Values as the dominant
Loyalty to purpose is the central
value. Loyalty to self-promotion and
self-preservation is an accident waiting to happen.
Provident Hospital was chartered in Chicago in 1891 pri- marily to treat the “sick poor” in the
community. From the
outset, Daniel Hale Williams, chief of
staff at the hospital, insisted that phy-
sicians and nurses there maintain the
highest standards of patient care,
including cleanliness of the facility.
This was a tall order in-and-of-itself, but likely made more difficult
because the hospital started with an
operating budget of $5,429—or about
$130,000 in 2010 dollars. Yet the values that Williams put into practice had
a meaningful effect, especially two-and-a-half years hence, when a patient
with severe stab wounds in the chest
was transported to Provident.
Just after arrival, Williams operated on the victim by opening the
patient's chest, locating damage to the
pericardium, suturing it, applying antiseptic and, finally, closing the chest.
The patient, James Cornish, walked out
of the hospital completely recovered 51
days later and lived another 50 years,
the first recipient of an open heart
surgery—and the first patient known
to have had his chest cavity opened
without death from infection.
That values are so critical to effective- ness is further evi- dent in the example of William Worrall
sons gradually built what would now
be called a patient-centered practice,
grounded in integrated care, shared
knowledge, and scientific and technological innovation.
This followed the cooperative
standard of care that appealed to
Mayo when he organized a group
to provide care for people affected
by bloody battles between Dakota
Indians and white settlers in 1862,
examined Civil War recruits beginning the next year, and, 20 years
later, coordinated medical treatment for those injured after a tornado ripped through the town of
Today, the Mayo Clinic claims an
impact of more than $22 billion on
the United States economy, yet still
holds as its primary value that “the
needs of the patient come first.”
The significance of values could
also be applied to something on the
order of the preference physicians
have when prescribing a branded
drug versus a generic one.
There has been plenty of scrutiny over ethical concerns about
the relationship between physicians
and the pharmaceutical and medical
device industries, because physicians
possess the professional and legal
authority to prescribe therapies to
patients, who are customarily in less
of a position to appropriately evaluate
which methods are the most condi-tion- and cost-effective.
In most cases, however, the
scrutiny is unwarranted and punitive; the physician is interested in
prescribing the drug therapy that
effectively and efficiently resolves
the patient's condition. Further, the
physician depends on the drug manufacturer to develop compounds that
benefit the patient and on the health
insurance plan to cover the cost of
the drug when it is dispensed.
The physician is also often too
far away from the financial results of
the manufacturer and more conscientious about what the drug does for
the patient than who profits from its
distribution. Thus, the physician is in
most cases passive as to whether the
patient takes the branded or generic
version of the drug.
This explains why, after the
branded drug is discussed during an
office visit and the physician writes
the prescription for it, the patient
becomes confused and skeptical when
the pharmacy dispenses the generic.
Physicians enter the medical profession because of an interest in maintaining and improving the physical
and mental health of human beings.
They understand that they are in the
business of delivering health care, not
running an office, clinic, or hospital.
As a result, they know it is their duty
to promote whatever and wherever
they believe is the right kind of care
for the patient.
This means putting the patient
ahead of economic and political interests. If they thought otherwise, they
would surely have chosen to spend
their 20s in a bank vice presidency
rather than a clinical residency.
The “defining moment”
Profit follows purpose—and
there are a handful of ways to achieve
purpose. Yet unless the right people
are in the right positions, no one will
be effective in achieving anything.
Putting people where they fit best
starts with those who know and carry
with them the point in time that
made them the person they became.
Not long after a 7.0-magnitude
earthquake devastated Haiti in
January 2010, a passenger jet and
a cargo plane took off from Israel
bound for the disaster zone. The first
plane carried an advance team of
rescue and relief personnel who
boarded the 16-hour long flight