Monday, February 3, 2014

Transparency & Strength of Character

Their importance and institutionalising them

The background is I live and work (as a strategic adviser to companies) in a country whose institutions and citizens (and certain of its diaspora) have become increasingly and quite distressingly prone to financial and moral abuses that have entailed a significant cost.
No reason for confidentiality herethe only reason I havent mentioned the name of the country is that I believe the same holds good for several countries and economies, particularly in the developing i.e. emerging or frontier markets but also in the developed world.
Things have come to the point in my country where people I meet socially and who I know are similarly distressed by how things are going, often find the only practical option available to them is to stay well clear, professionally and personally, of those with poor reputations, warn their colleagues, friends & family who may be exposed to them of the more odious characters they are aware of and resort to weak humour about modern realities.
Some of those who read this may also, as they've got older, identify with what I've experienced and become more willing to challenge the established way of doing things while realising, perhaps from firsthand experience, that a fairly minimal effort well directed can have fairly significant results.
The experience that recently and powerfully brought home to me how much of a role strength of character can play even in situations where no impropriety is suspected, is when I recently lost my father to a major disease that could not be directly treated for a while due to associated complications. He was in one of the country’s best hospitals by reputation under the overall care of one of the country’s most reputed physicians. However, I realised too late that the physician and specialists who were treating the complications were floundering somewhat and in consultation with a friend with some expertise in these things insisted on a change in the specialist to a particular doctor. This doctor was able to achieve in about a half hour what the physician & earlier specialists were unable to achieve in over a month. Too late it turns out as this prevented the main disease from being treated during this period but it was revealing that after the change in specialist was effected that several other doctors who were aware of the case expressed total support to our decision but NONE of them recommended this earlier and the insisting on the change in specialist was basically left to the initiative of a person with no medical knowledge to speak of.
I can understand the reluctance of the attending doctors to speak up and bear them no ill will— the aforementioned physician is famously unreceptive to alternative suggestions and the hospital quite likely doesn't have a mechanism in place to encourage or reward real initiative and strength of character. Also, the other specialists involved in what was a complicated case could perhaps be justified in saying that they were qualified and enlisted to look at their areas of expertise only.
I then got to thinking what information, if mandated by the hospital’s systems and processes and if it had been available to me early on in the process, might have made a real differencethe answer I reached is deceptively simpleif the hospital were to maintain a list, of the specialists their own doctors consulted when they or their family members needed medical attention AND in which hospital they sought such treatment, that would be useful information and as relevant should be shared with patients and their caregivers shouldn’t it? The outcome of this could not be inconsistent with the best practicable expertise being brought to bear for the patient’s benefit. Some might argue that giving patients this information could lose the hospital some patients in the near term but over the medium to long term it should certainly motivate the hospital to do whatever is necessary to attract the best doctors shouldn't it? This would also be valuable feedback to the hospital management & administrators.
It could be argued that executives of automobile companies routinely drive their own company’s cars, airline executives fly that airline only etc. but the key is when the purchase is truly discretionary and involves serious thought and potential implications (e.g. major surgery) who do those you don't have direct control over like independent contractors (e.g. panel doctors) go to?
Real transparency is not easy to institutionalise but when this is done successfully, by an institution with inherent quality, it should have lasting impact. Even in cases where the institution doesn't have much fundamental strength real transparency will help avoid expensive mistakes and alert financial backers to the need to consider pulling the plug earlier.
In terms of incentivising people to display strength of character by their actions, that is more complicated but I am reminded of the advice the then CEO of a company I joined after my MBA gave the group of new recruitsgive the client advice you think is best for him, even if it wouldn't make us the most money. Also, he told us that if we were ever asked for a kickback we should tell someone in senior management one of whom would very likely know someone more senior than the “solicitor”. Institutionalising such values and systems must involve an effective whistle blower protection system that is implemented and overseen by persons capable of and tasked with acting truly independently of management.
This has incidentally been my first post on MediumI have read several posts with interest and I look forward to participating more actively henceforth.

Thanks for your attention!

P.S: Apologies for recent blogging silence - the events described above are a partial explanation. This post has also been posted on Medium ( It is possible that blog posts in future may only be on Medium

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