Human Limits

Exploring performance and health with Michael J. Joyner, M.D.

Photo of Michael J. Joyner, M.D.

Corporatization & Medicine: Three Cautionary Tales

Medicine is being corporatized and even prestigious academic institutions are not immune. This is a topic that is being discussed by physicians and researchers in coffee rooms and cafeterias at leading hospitals and academic medical centers all over the world. Here are some of the concerns, lessons and tales – along with some recommendations – that I have heard in my travels that might advance this discussion.

Cautionary Tale #1: “Business Leaders” are not clairvoyant, so why are leaders at prestigious medical institutions so enamored with everything corporate and financial types on various oversight boards suggest? The person who asked this question pointed out to me that many big retailers like Best Buy were caught flat footed by the internet and while doing better more recently, they are still struggling with issues like long term growth. Others have pointed out the ethical and judgement issues associated with the accounting, banking and finance scandals of the last 15 years. As an example here is a top 5 list for accounting giant PriceWaterhouseCoopers. Given these sorts of lapses in strategic thinking and ethical judgement why is medicine so anxious to adopt a “business model” approach to the world?

Cautionary Tale #2: What happened at MD Anderson and/or Sweden’s Karolinska Institute can’t happen at my center. Both MD Anderson and the Karolinska Institute have had recent major meltdowns related to a host of ethical, management and leadership issues. The people running these organizations have all essentially been fired or resigned in the last couple of years. While the specifics differ, key common features of both situations include leadership that became disconnected from long standing institutional culture, rank and file clinicians and researchers were marginalized in the decision making process, and leadership sought or developed carve outs from normally rigorous internal oversight mechanisms. It is incumbent on us all to hold leadership’s feet to the fire at our institutions and make sure they don’t lead to full-blown ethical breakdowns. We are all busy, we all worry about retaliation and marginalization, and we all thing our voice matters less than it used to. However this is no time for learned helplessness, and we need to speak up.

Cautionary Tale #3: The people raising concerns are a small minority and merely disgruntled whiners and alarmists – they just don’t understand. This Tale is typically promulgated by members of leadership or various allies in the institutional establishment. It is designed to marginalize and suppress competing views and dissent no matter how constructive or legitimate. The short response to Tale #3 is NASA O Rings and the Challenger disaster, the quagmire in Iraq, and the Banking Crisis of the late 2000s. In each case a few experienced and insightful people issued detailed warnings that might have averted disaster and were ignored or worse as institutional groupthink prevailed.

Please Leaders Remember:

  1. Corporate leaders and financial bigshots don’t walk on water and don’t be overly impressed by private jets, fame and who says what at Davos. Carefully check their track records and where they have really led their organizations. Many are well paid or well off in spite of being at the helm of huge system failures and failures of vision of a magnitude that should never be tolerated in medicine.
  2. Repeat after me….. It can happen here, and make sure you have at least a few truth tellers nearby at all times. Read the Emperors’ New Clothes and Animal Farm yearly.

Cultivate dissent and don’t marginalize it. Medicine is full of people looking to get the right answer on the test. Find the people in your organization who can ask the right question and who are not afraid to speak up. My guess is that if you contacted the people responsible for the recent meltdowns at MD Anderson and Karolinska they would tell – that in retrospect – they wished they had paid much more attention to the dissenting voices at their institutions.

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