Three years doesn’t seem like a particularly long time to hold a job, but when you’re commissioner of the Minnesota Department of Human Services, that length of tenure is actually quite impressive.
The position is so demanding that many DHS commissioners barely make it past their first year. The fact that Emily Johnson Piper stuck with it as long as she has is worthy of the record books.
“I think I am the third or fourth-longest serving DHS commissioner in the state,” Piper said with a chuckle. “Nationally, the average lifespan of a DHS commissioner is a year and a half.”
In November Piper announced to her staff that she had decided not to seek reappointment, leaving the position open to be filled by Gov.-elect Tim Walz.
Piper isn’t concerned that her staff will falter in her absence. “My leadership team is so strong and the people who work there are mission-oriented by design,” she said. “Commissioners come and go with pretty high frequency. The mission of the organization and the work that we do continues on regardless of the commissioner.”
Piper said she thinks it is important that Walz and Lt. Gov. Peggy Flanagan are able to set their own priorities for the key department. Even though many of her goals under Dayton’s leadership align with Walz’s and Flanagan’s, she feels it is important to step aside so they can make their mark.
“A new governor has an opportunity, regardless of political affiliation, to set their own agenda and their own priorities, and the Department of Human Services is an important piece of that work,” Piper said. “It is in the best interest of a governor to have a human services commissioner that doesn’t carry with them the legacies and the priorities of the past administration.”
Though Piper has held the position longer than many of her predecessors, that doesn’t mean she stuck with it because it was a walk in the park.
“When people ask me what do and I say, ‘I’m DHS commissioner,’ the response I hear more than any other is, ‘That is the hardest job in state government,’ ” Piper said. “It is a really stressful, difficult job.” But other government jobs are stressful, too, she added: “I would say that being the governor’s general counsel is not darning socks and sewing on buttons, either.”
Though she has held other key jobs at the top levels of state government, Piper explained that holding the DHS commissioner position means being pulled at from all sides. “The varying interests of this job and its high-profile nature makes it particularly difficult to be successful at. When you are navigating the issues that are some of the most challenging in our society, it is really easy for people to point fingers at you personally or at members of your division. When there is bad press, you are the face of the department, and that can be stressful in itself.”
Piper joined the department in late 2015, taking over from Commissioner Lucinda Jesson, who’d been popular among mental health advocates for her outspoken work on behalf of Minnesotans with mental illness. Though the state’s mental health community was celebrating a legislative session that brought historic gains in funding for programs, DHS was undergoing some turmoil in its state-run mental health facilities.
The problems that Piper first focused on included, she recalled, “how our state-operated facilities were working or not working. Of particular challenge was Minnesota Security Hospital and Anoka-Metro Regional Hospital. There were also issues surrounding the sex-offender program and constitutional rights of clients.”
A Legislative Auditor’s report shed light on those challenges. Piper said that her department responded to the report and worked to address the issues it raised, including spearheading a major two-phase remodeling project at Minnesota Security Hospital in St. Peter and improving working conditions for staff at the facility.
“In all of those areas we have made significant improvements,” Piper said. “All of our licensing conditions are lifted on Anoka and on the State Security Hospital. Our sex-offender program is now in a better position than it has been since 2010.”
At the Legislature, Piper’s initiatives faced resistance from some Republican lawmakers. Though in the end the 2016 and 2017 sessions still showed bipartisan support for mental health and addiction initiatives, many advocates complained that the gains were not as notable as they had been in 2015.
Piper said that when it came down to securing votes, reaching consensus on issues turned out to be more difficult than it looked as though it would be at first assessment.
“The hard part about human services is that people really broadly agree that we need more mental health services or we want to expand the addiction services that we are providing as a state,” she said, “but when you get beyond that 100,000-foot visioning stage that everyone can get behind, the rubber meets the road and interests get divergent really quickly. That proved to be a challenge.”
When she looks back at her time heading the department, Piper said that though she experienced her share of disappointments, she also takes pride in a number of significant achievements.
She also points to state improvements in Medicaid administration during a time of political and social upheaval: “In an environment that has been really challenging, we are now better at administering Medicaid than we were when I started. During a time when we have an opioid epidemic, when we have real challenges in our mental health capacity, we were able to make real, lasting changes.”
Making those changes required DHS staff to be “aggressive” in their efforts to defend the rights of Minnesotans to access health care, Piper said.
“I think those efforts across the last few years have paid dividends so the people of Minnesota. We have taken legal action when needed to make sure our state’s interests are represented, including when the federal government was going to cut MinnesotaCare. Thanks to our legal action, the state received back some of the money to a fund that was going to be cut.”
While improving working and living conditions at Minnesota Security Hospital continues to be an ongoing project, Piper said that under her direction much progress has been made. “Minnesota Security Hospital is doing better than it was a few years ago,” she said. “We have a lot going on down there. We are building phase II of our facility. We have a significant construction project under way. Worker injuries are down. Patient care is improving. We are seeing very steady increases in the number of people we can safely say don’t belong there anymore.”
Though the statewide workforce shortage means that the facility is still short-staffed, she said that initiatives she spearheaded have made a dent in the problem. “Those workforce challenges still exist there,” she said, “but that is not unique, and the outlook is better.”
What do others think of DHS’ performance?
Leaders of local human services organizations offer mixed reviews of DHS’ performance under Piper’s leadership.
Julie Bluhm, executive director/chief executive officer of Guild Incorporated, said she has observed that under Piper’s leadership, DHS has “really been in a rebuilding period.” Major staff transitions and hiring meant that at times key employees appeared to be stretched thin.
“They’ve brought on really good people and have asked them to do a lot,” Bluhm said. “From our perspective, DHS leadership has been expecting staff to do more than one job at once.”
Though department staff may appear to be overextended, Bluhm said that she was also impressed with how, under Piper’s leadership, the department remained outspoken in its commitment to serving Minnesotans in need.
“Piper was successful at shining a light on the needs of those with mental illness,” Bluhm said. “This is something that she has been very effective at.”
Though Piper and her staff have worked hard to continue Minnesota’s legacy of leadership in human services, Jill Wiedemann-West, People Incorporated chief executive officer, said she feels that it is important that the department continue to innovate and keep up with the times. She is concerned that if leaders begin to feel complacent, any progress they’ve made at the Capitol could easily be lost.
“Minnesota has a rich history of being an innovative and active leader in mental health services,” Wiedemann-West said. “Right now the most important thing for us to do is freshen up our vision of what that looks like in the state of Minnesota and then execute that vision rigorously.” It’s too easy for lawmakers to rest on their laurels, she said. An active DHS should keep that from happening.
Wendy Jones, executive director of Minnesota Recovery Connection, said she believes that under Piper’s leadership the state continues to work to build supports for people in recovery from addiction. She would like to see the state’s focus shift away from funding treatment facilities to a more holistic definition of recovery. She said she’s seen DHS under Piper moving in that direction through policy and legislation.
“DHS has taken some good steps to help Minnesota catch up to other states that are ahead of us in their thinking about recovery and not just treatment,” Jones said. “A lot of this reform happened during Piper’s leadership.”
From the perspective of the state’s hospitals, Piper and other DHS staff have been seen as collaborative and effective, said Wendy Burt, Minnesota Hospital Association vice president of public relations and communications. “We’ve had a really good working relationship with her, particularly in the mental health arena,” Burt said.
Burt recalled that the Minnesota Hospital Association worked with Piper to expand competency-restoration services outside of Anoka-Metro Regional Treatment Center: “Since then, they have increased hiring at the community behavioral health hospitals and they have expanded capacity at Anoka.”
Under Piper, Burt said, DHS “zeroed in on the mental health piece. I think they have positive results to show at Anoka and at other community behavioral health hospitals.”
The right person for the job
The perfect candidate for the next DHS commissioner would possess many unique characteristics. Piper said that one key quality this candidate must possess is a greater vision that is focused on the department’s mission of “helping people to live in dignity so they can live to their highest potential.”
“The right person for the job has to have the ability to see the bigger picture of human services and also possess the strong intestinal fortitude needed to have the courage and confidence to recognize the reality of a situation and say no to really important, good ideas because they know they are not going to get done, period, or done in a lifetime,” Piper said. “The right person needs to know how to say no strategically and thoughtfully. That doesn’t diminish their work or the value of the efforts to make Minnesota a better place.”
Piper said she also hopes that the next commissioner will be a person who “values the dignity of every person, regardless of what they have to offer back to society. I know that’s not something at the forefront of everyone’s mind, but it is important to live the mission of our department.”
Heading DHS is “a really, really big job,” said Wiedemann-West. The ideal candidate, she said, would be confident, bold and visionary, “a bit of a cowboy or a cowgirl.”
The challenge is that the position is politically appointed, and that can make it difficult to identify a leader with those characteristics. “Being a political appointee can remove the potential for having that unbridled vision of what can be accomplished,” Wiedemann-West continued. “I’m not saying you can’t ever get that with a political appointee, but it is really tough. I can imagine that it could feel frustrating to try to make change at such a big department. It is like turning an aircraft carrier.”
Burt said the Hospital Association hopes that a future DHS commissioner “would place a big emphasis on being collaborative and working with the provider community. We’ve had that in the last two commissioners and we hope to see that again in the future.”
She said that she hopes the next DHS commissioner would be well connected in the health care stakeholder community and able to draw those people into key discussions. “It’s key to keep those folks at the table, from providers to patient-advocacy organizations like NAMI,” she said. “Keeping everyone connected and at the table is the only way to make change.”
Wiedemann-West said she hopes the next commissioner will be able to stay in the position long enough to make a significant, lasting impact on the quality of life for all Minnesotans. “We need someone who can be with us long enough to make it work,” she said.
Minnesota has always been a leader in human services, so the person in this position has the opportunity to lead initiatives that could have nationwide influence: “Given how much we’re talking about these issues right now in the state, this is an unprecedented time to start completely different conversations around mental illness. We need someone who can sit down and facilitate those conversations and make a real difference.”
The next DHS commissioner should also be someone with a demonstrated ability to roll up his or her sleeves and tackle serious societal problems, Jones said.
“We’re really hoping that what was started under Piper’s leadership will continue. We want the next commissioner to keep moving toward a change in mindset and culture and practice. We’re hoping that whoever takes the new position is up to the challenge of some hard, messy work.”
“Hard and messy” is a good description of a DHS commissioner’s job. Piper said that she is looking forward to taking a break from the mess, to having a few weeks or a month off to reflect on her legacy at the department before she decides on her next career move.
“I’m hoping I can take time to really think about my next step, about what I really want to do,” she said. “Part of that has to include me thinking about what I’m good at, what I not good at, what fills my bucket coming to work and what is the most draining. Having a job like this one often feels like I’m drinking out of a fire hose. You aren’t able to think about the next step. You just have breathe and keep going. I’m going to take time over the next weeks and months to take a breath and decide my next step.”