Preventive Medicine at Work

“We need your help – a doctor abused our patients. He’s gone, but this can’t happen again, ever.” That’s the call I got from a prominent healthcare establishment earlier in the year. They wanted me to review current policies, draft new ones if needed, and make sure everybody knew the rules. A great idea, I thought, but, alone, a waste of time and money.

Doctors are smart.  If they can get through medical school, they have the brain power to understand the clear boundaries of what they should and shouldn’t do, especially the kind of conduct I described above. Yet, the typical response to catastrophic rule violations in healthcare and elsewhere is to give the offender a serious penalty and then energetically teach the basics to those left.

That’s not the solution. Those who don’t care about the basics won’t care no matter how much they are taught. And pounding in the importance of obvious rules previously taught to those who already follow them won’t stop future violations committed by uncaring offenders.

I asked the people who called me if they had had any danger signals; they had. A complaint had been raised years earlier, but it wasn’t vigorously pursued because some thought that doctor just couldn’t have done that. More recently, others said they had not been comfortable raising their suspicions. My guess is they weren’t 100% sure and did not want to create a powerful enemy.

The protocols of compliance and law enforcement recognize that organizations must act to prevent, detect, and correct problems. Having complaint systems in place is important but not enough. Instead, convincing people to report suspected problems, listen to those problems with an open mind, and get help if they don’t know what to do needs far more attention. Getting people to act this way needs to be a standard that applies to any issues where conduct could harm the organization or those it serves, not just the narrower boundary of traditional risk management, which largely focuses on legal requirements.

There will always be bad apples; thinking you can purge their rot with new policies and an engaging lecture is delusional and wasteful. Figuring out how to find out about them and deal with them sooner rather than later is where the focus on culture, leadership, and compliance-related training needs to be directed.