By Alessandra Suuberg, Decency LLC
This past Valentine’s Day, I was sold a damaged box of chocolates.
It was a matter of a classic heart-shaped box within sturdy external cardboard packaging, which itself had noticeable crush-and-tear damage on the left side. I cannot be sure that staff noticed, though the purchase was quickly bagged after being produced from behind the counter, and I was prompted to take care and hold the bag a certain way.
If staff were aware, then, ironically, the un-damaged paper shopping bag used to hide the “crime” proved the box was not damaged after purchase.
Unexpectedly, it also made something click with respect to our work at Decency.
In 2022, I started this company with a goal of examining areas for improvement in the healthcare system. Having worked in healthcare and health law roles for six years prior, I had a sense that both professionals and patients had complaints about the system that were chronically unaddressed.
My goal with Decency was to gather those observations systematically and identify opportunities for change, having greater freedom to do so from the outside.
An early trend to emerge from this work was the corrupting potential of money in medicine. Often, it seems that where a need for change is identified but no action is taken, a paycheck is at stake, or the status quo is lucrative for one or more stakeholders.
My experience with the chocolate box brought another trend into focus: A human tendency to shift responsibility when problems arise.
In other words, if a professional notices or suspects that they made a mistake, or encounters a problem, they might find ways to create reasonable doubt about its cause, in some cases shifting a sense of responsibility onto a colleague, the customer, or the patient.
This tendency is not limited to healthcare roles. In the retail context, it might mean hiding a damaged product in a bag and letting the customer wonder if they caused the damage on the way home. Readers may be able to reflect on other examples from daily life.
In healthcare especially, though, there are strong incentives to shift, or deflect, responsibility. In areas such as mandatory reporting of child maltreatment, professionals can face fines or jail time for their mistakes. Medical malpractice suits are also a looming threat for American doctors; one recent analysis from the American Medical Association noted that around 1 in 3 U.S. physicians had been sued in the past. In addition, drugmakers frequently face litigation over medication side effects, where verdicts can reach millions or billions of dollars.
But if we identify fault-shifting as a recurring problem in healthcare, what is the solution?
We could look for role models among the colleagues who show a strong sense of accountability in business or patient care.
What drives them?
For some, faith may be instilling a sense that every deed is recorded. Maybe others are atheists, but their families or mentors taught kindness and fairness. Others might simply respect the rule of law or social contract, or draw lessons from moments in history when those broke down.
But not everyone is necessarily constrained by a strong internal moral compass.
With all of this in mind, how might we find ways—e.g., through the design of laws or institutional policies—to make accountability less costly and fault-shifting more costly?
At the very least, my hope is that someone might read this piece and consider, at some time in the coming weeks or months, whether they are about to shift responsibility unjustly. If so, maybe they can ask themselves why, and whether there is, in turn, an unjust external pressure forcing their hand. Maybe they can consider whether a better solution might be devised.
In any event, I am thankful to the anonymous chocolate-box retailer for bringing this trend into focus.
Disclaimer: The information and opinions on this site do not include legal advice or the advice of a licensed healthcare provider.