Thursday, October 13, 2005

Individual vs. Corporate Responsibility

The October 12, 2005 issue of The Boston Globe carried a follow-up piece on the heart surgery shut-down at the UMass Memorial Medical Center in Worcester due to an excessive mortality rate. It summarized the report of a review team of four heart surgeons and an anesthesiologist that had been appointed by the Massachusetts Department of Health to look into the situation.

The group said that “the underlying problem has been a lack of leadership.” Later in the article, Paul Dreyer, head of the state’s Division of Health Care Quality was quoted as saying “To me what stood out is that the problem seemed to be a hospital problem, as opposed to a problem with individual surgeons.”

Dreyer may have made a bigger statement than he knew. The concept of individual responsibility (as contrasted with corporate responsibility) lies at the very foundation of our system of health care. It is a concept that served well for many years, but is now out of date.

If Dreyer is right (as I believe he is), then the management and governance of the hospital – not individual professionals - should be held publicly accountable for the quality of clinical performance. But it seems that we are not yet ready to do that. The story quotes Dr. Walter Ettinger, Jr., executive head of the hospital, as saying that the hospital had implemented some staffing cuts several years ago in response to financial problems and “Probably the combination of financial strain and lack of clear-minded and strong leadership led to this happening.”

One may ask whose leadership he is talking about. Apparently not his, considering that he had been in charge of the place for over a year and a half at the time the Department of Health blew the whistle on its heart surgery program.

Once we get past this reluctance to hold institutional leadership accountable we will begin to see significant progress in the reform of our health care system.

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