What creates a toxic hospital culture?

https://www.kevinmd.com/blog/2015/10/what-creates-a-toxic-hospital-culture.html

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Hospital culture is largely influenced by the relationship between administrative and clinical staff leaders. In the “old days” the clinical staff (and physicians in particular) held most of the sway over patient care. Nowadays, the approach to patient care is significantly constricted by administrative rules, largely created by non-clinicians. An excellent description of what can result (i.e., disenfranchisement of medical staff, burn out, and joyless medical care) is presented by Dr. Robert Khoo.

Interestingly, a few hospitals still maintain a power shift in the other direction — where physicians have a stranglehold on operations, and determine the facility’s ability to make changes. This can lead to its own problems, including unchecked verbal abuse of staff, inability to terminate bad actors, and diverting patients to certain facilities where they receive volume incentive remuneration. Physician greed, as Michael Millenson points out, was a common feature of medical practice pre-1965. And so, when physicians are empowered, they can be as corrupt as the administrations they so commonly despise.

As I travel from hospital to hospital across the United States (see more about my “living la vida locum” here), I often wonder what makes the pleasant places great. I have found that prestige, location, and generous endowments do not correlate with excellent work culture. It is critically important, it seems, to titrate the balance of power between administration and clinical staff carefully — this is a necessary part of hospital excellence, but still not sufficient to insure optimal contentment.

In addition to the right power balance, it has been my experience that hospital culture flows from the personalities of its leaders. Leaders must be carefully curated and maintain their own balance of business savvy and emotional IQ.  Too often I find that leaders lack the finesse required for a caring profession, which then inspires others to follow suit with bad behavior. Unfortunately, the tender hearts required to lead with grace are often put off by the harsh realities of business, and so those who rise to lead may be the ones least capable of creating the kind of work environment that fosters collaboration and kindness. I concur with the recent article in Forbes magazine that argues that poor leaders are often selected based on confidence, not competence.

The very best health care facilities have somehow managed to seek out, support and respect leaders with virtuous characters. These people go on to attract others like them. And so a ripple effect begins, eventually culminating in a culture of carefulness and compassion. When you find one of these gems, devote yourself to its success because it may soon be lost in the churn of modern work schedules.

Perhaps your hospital work environment is toxic because people like you are not taking on management responsibilities that can change the culture. Do not shrink from leadership because you’re a kind-hearted individual. You are desperately needed. We require emotionally competent leaders to balance out the financially driven ones. It’s easy to feel helpless in the face of a money-driven, heavily regulated system, but now is not the time to shrink from responsibility.

Be the change you want to see in health care.

 

Pharma karma catches up: Shkreli sentenced to 7 years

https://medcitynews.com/2018/03/pharma-karma-catches-shkreli-sentenced-7-years/?utm_campaign=MCN%20Daily%20Top%20Stories&utm_source=hs_email&utm_medium=email&utm_content=61259603&_hsenc=p2ANqtz-9KZbK2I0aYCjcH-L8_oANZXZSsq2K8jondsl8vHF0rHfcb8_zR65kRtQV-cDsnd_VomLuc-G2in5Y4wJcsFWrR8zgKJg

The man who embodied the phrase “pharma bro” and once urged his fans to pull a hair from Hillary Clinton’s head at a book signing has had a visit from pharma karma. The judge in Martin Shkreli’s fraud case, Kiyo Matsumoto, has sentenced the poster man for pharmaceutical company greed to seven years. Estimates are that Shkreli, 34, might get out in a couple of years if his behavior is good.

At his sentencing hearing, Shkreli apparently, and rather uncharacteristically, expressed contrition and shed enough tears that the judge called for the court officer to bring the defendant a box of tissues. Shkreli, in making his plea for leniency, tearfully told the judge that “the one person to blame for me being here today is me.” The judge apparently was unmoved, although the sentence is less than the 15 years the prosecution requested.

Shkreli drew the time after a jury found him guilty of one count of conspiracy to commit securities fraud and 2 counts of securities fraud. The same jury found him not guilty on an additional five counts, raising some hope from his legal team that his sentence would be light. The crimes, related to stock manipulation of shares in Retrophin, one of Shkreli’s companies, and ripping off hedge fund backers, could have carried a sentence of up to 20 years.

In February 2018, Matsumoto found that losses resulting from Shkreli’s crimes tallied up to $10.4 million.

Although he’s probably best known for overseeing a 5,000 percent price hike of a toxoplasmosis drug for HIV-positive patients, Shkreli’s post-pharmaceutical shenanigans caught a much attention as his venality while helming Turing Pharmaceuticals. He dropped $2 million on the sole copy of the Wu-Tang Clan album ‘Once Upon a Time in Shaolin,” which the judge has included in his assets. He harassed a journalist on Twitter, getting himself suspended, and seemed to want to fashion himself into the Snark King of Social Media.

His posturing ended up being his downfall.

While awaiting sentencing, Shkreli boasted that he would end up serving hardly any time and what time he did serve would be in the relatively posh environs of a “Club Fed” prison for white collar criminals. But after he exhorted Facebook followers to pluck a hair from Clinton’s head and offered $5000 per sample, the judge who sentenced him revoked Shkreli’s bail and ordered him to be placed in Brooklyn’s Metropolitan Detention Center, a far different experience for the pharma bro.

Although Shkreli is at the center of his own story, some believe that the industry overall is not blame-free. STAT journalist Adam Feuerstein has pointed out that the pharmaceutical industry can’t entirely disown Pharma Bro and his behavior, noting that Shkreli “was doing what lots of other biotech and pharma CEOs did, and still do to various degrees. Legally.”