Conflicts of interest in health care journalism. Who’s watching the watchdogs? We are. Part 1 of 3

Ben Harder, a journalist with US News & World Report, recently tweeted, “Pharma ads subsidize many health reporters’ salaries.”

Elisabeth Rosenthal, who now heads Kaiser Health News after a long career with the New York Times, tweeted in that same discussion, “Many of my articles in the NYT carried pop-up ads for pharma. Infuriating.”

Many journalists are aware of the drug industry’s attempts to gain positive attention by buying placement within the nation’s health care news.  A few occasionally write or talk about it, as Harder and Rosenthal did publicly.

But I don’t think we talk often enough about why it matters if health care industry entities are allowed to advertise within, or sponsor, health care journalism content.  Americans spend more than $3 trillion on health care. Conflicts of interest in health care and research are rampant. The Journal of the American Medical Association (JAMA) last month published a special edition all about health care conflicts of interest.  JAMA included a Viewpoint article entitled, “Conflict of Interest:  Why Does it Matter?”  The first line:  “Preservation of trust is the essential purpose of policies about conflict of interest.”

But who talks about conflicts of interest in health care journalism? In a Gallup poll, “Honesty/Ethics in Professions,” respondents rated journalists’ honesty and ethical standards below psychiatrists, chiropractors and bankers….and just above lawyers.

There is great potential harm in a further erosion of trust in journalism and in health care.  There is a great potential harm in journalists – and the audience they serve – becoming numb to the presence of and influence of drug companies and other industry entities in the news and information disseminated to the public.  There is, as we have begun to point out repeatedly in our review of news stories and PR news releases, advertising and marketing messages, often a polluted stream of contaminated information reaching the public.  Often vested interests pollute that stream.  (We will discuss these potential harms in more detail in part 3 of this series.)

That’s why I think that this issue demands and deserves a deeper dive. Why now?  Because, as outlined in this series, there are a growing number of questionable alliances between a growing number of news organizations and health care industry sponsors. Money is exchanging hands and I ask “Why? Why do news organizations enter into these arrangements?  Why do they feel they need to?  Have they exhausted all other options?”  I want to shine a light on a collection of news organization practices.  I’m raising the same types of questions that journalists often raise as they report on various issues.  But I’m asking them because I don’t see enough journalists talking about it when their own organizations accept industry money.

Leaders can’t write a memo to change culture

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When Chris Van Gorder joined San Diego-based Scripps Health as COO in 1999, the health system had 55 days cash on hand, and there was no trust between the administration and clinical staff.

His first day on the job, Mr. Van Gorder attended a meeting at Scripps Memorial Hospital La Jolla (Calif.) with another Scripps executive to resolve a miscommunication surrounding contract renegotiations. Rising tensions between physicians and administrators boiled over at the meeting, which cumulated with the Scripps executive quitting his job on the spot so he could sue the hospital’s chief of staff for slander.

“The physician sitting next to me tapped my shoulder and said, ‘Welcome to Scripps, you’re on,'” says Mr. Van Gorder. “That was the end of my first day.”

Flash forward 18 years and Mr. Van Gorder — promoted to CEO six months after joining Scripps — now runs a $3.1 billion health system that’s been named to Fortune’s top 100 employers in the country 10 years in a row.

Mr. Van Gorder discussed Scripps’ transformation — and the leadership strategies he used to drive these improvements — at the Becker’s Hospital Review 8th Annual Meeting in Chicago.

Earn employees’ trust

Shortly after he took over the CEO role, Mr. Van Gorder met with every board member one-on-one.

“Everyone wanted me to fix everything all at once,” he says. “But I knew I needed to prioritize and first find a way to work with our physicians.”

Mr. Van Gorder says it’s crucial for leaders to ensure proper communication with employees to establish trust and set the groundwork for a culture change. To mend relationships with Scripps’ physicians, he called a meeting with the health system’s elected physician leaders entire to acknowledge the lack of transparency between administrators and staff.

“They had all these demands and expectations they wanted us to meet,” he says. “But they didn’t know we were on the verge of bankruptcy.”

Mr. Van Gorder developed a physician advisory body called the “Physician Leadership Cabinet” to serve as a liaison between the clinical and administrative teams and weigh in on decision-making. Giving physicians more responsibility to manage the health system’s limited resources helped them understand the institution’s financial constraints, thus breaking down the communication wall between them and leadership.

“It’s really easy to say, ‘I want, I want, I want’ when you’re on the outside,” says Mr. Van Gorder. “But when you’re on the inside, you realize how difficult it is to manage scarce resources.”

The Physician Leadership Cabinet has proven successful. Health system leadership has accepted every recommendation from the board in the last 18 years, and every vote except one has been unanimous, according to Mr. Van Gorder.

Drive culture change from the middle up

Once leaders earn staff members’ trust, they should shift their attention to changing the organization’s culture, says Mr. Van Gorder. He believes managers have the most influence on culture, as they manage a majority of the organization’s employees.

“Leaders can’t write a memo to change culture,” he says. “But our frontline employees and middle management can influence culture.”

To develop an umbrella culture for the organization from the middle, Mr. Van Gorder launched the Scripps Leadership Academy — a year-long behind-the-scenes program for managers at the health system. Every program starts with a two-hour Q&A session where Scripps executives talk about how they got to where they are today.

“I was a cop. I worked at Arby’s,” says Mr. Van Gorder. “Most people look at executives and just see the suits. But as soon as you remove the veil of the title away from the individual, they become a human being.”

The leadership academy strives to show managers how the organization operates and how decisions are made. Each graduating class also works on a change project to improve a specific aspect of the organization. After the academy ends, Mr. Van Gorder challenges the managers — his “agents of culture change” — to take what they learned and demand more from the people they work with.

Maintain regular communication

Leaders must maintain a positive relationship with staff members to sustain the improvements in trust and culture, says Mr. Van Gorder.

He sends out a daily newsletter to Scripps managers and employees who request it, highlighting major news in the healthcare industry, along with organization updates and photos.

“Even if they just read the titles, they’ll start to understand the external factors impacting our organization,” Mr. Van Gorder says. “The more they understand this, the more they’ll accept the changes we’re trying to make in our organization. They’ll see it’s not something forced on them from management — it stems from the changes in healthcare.”

As email is the one way he can connect with Scripps’ 15,000 employees, Mr. Van Gorder freely invites employees and physicians to reach out to him directly if they are not getting the support they need to do their jobs, or even if they want to say hello. He responds the same day to every email he receives — a feat he sees as a basic level of respect.

“One of our values is respect,” he says. “If I’m not responsive to them, I’m not being very respectful.”

Leading with Control Versus Leading with Influence

Let me be honest. I can be a controlling person. It’s part of my character. I know that. I test that way with StrengthsFinders. If no one is taking charge, I’ll take over the room. (And, not because I’m extroverted. I’m not.) If we both come to a four-way stop at the same time – as nice as I try to be and as much as I love others – I won’t stall long for you to decide if you’re going. It’s just how I’m wired. If the leader isn’t in the room, I’ll lead.

I think my team, however – or at least I hope – would tell you I don’t perform as a controlling leader. Some may even wish I controlled more. It’s been a long process to discipline myself not to respond how I am naturally inclined to do.

Leaders, if you want to to have a healthy team environment, you must learn to control less and influence more. The differences are measured in the results of creating a healthy team.

I have learned thought that successful leaders understands the difference in leading with influence and leading with control.

Here’s what I mean by the results of controlling versus influence:

In an organization where control is dominant:

  • The leader’s ideas win over the team’s ideas – every time.
  • The team follows, but only out of necessity (for a paycheck) – not willingly.
  • Change happens through fear and intimidation – not motivation.
  • People are managed closely – rather than led.
  • Team members feel unappreciated and often under-utilized – rather than empowered.
  • The organization is limited to the skills and ability of the controlling leader – not the strength of a team.
  • Passion is weak – burnout is common.


In an organization where influence is dominant:

  • The ultimate goal is what’s best for the organization, not an individual.
  • Team spirit develops as relationships and trust grow.
  • Willing followers, and other leaders, are attracted to the team.
  • Leadership recruitment and development is a continued endeavor.
  • Change is promoted through desire and motivation, not obligation.
  • The organization has the expanded resources of a team of unique individuals.
  • People feel empowered and appreciated.

Leaders, take your pick – control or influence. You can’t have it both ways. One will always be more dominant. Granted, I could write a whole blog post (and, I have) on the messiness of leading by influence. There will often be confusion, lack of clarity, and misunderstandings. It comes when all the rules aren’t clearly defined. This, however, is a tension to be managed not a problem to be solved. (I think Andy Stanley said that first.)

When it comes to creating organizational health – influence will always trump control. Every time.

Have you ever been or worked for a controlling leader?

Have you been in an environment where influence is dominant?

Which did you prefer?

True Sign of a Great Leader > How Well They Protect PTO


To me there is one way to know if a leader is worth their salt.  It is something I don’t recall seeing in leadership books, white papers, or in training sessions.  To me the simplest way to see if a leader is doing their job is to ask team members one question:

“Did you use all your PTO last year?”

When a team member tells me they did not, my antennae go up.  My follow up, of course, is “well, why not?”.  Answers I get:

  • I didn’t have time to take it
  • I didn’t want to leave my team short-handed during that data conversion
  • I forgot I even had PTO
  • I have so much PTO I could never use it all
  • I’d rather use our great benefit that allows me to “cash in” my PTO

Here is the deal.  If you are a leader and you are OK with any of these reasons, you are not doing your job. I’ll take it a step further and say you should not be a leader.  Quit.  Be an incredible individual contributor.  But you need to let go of your dreams of being a leader.  Let that go. It’s over.

I’m emphatic about this.

On the Far Side of Broken Trust – Hope for Those Who Have Been Betrayed

On the Far Side of Broken Trust – Hope for Those Who Have Been Betrayed

Betrayal and broken trust brings immense pain.

I know. I’ve been there. And you probably have too.

When we talk about breaking trust, there is a continuum of severity of the offense. My fellow trust activists, Dennis and Michelle Reina, have an excellent way of expressing this concept. First, you can categorize offenses as either major or minor. Second, within those categories you can view the offenses as intentional or unintentional. The severity of the trust betrayal happens on a continuum, from those instances where a person unintentionally behaves in a way that erodes someone’s trust, to those instances where the person intentionally behaves in a way to deceive or betray.

When we’ve experienced an intentional, major betrayal of trust, it can seem like all hope is lost of salvaging the relationship. After all, isn’t that the truth behind the cliché “trust takes a long time to build and just a second to lose?”

I’m here to tell you that there is hope on the far side of broken trust. If you and the other party are committed to restoring the relationship and putting in the necessary time and effort to rebuild trust, there is hope for the future. There are three important ideas to consider and remember:

1. Trust is incredibly resilient—Trust is much stronger than we give it credit for, as most people who have had long-term relationships can testify. Trust experiences ups and downs over the course of time, but if both parties learn to develop open and honest communication and practice forgiveness and restoration when minor trust offenses occur, they develop the strength necessary to weather a major breach of trust.

2. Trust can be stronger after a betrayal—Once a relationship experiences an intentional, major betrayal of trust, it will never be the same. But it can be better, deeper, and stronger than it was before. Betrayals of trust often cause the parties involved to realize the value of their relationship. Instead of taking it for granted, the parties can gain a new perspective on the importance and priority of the relationship and work to make it healthier than it was before the breach of trust.

3. It’s an opportunity for a new beginning…or a necessary ending—After experiencing a breach of trust, and before deciding to embark on the journey of rebuilding it, it’s important to consider if the relationship is worth preserving. For example, if your auto mechanic intentionally deceives you and charges you for repairs that weren’t needed, you may decide it’s better for you to end that relationship and find a new mechanic. That’s an easy choice with an impersonal service provider, but it’s quite another for a close personal relationship. Yet in spite of the pain caused by a betrayal in a close relationship, it presents an opportunity to pursue a new beginning. Both parties need to be absolutely committed to restoring the relationship in order to recover from a major betrayal of trust. Trust is a reciprocal process—one person gives it, the other returns it. You can’t rebuild it if only one party is committed.

Trust is the foundation of any healthy and thriving relationship. It may sound simplistic and perhaps counterintuitive, but the best way to build trust is to never break it in the first place. What I mean by that is trust is created through repeated interactions in a relationship where the parties prove themselves trustworthy to one another. The more trust is built over time, the stronger it becomes and is able to endure and persevere when a major betrayal occurs.

If you find yourself experiencing a betrayal, don’t despair. There is hope for having a stronger and deeper relationship as a result of going through the process of rebuilding trust.


Building Rapport Shows Employees You Care – How to Get Started

Building Rapport Shows Employees You Care – How to Get Started


If you’re a senior leader in your organization, chances are the vast majority of employees don’t view you as a real person.

Research by Nathan T. Washburn and Benjamin Galvin shows employee perceptions of senior leaders are governed by mental models they form through incidental interactions with the leader, such as emails, videos, speeches, or other impersonal means of communication.

So what should you make of that? First, it should make you question the level of trust people have in you. Second, you should know that without trust it’s virtually impossible to influence and inspire your team to follow your lead. And third, it should prompt you to consider ways to build a more personal relationship with those you lead.

But where to start? Start at the beginning. Start with building rapport.

Merriam-Webster defines rapport as “a friendly, harmonious relationship; especially a relationship characterized by agreement, mutual understanding, or empathy that makes communication possible or easy.”

Rapport is a fundamental component of having a connected relationship with someone, and the lack of personal connection is the reason people view their leaders as impersonal avatars. Research has shown the importance of warmth as a critical factor in building trust. Your team members are wanting to know that you care about them as individuals and not just nameless worker bees showing up to do a job.

People don’t care how much you know until they know how much you care.