Bastiat, a Teenage Magician, and Medical Group Decision Making

A magic show is about misdirection: that which is seen and that which isn’t seen. Just like the title of the essay by Frédéric Bastiat, the early 19th Century French political economist, but in a slightly different direction.

Bastiat’s point was that governments legislate to correct a problem (and then bask in the glory of having taken action) but never truly consider what problems they create when they enact the legislation to correct the problem. In other words, they act based on what is seen (the initial “problem” and the easily seen “solution”) but do not pause to consider the potential damage that their action will later cause.

For example, in the United States we had the Great Society movement — Lyndon B. Johnson — supposedly to help the poor. One of the prime programs was public housing, which, in actuality, deserves significant blame for having created an almost permanent underclass which is dependent upon public housing and other government programs.

The Great Society programs and the slice of help that they provided to then current beneficiaries was “that which is seen.” Unfortunately, the negative impacts, the “that which isn’t seen,” were never taken into account and never even considered.

It part, we can blame this on the short lifespan of term of office. “I’ll be out of office and retired in the Bahamas before the shit hits the fan.” In part we can blame this on the immunity from liability for negligence that we’ve given politicians and bureaucrats: I’ve heard, but can’t find any proof, that the Romans made bridge builders live under their bridges for a period of time, the ultimate test of quality planning and construction. We don’t impose any risk at all on politicians who impose harebrained schemes on us.

But, in large part, the problem is one of thinking, and it pervades industry and child rearing (“Okay, little Johnny, you can have another ice cream cone, just be in bed by 7:30 . . .”) and decision making of all sorts, including that within medical groups.

There are many methods by which a medical group can make decisions. Some are clearly ill advised and others far more likely to generate good results, or, at a minimum, results that can quickly be corrected.

But any decision making method must be governed by a decision making process: what is considered in making the decision?

To drive the maximum chance of success, both in terms of advancement and in terms of managing against risk, the process must incorporate not only a view to what will be achieved by the decision, but also a view as to what deleterious impact the decision itself might bring, perhaps not immediately, but bring just the same. Think plus and minus. Think positive and negative. Think that which is seen and that which isn’t seen.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

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Governance | Group Culture

Why Your Group Has to Get Out of Its Own Way: Governance

Overly democratic or consensus style systems of medical group governance make it impossible for the group to adopt a strategic, as opposed to a tactical, outlook.

For example, consider a consensus style group that is unable to come to agreement on how to respond to an important referral source’s request that they expand their office hours. From a purely tactical standpoint, the group considers the cost of the extra hours of operation and, although unspoken, of the convenience factor as run through each doctor’s personal filter.

But the strategic analysis is very different: If we value their referrals, how do continue to obtain them?

As to the question of who should be making that decision, true democracy doesn’t work in business any more than it works in running a city, state or nation. As I advise clients, I’m a strong proponent of the “strong leader” form of governance. Whether that leader is grandfathered in or elected every year or two is an issue that turns on the culture of the specific group. If elections are the culture, that’s where democracy comes into play: representative democracy.

Leaders must be empowered to lead. Not all of their decisions will be good ones, so they must be free to fail as well as to succeed. Requiring a group vote or establishing a board consisting of all of the shareholders guts leadership and replaces it with its poor relation, consensus, which by nature suffers from the defects of peer pressure and compromise.

Lead, follow or get out of the way. Or, as the English author G.K. Chesterton poetically put it, “I’ve searched all the parks in all the cities and found no statues of committees.”

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss


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