Unfortunately it frequently is. Capitalism and the profit motive go together like peanut butter and salami. At least they do at present, no offense to those whose epicurean preferences take you in that direction. Whoever thought bacon bits would go well in a chocolate bar? Apparently, not that well as it was just a trend that faded. You likely have to look in pork-centered stores to find it now. What I mean is Capitalism, as it is practiced, is often a repugnant business when it comes to human and environmental rights. The invisible hand, see Adam Smith and “The Wealth of Nations”, has taken on a new identity as we exploit our natural resources and in doing so compromise our futures.
Many of us have worked in places that have great Mission Statements. Here is typical sample:“We are committed to providing the highest standard of care, education, and research to all our patients/employees. We will deliver excellent care through all our interactions with patients. We will support education, fiscal responsibility, and adapt to changing environments.” Then there are the usual statements of values that include: excellence in everything we do, integrity, compassion, respect for the dignity of every person, and embracing diversity. This particular “blurb” is similar to many you see at medical facilities. The question is, are the actions of the institutions congruent with their words? The answer is…not so much. What was that first question I was asked in my trips to the Emergency Room/Urgent Care? Oh yes, I remember…do you have insurance? That certainly sets the tone. It would have been nice if someone had said “you look terrible, let me help you find a seat and find out what is going on with you.” By the way the “what religion are you” came in second at some hospitals. Jeez, do I really look that bad.
Even the most inspiring mission can become subverted when it becomes focused on profit instead of the people being served. And remember we are all a part of the biosphere that is rapidly deteriorating due to our activities. There is a bigger picture to consider. Administrators are often looking at the end of the month spreadsheet with the singular question being: are we in the red or in the black? It is a difficult position for an administrator to be in and this diffuses throughout the institution to the employees who are often overburdened with too many patients. Who can pay a bit more for Seventh Generation products when on the edge of bankruptcy? It is easy to fall into groupthink and lose sight of the forest for the trees. How’s that for linking it to environmental concerns! We have to view any workplace as a system and we often only see the picture through the lens of our own professional training.
The research on increases in patient mortality when nurses have too many patients is terrifying. I, and I certainly hope my insurance company, are not paying for me to be put at greater risk of death because the hospital had to cut back on its staff. But that is the reality that we have created. Multitasking is overrated and when fatigue sets in even more errors occur. This type of fear and stress does not help my recovery from whatever illness I may have. Employees need time to rest physically, mentally, and emotionally. Putting something in the Employee Manual about “making sure you take your break as self-care is important” is offensive if it is not genuine. It presents a double bind that ensures even greater stress if it is nothing more than a CYA move by management. You are not going to be able to take that break if you have patients to care for especially if you have too many of them.
I had the opportunity to work in mental health and chemical dependency treatment for a long time. I experienced audits, when a team comes in unannounced to determine if your clinic gets to keep its operating license, as a direct service provider and a Program Director. Audits are stressful when things are going well but if there is a budget shortfall on the state or federal level the stress is amplified. If the team comes in with the instructions to cut costs you are in for a long few days. How anyone in authority could permit this to devolve into an adversarial situation is puzzling and certainly incongruent with the Agency Mission. One of my adventures was in a rural setting where providing services was expensive. We simply did not have a big enough population to run enough daily groups to bring in the fees that many clinics did. The audit team had a habit of asking questions like “how many units of service” do you do monthly and why were your “units of service” down for January (because of bad weather, it happens annually, they were very aware this). Every time they did so I would reframe UOS to how many people we treated for the myriad of issues they came in with. I would use client names, this is all confidential as the auditors were part of our “umbrella”, and attempt to personalize the people we served as much as possible. I wanted auditors to understand our clients were people too, suffering, and in need of care. I wanted to awaken empathy and compassion in them.
So what am I getting at today? I am touching on numerous issues including patient rights, employee rights, and human rights in general and that includes environmental rights. I am questioning the manner in which we treat each other and what motivates each of us. And I am challenging myself and each of us to consider embracing a broader view in our daily interactions with each other and the entire world in which we live. Can we perhaps consider that people and the planet come before profits? Can we structure our individual ethical systems and our political and economic systems to reflect the reality that we are indeed interdependent? I will leave you with the following insights to consider:
“Injustice anywhere is a threat to justice everywhere. Through our scientific and technological genius, we have made of this world a neighborhood and yet we have not had the ethical commitment to make of it a brotherhood. But somehow, and in some way, we have got to do this. We must learn to live together as brothers or we will perish together as fools. We are tied together in a single garment of destiny, caught in an inescapable network of mutuality. And whatever affects one directly, affects all indirectly. For some strange reason I can never be what I ought to be, until you are what you ought to be. And you can never be what you ought to be until I am what I ought to be.
-Martin Luther King Jr.