What Happens When an Organization Loses its “Noble Cause”?
It stagnates and dies….
In the early 1990’s, titanic changes were taking place in healthcare. Methods of payment changed. Things were shaken. New entities came on the scene, driven by a desire to capitalize upon these new payment mechanisms. Millions of dollars were at stake. There was a great temptation to obtain the payment for a population and then limit the utilization by that population and pocket the difference. Needless to say, this upset many physicians.
I came into this storm as the newly elected Secretary of the medical staff of a large flagship hospital of a rapidly growing system. I was informed that my new job (the Secretary really did very little, after all!) would be to lead the Continuous Quality Improvement (CQI) program.
About a dozen of us were flown to Salt Lake City to spend a week at Intermountain Healthcare and learn the wondrous things being done by Brent James and his crew. His was a wonderful message to those of us who were sick of the pressure to not use resources in treatment to ensure a profit for the healthy entity that held the insurance dollars destined for their care. He said we could cut out the “quality waste” in care and save at least 25% without sacrificing quality. Indeed, by doing the “right thing the first time” really resonated with us.
We learned his techniques and came back on fire. We had a quality representative in every department. It was an eclectic group of physicians, nurses, aides—everyone involved in the care of the patient. We chartered dozens of projects that saved millions of dollars. The clinical care givers were happy, the patients were happy, and the quality metrics improved. It was great. We had a “Noble Cause” that energized us. Everybody benefitted.
Then reality hit, and it hit hard.
The head of the emergency department realized we were admitting a large number of patients who presented with chest pain and had equivocal EKG findings and enzyme studies. They would undergo stress testing and most of them were discharged. By having a stress lab in the emergency department, we would: 1) deliver the best care to those who really needed it; 2) assure those who did not have cardiac disease that they were indeed OK; 3) expend resources in a responsible way. It made sense to all of us except the hospital administration. They nixed the idea because the revenue they gained from the unnecessary admission was significant.
We realized that all the talk about “increasing quality” was just a lie. The whole CQI problem was a ruse. It was all about money and only money. Rapidly, what was an intensely, even passionately, driven program based on a Noble Cause fell apart.
A similar loss of the Noble Cause occurred in the church to which we belonged for over 30 years. What had been a thriving, Spirit-filled congregation rapidly imploded when the new pastor attempted to make it into a training ground for social justice warriors.
The professional organization to which I belonged for over 40 years likewise lost its Noble Cause. It had taken the leadership for education in my area of specialization, training the majority of physicians active across the world in this subspecialty. It was the model for educational fellowships and continuing medical education. Under a change of leadership, this Noble Cause was transferred to another entity without a vote by the membership. The turmoil caused does not bode well for the future of this organization.
The recent substack by Dr. Peter McCullough and John Leake:
can be viewed as yet another facet of the loss of the Noble Cause to which medicine aspired for centuries. The Noble Cause of delivering the best possible individual care to patients regardless of their political views or social status has been abandoned and replaced with allegiance to socio-political boxes and the responsibility to the “herd” rather than the individual. We have become more concerned with virtue signaling than with actual virtue! Organized medicine chose to ditch critical thinking and follow the lead of an elite few who seemed more concerned with insuring profits of Big Pharma rather than assuring patients of exquisite care. Many physicians traded the trust of their patients for obedience to the elites, even though it made no medical or scientific sense. I covered part of this in an earlier post:
https://russellgonnering.substack.com/p/the-hippocritic-oath
While that earlier post dealt with the moral and ethical consequences of the actions of medicine as a whole as well as individual physicians during the Great COVID Disaster, this post will explore the “business” consequences of losing the Noble Cause.
In Tribal Leadership: Leveraging Natural Groups to Build a Thriving Organization
Dave Logan and co-authors explain the importance of a Noble Cause in advancing the Organizational Culture of an organization. Dave and I wrote an agent-based model to show the critical importance Organizational Culture plays in Organizational Performance. Without a Noble Cause to increase organizational engagement, the performance just stagnates:
In Drive: The Surprising Truth About What Motivates Us, Dan Pink also emphasizes the importance of the Noble Cause in motivation:
The RSA animated summary demonstrates that especially well:
What is ominous in all of this is what I call the Camelot Factor. Once the Noble Cause is dashed, can it ever be recovered? The CQI program at my old hospital never recovered. The cynicism on the part of the medical staff could never be overcome. The church I mentioned finally found a new lead pastor after a multi-year search. Their membership is still considerably down, as is their influence. My professional organization is in the process of imploding, and we are watching it destroy itself in slow motion. Can healthcare in general and medicine in particular ever recover integrity and the trust of the population? I don’t know. For now, I feel a bit like Arthur talking with young Tom of Warwick:
Unfortunately, the most significant loss of focus on a Noble Cause has happened to medicine as a profession. During the Great COVID Disaster (I refuse to call it a pandemic as much more harm was done from our response than from the virus) medicine completely forgot about critical thinking and care of patients and began to be a force to enforce compliance with things that made no medical sense at all. The code of ethics that guided Western medicine for well over a millennium:
I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel.
seems to have been completely forgotten. Tucker Carlson has termed this the “Beclowning of American medicine.” One really must watch his Twitter episode to understand the full extent of this incredible lapse in moral judgement of an entire profession:
https://twitter.com/i/status/1672014260480901120
If you do, you may like me have visions of a similar individual who 70 years ago similarly cowed the American populace with equally illogical arguments until, at long last, he was shown for what he was.
There is no bow tie, but the delivery and the self-promotion are remarkably similar.
The Noble Cause to Medicine seems to have replaced the Noble Cause with the Expedient Cause, and it shows. It is in a wasteland. Medicine lost the moral high ground and now it stands not just to lose respect, but the business of treating patients as well. Many people have given up on care from allopathic physicians, instead seeking the care of nurse practitioners and naturopaths.:
https://aanmc.org/featured-articles/patient-centered-care/
Yes, American medicine has been beclowned. A few courageous individuals braved the canceling and vilification and remain as a conscience. They give testimony to a spark of memory of what once was and could be again.
Exactly my observations. Well considered and, sadly, all true. When I heard Tucker note the "Beclowning" of medicine, I recognized how apt that phrase was and how sad it made me.
Most everyone I know feels the same, but no one seems to be able to do anything about it. Why is that? I have to assume that it is extra-medical forces that are making sure those who support goodness are forever squelched. It all just seems so bizarre.