The Hatfields and the McCoys: When a Health Department Board Splits in Two

Adapted from Dr. Steve Cohen’s book Mess Management: Lessons From a Corporate Hit Man. Names and identifying details have been changed or left out.

The call came from the chair of a county health department board. She told me there was a significant mess and she needed help sorting it out. When I asked for the broad-brush overview, she said the board was deeply divided, nobody was certain of the facts, and chaos was ruling.

The stakes were high. Residents of that rural county relied on the health department for most of their primary care. Nurses had resigned without notice, patient care was suffering, and the chair was worried, correctly, that the state could step in and shut the department down.

The informal allegation was specific: the executive director had pushed out a highly respected director of nursing and replaced her with one of the director’s own relatives. The general allegation was that the executive director lacked the skill and judgment to run the department.

Slow down long enough to write a plan

The chair wanted me there the next day. I understood, but I insisted on a written scope document first, and I wrote it that same day so I wouldn’t hold anything up. My first rule in any crisis is to never make a bigger mess than the one you walk into. A plan the client approves in writing keeps everyone clear on what I will do, who will do it, how long it will take and what it will cost.

The plan was simple. Interview every board member. Interview the staff raising concerns. Interview the person the allegations were about, with clear instructions that there would be no retaliation. Talk to former employees if needed. Then analyze what I learned and report findings and recommendations to the board.

A board split four to three

The board interviews showed me what I was dealing with. The board was polarized four to three, and I started thinking of them as the Hatfields and the McCoys. The McCoys saw the executive director as a saint. The Hatfields saw her as a good person who was also the source of the problems.

The staff were split the same way. About half supported the executive director without question. The other half thought she was failing as an administrator. On one point everyone agreed: the director of nursing she had terminated was highly respected, as a person and as a practitioner. After that termination, three staff nurses resigned in protest without notice. The executive director, also a registered nurse, stepped in to make patient visits herself, which left the administrative side of the department unattended.

What the investigation found

I interviewed the former director of nursing and the nurses who had resigned. I also spent several days on the business side, from HR systems and the policy manual to the budget and financial controls. Those areas were in complete disarray. The only thing that functioned properly was the nursing service.

My report substantiated both allegations. Among the findings:

• Finances. The executive director could not tell me the department’s annual budget and badly underestimated its fund balance. The bookkeeper was effectively running the budget.
• Leadership. Even her supporters said she was “too nice.” She approved leave without checking the schedule. When two aides who were covering every weekend asked for help, she told them that since nobody wanted to help, they would have to cover it themselves. She watched two employees in a shouting match trade personal attacks and did nothing to stop it.
• Ethics. The former director of nursing told me she had made it clear she wanted no part in bringing the director’s relative on staff, and that she felt pressure from that point on. With the relative installed as second in charge, staff had no safe way to raise a concern about either of them. Patient complaints about the relative’s care and charting went nowhere, and her personnel file showed no record of any review.
• Confidentiality. In every personnel file I reviewed, employee health records were mixed in with other records. Patient records were visible to visitors, and all incoming mail, including staff members’ personal mail, was opened.
• Credibility. After a state grant report went unfiled despite a reminder, the executive director told a staff member she couldn’t understand why the state was demanding it with no notice. The staff member knew she had received the reminder. An honest “I blew it” would have been fine. The denial cost her the staff’s trust.

In my experience, complainers and snipers don’t mutiny about nothing. It is always about something. Taken together, the findings told me her position could not be salvaged.

I didn’t want one side to “win” and the other to “lose.” Everyone was hurting. I recommended that she step aside, that an interim director lead while the board searched for a permanent one, and that the department finally get the HR tools it lacked: a policy manual, job descriptions, an appraisal program, a wage and salary plan, and training on how to use them. For the board, I recommended written job descriptions for members and the chair, and bylaws that would keep meetings from being captured by staff or the public.

The vote, and the meeting that almost undid it

The board accepted the report four to three. The McCoys rejected it, even with the facts in front of them. In the second phase, the executive director agreed to resign, signed a hold harmless waiver and stayed on as a staff nurse for eight weeks under a time-limited contract while she looked for her next job. That bought time to fill nursing positions and gave everyone a cooling-off period. The former director of nursing came back as a staff nurse. The state was cautiously satisfied, and the chair had lined up an interim executive director pending a formal vote.

Then came the board meeting. The community packed the room, and I asked that the sheriff attend for crowd control. The chair was called out of town by a family emergency, so the vice chair ran the meeting. As soon as he called it to order, one McCoy member launched a personal attack on him, and a second picked up where the first left off.

It took me a minute to see what was happening. If he got angry or embarrassed enough to resign on the spot, the McCoys would hold a 3-2 majority of the members present. They could cancel the consultants’ contracts and bring the executive director back. I was shouted down and told I had no right to speak, so I leaned over and quietly told him to stay calm, stay seated, let them run out of steam and simply thank them for their comments. He held firm, and the attempt failed.

The interim director’s contract was approved. Within three months, a qualified, experienced executive director was hired. The Hatfields and the McCoys were still on the board, side by side, but the department settled down and the community calmed down with it. The steady state of any organization should be peace.

What leaders should take from this

• Ethics has two tests. To be called ethical, a decision has to be ethical and look ethical. Pushing out a respected manager and hiring a family member fails both.
• Nepotism kills accountability. When a leader and a relative hold the top two jobs, employees have nowhere to take a concern, and complaints quietly die.
• Get the facts before anyone picks a side. A neutral, written investigation gave the board something solid to act on, even though not every member accepted it.
• Boards need structure. Defined roles for members and the chair, plus bylaws that keep meetings disciplined, are what keep a divided board from tearing an organization apart.

Frequently asked questions