and the Four-Letter F Word



     That got your attention, I bet!

     No, I am not going to write about porn,
even, as Trekkie Monster points out in Avenue Q, “in volatile market, only
stable investment is porn.” A co-ed at my alma mater has now taken the use of
this vehicle as a means of paying for furthering her education to new levels
(high or low?), so enough…

     It’s the use of the word by Associate
Justice of the Supreme Court Potter Stewart that brings this subject to mind.
He said of pornography that “he knows it when he sees it”. I think the same is
true of the four-letter F word—FAIR. Most of us have a pretty good feel for
fairness and an even more acute sense of unfairness.

     Fairness actually is a highly variable
commodity for it, like so much else in life, is in the eye of the beholder. For
Democrats, fairness may look like a higher minimum wage, an expansion of
federally funded health insurance, or greater investment in public K through 12
education. For a Democrat, fairness may depend on an outcome, usually based
upon dollar redistribution (did you know Robin Hood was a Democrat?) Everyone
gets a certain amount at least. This I would term communitarianism. It is the
primary sentiment driving the governments of Western Europe. It’s why they have
universal health care systems and America does not. Essentially, I think
Europeans, so traumatized by WWII, refuse to have a nation of have-nots grow in
their midst and so are more willing to act communally. They view it as
preserving the peace for all.

Republicans tend to look upon fairness as an
equal opportunity issue. It doesn’t really matter what you wind up with as long
as you had an equal chance to get it. This is more the individualism
exemplified by the cowboy of the Old West as portrayed by John Wayne and
embodied in our politics by Ronald Reagan. This is a uniquely American national
sentiment, I believe, although Margaret Thatcher bonded with President Reagan
over the need to allow for individual success through equal opportunity without
the guarantee of equal outcome.

Of course, the truth is somewhere in between
because who is to say what an “equal opportunity” looks like (other than the
EEOC, of course).

To be clear, I am not entering or even proposing
to enter this debate for it can never be ended. (Or if it ends it is usually
with a bad result as in the former Soviet Union). People just differ with
regard to their view of what fairness looks like when the government is the
arbiter of that fairness.

     In a corporation, things are not quite so

I have been thinking about this a great deal of
late as I consider why great institutions go off the tracks, even, as they
appear to be doing well financially. As an example, let’s start with our
favorite institution of health care delivery, MD Anderson Cancer Center.

     By any measure, MD Anderson is a success.
It has been ranked by US News and World Report as the number one place for
cancer care in the country. It consistently boasts the greatest number of NCI
grants and the most SPORE grants. Its Cancer Center Support Grant is huge and
the most recent review of this CCSG was exemplary. The patient population for
both cancer care clinicians and clinical investigators is second to none. There
are now 5 IOM and 2 NAS members among the Anderson faculty. And the physical
plant, sprawling though it is, is also up-to-date and growing. Why then would
anyone at Anderson choose to leave? But many of the brightest stars have.

I think there is a perception that at Anderson
what was once a very Republican and American (and dare I say Texas) idea of
fairness based on opportunity has degenerated into a two-tiered culture of
inherent unfairness. Most faculty members live in a Democratic world of stifled
equity (approaching socialism?), with dismal outcomes in their work life
despite reasonable salaries and great benefits. Then there is a small number of
the leaders living in dachas supported by the labor of the rest of the clinical
faculty (the oligarchy of Putin’s Russia or the recently fallen Ukrainian
administration. MD Anderson just doesn’t have its own zoo, but it does have
lots of animals.) This just doesn’t seem fair to most people.

     There are a host of rules involving
conflicts of interest, nepotism, self-dealing, internal grant reviews and the
redistribution of institutional resources for research that appear to be
suspended when the FORDs are concerned, but which the rest of the faculty must
obey. This does not seem fair.

I even discussed all this with the Compliance
Office when they wrote to me after my separation from Anderson and requested my
input on any compliance shortcomings I had observed during my tenure. I would
not write about anything, but instead scrawled my cell number on the back of
their survey, mailed it back and eventually was contacted. I discussed my
observations with that office on the phone. As far as I can tell, nothing has
happened and no one has gotten back to me about any of the things I identified
as problems in compliance or even matters that color awfully close to the legal

I think the reason folks are looking to leave
Anderson is that they have simply had enough of the nonsense perpetrated by its
leadership since 2001 and which intensified in 2011.

It’s one thing to need a drink every night after
you get home, but a shower to remove the slime? That’s too much for most of the
good people I know at Anderson and most of the people I know at Anderson are
certainly good.

What is so tragic is the ease with which
unfairness can be removed from the culture as a source of discontent, but rarely is. Here’s an
example I learned about recently:

A small company with about 200 employees moved
into a brand new facility. This was a company with both a technical component involved
in laboratory work and an administrative component handling HR, sales, IS, etc.
The new building was separated into two floors. On the first floor was the lab.
On the second was the small executive suite and all the support services.

Those working on the first floor were mandated to
adhere to a very specific, though not oppressive, dress code. No shorts. Long
sleeves only. No open toe shoes. The second floor workers could wear what they
wanted to. Believe it or not, this created a culture of unfairness because
people doing the same jobs on the first or second floor (e.g., administrative
assistants) had to abide by different dress codes. Of particular annoyance were
the shoes.

Fortunately, the CEO rapidly detected the problem
and mandated the first floor dress code for everyone. The unfairness issue went
away. This did not create a perfect work environment but it removed unfairness
and a sense of we-they/first floor-second floor from the culture.

CEOs could learn from this leader. One set of
rules for everyone because even the most “lowly” worker (if you believe that
there are any of these, and I don’t, and neither did Dr. LeMaistre) knows fair
when she sees it. It doesn’t take a Supreme Court Justice for this.

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