Heather Sherman on her first day as a federal employee at AHRQ in a patient safety improvement role … [+]
Four days after emergency surgery and barely able to walk, Heather Sherman flew from Chicago to Washington for first-day-of-work onboarding at the Agency for Healthcare Research and Quality. Fourteen months later, Sherman suddenly became one of the thousands of federal employees summarily dismissed by a weekend email telling them they were “not fit for future employment.”
The trauma of that abrupt ending in mid-February – giving her just a few hours before all access was shut off – still lingers. “This was my dream job,” Sherman told me.
If Sherman were an air traffic controller or nuclear materials expert, her work keeping the public safe would be obvious. But as a mid-level employee with a technical role at a little-known agency in the mammoth Department of Health and Human Services, her curt dismissal and that of an undisclosed number of AHRQ colleagues prompted not even a ripple of news coverage.
Yet what a New York Times editorial decried as a “haphazard demolition campaign” by the Elon Musk-led Department of Government Efficiency, one undermining “the safety and welfare of the American people,” applies to agencies like AHRQ and low-profile jobs like Sherman’s just as much as to more high-profile positions.
In complex systems, of which health care is surely one, carelessness has consequences.
(A brief personal disclosure: I’ve known Sherman for years, and while I serve on AHRQ’s National Advisory Council, I have no inside information. All opinions are my own.)
For Sherman, with two master’s degrees and a PhD, the anodyne title of Health Scientist Administrator masks a beyond-the-data devotion to patient safety. A 2023 report by the President’s Council of Advisors on Science and Technology declared patient safety “an urgent national public health issue.” In truth, the urgency is embraced mostly by a small number of individuals determined to drastically reduce the estimated 160,000 Americans perishing each year from preventable medical errors in hospitals.
That death toll is a conservative estimate by the Leapfrog Group. Food and Drug Administration administrator-designate Martin Makary has called medical error “the third-leading cause of death” and estimated a death toll of more than 250,000 Americans.
Saving Lives and Money
Even if the focus is only fiscal – leaving aside the human impact – medical care that causes unintended harm is inefficient and costs money. The potential savings are large: an in-depth examination of medical records by the HHS Office of the Inspector-General found that a shocking one-quarter of Medicare patients suffer some level of harm during a hospital stay.
It’s that “inefficiency,” human as well as financial, that Sherman wanted to attack at AHRQ. She proposed an initiative enabling hospitals nationwide to collaborate within a legal framework that promotes candor by protecting their interactions from being discoverable in a malpractice lawsuit. That structure is known as a “patient safety organization,” established by Congress through bipartisan legislation in 2005. The process of ongoing collaboration is known as a “learning health system.”
Sherman recalls reaching out to everyone she knew whose organization was affiliated with a PSO and asking what they needed to meet today’s challenges. “The almost unanimous answer was, ‘We want a place to find solutions, a place to share solutions,’” Sherman said. “’We want to know what to do.’”
“Any kind of systemic prevention of problems saves money,” she added.
To be effective, however, collaborative problem-solving on a large scale requires more than just setting up Zoom calls and sharing documents. It quickly gets technical; e.g., ensuring that all participants classify and report an adverse event in the same way.
“Classification is the key,” Sherman said. “It’s like a box of different-colored Lego pieces in different sizes. Each Lego is a data element. Everybody has to understand what it means in order to use it.”
Along with her technical expertise, Sherman also brought a determination to expand what information was collected and how it was used; for instance, by bringing in patient and family input. “The law was not meant to exclude reporting of problems by anyone who wasn’t a clinician,” Sherman said. She also planned to utilize qualitative data “to tell a story. You learn a lot more about the nuances of error in the qualitative data.”
To accomplish those ambitious goals, Sherman began seeking buy-in from AHRQ leadership while also planning a national kick-off conference for May. Until, awakening on Saturday morning, February 15 on turning on the TV news, she heard a White House correspondent report that government departments were firing “probationary employees.” Soon afterwards, the dreaded email popped up in her inbox from the HHS personnel office.
“We all knew it was coming, we just didn’t know when,” Sherman said.
A Legal Loophole
Excerpt from letter sent to probationary federal employees laying out the legal justification for … [+]
“Probationary employee” has a different meaning for federal employees than for private-sector ones. In the private sector a probationary period might last a few months, but an employee can typically still be fired “at will” any time afterwards, barring protections related to union membership or illegal discrimination. In federal employment, in contrast, the probationary period before Civil Service job protections kick in can last one, two or even three years, depending on various factors, and the probationary period can start over even for long-time employees if they’re promoted or switch agencies. Sherman was hired on a two-year probationary period.
Even probationary employees, however, can be fired only for certain reasons. Hence the careful language of the DOGE-driven form letter signed by HHS Chief Human Capital Officer (Acting) Jeffery Anoka that informed Sherman she’d not met “the burden to demonstrate why it is in the public interest” for the government to finalize her appointment. It continued, “Your ability, knowledge and skills do not fit the Agency’s current needs, and your performance has not been adequate.”
“I was very calm that day,” remembered Sherman. “The next day I was a mess.” Questions of what would happen to her work, as well as compensation for unused sick leave and time off, remain unresolved; senior AHRQ managers are also in the dark. “Nobody knows anything, and there’s no guidance,” she said. “I am disheartened and disappointed.”
At the Centers for Medicare & Medicaid Services, a senior manager named Jeff Grant pushed back hard in a letter to Anoka posted on LinkedIn after 82 employees in his group were told they were “not fit for continued employment.” Grant began by announcing he was immediately retiring after 41 years of federal service, emphasizing later that he had served with equal dedication both Republican and Democratic administrations. Grant went on to refute accusations of incompetence by saying the fired workers had not only passed a series of formal reviews with high marks, but the interview process, one in which he was personally involved, allowed CMS to select “truly the best of the best” out of hundreds of resumes.
Moreover, Grant pointedly noted, many of those fired at his Center for Consumer Information and Insurance Oversight were set to work on writing and implementing a new rule announced as a Trump administration priority. That rule, he wrote, “is projected to save billions in program dollars…which is the ultimate in government efficiency.”
A Plea For Public Service
On an even more personal note, an “open letter to America from career federal civil servants,” written anonymously to avoid retaliation, poignantly reminded the public, “We are your neighbors, friends and family….Most of us heeded a call to serve because we love this country and what it represents as much as you and wanted to give back. The hard work we do, we do on your behalf.”
That declaration resonates with Sherman, who said she’s long yearned to work for AHRQ, a small-budget agency with the big-mission task of helping make U.S. medical care better and safer.
“I never wanted to leave AHRQ,” Sherman said. “I wanted to be in this department, in this job, for the rest of my life. I didn’t go into this profession to be rich. I went into this profession to make a difference in people’s lives.”
The “chainsaw” approach favored by Musk continues: the administration has ordered every federal agency to turn in a plan for even more drastic cuts by March 13. For Sherman, meanwhile, there are two poignant codas to her career situation. DOGE, the force behind her firing, has been criticized for acting with both joyful cruelty and dubious legal authority. As it happens, Sherman’s undergraduate major was in judicial morality and constitutional democracy.
Meanwhile, although Sherman almost immediately lost all job-related access, her last official day on the AHRQ payroll was March 14. This year, that’s the next-to-last day of Patient Safety Awareness Week.
