The dominant theme of Health Care Renewal has been how problems with the leadership of health care organizations have lead to our current state of health care dysfunction. We have discussed examples of ill-informed, mission-hostile leadership rewarded with excess compensation, exhibiting impunity in the face of alleged misbehavior, and at times descending into corruption. The cause of these problems is doubtless multi factorial. However, one possible cause is that rather than exercise stewardship and hold leadership accountable, those in charge of governance of health care organizations, that is, boards of directors or trustees, have instead infected the organizations with the amoral culture now dominant in much of the business world, especially finance. We have discussed, most recently here and here, how the boards of health care corporations often include heavy representation of leaders of finance, including many of those who seemed responsible for the global financial collapse, great recession, or whatever we will end up calling it.
I recently stumbled upon a particularly graphic example of the sort of predatory culture that now exists on the boards of health care organizations. (More on how I did so later.) Below is an embedded YouTube video of a speech made by a current Trustee of New York - Presbyterian Hospital (who has been on the board since 2007). He is Richard Fuld, the former CEO of Lehman Brothers, whose continuing role on the hospital board, despite his failed leadership of one of the financial firms whose bankruptcy ushered in the global financial collapse, we discussed first here.
Just to underline it once more, Mr Fuld, referring to short sellers of his company's stock, said he "what I really want to do is I want to reach in, rip out their heart, and eat it before they die."
Can there be a more stark reminder of what has gone wrong with the governance of health care? Can anyone watch this video and argue that Mr Fuld ought to be on the board of a hospital system? Why is he still on the board in January, 2012, when this video was released in October, 2011?
While I suspect not many other hospital system board members have been videographed displaying equally brutal sentiments, there are likely others with similarly barbaric tendencies.
So, on a more positive note.... The boards of hospitals, hospital systems, medical schools, and their parent universities ought to be populated with people who take their stewardship roles seriously. They ought to be people who understand, agree with, and support the organizations' mission, and their dedication to patient care and teaching. They ought to understand what good leadership of health care organizations entail. Needless to say, they ought to be of good character and above any ethical reproach. In short, they ought to be the opposite of the sort of person displayed in the video above.
It should now be obvious that grievous problems with the leadership and governance of health care organizations are principle causes of the dysfunction in our health care system. True health care reform will require wholesale changes in health care leadership and governance.
PS - In case the video above seems too short on context, see the one below: