Organizations “Die”….Can a Profession?
Patients or Protocols??
Organizations “Die”….Can a Profession?
Dr. Geoffrey West, the Shannan Distinguished Professor and past president of the Santa Fe Institute, has written an amazing book that everyone interested in the Big Questions should read. Professor West has distilled decades of sometimes arcane research into a form that is both understandable and enjoyable to read by anyone with curiosity.
West and his colleagues explored a universal allometric scaling equation that explained biological variables such as metabolic rate, heart rate, lifespan, radius of the aorta, respiratory rate, etc. which can be characterized by this equation:
Where B is the biologic variable, B0 is a normalizing coefficient, M is the mass of the organism and X is some integer multiple of ¼. This quarter-power exponent is related to the four-dimensional fractal-like character of biologic networks and has to do the branching transport systems and the observation that the terminal branch units, like capillaries in the vascular system and even the mitochondria within the cells are all of the same size, regardless of the species. What is truly remarkable is that these laws hold not only for mammals and plants, but also for unicellular organisms like bacteria, indicating that distribution networks within individual cells respond to these same principles! It is interesting that West uses the term design principles…If there is a design, is there also a Designer?
West’s collaboration with fellow Santa Fe Institute researchers Luis Bettencourt, Jose Lobo and Dirk Helbing explored a similar allometric scaling in cities.
https://www.pnas.org/doi/10.1073/pnas.0610172104#F1
Instead of mass, population was the determining factor in cities. Amazingly, the scaling relationship seemed to hold, but the exponent fell into three categories. For individual human needs such as job, house, water, etc., the exponent approximates 1. There is linear scaling. For infrastructure such as gasoline stations, road surface, etc, it is close to the ¾ sublinear exponent seen in organisms, indicating a certain economy of scale. However, for other social elements such as information, innovation, wealth, crime, etc. the exponent is closer to 1.15. The scaling is supralinear! In a city, the interactions between the elements scaling sublinearly, linearly and supralinearly are complex indeed. Though it is difficult to “kill” a city, at least up until now, it remains to be seen if that will persist into the future. According to their model, it will persist..as long as we can continue to innovate at a faster and faster rate.
Is this research relevant to companies and organizations? In 2015, West and Daepp, Hamilton and Bettencourt published The Mortality of Companies:
https://royalsocietypublishing.org/doi/10.1098/rsif.2015.0120
Their findings suggest that companies behave more like organisms than cities. Companies “die”, and most die at a predictable rate based on the number of years in existence, though that death is most often in the form of mergers and acquisitions. They may start out growing rapidly, like organisms, but eventually growth slows and they reach a maximum size. Companies become limited by bureaucracy and administration, which stiffle the capacity for innovation that is feeding the growth and vitality.
West explores this in a thought provoking TED talk:
Interestingly, there are outliers. Some companies have existed for hundreds or even over a thousand years!
https://en.wikipedia.org/wiki/List_of_oldest_companies
Outliers have always been fascination of mine. What can they teach us? Most of the companies that have lasted the longest are either family-run or deal with hospitality concerns such as lodging, food and drink. Is there some underlying commonality that can explain their longevity?
In 2016 Costanza and associates published “The Effect of Adaptive Organizational Culture on Long-Term Survival” in the Journal of Business and Psychology:
https://link.springer.com/article/10.1007/s10869-015-9420-y
They found two broad factors influenced adaptive culture: they valued change and action-orientation. The authors quoted J. P. Sheppard’s article, “Strategy and bankruptcy: An exploration into organizational death” appearing in the 1994 Journal of Management:
https://www.sciencedirect.com/science/article/abs/pii/0149206394900310
in which Sheppard succinctly stated: “The most straightforward way to define organizational death is to simply say that the organization dies when it stops performing those functions we would expect of it.” (emphasis added)
In a series of presentations and publications, David Logan and I used an agent-based model to investigate how Organizational Culture (“The pattern of, and capacity for, constructive adaptation based on a shared history, core values, purpose and future seen through a diversity of perspective”) was spread through an organization. Organizational Culture is spread in an organization as a meme, primarily through oral and written communication and actions.
It is augmented when an organization takes active measures to enhance engagement with its members, and diminished when instead, the administration concentrates on compliance:
https://link.springer.com/chapter/10.1007/978-3-319-55774-8_9
So, what does this all mean? Organizations are mortal. Most cease to exist at some point, and specifically when they “stop performing those functions we would expect of them”.
There are notable exceptions, with some previously noted organizations and companies lasting over a thousand years. Dave Logan and I postulate, and other authors confirm, that such longevity is most likely due to extraordinary attention paid to advancing their Organizational Culture as well as to delivering their useful and valued “product”.
Over the past few years I have had a ringside seat, as it were, to the death of two organizations to which I belonged. Both were incredibly successful, at least for a time, in what they did. Each lasted over 50 years. One was a medical organization, the other a church. Their demise was rapid and occurred when the leadership no longer felt engagement with their membership was important and instead shifted to an emphasis on compliance. Their innovation and vitality were destroyed by a shift to bureaucracy and administration. In effect, they committed “organizational suicide”.
Can a profession, like an organization, also commit suicide? I think we may soon find out. Has the job of “physician” changed, especially since the COVID-19 Disaster? Do people still have the expectation that there will be a human being, skilled in medical care, who will compassionately listen to their complaints, competently perform an examination, use their experience to formulate a diagnosis, select an optimum treatment, give counsel and answer questions and then follow up to make sure the treatment is effective?
While patients may still have that expectation, is that what is being delivered? Much of the country was shocked in early 2019 when a telehealth robot told a patient and his family that he didn’t have long to live:
Less than a year later when COVID-19 hit, the standard of care became:
· Social distance and wear a mask
· Stay home
· If you are sick, get a PCR test
· If it is positive, sicken at home until you became dangerously short of breath
· Then go to a hospital where they will put you on a ventilator
· Die or somehow get better.
Care, if one could call it that, was delivered centrally from the CDC. There was no need for an examination. Those few physicians who still tried to function as a professional were vilified and cancelled for trying to practice their profession. It is difficult to know exactly how many were fired from their jobs for attempting to serve their patients. We know about those whose names were in the news because of their prominence prior to the COVID-19 Disaster. These include Drs. Peter McCullough, Pierre Kory, Ryan Cole, Umberto Meduri, Simone Gold, Brooke Miller, Mary Bowdin and Paul Marik in this country and Didier Raoult in France.
Dr. Raoult is the recipient of multiple international awards in science and medicine. His publications have been cited over 194,000 times and his h-index (a measure of citations) is an astonishing 197! Mine is 8.24…..
Sadly, the true number of those who lost jobs is in the hundreds or even the thousands. Tens of thousands more, like Drs. Zev Zelenko, Ivette Lozano, George Fareed and Richard Urso and the originators of the Great Barrington Declaration Jay Bhattacharya, Sunetra Gupta and Martin Kulldorff, may not have been fired but were bullied by their colleagues, the media, medical boards and institutions for their stand:
Drs. Bhattacharya, Gupta and Kulldorff were even targeted for a “quick and devastating published take-down” by Drs. Francis Collins and Anthony Fauci of the NIH:
https://childrenshealthdefense.org/defender/fauci-nih-great-barrington-declaration-emails/
Probably hundreds of thousands of other physicians, nurses and other healthcare professionals were cowed into silence. As Upton Sinclair wrote in his book, I, Candidate for Governor: And How I Got Licked:
“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”
That is in addition to the hundreds of thousands first responders, teachers and members of the military who paid a steep personal price because they would not support a policy they knew to be wrong.
But it even gets worse than that. Not content with merely firing those physicians who stood up for patients from their current jobs, the medical establishment proceeded to make sure they could not work anywhere by going after their license to practice medicine. The case of Dr. Meryl Nass has received national attention:
https://www.lifesitenews.com/opinion/dr-meryl-nass-compares-maine-medical-board-hearings-on-her-suspension-to-a-kangaroo-court/
I personally know of many others who are facing a similar situation.
Dr. Peter McCullough is facing revocation of his Board Certification in Internal Medicine:
Indeed, one can expect this to be a new tactic from a number of medical specialty boards:
https://www.abim.org/media-center/press-releases/joint-statement-on-dissemination-of-misinformation/
Blackbird.AI, an artificial intelligence driven platform aimed at combatting “disinformation” has recently announced a strategic partnership with global PR firm Weber Shandwick:
It is now clear that there is an actual contractual alliance between Big Pharma, the governmental agencies that should regulate Big Pharma but have been captured by them through their financial power and the organizations controlling physician practice….What could possibly go wrong?
For the entire time I was engaged in clinical medicine, I was bound, ethically and legally, by the doctrine of Informed Consent. It was my affirmative duty to inform my patients of the “risks, benefits and alternatives” to my prescribed course of action. That has not been turned on its head. In California, it is now against the law to do just that:
https://www.theepochtimes.com/mkt_app/california-doctors-sue-state-over-new-medical-misinformation-law_4777598.html?utm_source=Google&utm_medium=DigitalMkt&utm_campaign=DSA&utm_adgroup=142141192685&utm_term=2002-ACC3-DSA_11152022&utm_content=registration&gclid=Cj0KCQiAg_KbBhDLARIsANx7wAxk37l6Ja6imcjc_1QX9KdwDJ1fIaPpik1964GuDdDA_gXXmQsRsc4aAlz1EALw_wcB
It is now against the law in California to fully inform a patient of anything that at that point in time is against a vaguely defined “consensus”opinion. Thanks to Emerald Robinson for her insightful substack:
in which she puts it this way:
It gets even worse.
https://news.yahoo.com/top-med-schools-weed-dei-165745578.html
Medical “education” is banding together to make sure only those students who are proponents of a rigid orthodoxy are admitted to the profession….
If anyone doubts the dire straits the profession of medicine is in today, they must read:
https://www.amazon.com/COURAGE-FACE-COVID-19-Hospitalization-Bio-Pharmaceutical/dp/B09ZLVWMD9/ref=sr_1_1?crid=3169L6L0DT01I&keywords=dr.+peter+mccullough+and+john+leake&qid=1669143812&sprefix=leake+mc%2Caps%2C387&sr=8-1
While the entire book is worthwhile, pay special attention to Chapter 33, “Rest in Peace, Weezey”. It relates the frankly shocking episode surrounding the care given to Mr. Sun Ng. Mr. Ng traveled to the Chicago area to visit family. He fell ill with COVID-19 and was admitted to the hospital where his condition deteriorated. His daughter, a PhD in engineering, demanded that he be given Ivermectin. A judge agreed and ordered the hospital to comply. The hospital refused citing Ivermectin could have side effects, it would violate hospital policy and would be judicial overreach.
Finally, after further delaying tactics by the hospital, it allowed courageous Dr. Alan Bain to deliver the medication. Mr. Ng left the hospital 2 weeks later:
Begging for the use of Ivermectin was commonplace. Unfortunately, most of the time it did not end as positively as this case. Who knows how many lives were needlessly sacrificed? Estimates reach into the hundreds of thousands. Does this sound like a profession that is viable? Is it continuing to “perform those functions expected of it”?
Look back to the TED talk by Dr. Geoffrey West and his explanation as to why cities are immortal and companies die. Look to our model of Organizational Performance, Organizational Culture, engagement and compliance. Innovation and critical thinking allow new companies to behave like cities at first with supralinear growth, but then switch to sublinear growth and a finite future when they are controlled by administration and bureaucracy.
If the profession of medicine is not already dead, it is clearly on life-support. The term “physician” seems to have been redefined as “an individual given a license to deliver healthcare according to the dictates of an unholy alliance of Big Pharma, Big Tech, Big Politics and Big Medicine”.
Although there still will be a need for those with technical abilities to deliver those services, it seems that there is a high likelihood that permission for those may be only granted through Artificial Intelligence directed by a central authority. Protocols, not individual situations, will determine what is done, when it is done, by whom it is done and to whom it is done.
Unless the public and healthcare professionals once again exert a voice for the patient, I am extremely pessimistic about what is on the horizon. The time is now, as tomorrow may be too late.
Excellent information identifying the "dis"ease that so many who have spent decades working in healthcare have felt throughout this strange time known as "covid". Thank you for recalling the facts and helping to focus on a question that I have been baffled by: What happened to the "care" in what used to be known as healthcare? May G-d help us! .... and the Good News is, He does as He always has. Blessing and Protection over you and yours.
This, plus the DEI protocol for allowing admission to med schools (and shucking the MCAT scores entirely) paint a very bleak picture of the medical care of the future. We will need to rely on natural healers and take better care of ourselves.