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Roubideaux: IHS reform and the Aberdeen investigation

On Sept. 28, the Senate Committee on Indian Affairs held a hearing on the serious management issues within the Aberdeen Area Indian Health Service. As a member of the Rosebud Sioux Tribe, I am acutely aware of the longstanding problems and challenges within the Aberdeen Area, including insufficient accountability with respect to performance and financial management; the difficulties of providing care in rural, remote and impoverished communities; and limited resources to address the problem. I have witnessed these problems firsthand, and see the consequences for Indian people.

As I stated at the hearing, these problems and issues are unacceptable, and that is why we are working to correct them. While we have made some progress, we have a long way to go. Sen. Dorgan and I share the same goal – we believe the Aberdeen Area IHS must do a better job of serving its communities. We also share a mutual conviction that the management policies, principles and practices must continue to change and improve in the Aberdeen Area and throughout IHS. I believe effective collaboration between IHS and Congress is essential to helping us achieve our shared goals, and IHS is cooperating fully with the committee’s investigation.

As a part of our priority to reform the entire IHS, we are working to improve the way we do business and how we lead and manage our employees by putting into place fundamental reforms in management practices and our organizational culture to create lasting change. This starts with a strong tone at the top. I have communicated clearly to all IHS employees the importance of improving our customer service, professionalism and ethics, and have insisted that we do a better job of holding employees accountable for poor performance or improper conduct. I have implemented a stronger performance management process with higher performance standards for our employees, including measurable goals to ensure that we can more effectively manage performance.

Leadership and managers are being held accountable to balance budgets, justify expenses, and do better fiscal planning. We are also working aggressively to improve the quality of services provided to our patients and to maintain 100 percent accreditation of our health care facilities. And we have implemented a new property management system that holds all employees financially accountable for property they use in their work. These are just a few examples of the actions we are taking to begin the difficult work of changing and improving the Indian Health Service.

I believe we have an Aberdeen Area director who is committed to bringing the same kinds of changes. She faces a daunting task, but has demonstrated progress. She has made it a priority to hold managers and employees accountable for the performance and, under difficult circumstances, has made meaningful progress in response to both the IHS administrative management review that was completed in April 2010 and the committee’s investigative findings. As a result of her efforts, this past year, all Service Units in the Aberdeen Area balanced their budgets for the first time in 20 years, and third party collections increased by $30 million.

Specific concerns raised in this week’s hearing are also being addressed. The Aberdeen Area is implementing better security in its pharmacies to ensure that medications are used for patients’ medical needs and not diverted for other purposes. We are improving the way we conduct background checks for prospective employees to ensure we hire only the most qualified and upstanding candidates. And we are working to minimize the practice of placing employees on administrative paid leave for long periods of time, while continuing to appropriately address conflicts, threats to patient safety, and other issues that may require the removal of an employee from the workplace while an investigation is underway. I have made it clear that we need to address performance issues as quickly and as fairly as possible.

IHS is changing. The challenges we face are enormous, but we are committed to making meaningful and tangible improvements in the coming weeks, months and years. To learn more about how we are changing the IHS and get updates on our activities, visit my Director’s Blog at

Dr. Yvette Roubideaux is the director of the Indian Health Service.