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There is an abundance of complexity in the daily operation of a hospital that affects quality of care and patient safety, and contributes to the new estimate of more than 440,000 preventable deaths each year.  Back-stabbing politics and abusive managers should not be anywhere on any list of contributing factors.  However, anecdotal evidence from 20 years of interviews with hospital employees, and common sense, suggest that these issues are indeed part of the problem.

four-killed-in-us-stabbing-rampageI have discovered that the average hospital employee ranks back-stabbing politics or abusive and inept management as the two things about their current job that they hate the most.  They are not shy about claiming that these bad behaviors get in the way of quality care and patient safety.

When hospital employees place their own interests, egos and insecurities ahead of the patients they have a solemn duty to protect and care for, then the stunning recent findings on preventable deaths in the Journal of Patient Safety are sadly easier to wrap your mind around. 

For executives who know and who tolerate this behavior, for whatever reason – and most defy logical, sane reasoning – then they are more culpable, I believe, than the misguided jerks who play these games.

Office politics is rarely about transparency or honesty.  There is an analogous link to malicious gossip.  It exists because it is rarely exposed to the light of day, otherwise known as the truth.  

Given the sanctity of our duty to safely and carefully watch over our patients, perhaps all hospitals should have a hard wired rule: if you want to put your own agenda, and your own career aspirations ahead of the patients, then go somewhere else.  Now. Unfortunately, far too often, this type of behavior, the back stabbing and the abuse, is ignored and tolerated and patients inevitably suffer.

OK, if we do not have the courage to get rid of people who want to play games, then at least we should insist on some form of honesty in practicing this behavior: front stabbing.  At least everyone will know.