How dictator-bosses cause patient deaths
Imagine you're in hospital undergoing treatment for something serious. Understandably, you're anxious. Above all else, you don't want someone to make a mistake. And you have good reason to be anxious: medical errors kill thousands of people every year. The odds of dying in a hospital in the developed world because of mistakes are a horrifying 33,000 times higher than the odds of dying in an air crash, according to this Guardian article.
But if a health professional knows a medical error is being made, you'd assume that at the very least, the individual would speak up. Does this happen? Let's look at research by Harvard professor Amy Edmonson, who studied how leadership and co-worker relationships affected drug-treatment errors in nursing units. Understandably, Edmonson assumed that better leadership would mean fewer mistakes.
Stanford professor Bob Sutton quotes the study in his book, the 'No Asshole Rule'. The study's results were astonishing - Sutton writes: "Units with the best leaders reported making as many as ten times more errors than the units with the worst leaders." In short, better leadership seemed to produce far more mistakes. What on earth was going on?
Edmonson realised that, in fact, the nurses in the best led units reported more errors because they felt safe enough to admit mistakes. The nurses said: "You are never afraid to tell the nurse manager", and that the manager created a psychologically safe atmosphere in which to work.
In sharp contrast, fear was rampant in units that rarely reported mistakes. Nurses said: "The environment is unforgiving; heads will roll", or "you get put on trial". Naturally, in this intimidating atmosphere, people worry about their own jobs rather than bring trouble upon themselves.
Sometimes, when doctors do speak out, they get into trouble with their own bosses. In the UK, a combination of fear and payoffs (running into millions) has gagged whistleblowing doctors, according to an Indpendent article.
Mike Parker, of the Royal College of Surgeons, was quoted as saying: "The [NHS state-run] trusts find something upon which they can influence this individual and hold them virtually to ransom, and say: 'You speak up and this will happen.' It's effectively a form of bullying, if you like, but we do hear about this sort of thing happening."
The article mentions the case of Dr Kim Holt, a pediatrician, who repeatedly told her management that she believed the children's services at a particular hospital were unsafe. Dr Holt and three other doctors even wrote to the management warning that the clinic was "falling apart" and risking lives. A year later, a baby died at the same hospital after a locum failed to spot that the baby's back was broken. Dr Holt was offered money to keep quiet, but she was quoted as saying:
"I was not going to be gagged. I've done nothing wrong. I raised concerns: it was obvious the place was a mess. I refused to retract my concerns. They wanted me to stay quiet. Gagging orders are wrong and shouldn't happen. I don't think they should be happening to anyone in the NHS. There should be much more transparency.
It's not the done thing to challenge management. That's basically it. The pattern seems to be you make a stand and life is made hell. Most people end up either becoming sick or they take money to end it all. The money is nearly always associated with a gag – what this is about is hiding their inefficiency."
Why is not the done thing to challenge management? Why do hospitals, of all places, enforce gagging orders?
Because in a dictatorship, it's not the done thing to challenge the dictator. Because a hospital, despite being a place of caring, is a dictatorship, just like profit-seeking corporations. Dictatorships stifle dissent - it's how they work.
The larger point is, while patients and their families suffer, this ultimately impacts the doctors and the hospitals themselves. Bosses and other staff may not even realise mistakes are being made and everyone loses in the end.
© Chetan Dhruve