After a testy discussion, the board of the Jackson Health System approved by a vote of 4-2 a global agreement intended to resolve several major tensions between management and SEIU Local 1991. The deal now goes to the Miami-Dade Board of County of Commissioners for final approval. The agreement, reached earlier this month, means management will stop exploring outsourcing physician and some other services in the Jackson Memorial adult ER., but might still explore getting outsiders to provide pediatric services at Jackson Memorial as well as all ER services at Jackson North and South.