Sound Off: Governance of hospital needs a new model


As one of the three finalists for the open commissioner position at Whidbey Health, I want to reflect on my experience. Not on the obviously legally flawed process and not on the individual selected (as I note below, I think he was the best choice) but on a much larger issue: the governance model itself. I will say that it was such an uninspired and uninspiring process that I drove home and withdrew my candidacy (although I gather they had already voted by that time).

I think there are two linked core issues that might bear analysis: size and process. In the extremely challenging environment for rural, critical access hospitals (which are failing around the country), the job is simply too big for five very part-time people.

I also believe having the entire commission elected is a set up for failure: any board needs to manage changing needs for expertise. The electoral process is demonstrably ill suited for electing people based on special expertise. Although I think the individual selected had the best background among the three of us for the current needs, an election process could just as easily have led to my appointment. The electoral process also heavily weights the process in favor of incumbents which limits flexibility—a critical attribute.

At the same time, I do believe elected accountability is necessary to keep the organization tied to the community it serves. There are multiple examples of rural communities losing control over this vital resource to private corporations. I’m sure a number of alternatives to the current set up would work, but I have a fairly simple model to offer: Elect five commissioners with term limits (maybe eight years — it takes a while to become fully integrated into the organization and its processes) and have them appoint another four commissioners with shorter, staggered terms in order to facilitate acquisition of relevant expertise (and I don’t just mean technical expertise: political, social and value based issues like equity and inclusion are often more important).

I believe strongly that Whidbey Health is a vital resource with great potential. From my very narrow window, I thought the rescue organization they hired to rebuilt internal accountability seems to be working well and has forged positive relationships with the existing commissioners. But I also believe it needs and deserves a larger, more adaptable governing body.

David Allen