The Health and Human Services Commission “Kitchen Cabinet”

HHSC Executive Commissioner Kyle Janek
HHSC Executive Commissioner Kyle Janek

The 92-page report of the Health and Human Services Strike Force has some very interesting information and observations on the operations of the Health and Human Services Commission that led it into difficulty of which the 21CT contract was essentially only a symptom of overwhelming organization and management problems.

One particular section is on Executive Commissioner Kyle Janek’s “kitchen cabinet” that would gather regularly for lunches and was outside of regular agency executive management.  These staff members had a strong personal connection with Janek and he  trusted them.  This arrangement created tension within the agency and some of the members of this informal arrangement were not worthy of his trust.

Here is that section from the report:

Not regular management but defined by personal relationship

“The “Kitchen Cabinet” Dr. Janek seems to have recognized his need for administrative support with his broad responsibilities, but the path he took to answering this need has proven problematic. In numerous interviews, we were told that the executive commissioner had created an “executive team” apart from executive management, including the chief of staff, deputy chief of staff and several other staff members, many of whom were new or relatively new to the health and human services arena but who had Dr. Janek’s confidence. We were told that this group, which we heard called “the bubble,” “the inner circle,” the “kitchen cabinet” and other names, met regularly for lunch to make decisions without input from deputy executive commissioner-level managers. Several of these individuals were tied together by longstanding relationships, some personal and some professional. Some had ties to the executive commissioner dating back to his service in the Senate.

“Us” vs. “Them”

“Based on our interviews, however, we do not believe that this was the case. The lunch meetings seem mostly used to brief the executive commissioner on events, but whatever their purpose, these meetings created a sense of “us vs. them” — the insiders versus the outsiders — within senior management. And as other events demonstrated, some of these individuals took advantage of their privileged position to take actions that reflected badly on HHSC, often while allegedly acting in the executive commissioner’s name.

“That said, most interviewees called Dr. Janek an affable and knowledgeable boss, but one insulated from many issues by his immediate staff — and not always well served by them.

Source of morale problems and barrier to communication

“It is not unusual for any manager to rely on trusted staff members; that reliance, however, should not become a barrier to communication within the broader organization, or a source of morale problems among other managers. In this case, it was both. Our early interviews with staff, conducted in the midst of the publicity surrounding the 21CT controversy, were often marked by frustration. This remained evident, in varying degrees, throughout our time at the agency.

“It is clearly true that certain decisions were made outside the formal organizational structure. For example, in several interviews we heard that many senior staff members and commissioners had no opportunity to comment in detail on the Sunset recommendations, with some of which they disagreed. The commissioner of State Health Services told us that DSHS knew nothing about the RFP seeking to outsource the Terrell State Hospital, one of its responsibilities, until very late in the process. This RFP subsequently became another major problem for HHSC and the subject of another State Auditor review.

Deputy Executive Commissioners in the dark 

“Concerning the Sunset report and possible further consolidation, some deputy executive commissioners did not realize HHSC had formed a Transition Committee of employees from across the enterprise — including some of their own staff in some cases — until we showed them its organization chart.

Not served well by immediate advisers

“It’s also clear that Dr. Janek was not served well by his immediate advisers. Among the employees who left the agency in the wake of the 21CT controversy, at least two — Erica Stick, the chief of staff, and Casey Haney, the deputy chief of state —were part of the informal “kitchen cabinet.” Haney, for example, was working on a graduate business degree at the University of Texas at Austin. His tuition was prepaid out of the HHSC budget, an unusual — and unusually large — tuition agreement. We were also told that Haney dealt with a specific member of the Human Resources staff in placing individuals for employment, bypassing the normal hiring process, and that among those hired through this unorthodox process was one of his personal friends.”

Dr. Janek has written a letter in response to the Strike Force report.

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