Physician questions leadership at Cabinet Peaks Medical Center

A friend of mine, a nurse who has worked at a number of different hospitals in her career, recently sent me the following quote: “An environment that is not safe to disagree in is not an environment focused on growth – it’s an environment focused on control.”

The author of that quote, Wendi Jade, was writing it in the context of fundamentalist religious organizations, but it has a lot of applicability in work environments as well.

Anyone who has had more than one job in their lifetime generally knows what it’s like to work for a toxic organization. You feel undervalued and are often made to feel replaceable.

You learn not to speak up because at best you’ll be ignored, or at worst retaliated against for questioning or offering differing opinions.

Hopefully most people also know the experience of working for a better type of organization, where your work is valued, you are treated like a team member, and while not everyone’s thoughts or opinions are acted on, they are at least listened to with respect and appreciation.

But does work environment matter beyond just whether or not you are happy as an employee?

I recently listened to a podcast called Work Life with Adam Grant. The episode was called “Is it Safe to Speak Up at Work?” (Season 4, Episode 14).

In it, he interviewed Ed Pierson, a retired senior manager at a Boeing 737 factory near Seattle. In the podcast, he describes that Boeing factory as one with “a culture where people could not speak up or raise concerns without fear of retaliation or humiliation.”

Specifically, Ed claims that he tried to raise concerns about production pressures that were leading to fatigue and exhaustion on the part of workers, which led to an increase in quality defects. Ed said he tried to escalate his concerns higher in management, and talks in the podcast about how not only were his and others’ concerns ignored, but there was a culture of humiliation and retaliation against those who weren’t meeting quotas.

In 2018 and 2019, two Boeing 737 Max planes crashed killing over 300 people.

Ed later testified in front of Congress regarding this incident and how he believed the culture of the organization was one of the root causes of these tragedies.

On the same episode, the host also interviewed Admiral William McRaven, one of America’s most decorated military leaders who led the missions that captured Saddam Hussein and killed Osama bin Laden.

Among the men he has led, it is well known that he WANTS to be challenged and corrected. He is quoted as saying “the environment I want to cultivate is that you guys are fearless in telling me when I’ve got something wrong… the stakes are too high.”

While the importance of open and transparent communication in life and death military situations may seem obvious on some levels, it also in many ways goes counter to the perceived top-down rank and leadership style we often think of particularly in a military setting.

And yet Admiral McRaven would argue that his relationship with the lowest-ranked members of his team and their ability to call him out when they feel he’s making a mistake is one of the most important things that has made him such a successful military leader.

How does this apply to Libby?

A few months ago, I wrote a letter to the Board of Directors of Cabinet Peaks Medical Center where I served as Vice Chief of Staff. In that letter I raised concerns that I have about the culture and current environment in the hospital, and decisions that the current hospital administration are making that is creating what, in my opinion, is a culture of fear and silence.

The only response I received to that letter was a letter from their lawyer demanding that I “cease and desist” making “defamatory” statements about the Cabinet Peaks administration, and threatening legal action if I was to continue to voice these concerns.

It was after receiving that letter that I chose to abruptly and completely cut all ties with the hospital. And if that kind of response doesn’t perfectly exemplify what I meant by a culture of fear and silencing, then I don’t know what does.

This kind of toxic culture where people are not free to voice their concerns can absolutely have consequences in a medical setting. Based on my experiences in the last few years and despite the fact that I have great respect for the providers, nurses, and other medical professionals that work there, Cabinet Peaks is not a place I would seek care for myself.

Cabinet Peaks Medical Center is a 501c3 nonprofit organization, and as such is ultimately led by a Board of Directors.

According to the Montana Nonprofit Association (MNA), one essential practice and widely recognized industry standard is that the board “assumes responsibility and accountability for healthy functioning, diversity of thought and representation, and culture of the organization.”

While they are not responsible for the day-to-day operations of the organization, they are responsible for choosing the leadership that is, and as such set the tone for the organization as a whole.

The MNA also notes that while the legal minimum requirement for the number of board members is three, the recognized industry standard is “at least five persons, unrelated to each other or to staff, to ensure appropriate deliberation and diversity.”

The current makeup of the CPMC Board of Directors is five members, two of whom are married to each other and also have a daughter who is a manager within the organization. In the last five years that I have been part of this medical community, the board has lost some members but have not yet expanded their membership.

While there are many factors that have led to the culture of the hospital being what it is currently, I do believe a large part of the responsibility lays with the board. I would strongly encourage them to expand their membership to be more representative of the community, to expand their views and opinions, and move the hospital in a more positive direction.

I write this with the full expectation that either the Board or the administration at Cabinet Peaks will try to retaliate, as they threatened in their “cease and desist” letter to me.

I plan to leave this community in the next few months since I no longer feel there is a safe place for me to practice medicine here. I write this simply because I feel this community deserves better.

You have a wonderful community of physicians, NPs, PAs, nurses, and other medical professionals living and working here, all of whom care deeply about this community. I have felt fortunate to have worked alongside them.

But even the best professionals cannot overcome a toxic environment and toxic leadership.

Demand better from your hospital and your Board of Directors.

Kelli Jarrett, Libby