provide these services. In most cases the rates the agencies receive are inadequate to cover the costs of care and support. In most cases these agencies and the supports they provide have been routinely reduced, transformed and cut. These are good people, the employees and the agencies, who deserve better from their corporate leader.

To add insult to injury, the Governor created a well intentioned investigative unit called the Justice Center that can force an agency and one of their employees to be out of work, unpaid for days or months while they try to figure out how to investigate charges of abuse and neglect. The bureaucracy that was created does less to control abuse it seems, but certainly helps people decide about their career choice.

Good intentions are nice. They help us align values. But more is needed then good intentions. If Governor Cuomo wants CEO's of private companies to step up, if he wants the Legislature to step up, if he wants non profits to step up, he needs to look in the mirror and step up himself. He needs to put his money where his mouth is. He needs to recognize that the state of NY has to provide resources to pay people a decent and living wage especially when they are supporting people and doing work that the state has a responsibility to provide.

Non Profits Need Ethics & Transparency Too

I've posted before about transparency in government, or sometimes the lack of it. Some of this got me thinking recently about how all of this impacts the non profit world. I've worked and sat on numerous boards of non profit organizations over the years and some are certainly better than others when it comes to transparency or sharing information.

I'm aware of one large non profit that insists on an executive session at just about every meeting, shooing people from their presence to conduct major discussions and big business behind closed doors. If anyone is critical, the answer is always the same. It goes something like, "We're not covered by the Open Meetings Law, or Freedom of Information Laws." There's also usually a variation about the inability to "trust" those in the audience with information. In this particular organization, there is not even an attempt to be transparent to donors, members or other related parties. There are other organizations who try to be transparent but many times they fall back on "executive sessions" at a moments notice if some threat, real or imagined, seems afoot.

Now technically these organizations are right. They usually aren't subject to Open Meetings legislation, at least not yet. Of course probably the best way to change that is to show constituents and then government that you need to be forced to be open and therefore subject to new or existing legislation. I suspect that will happen over time. They are also technically right about FOIL requests. On the other hand most documents, financial reports, etc. that non profits provide to government agencies are accessible through a FOIL request to the particular state agency so why make it so difficult.

Now really good non profits tend to try to model their meetings and their openness on state Open Meetings Laws even though they may not be subject to them. It's easy enough to do. Create rules and practices that most everyone understands and agrees with. Executive sessions can and should be held around personnel issues, real estate transactions, litigation and a few other confidential areas. Conflicts will arise but at least there is and can be an attempt at openness and transparency. In addition, an organization that operates like this will be much better prepared for the day when these practices are mandated by government.

I mentioned trust early on. Many organizations are quick to point out that they can't trust people with information or discussions that go on in their meetings. It's my opinion that this just continues a vicious cycle of mistrust among all of the players. When people hear that people think they can't be trusted, they tend to mistrust the parties even more and so on and so forth. Trust is something that needs to be built over periods of time. When people in power use their power to control and withhold information from other people, especially stakeholders, relationships fail. It's just natural. So openness, supportive relationships and sharing of ideas, although sometimes difficult, can work miracles relative to building partnerships and trust.

The bottom line is that we can't just always point our fingers at government for not being open. The private sector of non profits has big responsibilities in this area too. A great resource for good governance practices can be found at the Independent Sector's Website. Non profits and their board members would be well served by reviewing these materials and discussing open business practices.

TED Talks - Take Advantage!

A few years ago I discovered TED Talks and I've been taking advantage of them and spreading the word about them ever since. TED Talks are an example of what a great resource the Internet can be for millions of people, giving access to terrific information on a wide range of topics. Short, entertaining and information filled sessions on hundreds of thousands of subjects.

If you haven't ever heard of TED Talks or listened to any of their sessions here's a brief description taken directly from their website:

"TED is a nonprofit devoted to spreading ideas, usually in the form of short, powerful talks (18minutes or less). TED began in 1984 as a conference where Technology, Entertainment and Design covered, and today covers almost all topics - from science to business to global issues - in more than 100 languages. Meanwhile, independently run TEDx events help share ideas in communities around the world."

So here's a place where you can hear well known experts or up and coming doers and thinkers talk about leadership, education, technology, business practices, politics, philosophy, architecture and any number of other topics. It's all there for the taking and sharing. My advice is, take advantage of it and spread the word about it. We all benefit.

So click on the link and begin to enjoy TED Talks.

Consolidations, Collaborations and Mergers

There are many discussions going on about consolidations, collaborations and mergers. School districts, towns and villages and and non profits are all looking at these issues. As I've pointed out before, these are difficult discussions. There are lots of agendas from different audiences who sometimes know very little about the organizations, finances or operational issues. Then you have the protectors of the status quo. Those who blindly state that it can't and shouldn't be done, usually because of some personal interest.

All of this requires minimally two things and I've written about some of it before. First, leadership. There have to be leaders who really are leaders and who are willing to talk to their own organizations, their constituents and their potential partners. Collaborative communication is the second item that has to take place. As the saying goes, "it takes two to tango" and this tango requires partners who are willing to talk openly and honestly, sometimes privately and sometimes in public. There also need to be shared values aimed at some greater good. All of these things are difficult and hard to come by in a competitive environment.

Recently I've seen talks begin to take place in a number of local school districts. It always seems to begin with discussions about too many superintendents and quickly deteriorates into discussions about the critical importance of local sports teams and athletic fields. The reality is that in most cases, real dollars aren't saved by reducing a superintendent's position. That usually comes out early and some people use that as an excuse to put the discussion to bed. The athletics piece is also potentially a red herring that has more to do with team/community loyalty. This is where leadership and communication really need to kick in. If savings are not really there (reducing an administrator), where. How do we get to real savings or perhaps more importantly, better services. It's a huge discussion that has to take place with information and above all else, honesty and trust.

Shared services are possible. BOCES (Board of Cooperative Educational Services in NY) figured it out a long time ago. Things like payroll, accounting, purchasing, transportation, Information Technology and staff training really built the BOCES model. Like everything else there was an over reach and problems with accountability and transparency, but the basic model and concept worked and does work. The state of NY has recently finalized a report on government efficiencies and no surprise, back office functions are pretty clearly identified.

All of this falls apart though when the people in charge of their particular back office don't want to play or keep saying it won't work. From what I've seen and experienced, a break down occurs quickly when people want to defend their particular infrastructure, be it software, hardware or equipment and processes of some type. Real and strong leaders need to get involved in those discussions early and let people know that those arguments and discussions aren't helpful. It's hard but necessary and it separates real leaders from the rest.