The Fourth Core Value: Accountability

The Fourth Core Value: Accountability


Leonard Zwelling

Apparently there was a mistake. One of the two patients that MD Anderson reported to CMS as having died is actually alive and still under treatment. According to Todd Ackerman’s article, the mistake was based on an error in reporting to CMS by MD Anderson.

Apparently, three members of the MD Anderson faculty of Chinese nationality were discharged for having sent confidential NIH grant information to colleagues in China, which is against the NIH rules. This we learned from an on-line article in the New York Times by Gina Kolata. Until then, no one knew why the three were fired. There is no heuristic value for this management decision for the rest of the faculty. The leadership must have feared being called out for overly harsh discipline of faculty. If you are going to fire faculty and they are all of one nationality, at least explain why.

Apparently we learn that all has not been corrected at the MD Anderson Hospital with regard to deficiencies noted by CMS in their site visit. Todd Ackerman reports on nine areas needing further improvement. If you listen to executive management, it sounds like it’s all been fixed. Mr. Ackerman reports otherwise. Which is it?

It is one thing to not tell the truth about mishaps at an academic medical center. It’s quite another when the truth is revealed first in the newspaper. There is something askew when the facts of a mishap are articulated first by the local press not the leadership of the cancer center.

Apparently the leadership of MD Anderson is not being forthright with the faculty or the staff with regard to what really happened and why it happened when a problem hits the fan.

Caring, discovery and integrity are all very key core values. So is telling the truth and being transparent about a mistake or error in judgment that hurts patient safety or appears to. As my mentor Steve Stuyck always said about bad news, “get it out, get it all out, and get it out the first time.” MD Anderson seems to be struggling with fulfilling Stuyck’s Postulate. In short, along with the classic three core values in the MD Anderson code of conduct—caring, discovery and integrity–we should add a fourth, accountability. It’s not enough to have made the mistakes and then have to have the error delineated in print as leadership obscures the true nature of the damage. Someone needs to be held accountable. Who made the wrong report to CMS? Why did it happen? Who decided to fire the Chinese faculty and was that the only way the problem could have been dealt with? And why haven’t the obvious deficiencies in nursing and other aspects of patient care that have festered for years been repaired by now? This is old news according to many with whom I have spoken.

I have to question the wisdom of the current series of management decisions made by the leaders of MD Anderson with regard to these issues. Given the questionable ethics of past MD Anderson administrations, it is time to right the ship. Let’s shed a little light on why these decisions are being made and not have to learn about them in the newspaper.

All is not well. It can be. But first, a little clarity is in order. Who at MD Anderson will be held accountable and how?

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