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Unaccountable – Why We Should Care

There’s been an interesting conversation in the ‘halls’ of academia regarding the book Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care by Marty Makary, MD (Bloomsbury Publishing) and its significance in teaching early careerist in graduate school. I would like to share with you comments that John Griffith of the University of Michigan made in his recent posting on the Association of University Professors in Health Administration Open Forum site. Griffith provides this short synopsis of the book: “Unaccountable is a combination of anecdotes and rhetoric that details the catastrophic failures that occur in modern surgery. Many of the anecdotes come from Harvard, Hopkins, Georgetown, and other famous places. He uses them to make some conclusions:

  • ‘Hospitals have merged…into giant corporations with little accountability, and they like it that way.’
  • It is hospital administrators’ fault.
  • It is the payment system.
  • If we just make a few changes, we can do better.
  • Mayo, Cleveland Clinic, and Geisinger know how to do it right.”

Griffith  goes on to ask, “Why should we care?” as it would be easy for the field to dismiss this book. He provides the following reasons:

  1. “First do no harm”, from Hippocrates to today, is a moral foundation for all of us in healthcare.
  2. There’s plenty of data to show that the underlying problems are real. They occur daily. They cost lives and substantial dollars.
  3. A growing number of professional managers know how to improve performance on these problems, as well as other important ones, like financial soundness and chronic disease management.

The book enumerates a number of leadership challenges through anecdotal cases that can be easily used in the classroom or leadership programs to raise awareness, to challenge the status quo, and to teach culture change and leadership skills. We’d like to hear what you think of Markey’s book. And, to Griffith’s question, “Why should we care?”

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