Guardrails – whether physical, organizational, or behavioral – are vital mechanisms that ensure safety, protect privacy, maintain standards, safeguard free expression, and shield individuals from both their own actions and the influence of those in power.  They provide guidance across diverse contexts, from physical infrastructure and organizational governance to clinical protocols, human behavior, and, more recently, artificial intelligence systems.  Given their significance, any modifications to these guardrails should be approached with careful consideration and thoughtful deliberation, keeping in mind the impact on those affected by the changes.

My career in healthcare IT began over 40 years ago at Wadley Institutes of Molecular Medicine, a cancer and leukemia research institute in Dallas, TX, which included a 110-bed hospital, clinic, radiotherapy center, and community blood bank.  Healthcare is a highly regulated environment, as it should be, to ensure patient safety and maintain high standards of care.  We welcomed visits – sometimes unannounced – from many respected oversight bodies[i] that conducted independent reviews and audits.  Those evaluations ensured we operated within guardrails designed to protect patient safety while maintaining care standards that were often more advanced than those commonly practiced in the community.

During my tenure as a CIO at 2 large health systems in Dallas, I had the distinction at both of being the beneficiary of more audits – internal and external – than any other department at both institutions, 21 in a single year at one of them.  And yes, I mean beneficiary.  Each review either confirmed we were doing the right things or identified areas for improvement, all observations provided in a constructive manner.  Those reviews only made us better; hence, we embraced them.  We adhered to and exceeded industry and federal standards to ensure our employers that we were acting in the best interests of all stakeholders.

Upon my White House appointment as Principal Deputy National Coordinator at HHS in the Office of the National Coordinator, I underwent a comprehensive and rigorous background investigation.  The process included an in-depth review of my professional history, as well as an examination of my family’s background and social associations.  The agency responsible for this vetting aimed to confirm both my competence and trustworthiness for the role.

Unbeknownst to me at the time, the investigators conducted interviews with my neighbors and colleagues.  They also approached security personnel in the building where I was employed and engaged with individuals sharing elevator rides to my office floor.  Throughout this extensive screening, at no point was my political allegiance or loyalty to the current administration questioned.  My commitment was, and remains, to serve the people of the United States, regardless of political party affiliations.

On my first day as a federal appointee, I underwent fingerprinting, took the oath of office, and was assigned an ethics official from the Office of Government Ethics (OGE).  Given my Public Trust and subsequent Top Secret clearances, I had regular consultations with this official to ensure compliance with ethical standards.  I was informed that, throughout my tenure and for the rest of my life, an OGE official would be available to provide guidance on ethical matters.  Former employees remain subject to certain post-employment restrictions designed to prevent conflicts of interest and protect sensitive information.  This commitment to ethics oversight underscored the federal government’s dedication to upholding the integrity and security of our nation.

The recent dismantling of some protective agencies and mass firing of government employees causes me grave concerns.  In no particular order, here are illustrative examples of actions that are very concerning:

• Firing of 17 inspectors generals across various agencies, the people who are internal, independent watchdogs responsible for overseeing agency integrity and accountability
• Use of an Executive Order granting the White House direct oversight of independent federal regulators such as the SEC, FTC, and FCC whose autonomy is important to avoid undue influence
• Mass firings of federal employees:
  • VA – 1,000 including researchers in critical health fields
  • HHS – 5,200 with heavy impact on 1,300 employees at the CDC, the agency whose efforts during COVID were nothing short of heroic and 1,500 at the NIH
  • EPA – 388 affecting environmental oversight and enforcement
  • DHS – more than 200 from FEMA and 130 at CISA
  • US Forest Service – 3,400 raising concerns about wildfire prevention, forest management, and public safety
  • IRS – thousands of probationary workers in the middle of tax season
  • DOE – 350 in the National Nuclear Security Administration
• Announced culling of 5,400 civilian employees at the Pentagon
• Ordered the Consumer Financial Protection Bureau to stop nearly all its work
• Forced layoffs of 1,000 at the National Highway Traffic Safety Administration, the company that is currently investigating whether self-driving technology in Tesla vehicles played a role in the death of a pedestrian, an agency in the Department of Transportation which sets standards for national highway guardrails.

My concerns about the recent terminations and the erosion of protective measures are both profound and timely.  Drawing from my experience as a CEO and CIO, I’ve faced the difficult task of downsizing.  It’s a process that profoundly affects employees, their families, and their communities, initiating a grieving process that is deeply personal.  I never used and insisted managers never use the phrase, “It’s not personal”.  Firing someone individually or as part of a group is as personal as it gets.

Making a termination more difficult and painful is when the motives of the employer are suspect.  In my career, my team and I approached every termination with care and compassion to lessen the emotional toll.  Decisions were often driven by the necessity to protect the organization’s financial health, and when possible, we explored retraining opportunities for employees whose skills no longer aligned with organizational needs.  Termination was never motivated by anger, power dynamics, or political agendas.  Instead, they were conducted deliberately and respectfully, upholding the dignity of each individual.

The image of a designated leader celebrating terminations and dismantling safeguards with a metaphorical chainsaw raises critical questions about our nation’s values and the current administration’s approach.  Such actions can severely damage an organization’s reputation and erode trust among remaining employees.  Studies[ii] have shown that layoffs can impact a firm’s reputation and lead to decreased productivity, reduced morale, and a loss of institutional knowledge.

Questions for Reflection

• Organizational Integrity: What message does it send when leadership celebrates mass terminations? As an alumnus of the Executive branch, I wonder how this reflects on our national values and the ethos of the Executive branch?
• Sustaining Protections: With the removal of critical safeguards, what strategies are in place to ensure continued protection of public health, especially in the face of re-emerging diseases or new pandemics?  What does unprecedented access granted to non-governmental employees to federal digital infrastructure say about the nation’s commitment to data security and privacy?
• Technological Oversight: As power-hungry technologies like blockchain and AI evolve, how are we preparing to implement new guardrails to manage their societal impact responsibly? What central role should the government play in coordinating efforts to establish governance guardrails for AI?
• Impact Assessment: Were the consequences of these terminations thoroughly evaluated? What measures are being implemented to facilitate a smooth transition to a new operational norm?
• Resource Allocation: Will the anticipated cost savings from these terminations be offset by the potential need for higher-paid contractors or the costs associated with failures due to the absence of experienced staff?
• Global Perception: How do our allies perceive these actions? Are we upholding the principles that define a robust democracy?

Let’s focus on fostering a resilient nation grounded in respect, dignity, and collaboration domestically and internationally.  Let’s embrace a multipartisan approach that can help rebuild public trust and ensure that our actions reflect the core values upon which our country was founded.

By prioritizing ethical considerations and the well-being of all stakeholders, we can navigate these challenges and emerge stronger as a unified nation.

[i] Oversight bodies included the AABB – American Association of Blood Banks, FDA, TJC (now the Joint Commission), CLIA, and many other local, state, and federal agencies including OCR and the HCFA, the precursor to CMS.

[ii] The Effect of Layoffs on Firm Reputation

The Devastating Toll of Layoffs: Measuring Human and Organizational Costs

Organizational Trust Leads to Positive Employee and Organizational Outcomes (SIOP)