Monday, February 3, 2014

A recent comment on Bob Wachter's blog caught me up short because of its obvious applicability to the situation at the University of Illinois Hospital and Health Sciences System.

Bob had written about the recent case involving Charles Denham, who has been accused on conflicts of interest with regard to several patient safety matters.  Many of us know of Chuck's excellent work  over the years, and so we are all in a bit of state of denial over the case.  Indeed, much of the commentary on Bob's blog has been about how to ensure that there are systems in place to help avoid such conflicts of interest.  And many of us, including me, have also tried to make the case that Chuck's many good deeds should not be forgotten in all of this, even if some of his actions may be inexcusable.

But look at this thought by Debra, responding to human factors expert Terry Fairbanks:

Terry, not all problems are systemic. Some problems are a result of people taking advantage of situations and other result of people who don’t care about others. When a pilot shows up drunk for a flight, he’s relieved and there is no long and drawn out discussions of what noble acts he has done in the past, how good his intentions are, or how misguided he might have been by circumstances in his personal life. The first and pretty much only concern is that of the flying public. And that means he or she is not flying a 747. Period. 

I used to be part of the missile community. Some problems are system issues, process issues, equipment issues, design issues or engineering issues. But not all problems are system issues and one will minimize system issues when you properly manage people and enforce conduct that conforms to expected norms. Some people issues are leadership, but sometimes people ARE the problem, period, because they refuse to conform the the requirements. Systems are ultimately made up of people and if there are people who are greedy, or sloppy or not competent, the solution to that problem is removal of the person. Leadership means making those decisions. And that doesn’t happen because doctors in particular refuse to hold their colleagues to account when needed. 

It is the last line that is apt in Chicago.  Recall that this issue was a national advertisement that resulted in the misappropriation of the University's name in support of a private company, a matter that violates the University's code of conduct, its administrative procedures manual, and maybe state law.  The ad contained pictures of 12 people, including doctors, nurses, a surgery technician, and a non-medical staff person.  I have learned enough now to know that a number of the people who were in the photograph did not know their image and name were going to be employed in that manner.  I hear that some of them were quite upset to learn they had been used that way.

Did any one of these people report the incident to any person of authority in the hospital or the University?  I bet the answer is no.

Now, I don't expect a surgery technician to risk her job by doing this, but I do expect physicians to hold their colleagues to account when there is a clear violation of the conflict of interest rules.

Why didn't the doctors hold their colleague accountable?  Fear?  Sympathy?  Concern for the reputation of the program?  It is an analysis of these matters that should be at the core of the Trustees' investigation of the incident.

Oh, but the Trustees themselves have now fallen victim to the underlying problem.  They are so concerned that a major surgical program (read, financially important program) of their hospital system will be tarnished by this event that they have started to stonewall the issue altogether.  In so doing, they have now become complicit to a culture that refuses to hold their medical staff accountable--in Debra's words--to matters of personal greed, sloppiness, or incompetence.


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