Underpaid; high turnover; cronyism, nepotism, and arrogance epidemic in management
To be fair, about half the organization including management is competent and well-meaning. However, a good population of their management is not.
There is a strong mix of people making career changes along with recent college and grad school graduates eager to learn the trade. They are underpaid, so once they earn their battle scars, they leave for greener pastures. In the top ranks, some of the managers are good and competent and well-meaning, but a good portion of them are under-qualified sycophants who rose to where they are based more on who they know than any sort of merit. Arrogance in the higher ranks is an issue, and many parts of the organization suffer from low morale because of it. Turnover in general in the lower ranks and arrogance and bumbling in parts of the upper ranks create the perception of overall organizational incompetence. Furthermore, the nature of the union-protected bureaucracy creates a staple of unmotivated or incompetent workers motivated only to earn a paycheck, with no drive toward adequacy let alone excellence.
The governor should hire efficiency experts and qualified medical professionals and analysts to do a top-down purge -- a shakeup -- of the organization.