“Corporate Culture”

Atul Gawande, the Brigham surgeon and author, has a fascinating article titled “The Heroism of Incremental Care” in the January 23rd New Yorker magazine. His subject is the importance of good medical management over time. He writes, “Success, therefore, is not about the episodic, momentary victories … It is about the longer view of incremental steps that produce sustained progress. That … is what making a difference really looks like. In fact, it is what making a difference looks like in a range of endeavors.” He concludes that the corporate culture of healthcare must acknowledge, “The heroism of the incremental.”

The importance of careful process is a critically important subject that I tried to emphasize with house officers in training during my academic medical career. As readers of Nesiritide know, I carried that interest in process over to my work in the pharmaceutical industry as well. So, it may not surprise anyone that over a wee drop of very nice Scotch my neighbor, an upper-level manager in the automobile industry, and I fell into a talk about Volkswagen’s diesel emissions problems. I asked, “What went wrong at VW?” Which is how I ended up reading a fascinating article by Robert Armstrong in the Financial Times of January 13th.

After a review of the public-domain facts, Armstrong came to the conclusion that “something went wrong with VW’s culture such that immoral behavior became acceptable,” and he found this “an uncomfortable conclusion.” He went on, “I will confess I understand little about how corporate cultures work or how to improve them.”

Today, I talked with another friend, a businessman from Chicago, who had heart surgery at the Cleveland Clinic a few days ago. He was delighted to be feeling well and walking in the halls, but what he really wanted to talk about was the Clinic’s corporate culture. He said, “They really DO the patient-first thing here; everyone from the janitor to my heart surgeon does it.”

Corporate culture is about what the members of an organization believe about the enterprise and how they behave in both internal and external interactions. Leadership articulates the vision and values of the corporate culture and implements the practices of that culture.

I’ve been working with a group of college classmates on a project related to President Kennedy that’s driven in part by his 100th birthday this year. As President, he articulated a vision of the national “corporate culture” that asked citizens to participate in the great social enterprise. If we hope to get through the next few years, we must all get involved in defining our vision and values. Have a look at the website, watch the short video, and share your thoughts, please.

Scottish mysteries. A great get-away vehicle.

My goodness, it is difficult to write without diving straight into politics. I’m going to try to avoid the subject by telling you about a couple of really good books.

The first is Peter May’s new Coffin Road, a mystery set in Scotland and the Outer Hebrides. May writes both beautiful descriptions and complex, but credible plots. In this tale, he also weaves some serious environmental concerns into the mix of memory loss and murder. If you’re not already familiar with Peter May, start with his Lewis trilogy. The first of the three books is The Black House, followed by The Lewis Man and The Chessmen.

The second is Out of Bounds by Val McDermid. This is another Scottish murder mystery, and McDermid will have you turning pages as fast as you can! There’s also a marvelous subplot addressing the flood of Middle Eastern immigrants in Scotland. And she writes with a recognizable voice and accent.

Where am I going with this? There’s a whole world of marvelous writing and thinking going on that will, for a few hours at least, transport you away from the faux-immediacy of Wolf Blitzer and the talking heads. Enjoy it.

On a totally different topic, my wife and I have had some fairly routine interactions with the health care system over the past two months. As a patient, I sense the intrusion of the electronic health records (EHR) system in the process, and resent it. Both our primary care and specialty physicians have adopted the use of “scribes.” The presence of the scribe, with his or her laptop, becomes a “gorilla on the table” in terms of conversation with the physician. There has to be a better way!

Speaking of the EHR, I followed a couple of links in my morning e-mail and learned that M.D. Anderson Cancer Center had losses of over $100 million last year. “Dan Fontaine, the chief financial officer, attributed much of MD Anderson’s financial difficulties to the rocky implementation of an electronic health record system in 2016.”

Finally, Nesiritide. The Rise and Fall of Scios received a nice review in Kirkus Reviews. Please have a look and add your comments on the site.