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The way it works: Connections and politics at Guam Memorial Hospital



Lessons from Everyday Life By Theodore Lewis

It was a typical, beautiful morning on Guam. I was a passenger riding with my finance executive from Guam Memorial Hospital to a meeting we had been invited to at the governor of Guam's office in Adelup.


At that time, then Gov. Eddie Calvo had a small group of "advisors" advising him on the affairs of GMH. This group included the hospital CFO, a physician at the hospital, and a couple of the governor's staff. My inclusion in some of these meetings had only recently occurred. This advisory group for GMH did not include anyone from the GMH Board of Trustees.


I had been in the role of interim CEO at the government-run GMH for a few months. As the hospital had just completed a survey that had restored its regular Joint Commission on Accreditation of Healthcare Organizations accreditation status after being on probation, I had an optimistic outlook on the hospital's ability to continue positive improvements. Part of my optimism came from seeing how invested the Board of Trustees was in improving its knowledge of the hospital's operations and providing positive leadership to the executives and medical staff.


Hospitals are complex organizations, with each having its unique characteristics. The Joint Commission on the Accreditation of Healthcare Organizations has developed standards and guidelines for a successful hospital organization.


A significant part of JCAHO’s prescriptive standards includes the strong involvement of hospital boards in oversight and participation in the direction of the hospital. This includes the selection of the CEO and ensuring that the hospital adequately represents and addresses the needs of the community it serves.


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The experience of traveling along Marine Corps Drive toward Adelup is breathtaking and I was happy to have the opportunity to sit on the vehicle's passenger side in full view of the gorgeous blue and green waters to the right of the roadway. As we were passing Alupang Beach Park, the serenity of my view was shattered by an abrupt and terse conversation that blared extreme warning signs to me.


At our previous group meeting at Adelup, Eddie Calvo, then governor, asked me to hire an individual for a position at GMH. I had replied that I would investigate the individual's qualifications and assess the hospital’s needs, but I had not indicated an affirmative to the request.


Now on Marine Corps Drive, I was told by the CFO, in very descriptive language, that the governor had placed me in my position, and that if I didn't follow the governor's requests explicitly, the governor would remove me from my position.


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That evening I related my experience of the day to my good friend on the 4th floor balcony at Alupang Beach Condominium. He shared with me his opinion that the CFO was probably just following orders. I asked him why the governor often referred in these meetings to his power and authority over GMH under the "Organic Act."


I learned that the Organic Act of 1950 gave Guam great powers to manage the civil affairs of the territory without interference from the federal government. As a result of this power, Guam's governors frequently used the hospital to reward friends, contributors, and family-related businesses with favors, jobs and contracts.


Now I understood why the governor and his "advisors" ignored the board of trustees, considered them an obstacle, and made their own decisions regarding strategies for GMH. When it came to GMH, Adelup thought they knew best.

I had attended my last "advisors" meeting at Adelup.


In the forthcoming weeks, I continued to work with the board in attempting improvements to the operations of the hospital. Significant improprieties were discovered and I became a threat to Adelup and the "advisors." As a result, I experienced a well-executed effort to eliminate me.


Predictably, the governor requested the board chair to dismiss me. When the board chair refused, the governor demanded his resignation, and my fate was sealed.


Each board member's appointment at GMH is confirmed by the legislature from the governor’s recommendation. According to the GMH bylaws, the CEO is to be selected by the board "with the approval of the governor.”


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An important principle in life and within the management of organizations is the relationship of authority and responsibility. Responsibility cannot be assigned without a commensurate amount of authority and authority cannot be utilized without a commensurate amount of responsibility.


I have read recent news reports on Guam related to the current governor’s proposal for a new medical complex and a different GMH hospital location. Many in the medical community are opposed to the proposal.


Some reports have suggested the planning for a new hospital location was done and a proposal made to the legislature without input from most of the hospital's medical staff or communities that utilize the hospital. Now there are angry confrontations that are occurring between the governor's office and stakeholders of the hospital.


The GMH CEO seems understandably supportive of the governor's "vision" despite the strong feelings in the medical community against the proposal.


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The current governor of Guam can, as previous governors have, exercise very broad powers as it relates to GMH. Perhaps she is following in her predecessor's footsteps at Adelup, thinking that she knows best, and the opinions of key stakeholders are less relevant.


The reality of GMH is that the governor selects the CEO as well as board members. Maybe it's time to let the board have true oversight of GMH.


Regardless of how things play out, authority and responsibility go hand in hand, and the exercise of great authority will always bring great responsibility.


Theodore Lewis is the former CEO of Guam Memorial Hospital and has a healthcare consulting business in Bridgman, MI. He is collecting stories about lessons learned in life and can be reached at theodorelewis@yahoo.com.




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