UO > Remarks > Putting Trust Back in Health Care

Putting Trust Back in
Health Care

Improving the public perception of health-care organizations is
the responsibility of both physicians and administrators, says
one physician executive.

By arthur lazarus, md, MBA. Published July/August 2005

Why do certain health-care organizations struggle with their public image?

In the course of my career, I have worked in academic medical centers, managed care organizations, and pharmaceutical companies. The public image of all of them has taken a beating, especially HMOs and pharmaceutical companies. I’ve often wondered whether trust is at issue here. Is there is an emerging crisis in trust in health-care organizations?

Whom Do You Trust?

A recent Gallup poll is telling. Participants in a 2004 Gallup survey ranked nurses as having the highest honesty and ethical standards of 21 professions. Pharmacists were ranked third, and physicians ranked fifth. Business executives were seventeenth on the list, with only 20 percent of respondents rating them as “high” or “very high” in honesty. Rank order has been fairly consistent for the past six years that Gallup has conducted the poll.

Is it possible that the public’s higher trust in health-care providers (relative to business executives) enhances the image of some health-care organizations more than others? After all, doctors, nurses, and pharmacists are perceived as more honest than business executives, and health-care providers are more visible and numerous in hospitals and health clinics, for example, than in HMOs and pharmaceutical companies.

Honesty builds trust, which is essential to fostering effective working relationships with the public and regulatory authorities. Honesty may have a measurable effect on the image of an institution. If this is true, then organizations must make it a priority to put trust back into health care. This means raising the ethical bar for everyone working in health-care organizations, as well as for people connected to them—lawyers, politicians, and marketers. Those professionals, in particular, had low honesty ratings in the Gallup poll.

ACPE Survey

A survey on ethical business practices conducted by the American College of Physician Executives (ACPE) also disclosed deep concerns about unethical activities affecting the nation’s health-care system. The ACPE survey included responses from about 1500 physician-executives. Fifty-four percent of respondents said they believed there were health-care organizations in their communities that were involved in unethical business practices. Common problems included the influence of pharmaceutical and medical device companies, conflicts of interest among board members, and financial concerns dictating the nature of medical practice.

Another important finding was the fact that two-thirds of physician leaders who responded to the survey were either very concerned or moderately so about conflicts of interest among non-physician executive leaders. However, physicians also pointed the finger at themselves. One-third of the respondents believed that one or more physicians within their organization were involved in unethical business practices.

In an article in Physician Executive, Richard E. Thompson questioned whether the term “honest physician” was a 21st century oxymoron. Although doctors used to be among the nation’s most respected and admired professionals, physicians now rank below grade-school teachers. Do physicians exemplify the society of Diogenes, who believed people were fair and just only to the extent necessary to obey rules and laws? Probably not, according to Thompson. He remarked, “For every doctor on the take, there are several who abhor these stains on the honor of the medical profession.” Still, the Gallup poll and ACPE survey remind us of the importance of evaluating the character of all health-care professionals and hiring only the best.

Compliance Programs Foster Trust

All health-care companies should have a corporate compliance program to ensure the integrity of their clinical and business relationships. A chief compliance officer and compliance committee should monitor and enforce adherence to the program, including a Code of Conduct for all employees, written policies and procedures, educational and training initiatives, and review and disciplinary procedures. Here’s a sobering statistic—while more than 70 percent of physician-executives surveyed by ACPE indicated their organizations had a code of ethics spelling out the groups’ ethical policies, only about 60 percent said these rules are actually enforced.

Thus, compliance programs should be implemented to instill company values and proactively provide guidance for health-care workers. Corporate integrity agreements developed in response to ethical and regulatory violations uncovered by third parties (e.g., the Department of Justice) tell us that the manner in which organizations respond to mistakes and wrongdoing is vitally important. A handful of recent studies reviewed by Joseph Mantone in Modern Healthcare suggest that apologizing for medical errors may be an effective strategy for hospitals to prevent lawsuits. Admitting fault may also have a healing effect on providers. Bringing honesty and candor to other sectors of health care may foster the widespread openness essential to improving the public image of all medical institutions.

Enabling Business Performance

In health care as in other industries, the cost of acquiring new customers is 6 to 10 times greater than the cost of retaining existing ones. Whether those customers are patients, employer groups, or other health-care companies, gaining their trust is critical to the bottom line.

Perhaps most important, results from the Gallup poll and ACPE survey imply that restoring the image of health-care organizations requires increasing the level of trust between business executives and health-care providers. Dissimilarities between these groups contribute to dysfunctional conflict and discord, creating barriers to integrated leadership—so essential in today’s health-care organizations. Business executives and health-care providers can no longer expect to coexist under conditions of mutual distrust and disdain if they are to gain the respect and confidence of the public.

The time for a face-lift is now. g

Arthur Lazarus, MD, MBA, is a psychiatrist in Chadds Ford, PA. He is the author of MD/MBA: Physicians on the New Frontier of Medical Management (American College of Physician Executives, 1998).

The comments in Remarks are solely those of the author and may or may not be shared by UO or its advertisers.

@ 2005 UO Inc. www.uoworks.com 800-888-2047










					Putting Trust Back in Health Care Improving the public perception of health-care organizations is the responsibility of both physicians and administrators, says one physician executive. By arthur lazarus, md, MBA. Published July/August 2005 Why do certain health-care organizations struggle with their public image? In the course of my career, I have worked in academic medical centers, managed care organizations, and pharmaceutical companies. The public image of all of them has taken a beating, especially HMOs and pharmaceutical companies. I’ve often wondered whether trust is at issue here. Is there is an emerging crisis in trust in health-care organizations? Whom Do You Trust? A recent Gallup poll is telling. Participants in a 2004 Gallup survey ranked nurses as having the highest honesty and ethical standards of 21 professions. Pharmacists were ranked third, and physicians ranked fifth. Business executives were seventeenth on the list, with only 20 percent of respondents rating them as “high” or “very high” in honesty. Rank order has been fairly consistent for the past six years that Gallup has conducted the poll. Is it possible that the public’s higher trust in health-care providers (relative to business executives) enhances the image of some health-care organizations more than others? After all, doctors, nurses, and pharmacists are perceived as more honest than business executives, and health-care providers are more visible and numerous in hospitals and health clinics, for example, than in HMOs and pharmaceutical companies. Honesty builds trust, which is essential to fostering effective working relationships with the public and regulatory authorities. Honesty may have a measurable effect on the image of an institution. If this is true, then organizations must make it a priority to put trust back into health care. This means raising the ethical bar for everyone working in health-care organizations, as well as for people connected to them—lawyers, politicians, and marketers. Those professionals, in particular, had low honesty ratings in the Gallup poll. ACPE Survey A survey on ethical business practices conducted by the American College of Physician Executives (ACPE) also disclosed deep concerns about unethical activities affecting the nation’s health-care system. The ACPE survey included responses from about 1500 physician-executives. Fifty-four percent of respondents said they believed there were health-care organizations in their communities that were involved in unethical business practices. Common problems included the influence of pharmaceutical and medical device companies, conflicts of interest among board members, and financial concerns dictating the nature of medical practice. Another important finding was the fact that two-thirds of physician leaders who responded to the survey were either very concerned or moderately so about conflicts of interest among non-physician executive leaders. However, physicians also pointed the finger at themselves. One-third of the respondents believed that one or more physicians within their organization were involved in unethical business practices. In an article in Physician Executive, Richard E. Thompson questioned whether the term “honest physician” was a 21st century oxymoron. Although doctors used to be among the nation’s most respected and admired professionals, physicians now rank below grade-school teachers. Do physicians exemplify the society of Diogenes, who believed people were fair and just only to the extent necessary to obey rules and laws? Probably not, according to Thompson. He remarked, “For every doctor on the take, there are several who abhor these stains on the honor of the medical profession.” Still, the Gallup poll and ACPE survey remind us of the importance of evaluating the character of all health-care professionals and hiring only the best. Compliance Programs Foster Trust All health-care companies should have a corporate compliance program to ensure the integrity of their clinical and business relationships. A chief compliance officer and compliance committee should monitor and enforce adherence to the program, including a Code of Conduct for all employees, written policies and procedures, educational and training initiatives, and review and disciplinary procedures. Here’s a sobering statistic—while more than 70 percent of physician-executives surveyed by ACPE indicated their organizations had a code of ethics spelling out the groups’ ethical policies, only about 60 percent said these rules are actually enforced. Thus, compliance programs should be implemented to instill company values and proactively provide guidance for health-care workers. Corporate integrity agreements developed in response to ethical and regulatory violations uncovered by third parties (e.g., the Department of Justice) tell us that the manner in which organizations respond to mistakes and wrongdoing is vitally important. A handful of recent studies reviewed by Joseph Mantone in Modern Healthcare suggest that apologizing for medical errors may be an effective strategy for hospitals to prevent lawsuits. Admitting fault may also have a healing effect on providers. Bringing honesty and candor to other sectors of health care may foster the widespread openness essential to improving the public image of all medical institutions. Enabling Business Performance In health care as in other industries, the cost of acquiring new customers is 6 to 10 times greater than the cost of retaining existing ones. Whether those customers are patients, employer groups, or other health-care companies, gaining their trust is critical to the bottom line. Perhaps most important, results from the Gallup poll and ACPE survey imply that restoring the image of health-care organizations requires increasing the level of trust between business executives and health-care providers. Dissimilarities between these groups contribute to dysfunctional conflict and discord, creating barriers to integrated leadership—so essential in today’s health-care organizations. Business executives and health-care providers can no longer expect to coexist under conditions of mutual distrust and disdain if they are to gain the respect and confidence of the public. The time for a face-lift is now. g Arthur Lazarus, MD, MBA, is a psychiatrist in Chadds Ford, PA. He is the author of MD/MBA: Physicians on the New Frontier of Medical Management (American College of Physician Executives, 1998). The comments in Remarks are solely those of the author and may or may not be shared by UO or its advertisers. Back to top @ 2005 UO Inc. www.uoworks.com 800-888-2047