You’ve probably felt the battle raging within you. To hold onto your beliefs. To boldly proclaim and do what you feel is right.
The world is crying out around you to do that what they believe to be true. All the while trying to pull you to their side and strip away your integrity.
There’s a battle happening. The battle to maintain our integrity while living in a world that beckons us with the desires of others.
While these posts received quite a bit of positive attention, there were also questions regarding the posts. Partially relating to maintaining your integrity while being told to tweet something one of these great men had said.
Instead of tweeting out quotes from Nelson Mandela or Martin Luther King Jr, it was suggested to take the quote, make it your own, and take action. Eventually changing the world because of the action you took.
This blew me away as I never equated asking someone to retweet a quote to losing their integrity. I thought it was a great way to remember these special men and to share some of their great insights.
After this was brought up, I can see how one could possibly begin to lose the fight to maintain integrity. If all we ever do is tweet good words and yet never act on them, what good are we? How are we really improving the world?
Those thoughts brings me to this post and the idea of maintaining our integrity while living a life true to ourselves.
So, what can be done to win the battle that wants us to lose our integrity?
Be true to yourself: First and foremost, be true to yourself. If someone asks you to retweet a quote or a link and you don’t feel it lives up to your standards or goals, don’t do it. Or if someone asks you to do something that goes against what you believe, tell them no and don’t do it.
This brings up memories of my middle school days. In 6th or 7th grade, my friends began to think it was fun to use profane words.
These guys would hang out behind the school whispering and sharing the bad words they’d learned.
One day a couple of these friends approached me and tried to influence me to curse with them. However, even at that age, I knew it would affect my integrity to do so.
When I refused to use the same words they used, they resorted to offering me cold, hard cash to do something against my beliefs. In the end, I knew what was right and what was wrong. I refused to do what was asked.
Don’t cave into the requests of others just because you follow them and they ask. You’ve got to stay true to your direction even if that means going against the request of someone else.
Be honest with others: I’m so glad a couple of readers brought up this issue with the request for tweets. This issue of integrity never crossed my mind when I asked others to retweet the quotes.
Rather, I was hoping it would inspire people. That they would see what great men have done and hope to do the same.
With this honest reply, I was able to see not everyone sees this in the same light. It also helped me realize people react to requests in different ways.
Honesty opens up the eyes of others and allows you to be true to yourself.
Be aware of your choices: Robert Brault once said
“You do not wake up one morning a bad person. It happens by a thousand tiny surrenders of self-respect to self-interest.”
Each choice you make has an effect on your integrity. You either make choices that add to your integrity or choices to surrender and lose the integrity you hold so dear.
Learn to examine the choices laid before you. Decide whether or not they add to your integrity. Make the choices that will make you a person of integrity.
Integrity can be an easy thing to lose. It can also be an easy thing to maintain when we’re aware of the actions we can take to keep it.
I know you want to live a life of integrity. I encourage you to do so.
Remember, be true to yourself, be honest with others, and know the choices you make affect your integrity.
Question: How do you maintain your integrity?
Doctors, when surveyed, say they are opposed to the very idea of skewing their prescribing practice in favor of companies giving them money. The problem is, they still take lots of money in the form of honoraria, speaking fees, research grants, and outright gifts from pharmaceutical and medical device companies. Research suggests they can then fail to recognize that they’ve been influenced.
Psychologists George Loewenstein and Don Moore argued in a 2004 paper that while people consciously think about their professional obligations, the other half of a conflict — self-interest — is “automatic, viscerally compelling and often unconscious.” That theme keeps returning in more recent research.
As MD turned ethics professor Sunita Sah of Georgetown University concluded in a review paper, even if doctors don’t recognize what’s going on, those in the pharmaceutical industry understand social psychology and know what works. Reciprocity is a part of human nature, and field studies have shown that doctors change their practices to reciprocate gifts and favors. Those who ultimately lose in this game are the patients, who are at risk of prescriptions that are not entirely in their best interest.
Every once in a while an extreme case leads to a dramatic downfall. That happened recently when a New York Times/ProPublica story revealed that Memorial Sloan Kettering Cancer Center’s chief medical officer Jose Baselga had accepted millions from industry and then written numerous scientific papers without disclosing financial ties to the companies whose products he was studying.
He resigned within days. The larger problem remains: Conflict of interest is the norm in medicine. According to a 2007 survey, 94 percent of physicians had some sort of industry ties. And as Sah and other social scientists have shown in their research, this can bias their behavior even as they insist they are above it.
Sense of entitlement is a big factor in physicians’ acceptance of industry money. In one study she co-wrote with Loewenstein, doctors were more likely to agree they would accept industry payments when they were reminded of their sacrifices — years of medical school, debt incurred, sleep deprivation when on call. She compared the attitude to that expressed in the famous commercial for L’Oreal hair products: “I’m worth it.”
In addition to the lure of money, pharma and medical device companies can appeal to physicians’ egos by anointing them “key opinion leaders.” In one of her papers, Sah quotes one such leader, a psychiatrist, saying: “It strokes your narcissism. … The first thing they do is take you to a really nice hotel. And sometimes they pick you up in a limo, and you feel very important, and they have really, really good food.”
In another study, which examined conflict of interest and bias across professions, Sah and Lowenstein showed that people were less likely to offer biased, self-serving advice when they worked with individuals, known by name. In experiments, subjects designated as advisers could guide advisees in a number estimation game — the adviser having access to more information than the advisees. The advisers could benefit from causing advisees to make an overestimate, while the advisees benefited from getting the number right.
When they were giving advice to individuals, advisers were less likely to act selfishly. When dealing with groups, self-interest became a bigger factor, though subjects weren’t aware of the change. They reported afterward that they were unbiased and gave good advice. In interpreting the findings, the researchers suggested that in doctor-patient relationships, empathy might guide decisions. But people have more trouble feeling empathy toward nameless groups, as they would in, say, making clinical guidelines or public health recommendations. Grants for studies also appears to create a bias. Industry-funded studies are more likely than independent ones to show a product is effective, according to a 2017 review.
Disclosure rules are supposed to limit the damage, but other studies show they don’t help much. In a 2005 paper, researchers argued that advisers feel “morally licensed and strategically encouraged” to give even more erroneous or exaggerated advice once a conflict was disclosed. In another paper, Sah and colleagues showed that patients were just as likely to take advice after a conflict-of-interest disclosure. Some thought that if a doctor owned a stake in an imaging center, for example, then he or she must have expertise. Others reported they felt awkward about refusing. After a conflict-of-interest disclosure, she said, “advice can be harder to turn down because it suggests you think the doctor is biased and corrupt.”
The main benefit is that disclosure rules can discourage providers from taking money that creates a conflict in the first place. There is hope, however, that doctors can be more principled than other kinds of advisers. In a recent study, volunteers were asked to play the role of either doctors or financial advisers and were placed in a conflict situation where they could make money at the expense of advisees. Those who were reminded of their responsibility as doctors gave less selfish advice, and those reminded of their role as financial advisers gave more selfish advice. When researchers carried out the same experiment with real doctors and financial advisers, Sah said, they got pretty much the same result.
So maybe doctors are a little special after all, in that they work by professional standards that put patients’ well-being above fancy dinners, prestige and the almighty dollar. But with drug companies and others cleverly playing to doctors’ selfish desires, they may sometimes need a reminder.
Frustrated with insurers, some large companies — including a certain cable behemoth — are shedding long-held practices and adopting a do-it-yourself approach.
It’s hard to think of a company that seems less likely to transform health care.
It isn’t headquartered in Silicon Valley, with all the venture-backed start-ups. It’s not among the corporate giants — Amazon, Berkshire Hathaway and JPMorgan Chase — that recently announced, with much fanfare, a plan to overhaul the medical-industrial complex for their employees.
And it is among the most hated companies in the United States, according to many surveys on customer satisfaction.
It’s Comcast. The nation’s largest cable company — the $169 billion Philadelphia-based behemoth that also controls Universal Parks & Resorts, “Sunday Night Football” and MSNBC — is among a handful of employers declaring progress in reaching a much-desired goal. In the last five years, the company says, its health care costs have stayed nearly flat. They are increasing by about 1 percent a year, well under the 3 percent average of other large employers and below general inflation.
“They’re the most interesting and creative employer when it comes to health care benefits,” said Dr. Bob Kocher, a partner at Venrock, a venture capital firm whose portfolio companies have done business with Comcast. (The cable company declined over several months to provide executives for an interview on this topic.)
Comcast, which spends roughly $1.3 billion a year on health care for its 225,000 employees and families, has steered away from some of the traditional methods other companies impose to contain medical expenses. It rejected the popular corporate tack of getting employees to shoulder more of the rising costs — high-deductible plans, a mechanism that is notorious for discouraging people from seeking medical help.
Most employers now require their workers to pay a deductible before their insurance kicks in, with individuals on the hook for $1,500, on average, in upfront payouts, according to the Kaiser Family Foundation. Instead, Comcast lowered its deductible to $250 for most of its workers.
“We believe that no one should be required to be an expert in health care,” Shawn Leavitt, the executive overseeing benefits at Comcast, said in a 2015 interview with a consultant. “Our model is based on providing employees support and assistance in making the right decisions for themselves and their families. Employees should not feel alone, confused and overwhelmed when it comes to understanding and selecting their benefits.”
Cable TV subscribers who have felt confused and overwhelmed when dealing with Comcast customer service may be surprised to learn how nimbly the company has upgraded services for its employees. While Comcast continues to work with insurers, it has largely shunned them as a source of innovation. Instead, it has assembled its own portfolio of companies that it contracts with, and invests in some of them through a venture capital arm, Comcast Ventures.
One such company is Accolade, in which Comcast is an investor, and which provides independent guides called navigators to help employees use their health benefits. Another, called Grand Rounds, offers second opinions and help in finding a doctor. Comcast was also among the first major employers to offer workers access to a doctor via cellphone through Doctor on Demand, a telehealth company.
“We see the start-up community as where the real disruption is taking place,” said Brian Marcotte, the chief executive of the National Business Group on Health, which represents large employers. “We weren’t seeing enough innovation.” The group now vets some of these companies for employers, including Comcast.
Comcast “is the tip of the spear,” Mr. Marcotte said.
The corporation, of course, is controlling costs and offering these unusual benefits out of self-interest. And these services are sometimes handed out at the expense of improving wages. In a tight labor market, Comcast also needs to remain competitive for not only highly skilled employees, but also lower-wage workers whose direct contact with customers has generated so much dissatisfaction over the years. “We do these things because it’s great for business,” Mr. Leavitt said.
But much of what sets Comcast apart is its willingness to directly tackle its medical costs rather than relying on others — insurers, consultants or associations. It’s a luxury only the largest companies can afford, and roughly a fifth of big companies continue to see annual cost increases of more than 10 percent, according to Mercer, a benefits consultant.
While fate may play a role — a single expensive medical claim can drive up a company’s costs in any given year — employers, like Comcast, that use a variety of strategies tend to have the lowest annual increases. “You attack this thing from different angles,” said Beth Umland, Mercer’s director of research for health and benefits. “The intensity of effort pays off.”
Other employers are focusing more attention on unsatisfying hospitals and doctors. Walmart has been at the forefront of efforts to direct employees to specific providers to get medical care, even if it means paying their travel to places like the Mayo Clinic.
The retailer said it had found, for example, that employees were being told they needed back surgery even when they would not benefit from the procedure. “Walmart isn’t going to stand for this,” said Marcus Osborne, a benefits executive, at a health business conference. “We aren’t going to sit around to try to build another coalition or bureaucracy.”
The majority of working-age Americans — some 155 million — get their health insurance through an employer, and most companies cover their own medical costs. The companies rely on insurers to handle the paperwork and to contract with hospitals and doctors. Insurers may also suggest programs like disease management or wellness to help companies control costs.
But employers, including that Amazon-Berkshire-JPMorgan alliance, are increasingly unhappy with the nation’s health care systems. Companies are paying more than they ever have. And their employees, saddled with escalating out-of-pocket costs and a confusing maze, aren’t well served, either. “The results haven’t been there,” said Jim Winkler, a senior executive at Aon, a benefits consultant. “There’s frustration.”
At Comcast, some workers probably miss out on the new ventures altogether and others don’t have much choice but to go along. The company’s relationship with labor is often strained, and it has largely managed to fend off efforts by groups like the Communications Workers of America to organize its employees. Robert Speer, an official with a local of the International Brotherhood of Electrical Workers in New Jersey that represents about 180 workers, noted the company’s use of independent contractors to do much of its work, none of whom are eligible for benefits and can be paid by the job rather than hourly. “You are making no money,” he said.
And, like many other workers, many employees are being pinched by the rising cost of premiums, Mr. Speer said.
Comcast workers with company coverage are told to go to Accolade first. Its phone number appears on the back of their insurance cards and on the benefits website. “The key to Accolade’s success is being the one place to go,” said Tom Spann, a co-founder of the company.
Geoff Girardin, 27, used Accolade when he worked at Comcast a few years ago and he and his wife were expecting. “Our introduction to Accolade was our introduction to our first kid,” Mr. Girardin said. He credits Accolade for telling him his wife was eligible for a free breast pump and helping find a pediatrician when the family moved. “It was a huge, huge help to have somebody who knew the ins and outs” of the system, he said.
For employees like Jerry Kosturko, 63, who survived colon cancer, Accolade was helpful in steering him through complicated medical decisions. When he needed an M.R.I., his navigator recommended a free-standing imaging center to save money. “They will tell me what things will cost ahead of time,” Mr. Kosturko said.
A nurse at Accolade helped him manage symptoms after he had surgery for bladder cancer in 2014. He developed terrible spasms because, he said, he wasn’t warned to avoid caffeine. The Accolade nurse thought to ask him and quickly urged him to call his doctor for medicine to ease his symptoms.
Mr. Kosturko also turned to Grand Rounds when his doctor thought he might need to stay overnight in the hospital to be tested for sleep apnea. The second opinion convinced him he did not.
In complicated cases, Grand Rounds can serve as a check on the network assembled by the insurer. It pointed to the case of Ana Reyes, 39, who does not work for Comcast and had contacted Grand Rounds after treatment for cervical cancer. When she continued to have symptoms, she says, she was told to wait to see if they persisted.
“This is my life at stake,” she recalled in an interview. “I need to know what I’m doing is the best plan.” Grand Rounds asked a specialist at Duke University School of Medicine, Dr. Andrew Berchuck, to review her case.
“Grand Rounds was able to get all my medical records, which is over 1,000 pages,” Ms. Reyes said. Dr. Berchuck reviewed and wrote his opinion in one week, recommending a hysterectomy because she was likely to have some residual cancer. “The same day, my treating physician, she called me to schedule a hysterectomy,” Ms. Reyes said.
Insurers are usually none too pleased with the employers’ use of alternatives: They’re reluctant to share information with an outside company and poised to undercut a potential competitor by offering a cheaper price. They may even refuse to work with some of the companies.
The largest employers push back. Fidelity Investments insists on cooperation between insurers and outsiders, said Jennifer Hanson, an executive at Fidelity Investments. “Those who don’t will be fired,” she said at a health business conference.
For Comcast, the next frontier is the financial well-being of its employees, many of whom live paycheck to paycheck and may not be able to afford even a small co-payment toward a doctor’s visit. Employees who run into financial trouble have no independent source of information, Mr. Spann said.
After talking to hundreds of companies, Comcast Ventures could not find a financial services start-up that would help employees without trying to sell them a product or earning their money on commissions. So Comcast recruited Mr. Spann to serve as chief executive of a new company, Brightside, that it created and invested in.
Employees who are less worried about their finances may be less likely to miss work or suffer from health problems, Mr. Leavitt said. Ultimately, he said, “there is a productivity play for Comcast.”
Amidst the social gatherings and backyard barbecues of the Independence Day celebrations that we have each year, there are many important and dramatic stories about the sacrifices of our founding fathers who signed the Declaration of Independence.
Some of them are inflated, but what is true is they knew that it was a bold, courageous step that would prompt a strong response from the mother country. What they expected was brutal military action against them by the best organized and equipped army in the world. There were personal and professional risks for those leaders.
The Price of Freedom in the POW Camps
The same challenges were true for our senior leaders in the Vietnam POW camps. There was a lot at stake as they wrestled to set an example for the rest of us to serve with honor in difficult times.
As POWs, we battled daily to have the freedoms that we enjoy in the U.S. We know what it’s like to live without freedom, and we don’t take it for granted. I know it can sound a bit trite, but it’s true—Freedom is not Free.
“FREEDOM IS THE BURNING DESIRE OF EVERY HUMAN BEING, BUT IT COMES WITH A RESPONSIBILITY.”
It can only be maintained by what my organization calls the core of courageous accountability – Character, Courage, and Commitment.
The Internal Battle
Human nature naturally goes toward the easy way out. The truth is that honor, character, courage, and commitment do not have many easy days.
“LIVING AND LEADING WITH HONOR REQUIRES SACRIFICE, AND IT’S MAINLY LETTING GO OF OUR EGO AND SELF-INTEREST.”
We’re always bound to self-interest, yet we must learn to periodically rise above it and that takes sacrifice to put the good of others first. That’s what our founders did, what the military does, and what our elected representatives are supposed to do.
In fact, we all play a role in preserving our freedom and national security.
Safeguarding our Freedom and Independence
As we reflect this month on our national independence and individual liberty, it’s a good time to reflect on our individual responsibilities for preserving these liberties that we can so easily take for granted.
So you might ask, “What can I do to help safeguard our independence and freedom?”Playing off our brand and mission at Leading with Honor®, we are engaged in a battle to be leaders who live with honor.
Here are three important points:
The Sacrificial Payoff
This mindset is not easy. It takes courageous, character, and commitment that’s supported by self-awareness and discipline. To be frank, living and leading with honor doesn’t come easy. It requires an ongoing battle with the dark and lazy side of human nature. it’s easy to just settle, drift and become indifferent and apathetic about our greatest treasures as a nation.
So as you gathered with your family and friends, I hope that you paused to remember your responsibilities as a citizen and as a protector of our freedoms.
It’s very clear that our founders understood that when they signed off on the Declaration of Independence and closed with these words:
“And for the support of this Declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our Lives, our Fortunes, and our sacred Honor.”
Please share your comments and experiences below, too.
The foundational pillars of Character, Courage, and Commitment form the bedrock to lead with a model of courageous accountability shown in the article. Want to learn the full model to continue growing as an honorable leader?
For a limited time, we’re offering the Engage with Honor Launch Package when you purchase a copy this award-winning book.