Some say doctors get away with murder. Hospitals CEOs stress about patients’ lengths of stay, often because doctors refuse to arrive early and discharge patients.
IT leaders groan when doctors mangle data entry. Health records departments lose their minds about overdue discharge summaries.
A former hospital CEO and management consultant took issue with my post: Experts Blame Doctors. He said this on social media:
“Your series so far has painted Drs as victims without much accountability.
Unfortunately, there are just far too many example [sic] of Drs acting total [sic] beyond accountability who seem to be protected by other Drs and their guilds. Like Dr God in Ottawa who fertilized eggs randomly with his own sperm who remained a member of the college in good standing for years.
Yes the payer and the patient can both have reasonable expectations that the practitioner doesn’t like. It is called work for a reason and pay has meaning.
A few suggestions about what your guild might do to be better would lend some credibility over this poor me stuff you have been putting out. Mix it up a bit like there might even be a public interest.”
Leaving aside Dr. God, for now, our CEO says docs might have “some credibility” if they offered solutions instead of “this poor me stuff you have been putting out”. Docs are unaccountable whiners.
Maybe our CEO speaks from personal failure?
His salary bonuses probably depended, in part, on doctors supporting his plans. If he had been wildly successful at engaging doctors, he probably would not speak so disparagingly about them.
(I did not call his hospital to find out.)
Most doctors are furiously independent. Doing what’s best for patients often means breaking rules, which makes administrators furious.
But our CEO should know better. Regulations and accountabilities already crush doctors. As a doctor, everything is scrutinized:
How many patients you saw,
when you saw them,
when you looked at lab data,
whether you acted on the data,
how you acted on the data,
what time you saw the patient,
when you said goodbye,
whether your billing matches with the times in your chart,
whether your preventative screening is up to date,
and a thousand other things.
Hospital rules, regulations, policy manuals, pre-printed orders, and other rules run for hundreds of pages unique to each hospital.
Add to that the regulatory college’s polices, provincial legislation, and regulatory changes to established laws; we have a legislation epidemic.
Overregulation makes us all criminals: see USA Today and Bloomberg.
If anything, doctors are accountable for too many silly things already. And government wants even more oversight, reporting, and accountability.
Our CEO should also know what docs have been through in Ontario since 2012:
Heckled in the Ontario legislature.
Heckled in federal Parliament by Prime Minister Trudeau and Minister Morneau.
Slandered in the media
Ignored for multiple pieces of legislation
Ridiculed by Deputy Ministers of Health on National TV
And doctors’ fees have been cut every year since 2012.
Every.
Single.
Year.
Net pay has dropped by over 30% in 2012 dollars.
All this drives MD suicide rates of over 2-3 times the general public. I’ve never seen so many doctors desperate to escape.
But what about Dr. God? It is true. A rare doctor is evil and dangerous. Will more regulation catch these sick individuals? I do not know. But I do know that most regular doctors live in terror of their regulatory college.
We remember the MRC pseudo-courts that made doctors pay hundreds of thousands in fines before they could even present their case.
Dr. Hsu took his own life instead of face of an MRC audit. That drove Justice Cory to shut down the MRC with a scathing indictment. The CPSO may never outlive the legacy.
Demanding that docs offer solutions, right now, is a bit like asking an abused inmate to put ideas in a suggestion box or to sit on a prison performance improvement and accountability committee.
Are doctors unaccountable whiners? To someone on the outside, maybe. But for someone in the business of healthcare, our CEO should know better.
Leadership Rule #1: Know your team. Find out how they are doing.
If they complain about feeling unsafe and unable to keep their offices open, then fix it, fast.
If they complain about not being able to work to the full scope of their training and expertise, you have arrived. Spend time talking about targets, transformation and accountabilities.
Most people have good intentions. They make comments, like our CEO did, but they don’t understand.
Or maybe our CEO was just trying to defend one of the experts in the last post?
Photo credit: http://emergesalestraining.com/86-coffee-talk-accountability/
A former hospital CEO? The pot calling the kettle black!
Good point, Perry.
Wow! Shawn! The blood must be running from the sides of your mouth as you must have bitten your tongue many times while writing this. This CEO’s comments reveal his personal hostility by the use of such terms as “guild” and “Dr. God”. I congratulate you on your reasoned response and confess that I would not have been so calm.
Thank you for noticing, Dr. Hayes! I had several drafts. Hopefully the final version does not come across as vengeful or histrionic.
Thanks so much for taking time to read and share a comment. Readers love the comments best.
Cheers
MDs should be accountable only for their own work…not for the meeting of the crazed plans / goals/ quotas./ guidelines/ protocols,/ rules and regulations ( with their inevitably negative consequences.) of the uninspiring CEOs and their arrogant management consultants who try to manage MDs as replaceable and interchangeable widgets on spread sheets.
MDs do not respond well to “management” …they do respond much better to inspiring leadership .
Of all the personnel in a hospital…the least missed would be the CEO’s and the arrogant management consultants ( the cleaning staff are far more valuable) …in their absence the hospital would hum, productivity would increase and patient satisfaction soar.
Time to pick up the pitchforks.
Andris, you never disappoint! Always a mixture of wisdom and provocation. I find myself agreeing with the first but cringing at the second.
You raise some good points about the ‘New Management’ (now old) approach to bureaucratic ‘efficiency’. People complain about it from both ends of the political spectrum. I’m flipping through Janice Stein’s, The Cult of Efficiency, right now.
As always, thanks so much for provoking us all to think about what you’ve said. You make it impossible to ignore your comments.
Best regards,
Should we be more accountable?
The comments of the former hospital ceo are informative – we are in an adversarial system. Dealing with “Dr. God” comments where my professional performance is lumped in with despicable behavior for the ceo political gain is a sign this administrator is making malevolent idiotic statements, but perhaps they are searching for clarity?
As for your question, Shawn, the answer is equally clear, “yes, I should be more accountable, but so should you!” It’s one of those rhetorical questions like “Am I my brother’s keeper.” Yes!
It begs the next question, what does that look like if I am more responsible?
A recent historical example to consider. . .
A few years ago, the leader of the Fed reserve, Chairman Alan Greenspan, revealed his own mistake in managing lending and risk taking behaviour in the US that nearly collapsed the world economy. He thought the best determination of who needs and qualifies for a loan is with the local loan officer talking to the individuals wanting the loan. That seems a reasonable assumption. Later he realized the culture of efficiency over moral leadership was promoted by bank CEO’s that changed everything. These leaders were disconnected from the broader public interest, changed the lending culture to maximize efficiency over prudent risk management.
This story is paralleled in our health system. Administrative-focused care has sought efficiency over moral leadership which has subtlety changed the rules of the health care game. Disconnected “experts” advise the MOH focusing attention on efficiency over effectiveness as the system of public trust crumbles. Moral Leaders have been replaced by accounting types, perhaps in our own individual minds, too. This is coupled with big egos believing they are smarter than the rest, invalidating the workers to gain favour.
Perhaps reading and writing about the issues at hand is exactly that, a means to become more accountable. Perhaps the hospital CEO is now more accountable having made stupid public comments and is now being schooled by those who are seeking to be more accountable?
Keep up the good work by providing forums like this to out the ignorance, the idiotic arguments and the malevolent behavior by those who need to change there attitude, and perhaps their career. Moral leadership is born of articulated speech, introspection and an awareness that being wrong is an opportunity to grow. Let’s see if that former CEO will respond to this.
Very thoughtful comments, Barry. Thanks so much for taking time to pull them together.
I especially like, “Disconnected “experts” advise the MOH focusing attention on efficiency over effectiveness as the system of public trust crumbles.” As money runs short and need continues to grow, we cannot resist the inevitable pull to serve the central payer instead of those we signed up to serve.
As for accountability, I think we should be first accountable to our patients. Patients should be our second, third and perhaps listed as our top 5 accountabilities. Silly, I know. But the popularity of dividing our accountability between patients, the population of patients we serve, and society at large has worked to erode the trust you mention.
Thanks so much for reading and taking time to share a comment!
Cheers
A patient of mine ( since the age of 8) , working in the bowels of our local hospital , complained of its bureaucratic “ top heavyness”…undermanned in her not so lowly sector , stressed by the constant and changing demands from above, plans to retire in the next year at the age of 55…she told me that the hospital had just hired a ( vice? ) President of People at great expense.
Is there such a position?
What does a Hospital President of People do?
Deals with HR? Paying for workers off on disability alone can cost a mid to large hospital more than 5 or 6 million annually.
Unfortunately the medical profession has given license to anybody with a mouth to slander the medical profession. They do this by adhering to the so called ‘professional standard’ of not responding and being ‘dignified’. The CPSO has been instrumental in this process by parading even the most ridiculous transgressions in its sheet of shame, The Dialogue. It is ironic that it is called the Dialogue because it is only a one-way communication as the College listens to no-one but the government. To be a bit more fair, the dialogue should publish the details (without names) of complaints that are thrown out in addition to it convictions list.
If a complaint is “thrown out” by the ICRC of a College, the complainant typically requests a review by the Health Professions Appeal and Review Board (HPARB) because there is no fee for requesting a review by HPARB. HPARB Decisions and Reasons are posted on the Canadian Legal Information Institute website.
Thanks for responding to Ernest, Perry. And great comment, too, Ernest.
I expect big changes to regulation over the next few years. Other countries have amalgamated the dozens of regulatory colleges we have in Ontario into one big central authority.
Your CEO may want to read Greenleaf’s excellent and concise book entitled “Servant Leadership”. Hint: Greenleaf was not only an executive at AT&T but more importantly a Quaker who thought carefully about his personal values and how he expressed them.