The organization is messy at best. Usually a health group of this size has a centralized or matrix management in place, and Bethesda is no exception. However, dig just beneath the surface and one would find, in actuality, this is not 100% the case. Most of the leadership that has been around longer than 5-10 years is still trying to operate as though their communities are not part of an organization, but as stand alone entities. While this can work in some cases it cannot work when the organization is trying to standardize operations across 6 long term care/rehab, 5 independent living, and 1 assisted living communities. Unfortunately the root of the issue starts at the top so the mid level management on the ground at the communities find themselves struggling for direction. The Board does not appear to manage the CEO - You might think "managing" the CEO shouldn't be necessary, or at least rare. In most cases this should be true, but in the case of Joe Brinker, we are dealing with incompetence in leadership at an extreme level.
In recent years, Bethesda has continued to lose money at rates that are historic for the organization; the record breaking continues this year. While this is affected by many things, including reduced government reimbursement for services, the Executive Team has utterly failed at attacking the challenges with anything remotely resembling a strategy. Hundreds of thousands are spent on consultants/consulting firms, hiring or promoting additional VP level overhead, and essentially blaming others for the financial struggles. As you might imagine, if a CEO cannot manage his subordinates in a fashion that provides solutions rather than infighting, the organization could best be described as rudderless. The people who pay the price, are always the front line team, which is the worst part - and we should not forget to mention that these front line staffers are tasked with caring for the elderly in need. So in that case, we should consider it as the residents who pay the ultimate price.