Category Archives: Ethics

Former CFO sues Texas hospital for defamation

Posted on by • Posted in Board, Breach of Contract, Chief Financial Officer (CFO), Conflicts of Interest, Defamation, Employee Benefits, Ethics, Executive Compensation, Hospital, Lawsuit • Leave a comment

https://www.beckershospitalreview.com/legal-regulatory-issues/former-cfo-sues-texas-hospital-for-defamation.html

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The former CFO of Huntsville (Texas) Memorial Hospital is suing the hospital for breach of contract and defamation, according to the SE Texas Record.

In his complaint, filed Aug. 28, Guy Gros claims he was hired as Huntsville Memorial’s CFO in February 2013. He was initially given a two-year contract and then a three-year contract with automatic renewals, according to the lawsuit.

Under the contract, the hospital could terminate Mr. Gros’s employment for cause. On Dec. 2, 2016 he was terminated for alleged cause. However, Mr. Gros asserts that he was fired for raising concerns about the hospital’s finances.  

Mr. Gros further alleges his reputation was damaged by false statements made by the hospital’s then CEO, who allegedly told a board member that Mr. Gros “did something illegal, something he should not have.”

Mr. Gros is seeking past and future wages, lost employment benefits and compensatory damages.

 

The Most Important Leadership Competencies, According to Leaders Around the World

Posted on by • Posted in Communication, Competency, Direct Communication, Direction, Empowerment, Ethics, Flexibility, Leadership, Learning, Ongoing Training, Safety • Leave a comment

https://hbr.org/2016/03/the-most-important-leadership-competencies-according-to-leaders-around-the-world?utm_source=facebook&utm_medium=social&utm_campaign=hbr&fbclid=IwAR3P_HH0Xd1-7iiT-xo0OydmS9uu6OOONRkj0ox_CH2phzt1wwr9p3suryE

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What makes an effective leader? This question is a focus of my research as an organizational scientist, executive coach, and leadership development consultant. Looking for answers, I recently completed the first round of a study of 195 leaders in 15 countries over 30 global organizations. Participants were asked to choose the 15 most important leadership competencies from a list of 74. I’ve grouped the top ones into five major themes that suggest a set of priorities for leaders and leadership development programs. While some may not surprise you, they’re all difficult to master, in part because improving them requires acting against our nature.

Demonstrates strong ethics and provides a sense of safety.

This theme combines two of the three most highly rated attributes: “high ethical and moral standards” (67% selected it as one of the most important) and “communicating clear expectations” (56%).

Taken together, these attributes are all about creating a safe and trusting environment. A leader with high ethical standards conveys a commitment to fairness, instilling confidence that both they and their employees will honor the rules of the game. Similarly, when leaders clearly communicate their expectations, they avoid blindsiding people and ensure that everyone is on the same page. In a safe environment employees can relax, invoking the brain’s higher capacity for social engagement, innovation, creativity, and ambition.

Neuroscience corroborates this point. When the amygdala registers a threat to our safety, arteries harden and thicken to handle an increased blood flow to our limbs in preparation for a fight-or-flight response. In this state, we lose access to the social engagement system of the limbic brain and the executive function of the prefrontal cortex, inhibiting creativity and the drive for excellence. From a neuroscience perspective, making sure that people feel safe on a deep level should be job #1 for leaders.

But how? This competency is all about behaving in a way that is consistent with your values. If you find yourself making decisions that feel at odds with your principles or justifying actions in spite of a nagging sense of discomfort, you probably need to reconnect with your core values. I facilitate a simple exercise with my clients called “Deep Fast Forwarding” to help with this. Envision your funeral and what people say about you in a eulogy. Is it what you want to hear? This exercise will give you a clearer sense of what’s important to you, which will then help guide daily decision making.

To increase feelings of safety, work on communicating with the specific intent of making people feel safe. One way to accomplish this is to acknowledge and neutralize feared results or consequences from the outset. I call this “clearing the air.” For example, you might approach a conversation about a project gone wrong by saying, “I’m not trying to blame you. I just want to understand what happened.”

Empowers others to self-organize.

Providing clear direction while allowing employees to organize their own time and work was identified as the next most important leadership competency.

No leader can do everything themselves. Therefore, it’s critical to distribute power throughout the organization and to rely on decision making from those who are closest to the action.

Research has repeatedly shown that empowered teams are more productive and proactive, provide better customer service, and show higher levels of job satisfaction and commitment to their team and organization. And yet many leaders struggle to let people self-organize. They resist because they believe that power is a zero-sum game, they are reluctant to allow others to make mistakes, and they fear facing negative consequences from subordinates’ decisions.

To overcome the fear of relinquishing power, start by increasing awareness of physical tension that arises when you feel your position is being challenged. As discussed above, perceived threats activate a fight, flight, or freeze response in the amygdala. The good news is that we can train our bodies to experience relaxation instead of defensiveness when stress runs high. Try to separate the current situation from the past, share the outcome you fear most with others instead of trying to hold on to control, and remember that giving power up is a great way to increase influence — which builds power over time.

Fosters a sense of connection and belonging.

Leaders who “communicate often and openly” (competency #6) and “create a feeling of succeeding and failing together as a pack” (#8) build a strong foundation for connection.

We are a social species — we want to connect and feel a sense of belonging. From an evolutionary perspective, attachment is important because it improves our chances of survival in a world full of predators. Research suggests that a sense of connection could also impact productivity and emotional well-being. For example, scientists have found that emotions are contagious in the workplace: Employees feel emotionally depleted just by watching unpleasant interactions between coworkers.

From a neuroscience perspective, creating connection is a leader’s second most important job. Once we feel safe (a sensation that is registered in the reptilian brain), we also have to feel cared for (which activates the limbic brain) in order to unleash the full potential of our higher functioning prefrontal cortex.

There are some simple ways to promote belonging among employees: Smile at people, call them by name, and remember their interests and family members’ names. Pay focused attention when speaking to them, and clearly set the tone of the members of your team having each other’s backs. Using a song, motto, symbol, chant, or ritual that uniquely identifies your team can also strengthen this sense of connection.

Shows openness to new ideas and fosters organizational learning.

What do “flexibility to change opinions” (competency #4), “being open to new ideas and approaches” (#7), and “provides safety for trial and error” (#10) have in common? If a leader has these strengths, they encourage learning; if they don’t, they risk stifling it.

Admitting we’re wrong isn’t easy. Once again, the negative effects of stress on brain function are partly to blame — in this case they impede learning. Researchers have found that reduced blood flow to our brains under threat reduces peripheral vision, ostensibly so we can deal with the immediate danger. For instance, they have observed a significant reduction in athletes’ peripheral vision before competition. While tunnel vision helps athletes focus, it closes the rest of us off to new ideas and approaches. Our opinions are more inflexible even when we’re presented with contradicting evidence, which makes learning almost impossible.

To encourage learning among employees, leaders must first ensure that they are open to learning (and changing course) themselves. Try to approach problem-solving discussions without a specific agenda or outcome. Withhold judgment until everyone has spoken, and let people know that all ideas will be considered. A greater diversity of ideas will emerge.

Failure is required for learning, but our relentless pursuit of results can also discourage employees from taking chances. To resolve this conflict, leaders must create a culture that supports risk-taking. One way of doing this is to use controlled experiments — think A/B testing — that allow for small failures and require rapid feedback and correction. This provides a platform for building collective intelligence so that employees learn from each other’s mistakes, too.

Nurtures growth.

“Being committed to my ongoing training” (competency #5) and “helping me grow into a next-generation leader” (#9) make up the final category.

All living organisms have an innate need to leave copies of their genes. They maximize their offspring’s chances of success by nurturing and teaching them. In turn, those on the receiving end feel a sense of gratitude and loyalty. Think of the people to whom you’re most grateful — parents, teachers, friends, mentors. Chances are, they’ve cared for you or taught you something important.

When leaders show a commitment to our growth, the same primal emotions are tapped. Employees are motivated to reciprocate, expressing their gratitude or loyalty by going the extra mile. While managing through fear generates stress, which impairs higher brain function, the quality of work is vastly different when we are compelled by appreciation. If you want to inspire the best from your team, advocate for them, support their training and promotion, and go to bat to sponsor their important projects.

These five areas present significant challenges to leaders due to the natural responses that are hardwired into us. But with deep self-reflection and a shift in perspective (perhaps aided by a coach), there are also enormous opportunities for improving everyone’s performance by focusing on our own.

 

 

 

Mixing medicine and money: Why the rise of health system VCs is raising ethical concerns

Posted on by • Posted in Bioethics, Conflicts of Interest, ECRI Institute, Ethical Pitfalls, Ethics, Food and Drug Administration (FDA), Health Policy, Health System, Hospital, Private Equity, Venture Capital • Leave a comment

https://www.healthcaredive.com/news/mixing-medicine-money-hospital-vc-funding-device-ethical-concerns/549392/

Industry-leading nonprofit health systems like Ascension, Providence St. Joseph and Cedars-Sinai have launched affiliated venture capital firms with increasingly more cash to fund start-ups. But the mixture of medicine and financial investment presents the potential for ethical pitfalls.

Deals involving at least one healthcare provider-linked corporate VC fund totaled roughly $1.3 billion last year, a record high nearly triple the amount recorded five years prior, according to data provided to Healthcare Dive by PitchBook, a financial data firm.

Health systems defend their corporate VCs, noting a separation of clinical and investment decisions along with general policies designed to prevent improper influence. Yet the potential for conflicts of interest looms, ethicists said in interviews — particularly when a health system’s hospitals adopt products from companies staked with funds via the affiliated VC.

“If you have a venture program that is really gearing up with some serious investments and they are going to use those devices in their own institution, I would say that’s a matter of concern,” said Jeffrey Flier, dean of Harvard Medical School from 2007 to 2016, in an interview.

“That doesn’t mean it would be done dishonestly, it just means that maybe they should promote doing it elsewhere, not in their own institution.”

A mixture of medicine and finance

The case of Gauss Surgical, a private medical device startup, illustrates how some of these questions can play out in practice.

Corporate VCs affiliated with nine hospital systems have invested in the company since its founding in 2011. A majority of those VC funds were launched in the past five years. A tenth system, Memorial Hermann Health System, invested directly in Gauss. All 10 systems also use — to varying extent — Gauss’ flagship Triton device in clinical practice.

A software platform designed to process images, Triton is used to quantify blood loss, typically during childbirth. Studies have shown standard practices, such as visually estimating or weighing bloody materials, to be inaccurate, leaving an opening for an improvement.

Between the 10 health systems invested in Gauss, 16 of their hospitals use Triton, according to Gauss. Overall, more than 50 U.S. hospitals use the device today, the Los Altos, California-based startup said.

Those running the funds invested in Gauss acknowledge the need for full disclosure to avoid any real or perceived conflicts of interest, particularly when their hospitals are using the device.

“It’s fair to ask why nonprofit systems have venture funds,” said Darren Dworkin, managing director of Summation Health Ventures, a joint VC arm for Cedars-Sinai and MemorialCare that launched in 2014 and has invested in Gauss.

Still, Dworkin, also Cedars’ chief information officer, argued the fund helps fill an investment gap for businesses like Gauss with promising ideas that might not otherwise have received financial backing.

“If there was perfect liquidity in the capital markets for all great ideas, maybe the case can be made that focus can be in other areas,” the exec said in an interview.

Timeline of investments in Gauss

Along with adoption — some hospitals routinely use the device in newborn delivery — has come controversy, however.

At one of those hospitals, St. Joseph Hospital in Orange County, California, an investment by the parent system’s VC fund led to objections from some healthcare staff over the adoption of Triton. The hospital is owned by Providence St. Joseph, which invested in Gauss through its VC arm, Providence Ventures.

Last April, 10 physicians working at the hospital signed onto a letter sent to Scott Rusk, the hospital’s chief medical officer, airing doubts over whether Triton improved patient outcomes, and questioning if its use was influenced by the chain’s financial investment in Gauss.

“We suspect that their use has been mandated by the health system due to investments made by the Providence Venture Capital Fund, and that the insistence that they be used has more to do with ensuring a return on investments than with improving patient care,” the doctors wrote, according to a copy of the letter obtained by Healthcare Dive.

In a statement to Healthcare Dive, Providence St. Joseph said clinical adoption decisions are made exclusively by clinical and operational leadership review, and are not influenced by Providence Ventures. After that review, hospitals in the system decide on their own whether or not to use such products.

“There was no directive from PSJH or Providence Ventures to use the device,” the chain stated on the Orange County hospital. “The decision was made to fund and adopt the Gauss solution at the local hospital level.”

Only three of the system’s 51 hospitals use Triton today, the organization said, and the Orange County hospital made the decision to start using the device before the merger creating Providence St. Joseph completed in July 2016.

But the fund isn’t entirely walled off from the rest of the system, as its leader also serves as a C-suite executive for the health system. Aaron Martin is the managing general partner at Providence Ventures as well as an executive vice president and chief digital officer for the broader PSJH system.

In response to the letter, Gauss stated it is “statistically impossible for a single practitioner or small group of practitioners to personally observe the impact of a monitoring device on patient outcomes across an entire population,” noting hemorrhage is a low-volume, high-risk event.

Testing Triton

The Food and Drug Administration cleared the device in 2014 as an adjunct to blood loss estimation techniques based on two clinical studies, respectively testing 46 patients and 50 patients, as well as a series of non-clinical studies.

Still, several doctors and one nonprofit group question Triton’s proven clinical value.

“It’s in its infancy,” said Abdulla Al-Khan, a doctor at New Jersey’s Hackensack University Medical Center, which has been testing the device since 2015. “Is it 100% reliable? I don’t think so. Is it perhaps better than a physician’s guesstimation of blood loss? Yes, probably.”

Al-Khan, who is the hospital’s director for its Division of Maternal-Fetal Medicine & Surgery and the Center for Abnormal Placentation, said earlier Triton studies “clearly had their limitations,” and plans to soon begin a study comparing all methods of blood loss estimation.

Daniel Katz, director of obstetric anesthesiology research at Mount Sinai, said in an interview arranged by Gauss that Triton’s clinical value has been well-demonstrated, giving healthcare providers a standard way to measure and keep track of blood loss. While Mount Sinai has an equity investment in Gauss through its corporate VC arm, Katz said he has not received any compensation from Gauss.

In a statement, Gauss said it “believes Triton has proven clinical value,” supported by “robust accuracy data,” particularly highlighting research done following its 2014 FDA clearance.

“Subsequent studies, published in peer-reviewed, academic journals, have demonstrated superiority compared with alternative means to measure blood loss and significantly improved clinical outcomes following adoption of Triton,” the company stated.

Gauss also noted a hospital pays a fee per annual subscription for the software as a service, no matter how often the product is used. It said adoption of the product is independent and goes through the hospital’s regular procurement process in instances where the health system has invested in the company.

The company did not make its CEO Siddarth Satish available for a phone interview.

However, the ECRI Institute, an independent organization that analyzes new technologies for providers, payers and government agencies, reviewed at Healthcare Dive’s request the body of evidence supporting Triton and concluded the device’s clinical value was far from established.

Diane Robertson, the institute’s director of health technology assessment, said the studies done have been small and low quality, noting limitations on trial design for controls, blinding and randomization.

“There isn’t any moderate quality or higher quality evidence on clinical outcomes improvement in patients with how this device is used,” she said.

In response to ECRI’s assessment, Gauss stated that a randomized, controlled trial would be “ineffective, impractical and potentially unethical.” The company further defended Triton’s studies, saying they showed it was more accurate than other estimation methods and is widely supported by leading physicians and experts.

A broader issue

Triton’s adoption spurs broader questions for nonprofit systems that have established VC arms.

About a decade ago, deals involving hospital-affiliated VCs were few, mustering less than $50 million in total value in 2008 and 2009 combined, according to PitchBook. Activity has steadily risen, surpassing $500 million in annual value in 2014 and reaching nearly $1.3 billion in 2018.

Little analysis has come with that money. Several ethicists told Healthcare Dive they were unaware of any published or ongoing studies examining hospital-affiliated VCs and the unique questions such funds pose for medical technology adoption.

“That is an issue of institutional conflicts of interest, which is, frankly, completely unsolved in general in healthcare,” said Steven Joffe, a bioethicist at the University of Pennsylvania. “We don’t have clear-cut mechanisms to make sure institutional conflicts of interest are navigated well.”

Most of the hospital systems invested in Gauss via corporate VCs said they take conflicts of interest seriously and have policies in place to prevent such influence.

For instance, Mount Sinai, which launched its VC back in 2008, has a board of people not affiliated with the health system to analyze the investments and clinical use, a spokesperson said.

According to ethics experts, such an independent review is a critical step to mitigate the potential for decisions to be made, which could compromise a hospital’s patient-driven mission.

But even the appearance of conflict can bring risks to an organization. In the case of St. Joseph in Orange County, uncertainty over the relationship between the hospital’s use of Triton and Providence St. Joseph’s investment in Gauss through its venture arm was enough to motivate physicians to speak out.

“One has to be very careful not to mix a medical practice with financial gain of an industry,” said Al-Khan, the doctor at Hackensack, which does not have such a VC arm.

The funds, though, appear to be here to stay.

In early 2019, Providence Ventures, which backed Gauss, literally doubled down, announcing its fund will expand from $150 million to $300 million. The fund targets companies just like Gauss: early-stage healthcare companies specializing in IT, medical devices and technology-enabled services.