Friday, March 6, 2015

IGR-2015: Australia on-course to become the Cheap White Trash of Asia

Amanda Vanstone succinctly summarised the LNP worldview being pushed by Hockey's IGR.
 “The Rich aren’t to blame for being Rich, It’s Policy" (stupid)
Abbott/Hockey could balance the budget, increase Productivity, deflate housing prices and improve the 40-yr outlook with a low-cost, high-impact Policy: Reduce Tax Expenditures, the Treasury keeps tabs.

  • $45B/yr is spent of Capital Gains exemptions on main residence. The USA doesn't do this, why do we?
  • $30B/yr is spent on Superannuation tax discounts: the majority going to the top 10%. Equity suggests a cap.
  • $5-6B/yr now goes on Negative Gearing. If you earn a Salary, you're not in Business, don't ask for business deductions.
Compare to $6.4B/yr for GST on Food and $3.9B/yr for GST on Education.
Which is fairer: $80B taxes lost for most wealthy or $10B for everyone?

There are massive structural problems with the Australian economy that aren’t mentioned in Hockey’s IGR, nor being raised by the ALP.
Anyone under 40 has to be deeply concerned for their financial future as a result.

According to the Government:
The Intergenerational Report is the social compact between the generations – with our children, grandchildren, parents, grandparents and each other.
Yet there is no mention of Housing, Housing Affordability, Rental or Mortgage Stress, First Home Buyer rates, or even Household Disposable Income.

The Hockey IGR is the biggest con-job is Australian Political History. The average working Australian is being shafted so badly, they can’t imagine the outcomes. It’s the Great Australian Dream, not Workchoices or Co-payments, that is “dead, buried and cremated”.

Thursday, February 21, 2013

Do Professional Societies care about the Public or only their Members?

Yesterday I was horrified when I made a phone call to CPA Australia asking if a) someone had been a member and b) if they'd ever been the subject to Disciplinary action or complaint, especially around 2004.

The answer given I found shocking:
That information is Private, it's part of the "Member Record". You have to get their permission to release that information. [In response to question on 'serial offenders' and 'irregularities' in Association accounts well over $1M.] This is our Policy. If you want to pursue this, you can write to our Legal Department who probably won't respond to you.
Compare that to Aviation, not just Pilots...
Not only do they have the best Quality and Safety systems of any Industry and Profession, they take it as a given that Open and Transparent Governance, including professional discipline matters, is fully public.

Sunshine is the best antiseptic for corruption, negligence and incompetence.

Today I wrote to a TV current-affairs program with:
If you thought Dr Death of Bundaberg and the Butcher of Bega weren't bad enough, what do other Professional Societies do that's different?
Members First, stuff the public!
Unlike Aviation, they are there to keep the Sins of their Members secret.
2 stories: IT Recruiters and Accountants (CPA)
IT Recruiting (ITCRA).
If you complain about a recruiter, whatever they decide about the compliant is a secret. Probably the same with general recruiting [the GM of ITCRA used to work for that Association. Commented they got many, many more complaints.]

My Story:

CPA Australia:
What happens when you ask if a CPA has ever been disciplined?
Even if you think they're part of a 20yr conspiracy, potentially a swindle, worth $1-2MM...
The Association Investigation: NSW Assoc Y0133609.

NOTE: the Association is NOT the subject of this commentary on Professional bad behaviour and are known for being litigious. I will not name them and ask others to maintain this confidentiality although the registered name appears on the official documents and their Journal referenced. [I do have the technology to black-out the information in PDF's.]

RL was the Public Officer Y0133609 from  21 July 1997 to 10 December 2009 according to the official Association Extract.  He was also Treasurer, though the period is uncertain as the historical Committee Register of Y0133609 is not available on-line.

These Association returns, fully public, were procured from the NSW Associations Register and contain the name and address of the Public Officer, RL, at Heysen Close, Pymble:

Y0133609 1996 Return.pdf

What's NOT in the forms that four years returns (1996-1999) were submitted on the one day, triggering at least two penalty clauses of the 1984 Act:
  • s54(1)(f) - Forced winding up on failure to lodge returns for 3 financial years
  • s27 - Lodge statements within 1 month of AGM.
The accounts, in my opinion, violate s26(6) in that they don't give a "True and Fair view" of the financial affairs of Y0133609. If I'd been at the AGM those accounts were presented, I and everybody I've known in a Professional Association, would've rejected those accounts.

RL gave a Business Hours number on the Public 1996-1999 returns, identifying his then employer:  "CCS Partners" in the City. CCS used to be Calligeros, Cassim & Simos.

CCS confirmed RL once worked there but would provide no other details, not even if he'd been a member of CPA Australia or the Institute of Charted Accountants.

There is a current White Pages listing for RL at 3 Ellendale Rd, Kenthurst NSW 2156.

The gross irregularities in Y0133609 accounts that I wanted to follow-up with CPA Australia is $1.25MM missing from the 1996-1999 Accounts attested to as correct by this upstanding, presumably registered, Accountant.

A large bequest was left to Y0133609 by Stanley Whaley of Queensland, except that it never appears in the Association accounts. The money was transferred to a Trust which under s26(6)(d) they were obliged to report as well, but never did.

Images of relevant Journal pages publicly declaring the Bequest and its movement to a Trust:

Y0133609 Journal 1995 #2 pg3
Y0133609 Journal 1995 #2 pp 5 & 6
Y0133609 Journal 1996 #4 pp 63-64

Full-text PDF on-line:

But the matter doesn't end there...

The Public Officer is seen under the Act as having special responsibilities, they are the official representative and where notices for the Association will be served by the Registrar. Under s23 of the Act the Committee has just 14 days to advise of a change of Public Officer and the new address to serve notices. It appears RL left Y0133609 5 or 6 years before the Registrar was notified.

RL is in the Journal of Y0133609 at the end of 2003, but never heard from again after that. He is still listed as being on the committee at the end of 2004 and there's no mention of him in mid-2005. After being a major "mover and shaker" within the Association, he's suddenly gone without trace.
Y0133609 Committee Nov 2004
Y0133609 Committee, Jun 2005
Y0133609 Journal 2003 #4

Yet he was still listed as Public Officer until 2009 when the Registrar took the highly unusual step of involuntarily cancelling the registration of Y0133609 for failing to lodge mandatory annual returns for 10 years.

After that little lapse of not filing returns for 4 years in 1996-1999, RL had never filed another one!
The official Association Extract shows Y0133609 didn't file a return in 2000-2003 nor any official documents until 07-May-2010.
After a period of almost a year, when accounts and returns for 2003-2009 were filed together, very strangely the Registrar, under s54A(2), reinstated Y0133609's registration as if nothing had ever happened. No penalties were levied, at least not according to the list of official documents available. Y0133609 were allowed to continue trading while formally deregistered, which makes me wonder "Why bother with the Act and registration at all?". I find this strange...

But this is about RL and his behaviour as a Professional Accountant.

Why were no accounts or returns filed by Y0133609 for the 4 years, 2000-2003?

The reason isn't on public record, but can't be related to a "7 year statute of limitations", nor to 5 years.

What we do know is that RL stopped writing in Y0133609's Journal in 2004.

What we see with the non-lodgement of the accounts is consistent with RL doing a massive Dummy Spit in early 2004 and withdrawing completely from Y0133609 and, we can guess, in a fit of temper deleting all records and files relating to them from his personal and work computers. If he'd felt this way, he also would not have felt a responsibility to inform the Registry of the Public Officer vacancy either. [Under the new Act of 2009, this is now an offence, with a penalty, for the Public Officer, but not then.]

As an Accountant acting as their Treasurer and responsible for filing BAS statements [noted in the Journal], he would've been handling the bookkeeping on a computer. Recreating that work from paper records would've been deemed too hard by both the incoming Treasurer and later by the Registrar.

I've been involved with a number of small Professional Associations and sometimes, in spite of the requirements under the Act, volunteers move on and records, especially 'the books' are lost forever.

It gets better yet, still.

In late 1999, the past-president of the "Victorian Branch", after years of confronting the Committee of Y0133609 and RL (still Treasurer), wrote about the events and misbehaviour in detail.

RL's actions were deliberate and intentional hiding this large bequest entirely from the Regulators and the Committee either went along with it or were involved.

The Victorian tried to publish his detailed account of the goings on at Y0133609 in the Journal of another well known and respected Society, but that editor withdrew the piece after threats of a defamation action.

Y0133609 was known for being litigious and for using Mr Whalley's money to back court cases. In its 1996 Report on Activities (the only one produced publicly), ~$180,000 was given to an individual for a failed lawsuit they'd followed closely, even reporting daily on. (The case was rumoured to have cost north of $500,000). This case, heard and appealed in the Federal Court, produced some much cited Case Law for the Trade Practices Act. The academic who took the action, a Professor, sold up and moved to Adelaide to pay his legal debts.

So, when there is strong Public Interest involved, why don't "Professional" Bodies automatically provide full public disclosure of complaints and disciplinary action?

Why are major and "serial offenders" in Law, Medicine and Accounting not publicly named and shamed to protect hapless victims that these people are known to prey upon but whom the Profession is sworn to serve?? How can these "Professional" Bodies, through deliberate action of suppressing information, not be held accountable for subsequent civil or criminal offences? How can they not have Public Interest as their first Duty of Care?

"Full Disclosure" is proven to work in all aspects of Aviation, so why do these other "professions" insist on still putting the interests of themselves and members ahead of the Public whom they supposedly serve?

My only conclusion, a personal opinion based on the evidence I can find, is:
That like RL, they are rorting the public and they know it...

Tuesday, August 21, 2012

The Professional Mandate Pt2: Continuous Improvement, No Regession

Previously, I've defined the central aspect of the Professional Mandate as:
Its "unprofessional" to repeat, or allow, Known Faults, Failures and Errors.
Which is the Deming/Shewart Quality Improvement Cycle: PDCA (Plan-Do-Review-Improve System, also Plan-Do-Change-Act).

All Quality, Safety and Performance Improvement programs share must contain these 4 elements and have a central element in common:
Conscious, deliberate learning and adaption.
Improvement is not accidental: If you don't design it in, why would you expect it to show up?

There is another, personal, factor underlying Quality and Professional Improvement:
Caring comes first.
Which is not quite a restatement of "Professionals owe a Fiduciary Duty to their Clients". Caring is an unforced, voluntary internal state, Duty is an an imposed external obligation. Good Professionals not only have to perform well, they want to.

More specifically, Professionals must both Care about the Client Outcomes they produce and how well they do job they do. Good Professionals aim, every day for every task, to produce their best performance and provide Perfect Client Outcomes.

Perfect Client Outcomes are NOT "Perfectionism" nor unrealistic and unachievable. It's not about a Perfect Performance, execution without flaw, impossible by definition for Real People ("To Err is Human") but about the Client Outcome:

  • Perfect for the Client may be getting any help whatsoever.
  • Perfect for the Client may be getting "Good Enough" service in a timely manner.
  • Perfect for the Client may be resolving an issue within a time-frame.
  • Some some Clients, Perfect is As Cheap as Possible or Really Close and Accessible,
  • whilst the PT Barnum rules also applies: You can please some of the People some of the time, but not all of the People, all of the time.
    • For some Clients, no outcome will ever be deemed by them to be Perfect.
The execution of a Professional Service may contain Errors, in fact you'd expect (small) Errors every time, but the System and Process creating the Client Outcome need to be tailored to noticing them before they can affect the Outcome and in preventing consequential effects.

It's OK to make an error, so long as its corrected before it has an impact or creates damage. Trying too hard to Be Perfect degrades the Performance and Execution - we are not machines... This is the "secret sauce" known by Elite Sports Coaches:
Perfect is the enemy of Great, Perfectionism doesn't lead to Best.
Expanding notions introduced in Part 1:

  • Professionals must refuse directions and work demands that result in unsafe Practice, endangering clients or the public.
  • Doing The Right Thing must never penalised.
  • There are two sides to improvement: 
    • What not to do,
    • What to do.

Extending the rubric to include "and practice What Works (ie. proven)".

But there are two sides to this:

  • Adopting new Practices when proven superior,
  • Extinguishing old Practices when shown inferior.
There are research papers that conclude that for some "high standard" Professions:
  • It takes 15 years for proven new Practices to be adopted by even 50% of Practitioners, and
  • and 40+ years for old, inferior or disproven Practices to be phased out. Universally? not sure.
This work dovetails with the 1961 book, Science Since Babylon by Derek De Solla Price where he estimates the doubling period of Human Knowledge as shown by Journals and publications at 15 years and ties it in to the working lifetime of Scientists to arrive at his famous observation:
80-90% of all Scientists who have ever lived are alive today
The same 3 doubling periods of the average worklife also explains the time to give up old, inferior practices.

more to follow.

Monday, August 20, 2012

Professions/Professionals: Conflicts of Interest

Consistent Altruism is a rare human commodity, probably impossible over a life-time, yet that's the standard implied by: Learned Professions owe a Fiduciary Trust to their clients.
That's All Clients, All the time.

It's simply stated and tested: Are Client Interests always placed before the Practitioner and Organisations? Yet its impossible without sustained, conscious, deliberate and co-ordinated effort by the whole Profession.

As a client or user of Professions, that's a reasonable standard for them to be held to.
As a Practitioner, Professional Organisation or Profession, it's a profound and never-ending challenge.

The overwhelming human behaviour is self-interest: often expressing as greed or avarice, but also in other "temptations", including sex, power and influence.
People may start with good intents, even living up to their ideals for a long time, but as Hollywood amply demonstrates, the road to hell is paved with good intentions.

Most people exhibit Altruism some of the time and often only towards related groups. How can that be leveraged to impeccable Professional Standards? It's not just a hard problem, but a diabolical one.

It's impossible for ordinary people to keep others interests before your own for an entire career, in the face of all direct temptations and, more importantly, preventing gradual, imperceptible declines especially in the face of "but everyone is doing it".

This is exactly what got the USA from a well regulated banking system in 1999 following the repeal of the 1933 Glass–Steagall Act, to a record financial collapse in well under 10 years.

All Professions have to address this central issue: How to monitor and deal with Conflicts of Interests.

The Iron-Cald Law of Quality applies: You cannot check your own work.

Which means ever Profession that needs to meet a Fiduciary Duty has to design, implement, staff and fund third party checking, investigation and monitoring systems (i.e. Governance and Audit), create Licensing, Compliance and Regulatory Bodies with real teeth and constantly train and check its Practitioners and Professional Organisations against those standards of Knowledge, Performance and Practice.

I'd argue that this Governance and Compliance function is more important for "Fiduciary Duty" Professions than Competency Testing and Licensing:
Without an absolute trust of Clients for the Profession's Services, it is fatally compromised and incapable of delivering good, let alone Adequate or Best Practice Services. If the Public won't come to you and don't trust you, it undermines your Mission/Purpose, devalues the Profession and pushes the Public to find substitutes.
In "mid standard" Professions two factors operate that limit the excesses increasingly found in Professions such as Banking, Finance, Financial Advice and Financial Audit which led to the record collapses of 2007/2008 requiring Public Bailouts:
  • By definition, only "high standard" Professions owe a Fiduciary Duty to their clients, the rest only owe "normal commercial and contractual responsibilities.
    • Consumer Protection bodies and legislation (ACCC and TPA/ACC in Australia) offer common law remedies (protections) to consumers against unscrupulous practitioners and organisations.
    • The Consumer Protection bodies actively monitor the business world (practitioners and organisations) for illegal or 'sharp' behaviour.
    • Cartels and price-fixing is illegal and is aggressively pursued by the ACCC.
  • There is seldom, in "mid standard" Professions, a Natural Monopoly of Practitioners, Professional Organisations or Professional groupings/Associations.
    • There are commonly large numbers of "best quality" practitioners and organisations for consumers to choose between:
      • The operation of a large Free Market prevents prices ratcheting up faster than inflation.
      • Market forces (Supply and Demand) act to regulate the number of Practitioners and Organisations offering the Service, including per location.
      • Sometimes there can be a "race to the bottom" caused by new entrants (e.g. Chinese Dental Laboratories) that undermine demand even for high-quality local practitioners.
    • Consumers often can find adequate Service Substitutes, either direct or within the Profession.
    • When the Service is only offered by a sole supplier, often the Public Service or a single Government Licensee, a Natural Monopoly and market competition cannot keep Service, Quality, Safety and Price in check.
      • Often in these situations, Audit and Governance ("Industry Watchdogs") organisations are formed in an attempt to restrain outrageous excesses.
So what's needed of Practitioners, Professional Organisations and Profession Groupings/Associations in "high standard" Professions?

The New Oxford Dictionary defines "Fiduciary" as:
involving trust, esp. with regard to the relationship between a trustee.
I use a more colloquial formulation:
Put the clients interests ahead of your own, every time, and in every way.
In Law, Business and Accounting, this problem is known as Agency Theory: How do you get an 'Agent', such as an employee, trustee or representative, to always put your Best Interests first, even to the detriment of theirs, either directly or through "Opportunity Loss" a.k.a. Insider Trading?

"High standard" Professions suffer multiple problems:
  • They are Natural Monopolies without good substitutes (think Law, Medicine and Public Service).
    • Where can the Public go if they don't like the Professions' Services? Nowhere...
    • The rich always have more options like privileged access to other countries and systems, which creates its own special Conflicts of Interest in both countries.
  • If they don't internally regulate, who can or will regulate them?
    • Nobody else can properly assess their performance, errors, omissions and over-servicing.
  • Because they are Natural Monopolies:
    • The Monopoly is usually explicitly granted by the State.
      • meaning there are Registration Boards and Licensing Examinations.
    • They are highly desirable as a choice of Work: well paid, "protected" jobs for life,
    • Numbers are tightly controlled,
    • There is intense competition for admission, often on criteria irrelevant to good Professional Practice, such as Academic prowess.
    • There is usually little effort in identifying desirable High Performer Professional characteristics and less effort or attention in selecting or evaluating against those criteria.
    • All emphasis is placed on The Barrier to Entry, gaining a License, close to none is spent on ensuring All Licences are of Equal Value (a 1910 notion of Flexner's), which implies frequent full competency checking, against all current Knowledge and Best Practices, to retain a license.
  • The traditional Learned Professions are backed by an extensive heritage of Common Law and Statues that create especial problems:
    • They usually embody, explicitly or tacitly, a No Harm or No Fault clause:
      • Medical Doctors, even unqualified frauds, are generally regarded as not ever having criminal intent to harm patients.
      • This unfolded in Australia with the "Dr Death" of Bundaberg case. Whilst strict Academic-quality Evidence indicted him with causing many deaths and huge numbers of injuries, the legal system requires direct causal Evidence, reducing the criminal charges to "harming" a very few patients and a 5- or 7-year sentence. For any "mid standard" professional acting this way, they would've been found guilty of multiple counts of murder and received a probable life sentence.
      • The 2011 sentencing of the "Butcher of Bega" underlines the on-going nature of this problem and jurisdictional inconsistencies.
  • If the Profession in a country systemically fails to regulate itself against Conflicts of Interest, particularly Financial, then you end up with the US Healthcare system:
    • 18% of GDP is spent on US Healthcare, versus 9% of GDP in Australia.
      • In 1960, the US spent 5% of ts GDP on Healthcare, almost a quarter current levels.
      • But Australians have universal Medical care access, out-live and have better health outcomes that US citizens, except for "Rescue Care", where the USA beats everyone.
    • Arnold Relman and Marcia Angell, editors from 1977-2000 of the New England Journal of Medicine, have run a very long campaign against Medical Profession "Conflicts of Interest", starting in 1980 with Relman's, "The New Medical Industrial Complex".
      • Despite unequivocal data and many high-powered, highly influential internal voices/activists, the US steadily increases the proportion of its whole economy spent on Healthcare and the proportion of uninsured people who are uninsured continues to climb.
      • Perhaps in-line with the increasing disparity between the Rich (top 1%) and the bottom 30-50%.
My observations on "high standard" Professions achieving near a uniform, on-going delivery of Fiduciary Duty to Clients are:

  • It's a war without end, every new generation has to discover their own solutions to the constantly evolving challenges. The Internet Changes Everything, including how Professions now experience Conflicts of Interest and the methods to address them.
  • Perfection in managing Conflicts of Interest, like Quality, Security and Safety, is a journey, not a destination.
    • If a Profession's Monitoring and Reporting systems are detecting nothing, they have failed.
    • Human Nature hasn't changed in the 400 years since Shakespeare, it's not changing soon.
    • The US "Medical Industrial Complex" that Relman and Angell have spoken against for 30 years versus the inexorable rise in Healthcare costs is definitive proof that without strong external intervention (from Politicians, pushed by the general public) a whole Profession can be wilfully blind to serious Conflicts of Interest.
      • Without specific Agencies with real teeth, nothing changes.
      • Simple, unequivocal definitions and tests are needed for the Qualitative Tests.
      • Absolute and rarely changed quantitative measures are needed to convert Qualitative goals to measurable, reliable data.
  • The NTSB/FAA example of separate, well-funded Investigation and Compliance, Licensing and Testing organisation staffed by selected dual-experts: they have to be both amongst the most Competent and Knowledgeable Practitioners and expert in Governance, Quality and Safety.
    • These organisations and their staff also take care to constantly monitor, test and train themselves, with periodic "refreshes", or systemic re-examination and redesign.
  • Initial Practitioner Selection and Testing and then through on-going Training, Testing and ReCertification regimes are necessary to even start to achieve high, uniform standards of "Fiduciary Duty" amongst Practitioners and Professional Organisations, along with Competency, Knowledge and Practices.
    • Initial Practitioner Selecting and Training needs to be targeted at selecting for High Performance Practitioner Traits and Characteristics.
    • Which implies they must be first researched, documented then kept current.
    • And explicitly not to default to mere Academic Prowess as the sole entrance test.
  • Fully public, Open and Transparent reporting of all Professional issues, Conflict of Interest and Practice of Individuals and Organisations is a minimum requirement.
    • Without full data, the Profession internally cannot know "how it is travelling" and be able to take corrective actions as necessary.
    • Without full public access, nepotism, cronyism and lax standards are inevitable and unavoidable. "We discipline our own, in private" is the hallmark of a Failed Profession.
      • It also invariably leads to a pernicious and pervasive Inversion of Loyalty and Duty: Professionals swap their perceived Duty to Clients to a Duty to Protect the Profession at the expense of the Public they serve.
      • This attitude of "We look after our own" is an absolute corruption of a Profession.  
    • Professions with strong Duty and Safety Cultures and full disclosure don't need expensive and embarrassing Royal Commissions or Courts of Inquiry: they are doing the job of ensuring Good, Competent Practice and reinforcing the Culture each and every day.
  • Structural elements have to be in place to prevent putting people in the way of temptation or compromise:
    • Laws and Regulations allocating Blame and Liability to individual Practitioners for Ordinary Accidents and Failures must be replaced with Indemnifying Individuals within Organisations, provided they have acted properly and followed all relevant processes and procedures.
      • Practitioners who exhibit unprofessional behaviours, should be stripped of all Professional protections and indemnities and be subject to stiffer Criminal charges and Penalties than the general public.
      • Failing in your Professional and Fiduciary Duty is not an extenuating circumstance, it calls for harsher treatment. Those taking more Responsibility must be held to higher standards.
      • Any Practitioner who self-reports Errors early on should be indemnified from censure for that event, though not for unprofessional action, such as repeating Known Errors, Faults and Failures.
      • Any Practitioner who fails to self-report or report anothers' Error should be metered out harsh penalties. The Professional Mandate requires everyone involved to "own up" to their mistakes - and to make sure everyone else does as well. "No Error goes unreported, ever."
    • Professional Organisations, and their managers, must be Criminally and Civilly liable for malpractice and failures in their Fiduciary Duties.
      • In order to Indemnify individuals within Organisations who act properly and professionally, legal liability and Onus of Responsibility have to transfer somewhere.
      • There also have to be powerful incentives for non-Practitioner Managers and Administrators to uphold the Professions' Fiduciary Duties, Competence, Knowledge and Practice standards and adherence to Quality and Performance Improvement.

Saturday, August 11, 2012

The Professional Mandate: Don't repeat Known Mistakes, yours or anyone else's.

My formulation of the Professional mandate:
It's "unprofessional" to repeat or allow, Known Faults, Failures and Errors.
That sounds complete, perhaps obvious, but let me unpack this some more...

What's "unprofessional"?

If you're a cleaner, mower mechanic or dish-washer, i.e. not someone held to the highest Professional standards, then it's probably "skiving off" or doing a dodgy or substandard job. It might get you reprimanded if detected and if its your normal mode of work, in most places it'll get you fired. But only if detected, and that's only going to happen in better run organisations that routinely check work.

If you're someone who holds other people's lives in their hands, especially in a Profession that owes a profound Duty of Care to them, like Aviation and Medicine, then you should be held to a much higher standard.

These are the usual types of "unprofessional" behaviour and generally not considered "criminal":
  • malfeasance: deliberate/wilful wrong doing/actions (in the discharge of public obligations)
  • misfeasance: wrong action (esp in the discharge of public obligations)
  • nonfeasance: didn't do what needed to be done (esp in the discharge of public obligations).
  • negligence: didn't pay enough attention or care to the execution of the task, inexpert or incomplete action.
  • incompetence: can't do the job, use the tools or know the process properly or incorrect action(s).
  • indolence: lazy, idle, a "failure to perform".
But we know there are more types of "unprofessional" behaviour:
  • failing to act in a timely manner, i.e. tardiness,
  • "wrong inaction" when action was necessary,
  • rushing to act without sufficient information, or on an incorrect and unquestioned judgement,
  • acting when "inaction" or waiting was necessary,
  • deliberate harm through acts committed or withheld,
  • systematic harm to cohorts of people through deliberate, "wilful blindness" of not reviewing previous outcomes or not implementing known "Best Practice" or continuing with known "Bad Practices".
  • deliberate and systematic "gouging" - resolving "Conflicts of Interest" in favour of monetary outcomes for the Practitioner, against the interests of clients or the public.
  • over servicing, over charging and deliberate price gouging (selecting high priced alternatives over technically equivalent or superior lower priced ones).
  • ignoring or failing to deliver adequate service to individuals and large cohorts of the public for whom they should be responsible.
  • acting whilst intoxicated or drug-affected.
  • deliberately under-performing, not giving or doing your best in all circumstances, including "phoning it in" or "just going through the motions".
Which leads to two questions:
  • In this, the Internet Age, can a Profession even call itself a "Profession" if it doesn't detect all deliberate or unintended errors of commission or omission and impose Professional Penalties on organisations and managers responsible for allowing preventable harm, injury or death to those for whom they were responsible, as they unequivocally fail the "Professional mandate"?
    • Individuals who've are appropriately trained and with current certification, correctly follow organisational guidelines, checklists and processes and attempt to deliver their best Professional performances, or at least self-report Errors, Faults and Failures or omissions, should be protected from legal liability. Professionals need to be explicitly protected from being made "the fall guy" for Organisational or System Errors or managerial malpractice. Doing your job well, to the best of your ability/competence, should never be cause for censure or penalty.
    • Organisations have a Duty of Care to the General Public, Community and the State to ensure the Professionals under their direction are properly selected, adequately trained, including on-going testing/training cycles, are properly informed of the latest/current Organisation Standards, Processes and Procedures and all Professional Performance properly and adequately checked and corrected and if necessary, individuals reassigned, stood aside or removed.
    • If you are a Private Professional Practitioner, you undertake to competently and adequately provide, and perform to, both the Organisational and Individual Professional Standards, being personally liable at both levels. In most current fields, with Knowledge and Skills/Processes/Tools/Equipment doubling every 3-5 years, not within the Professional working lifetime as it once was, this is now beyond even the most competent and able Professionals.
      • I believe Registration and Certification Boards should be acting to prevent Sole Professional Practitioners from getting in over their heads in this way. 
  • What should now constitute Criminal Action or Criminal Negligence by Professionals and their managers/organisations when they deliberately, or with "wilful blindness" or disregard, continue with, or allow harmful Professional behaviour?
    • In Corporations Law, individuals and boards are deemed liable "if they knew or should have know". Ignorance is not a defence, in fact, failing to be informed is in itself an offence.
      • Is there any reason Professionals directly responsible for Human Life should be held to a lesser standard than Corporate managers and boards?
    • What should constitute Evidence of such Criminal Action or Negligence when it can be clearly demonstrated statistically there were adverse outcomes for multiple clients, though individual attribution of harm, injury, death or wrongful act may not possible.
      • Statistics, and their use in the Analysis and Review of Professional Performance of individuals and groups, are well established and universally accepted, with appropriate "Confidence Intervals", as the highest level of Evidence in Research and Scientific investigations.
      • Why should these same tools and results not be acceptable Civil and Criminal Evidence? What counts as indisputable Scientific Evidence should be acceptable in a modern Court of Law.
      • Judges and members of the public empanelled on juries can, and should, be knowledgable in, or able to be tutored in, these concepts, tools and their interpretation and subtleties.
And a bigger question:
Are "high standard" Professionals liable for Errors and Injuries directly attributable to poor management decisions or yielding to "management pressure" to perform unsafely or continually at unsustainably high levels of 'commitment', either excessive hours, excessive supervisory load or "above my pay-grade work", i.e. substantially above their Professional level of competence?
I argue that Dr Brent James' notion of "Professionals owe a Fiduciary Trust to their clients" (and in return are given the right to Professional Self-Determination) applies. Managers, especially if current or once practicing Professionals, should not, either knowingly or not, put those they direct in these invidious position, in effect putting them in a "Conflict of Interest" situation: chose between your employment or career and the safety of those clients or the public for whom you are responsible.

It's not Good Practice, let alone acceptable Professional behaviour, to ever work a continuous 40-hour shift or 100+ hours/week when you may endanger others' lives.
Personally, I consider knowingly working whilst impaired in any way (alcohol, drugs or fatigue/exhaustion), isn't just Professional malpractice, but Criminal, especially if a repeated, even normal, action.

The Nuremberg Defence, "I was just following orders", is as unacceptable and specious, especially for high-standard Professionals, now as it was 6 decades ago. Professionals are solely responsible for their actions and must be held to account for them, in the same way that Managers can't transfer their Responsibility and Accountability to the Professionals that they direct.

Which creates another addendum to The Professional Mandate:
It's unprofessional to accept, or allow, tasks and responsibilities beyond your, or others, competence level or act whilst notionally or practically impaired, incapacitated or impacted by external factors. If you can't competently and adequately do the job before you, you should not be doing it. If others put you in the position where you feel you cannot decline a job/task/role outside you ability/competence, you are obliged to report both your own action and the situation, before, during or as soon as practicable after the event.
Specifically, I reject the widespread notion or "meme" for mangers deliberately demanding unprofessional conduct:
"You're a Professional, you have to 'do whatever it takes'" -  especially to fulfil roles, responsibilities or deadlines/commitments that you yourself did not commit to, but were imposed externally on you.
Any Professional who makes an explicit, not tacit, undertaking to deliver a Professional outcome should reasonably expect to be held to that Promise. Attempting to flip Accountability and Responsibility from Management to Professionals is a variation of this "Blame Assignment" technique and should result in personal liability for those attempting to assign blame.
The resulting Corollary is:
Professionals don't just have an implicit Right, but a Professional Duty, to refuse directions, including work rostering, that may, or will, result in unsafe Practice or a failure in their Professional Duty to clients or the public.
Or more simply: Professionals reserve the right to say "NO!", and make it stick, to unreasonable or unsafe management direction and be protected against reprisals, harassment or recriminations for such action.

Doing The Right Thing must be rewarded, never penalised.

Elsewhere, I've attempted to layout the context of Professional Behaviour within Professions. It isn't just about not doing the wrong thing, but also doing the right thing.

How a "professional" gets to know "What Works and What Doesn't" is another beyond this, "the Professional Mandate".

A relevant extract:

Barry Boehm neatly summaries the importance of the Historical Perspective as:
Santayana's half-truth: “Those who cannot remember the past are condemned to repeat it”

Don’t remember failures?
  • Likely to repeat them
Don’t remember successes?
  • Not likely to repeat them
The critical insight here is that there are two sides to improvement:
  • What not to do,
  • What to do.
So my rubric must be extended to include something like "and practice What Works (ie. proven)".

Thursday, August 9, 2012

Message to ISM/FoSiM: this is what Real contributions to the Healthcare Reform debate look like.

[Post moved to other blog.]

Atul Gawande's piece in the New Yorker on "Big Medicine: Can Hospital Chains Improve the Medical Industry?" is a tour de force on the issues, benchmarks, solutions and challenges facing us in the current Healthcare Reform debate.

At 9,500 words, while it was a riveting read for me, it may be a tad long for many people.

Even if you only read a page or two, you'll be well rewarded.

This is the work of an insightful, competent and engaged (Medical) Professional who is actively looking to mend the US Medical system and has taken considerable time and effort to construct a readable and informed piece to bring the issues, challenges of Real World change to Healthcare to the general public and even posits some solution.

Generally, I was impressed that Gawande didn't invoke Aviation as his Gold Standard, but used people and places the general public know and visit everyday and indeed, many will have worked for, and the majority will personally know someone who works in them.

He quietly and unobtrusively lets us know that he's done a bunch of real journalistic research to write this piece, pounding the pavements, spending hours or days with people in their workplace and asking tough questions.

 This was a carefully planned, researched and executed piece, possibly months in the making. It would've taken a few weeks to edit down and polish into this relaxed, chatty style.

He ends with:
The critical question is how soon that sort of quality and cost control
will be available to patients everywhere across the country.
We’ve let health-care systems provide us with the equivalent of
greasy-spoon fare at four-star prices, and the results have been ruinous.
The Cheesecake Factory model represents our best prospect for change.
Some will see danger in this.
Many will see hope.
And that’s probably the way it should be.
It's not a rant or tirade, it can't be mistaken for "personal attack" nor does it need a naive disclaimer like FoSiM's ("If you misunderstand what we've written, that's your problem, not ours.")

To Dwyer and his little Friends in FoSim, this is what a real contribution to the healthcare Reform debate by a competent Professional/Journalist looks like.

Compare and Contrast to the vapid, vitriolic and self-righeous outpouring of Ms Marron, your unpaid "CEO".

It'd be unkind to say that she remains unpaid because nobody with money would pay for her efforts, though it may be accurate.
Fanaticism and Zealotry in a cause, as demonstrated by FoSiM, don't make for persuasive journalism.

ISM/FoSiM: "Inversion" - Putting the Cart before the Horse in Healthcare Reform

[Post moved to other blog.]

One of the amazing arrogances and Blindspots of the fanatics and zealots of ISM and their "mini-me", FoSiM, is they've got the Healthcare Reform debate turned around completely. Colloquially, they've put the cart before the horse.

It's not hard to spot that the "vision statements" of both ISM and FoSiM aren't backed by any Evidence, any Theory but only Absolutist Assertion: it shows from the start that this is only Ideological based, not based in fact or need, nor indeed arrived at by any valid, credible process.

The "Inversion" of ISM/FoSiM is who they put at the centre of their Healthcare Reform proposal in their call for more "Science in Medicine", ignoring their one-eyed bias where they never examine the Practice or Science of their own, Medical Care.

What's completely missing is The Patient.

This is the Inversion. It's Practitioner- and Profession-centric, not Patient-centric.

This is the Big Lie, the massive horn-swoggle that ISM/FoSiM are attempting to pull off:
The Patient, their Outcomes, the Quality of their Care and their Safety under Medical Care is completely absent. And most importantly, Patient Accessibility and Affordability are missing.
The ISM/FoSiM advocacy for more "Science in Medicine", even taken at face value, is a clear call for:
Better Healthcare!
More "Science" won't deliver Better Medical Care, it can only deliver more expensive, less accessible and less effective care, and further stress already over-worked and failing individuals and organisations.

"More Science" does involve more money for research, more expensive devices, drugs, equipment and services and, for the very few that can afford it, much more expensive interventions ("Rescue Care") for extreme conditions. It's a Bonanza for everyone making money out of the process, the Companies, Practitioners and Researchers, and a FAIL for everyone else: the Patients, the Healthcare workers and the Governments funding it.

How can "More Science" equate to "Better Healthcare"?
Not in the Real World and not at all for Ordinary People who'll be paying for it... 
This is a scheme dreamed up by the privileged, for the privileged, of the the privileged:
ISM/FoSiM are Medical-Political Lobby groups aimed directly and solely at attracting More Money to themselves using the ruse of Better Healthcare through More Science.
The ISM/FoSiM pitch:
Better Healthcare is all about us, not the patient, it's More Expensive, More Profitable Business for us, everyone else is irrelevant!

If you'd like to know what Better Healthcare looks like, here's the definitive guide, with actual research references:
"Managing Clinical Processes: Doing Good by Doing Well" by Dr Brent James.