NH health commissioner 'functional conflict' and misinformation – Seacoastonline.com

When she steps down in December, New Hampshire Health and Human Services Commissioner Lori Shibinette will technically be leaving her term one year early. By another measure, three years of managing a pandemic crisis is a full term, and then some.
“I have 10 dogs at home,” said Shibinette, who announced her departure plans last week. “I always say COVID years were like dog years.”
The Bulletin talked with Shibinette, a trained nurse, about the role science played in the state’s COVID-19 response, her decision to leave early, and the risks – and benefits – of speaking up when lawmakers spread misinformation. 
She told us about priorities waylaid by the onset of COVID-19 and how the state can do better by juvenile offenders in its care. With help from pandemic funding, her legacy will include several mental health initiatives, including the purchase of Hampstead Hospital to expand inpatient treatment for children; a new 24/7 crisis hotline and mobile response teams; and more services to transition people out of psychiatric hospitals and into their communities.
Shibinette said she’ll return to health care but not immediately.
“I think if COVID did anything for us as a society, it has shown us that it’s important to focus on what really matters to you,” she said. “So I’m going to spend 2023 spending time with my family and nurturing my relationships.”
Q. Health and Human Services is the largest agency in the state. And it’s responsible for the biggest, hardest issues. Why did you want this job?
A. My answer today is clearly different than it was in 2020. When I was at Merrimack County (as chief executive officer of the nursing home), we were running a great seniors program for the county. My reason for coming to the state initially was, number one, to learn how to make government work, number two, to have a larger impact on the people within our state. 
At the nursing home, I had a group of people I could help provide better care to. Being the commissioner allows me a larger scale to hopefully provide better care to all the citizens of the state. 
Q. You came to the job with ideas and priorities. Which big ones did the pandemic force you to set aside?
A. I had hoped to redesign long-term care and really build out the mental health system. Once the pandemic hit, I set aside the plans around long-term care, not because I didn’t want to do them, but because long-term care as an industry was hit so hard by the pandemic. I did not think it was the right time to start working to change it. 
Q. What changes did you have in mind?
A. I believe that seniors in our community should live where they want to live. After spending 25 years in what is referred to as “institutional care,” that’s not the ideal place for many of our seniors, but it is the right place for some of our seniors. And I don’t believe we should take that choice away from people. 
New Hampshire, which is largely rural, can be very socially isolating. We’ve seen over and over again that our seniors lose their ability to drive and don’t have access to the community the way they used to. 
Many seniors want to go into a more structured setting. Maybe not a nursing home. It could be assisted living or even senior apartments where there is a community. My vision was to revamp or redesign the long-term care system to give our seniors more choice on where they live and where they receive care.
Q. Managing the pandemic has presented public health and political challenges, from remote learning and mask mandates to vaccine rollout and school-based testing. Were you and your team able to make science a key part of the state’s decision-making?
A. The department always pushed science. We were at the table for those decisions, and a really important part of our COVID response was having multiple sides at that table. Not opposing sides, but different people bringing different perspectives to the table. And that’s what you want.
For the health department, we are advocating and most concerned about the health of our citizens. We don’t have expertise in the economy. We don’t have expertise in education. So having all of those sides together at the table is really important to trying to figure out a system that takes care of the vulnerable and affords people the ability to work and to have a good education. 
We had very equal footing when we came together to make decisions. One of the reasons that New Hampshire was so successful in our COVID response is that we balanced all of those things.
Q. State commissioners need good working relationships with lawmakers to get their priorities funded and supported. You’ve been called “courageous” for pushing back when some lawmakers have promoted misinformation about COVID-19 and the vaccine. Did you see that as a risk?
A. Anytime you stand your ground, it’s a risk. But you have to weigh the benefits and the risks, and my main concern was getting the funding we needed to make our COVID response effective and to protect the people of the state. 
There was no ulterior motive behind any of those conversations. It was really just about advocating for public health and for the health of our citizens – for what I believe in. I don’t take those risks unless I absolutely 100% believe in what I’m doing and saying. 
A lot of the legislators supported what the department was doing. There were an outspoken few who didn’t necessarily appreciate the track we were taking.
Q. You’ve responded personally in emails and conversations to some of the groups promoting misinformation. Have those conversations been worthwhile?
A. In this role and in the role of anybody in state government, I believe we should be very responsive to our citizens. Believe me, during COVID, I probably received thousands of emails, some very supportive, some not so supportive. But I was always very clear on explaining the perspective of the department: It’s not my personal perspective. It’s science. It’s the best information we have.
I believe functional conflict is very healthy. When two people can come together, have different perspectives, share their perspectives, and listen to each other, they may not always agree, but it can move perspectives back and forth. I think that’s a very healthy conversation to have.
I think for the majority of people who contacted me because they disagreed with something the department did, we were able to have that discussion very respectfully and civilly. 
There was a small minority of people who started with the foundation that whatever I was saying was a lie. So if you’re starting with a foundation that I’m lying to you, then we don’t need to have this conversation because it doesn’t matter what I say. So I would share my perspective, not expecting to change theirs.
Q. The state has acknowledged that it failed the hundreds of children who were abused over several decades while held at the former Youth Detention Center. What’s needed to ensure that doesn’t happen again? And how do you restore the public’s trust in the agency?
A. We have a plan to move from a detention model to a clinical model. I think that the key is that the people who care for these kids day to day need to have a clinical background. They won’t have a corrections background or law enforcement background. I think that is going to make a difference. 
When it comes to developing a program that’s therapeutic for kids who have behavioral health issues, I think it’s going to take a long time to restore the public’s trust in that new facility. There were a lot of horrible, tragic things that happened. It’s unacceptable and we need to build a program that doesn’t allow that to happen again.
Q. Prior commissioners have differed in two big ways: They didn’t have a medical background or the spotlight of weekly televised COVID-19 updates. How has that informed your approach to the job?
A. One of the areas I’m most proud of is how well the department and all of the health care organizations have worked together. There were no lines. There were no boundaries. And I think that my background in health care, being a nurse and being in long-term care for decades, helped with that because they knew that I knew exactly what they were going through.
I obviously had the stage where I could be open and talk about things that I was passionate about. I don’t think that opportunity has always been given to other commissioners. I don’t think it’s changed the way I conduct myself. It just gave people the opportunity to get to know me a little bit better.
Q, You’re leaving with a year left of your appointment. Why now? 
A. It’s really important for people who lead other people to be very self-aware and self-reflective. And I think the entire department and the entire healthcare sector is tired. When I reflect on the last two and a half years, I think the department needs fresh legs and the fresh energy of someone who hasn’t been through a COVID pandemic. It needs someone who can push things forward like it’s their first day on the job. 
Q. As you prepare to leave, what will stay with you?
A. I love going out and visiting providers and the people who use our services. If you ask my team, they would say I insist that they interact with the people we serve. 
Sometimes in positions like this you become isolated and you lose touch with the people you serve. I love seeing what we do at work in the community. Besides that, great teams. The people here at the department are wonderful.
This story was originally published by New Hampshire Bulletin.

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