Wednesday, July 11, 2007

Dealing with Whistleblowers

I was scanning the web looking for leads on a story that has been circulating about Kaiser Permanente and a major failure of its reported $4 billion eHealth records management system. It started with a Computerworld article based on a 722 page internal report outlining the inadequacies of the system. Following up on yesterday's post on "Critical Reading" I was curious to find out how bad this system really was. BIG systems always have BIG problems, and my gut tells me that the fact that Kaiser commissioned such a comprehensive review of its system is a good thing.

More interesting though is how the story came to light. Justin Deal, a 22 year-old Kaiser employee was incensed at the waste and problems the system was causing and took it upon himself to send an email to 120,000 Kaiser employees. The Wall Street Journal quoted the email in part:

"In a blistering 2,000-word treatise, Deal wrote: “We’re spending recklessly, to the tune of over $1.5 billion in waste every year, primarily on HealthConnect, but also on other inefficient and ineffective information technology projects.” He did not stop there. Deal cited what he called the “misleadership” of Kaiser Chief Executive George Halvorson and other top managers, who he said were jeopardizing the company’s ability to provide quality care.

“For me, this isn’t just an issue of saving money,” he wrote. “It could very well become an issue of making sure our physicians and nurses have the tools they need to save lives.”"

Wow... How would you respond if you saw an email like that in your inbox?

Was Justin Deal right? Was he wrong? After reading his blog, I would have smacked him. He sounds like an immature, arrogant, self-righteous kid. [PLEASE NOTE Retraction of this comment] Although... I must admit I was once like that myself.

The issue here is how do we deal with whistleblowers.

Like Kaiser's system, many of our eHealth systems will have MAJOR problems. So much so that some people will feel compelled to expose waste, mismanagement, fraudulent acts, and errors that hurt people. We tacitly support the notion of whistleblowing, but as organizations we fail to provide a legitimate outlet or channel for people to voice concerns. They then turn to the media or other methods of exposing what they believe to be misdeeds.

I personally have experience with two whistleblowing episodes. In the first case the person, frustrated with the organization, went to the media with allegations of wrongdoing. This ended up badly for everyone. In the second case the person approached a trusted member of the organization's management. The trusted manager took the matter seriously, thoroughly investigated the matter and protected the whistleblower's confidence and identity. Issues were brought to the executive team's attention for action. This case ended up well.

In each of these two cases the whistleblowers had only part of the information and reported issues which, to the outside observer seemed troublesome, but upon investigation were found to be explainable and without malfeasance. The second case did point out some procedural issues that were easily resolved.

In both cases the whistleblowers were acting in what they believed to be the best interests for the organization and its clients. They knew the risks and put their jobs and reputations on the line. That's the challenge with whistleblowers. You're dealing with people who want to help and who care deeply for the organization and its mandate.

A risk management system must have a mechanism for people to report safety issues, privacy and security breaches, project and operational risks, conflicts of interest and wrongdoing. Most important: the person doing the whistleblowing must believe that following the right channel will result in a positive outcome, that their concerns will be taken seriously, and that they will not face retribution. Otherwise we force them to look for other avenues to expose wrongdoing.

Set up a whistleblower reporting system in your organization. A good starting point is Shaping Your Whistleblower System by Gerald Bloch. Don't waste your 15 minutes of fame on a headline or broadcast email subject line like the ones that Kaiser faced.

Check out the Wall Street Journal Health Blog for more discussion on the Kaiser incident.

1 comment:

Kim Sanders-Fisher said...

As a conscientious Medical professional who was fired for blowing the whistle on Deliberate Negligent Understaffing at my prestigious Maryland Hospital, I have strong views on this subject. You make it sound so straightforward to just do the right thing in reporting in a non-sensationalist way, but the reality is very different in an industry where there are remarkable few employee protections. Via a comprehensive review of after the fact reporting on the Internet, there is significant evidence to suggest that those who have reported up the chain of command first, subsequently contacting internal reporting departments like “Risk Management” or a Compliance Line, have experienced aggressive retaliatory practices on numerous occasions.
A highly publicized and impressive joint initiative between Kaiser Permanente of California and my former Hospital in Baltimore sought to “train surgical and critical care personnel to speak up about safety concerns....." I say beware of a powerful Healthcare organization's who attempt to cloak themselves in respectability by initiating impressive "Patient Safety" initiatives, go to: http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=362681 In the light of their well publicized behavior towards Whistleblowers at both of these institutions I am outraged by such “Double, Double-Speak!” To find out the sordid truth about how that Baltimore Hospital actually deals with their OR Staff reporting safety issues check out my Blog at: http://medteam.wordpress.com/keeping-surgery-safe/ I would love to hear your comments on “How long is too long for a member of the sterile team to remain continuously scrubbed into Surgery without a break?”
Unfortunately, once you have chosen to go to your supervisor and they feel threatened you can loose your job extremely rapidly and totally without cause. In some instances employees are coaxed into providing positive input or suggestions and then penalized for responding. Once you are removed it becomes almost impossible to report to external agencies as you are easily portrayed as a “disgruntled former employee with a grudge.” If you are fired from an influential and iconic Hospital, they can do no wrong so you must have an axe to grind; your chances of alerting authorities to serious public safety issues are zero! My Hospital was the Holy Grail of Medical Institutions and therefore absolutely untouchable. While you patiently wait for a proper hearing to reveal the truth your Hospital stalls for time and destroys your professional reputation with a smear campaign conducted behind your back.
I had a long history of providing positive input in the five years before I was fired; I even earned a letter of commendation from the Dean. When the Management changed radically to adopt policies that encouraged tenured Nurses to quit so they could be replaced by inexperienced new graduates, we were all overworked, overstretched and exploited to the point where it became dangerous so I spoke up. There were other issues that bothered me in an institution that considered they were above those petty regulations made for lesser institutions. It is this attitude of holier-than-thou, aloof complacency coupled by complete lack of oversight or fear of external scrutiny that I find so dangerous, hence my Blog where TEAM stands for TRANSPARENCY for EQUAL ACCOUNTABILITY in MEDICINE. At the time I made na├»ve suggestions about “Nurse Retention” to new Managers who only cared about cutting costs and working with the barest minimum of staff by driving them to the point of exhaustion. I complained about being left stranded for 12hours straight scrubbed into Surgery without a break until I nearly passed out; why? Because I was worried that such extremes were not just torturous for me, they seriously endangered my patient. I was forced to take unpaid leave and then fired.
I reported to the Hospital’s Compliance Line listing pages of issues where we violated regulations with impunity and ran shifts desperately understaffed. They refused to protect me from retaliation until I had exhausted all other avenues of recourse – basically until the retaliation had succeeded in my permanent removal! They were very reluctant to investigate the negligence issues I had bought forward. After a cursory review, and only when I demanded to know what was being done to correct matters, I was told that there was some truth to what I was saying, but they had decided to “just keep an eye on things.” I lost my job due to lies and vague subjective feeling expressed in solicited letters I was not allowed to read, but years of code violations and negligent policies that endangered multiple patients wasn’t considered relevant enough to bother disciplining rogue OR Managers.
My Managers had been unable to demonstrate to unemployment compensation that they had any cause to fire me, but the Compliance Line never bothered to monitor the increasingly corrupt disciplinary process used to railroad my career. After I had endured nearly 3 years of constantly changing false accusations, deceitfully suppressed documentation that could only be shown to agencies behind my back, and a sham Arbitration where Hospital Managers lied under oath, I lost all right to appeal any further. The Compliance Line then stated that since I was no longer an employee they were not obligated to investigate the retaliation charges I had presented; I was disgusted by their deliberate deceit! This meant that despite their Website assurances of protection from retaliation there was no point where they would ever have offered retaliatory protection. I am still challenging this assumption based on “truth in advertising.” How many Compliance Lines operate in this way to suppress charges of negligence or fraud and condone bullying employees into silence? We need a public inquiry of both Hospital Risk Management Departments and Compliance Lines.
When I believed that important safety issues had been ignored by the Compliance Line I also submitted detailed written reports to EEOC, the Maryland Commission on Human Relations, JCAHO, MEIMSS, the Board of Healthcare Quality, the Labor Board, the Maryland Board of Nursing, two Maryland Senators and my Congressman. Most of these Agencies were satisfied with a no questions asked simplistic assurance from the Compliance Line that all was OK. A corrupt Compliance Line is far worse than no Compliance at all since it provides a false since of security and an easy way to obscure serious negligence or negligence with sham self-policing. The Board of Labor cited my Hospital for “Unfair Labor Practices,” but did nothing to correct the damage or to prevent the continuous onslaught of additional and almost identical violations, mostly blocking access to all paperwork including false allegations against me. The Compliance Line didn’t notice the violation that supported my claim of retaliation, so the witch hunt continued unchecked; my personnel file became a revolving door of late submission false accusations to which I was denied access! With all of the other agencies I went from conscientious patient advocate to desperate defense of my personal credibility that left me stigmatized like a real criminal.
At the same time I was involved in a local community project to save a historic district of Baltimore and I frequently dealt with the press. Despite the ongoing battle with my Hospital that was becoming more and more blatantly corrupt by the day I felt it was unethical to go running to the press. During that period I managed to get a cover story in the Baltimore City Paper, but when asked about my job I discreetly skirted around the issue by saying I was “on a sabbatical from by job in the OR.” I was distressed by all that had occurred, still fiercely loyal and defensive of my prestigious Baltimore Hospital, so I cautiously protected their reputation while they decimated mine. Was I doing the right thing or inviting exploitation? Back then I genuinely believed that the full truth would be revealed and I would be welcomed back to my OR job. The possibility that self-serving rogue Managers might get away with such appalling negligence, deception and retaliation was beyond my comprehension, but they did.
I went into $60,000 worth of debt trying to hang onto my historic house in Baltimore, but in the end I was forced to abandon the only home I have ever owned. When all those Government Regulatory Bodies, Public Agencies, Patient Advocacy Groups, my own Union and the US justice system failed so miserably I left the US, penniless and in total despair I returned to England. If I am able to register with the Health Professions Council here in the UK to work as an ODP within the British NHS I must first “confess” that I was fired from a Hospital where I had worked for five years. This is taken very seriously in the EU as it implies that I might be capable of causing harm to a patient; I really have no choice but to tell the absolute truth about my wrongful termination as a Whistleblower. The more open I am about what happened, the better. The damage inflicted on my reputation is still impacting me today even as I try to gain acceptance as an unpaid Medical Volunteer with an NGO. Being fired from “America’s Best Hospital” has criminalized me without cause.
I am still fighting back, but now I am using the internet. Although it gives me great sadness and I remain very reluctant to choose this more public route there is no longer any other option. The US Healthcare industry is totally crippled by such pervasive corruption that I simply have to speak out. I have reached the conclusion that a little public embarrassment might just get that iconic Hospital to do the right thing and, considering their powerful position at the very top of the Healthcare industry, they might even introduce national regulatory safeguards. I have a Petition under Health on thePetitionSite.com, demanding that the Compliance Line at my former Hospital conduct an immediate investigation into my case, why? Even at this late date, it would establish the truth of those false promises made by the Compliance Line regarding their non-existent retaliatory protection. This is so important as I do not think my case was an isolated incident or that my former Hospital is the sole offender in Hospital non-Compliance. We need a public inquiry into these so called “Compliance Lines” as I believe they have been manipulated to obscure corruption and negligence. My Petition is at: http://www.thepetitionsite.com/takeaction/938995258
So which Hospital tried to silence me with lies and intimidation? I am not shouting it from the rooftops because I believe that more can be accomplished by diplomatically persuading them to correct serious problems, but if you want to know the truth visit my Blog. I have three Blog Sites, two of which are related to correcting what is wrong with US Healthcare: TRANSPARENCY for EQUAL ACCOUNTABILITY in MEDICINE: http://medteam.wordpress.com/cut-campaign-for-patient-safety/
http://medteam.wordpress.com/tag/innovative-solutions/
And the MedicIntegrity- TEAM: http://medicintegrity-team.blogspot.com/
Both sites expose important patient safety issues, calling for ethical conduct, increased transparency and accountability in US Healthcare. These two Blog sites are not just a place to gripe they are full of positive suggestions for change like the C.U.T! Campaign to CONTROL UNDERSTAFFING TODAY and a list of new rules and safeguard recommendations to restore the integrity and accountability of Compliance Lines My third Blog site is to promote the cause I have been working towards for many years, the humanitarian aid work that was derailed by my untimely dismissal. It represents my personal concept strategies for zero waste in Humanitarian aid after working for six months as a Medical Volunteer in Aceh Indonesia after the Asian Tsunami; It is called NGZer0: http://ngzer0.wordpress.com/about/
I still cling to the impossible dream that I might clear my name, but most of all I want to know that the ridicule, torment, unwarranted vilification and all of the excruciating personal sacrifices I was forced to make were not in vain. I am a non-vindictive person and I try to remain positive in the hope of stimulating important regulatory changes in the US Healthcare industry. I do not publicize my plight to seek compensation or fame; I would be happy in a tent, in a field, in a needy third world country, providing much needed Medical care!