Medical Associations – Good, Bad or Irrelevant?

bridgePeople find creative uses for things. We use lifejackets as cushions, books as coffee coasters and paperclips to fix bra straps.

But we never forget their original design. No one confuses new creative uses with original purpose.

Medical associations formed to do things that doctors could not do on their own. Doctors joined to promote education, safety and best medical practice. They soon began to advocate for MDs in talks with government and other stakeholders.

Medical associations became the home doctors relied on for everything from insurance and estate planning to incorporation and collective bargaining. Associations serve as the place doctors turn to for unquestioned support.

Doctors need their associations. Many associations forget that they need their doctors even more.

Medical Associations

Many medical associations face a crisis. Voluntary members do not renew memberships like before. Involuntary members grumble or decline requests to help out.

Across North America, members leave if they can. Those forced to stay are not happy. Associations grow by focusing on recruiting new members instead of keeping the old ones.

Good

Great associations make their members proud.

They tackle issues that members care about and do it in a way that draws praise from outsiders. The public admires the association.

Annual dues offer great value for money, and members are happy to contribute time and energy on committee work.

Bad

A few associations embarrass members. They forget that power rests with members, that leadership requires followers.

Bad associations help governments and other stakeholders get ahead at the expense of their own members.

They pretend medical politics has nothing to do with politics. They promote partisan issues in tasteless fashion and presume to speak for all without evidence of support.

Irrelevant

Many associations simply lose touch. They desperately seek the majority opinion, trample on diverse views and end up speaking for no one.

Irrelevant associations cling to legacy above all else. They care more about what they did than what they do. They fear change and adjust course only when disaster proves certain, not a moment before.

Many join the ranks of social justice warriors and special interest groups. They let their vision get hijacked; desperate to win the approval of vocal social influencers as a way to boost legitimacy, and hopefully memberships.

Irrelevant associations have members, but not committed ones. Members would leave if they could find the same services somewhere else. They stay because they have no better option, not because they love their association.

Getting it Right

Like lifejackets, doctors need their associations in a crisis. While their associations served all sorts of creative functions in between crisis, they must not fail in those rare times when the sky truly falls.

Lifejackets do not remove all sense of panic. People still feel they might drown or freeze. So too, associations cannot remove all sense of panic while they lead doctors to safety.

Thomas Edison tested over 3000 prototypes before submitting his first commercial patent for the incandescent light bulb in 1879.

Unfortunately, associations do not have 3000 tries to get it right. They usually take ages – sometime years – to realize they’re failing. By then, there’s little hope of success. Failed associations look more like bridges that don’t meet in the middle than quaint attempts at creating light.

Medical Family

Accidents will occur in the best-regulated families (Dickens). Our families only appear as kind, smart or as thoughtful as the people out front, in the public eye.

Every doctor has a medical association family. If doctors want their association to be bright, articulate, kind and relevant, then it will only be as bright, witty, articulate and engaging as the members who get involved.

Especially in a crisis, medical associations need as much help as they can get. Their power comes from members, from doctors’ passion and energy.

Doctors need great associations now more than ever. Strong associations rely on equally strong support from their members. Let’s hope associations remember why they exist and that doctors remember their associations are nothing without member support.

photo credit: www.goodreads.com

7 Questions Leaders Must Ask About Performance, Relevance & Change

gorbachevMikhail Gorbachev became President of the Soviet Union in March 1990. He had served as General Secretary of the Communist Party of the Soviet Union since 1985.

Less than two years after becoming President, he abolished his office and the Soviet Union with it.

Gorbachev started with the Communist party before 1955. How did he decide to dismantle what he spent most of his life building?

Questions Leaders Must Ask

People make an organization. You determine the character of your organization. If you serve in leadership for a few years, your perspective, the flavour you bring to discussions – everything about you – shapes the culture.  You cannot have zero impact.

Ideally, leaders ask tough questions long before crisis forces them.

Performance

  1. Is my organization performing to its full potential?

Influence

  1. Has my influence improved performance?

Direction

  1. Do I help my organization focus on important outcomes?

Succession

  1. When should I leave?

Relevance

  1. Has my organization outlived its relevance?

Change

  1. Is reformation best done from inside, working like Gorbachev, or from without, like social activists?

Renovation vs. Revolution

  1. Will incremental change help, or do we need a revolution, a complete reorganization?

Timing

Ambiguity is your friend.” They made us repeat this at a course years ago. Leaders often hold conflicting views in tension. But, leaders must also make tough choices.

Anybody can become angry – that is easy, but to be angry with the right person and to the right degree and at the right time and for the right purpose, and in the right way – that is not within everybody’s power and is not easy.

– Aristotle

We lost the American colonies because we lacked the statesmanship to know the right time and the manner of yielding what is impossible to keep.

– Queen Elizabeth II

To every thing there is a season, and a time to every purpose under heaven.

– King Solomon

Failure

We remember Gorbachev for his statesmanship. He would have failed if he had just let the Union fail. We forget the names of most other leaders who held office last. Gorbachev stayed, asked the toughest questions and helped transition, even when it meant dismantling what he created.

Ask tough questions early and often. It might frustrate others. Answers might not be clear. But it’s your best hope of working in an organization that’s relevant, meaningful and remembered.

photo credit: tristarmedia.com

Free Speech in Hospitals?

Truth or consequencesThe terror in Paris settled quickly but will flare again. Some people hate freedom and democracy. Some people believe they have a duty to punish those who say things they do not like.

Just as talk shows ran out of content, another hostage crisis erupted. Pundits comment and debate the slaughter. One theme focuses on freedom and the limits of expression in a free society.

Hospital workers also wrestle with free speech. What can they say without getting into trouble? Do they have a duty to report? Will they be protected if they hold an unpopular opinion?

In a time of universal deceit, telling the truth is a revolutionary act. George Orwell

Free Speech in Hospitals

In healthcare, ‘speaking up’ usually focuses on whistleblowing:

But can healthcare providers speak out on anything else? Should they?

Currying Favour with Politicians

Just after training, I wrote a letter to the editor about overcrowding in emergency departments. I asked the Minister of Health if he really knew what he was talking about. I invited him into our ED at “—Blank— Hospital” to see overcrowding for himself, to experience it firsthand.

My CEO blew up. He sicced the Chief of Staff on me. Then the President of the Medical Staff Association preached, “Never, ever, ever mention the name of the hospital in the media.”

My department chief said he agreed with my letter, thanked me for writing it and asked me to never do it again, ever.

Hospitals fight over one pot of tax dollars in Medicare. Thus, hospitals must never embarrass their political benefactors. Hospitals can lose project funding because one politician got their image tarnished. Image determines re-election, the most important political concern.

The public pays for hospital administrators to spend hours and hours in dozens of meetings worrying about “the media” or “the union bus getting parked outside” or a letter of complaint copied to the local MPP and hospital CEO. Dozens of meetings!  In a way, administrators care about public image just as much as politicians.

Free Speech Fallacy

Those who know cannot speak.

Those at the coal face often know frontline problems better than CEOs, bureaucrats or journalists. But they cannot speak. If they do, they get in trouble, lose positions or promotions, and might get fired. Even worse, they might make work much harder for colleagues. Is this free speech?

Rules of “Free Speech”

Publish accolades and praise without fear. But if you have less than glowing comments, do not identify:

  • your organization.
  • an individual by name.
  • specifics of a bad outcome you report.

Never comment on

  • concerns about safety.
  • decisions made by organizations you work for.
  • details about religion, race, sex or any specific identifier even if central to an issue.

Some topics attract more pain and suffering than others.  Avoid big labour, organizational movements and any hint of being politically incorrect. If you do, expect to be shouted down, punished and written off.

Is Free Speech in Hospitals Dead?

What if you’re an idealist? What if you can’t help but speak truth to power?

Go ahead; be an idealist. Talk about rates of this or that terrible thing; talk about ineffective efforts to improve X, Y or Z. (Yes, I’m too chicken to mention specifics!) Say it gently, kindly.

You might be in big trouble or out of work tomorrow. Another martyr for free speech.

photo credit: anonymousartofrevolution.com