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?
Nothing...
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)

Links

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:
http://stevej-on-it.blogspot.com/2012/12/recruiting-fail-non-response-of-itcra.html
http://stevej-on-it.blogspot.com/2012/09/recruiting-fail-part-3-itcra-complaint.html
http://stevej-on-it.blogspot.com/2012/09/recruiting-fail-how-to-foul-up-employee.html

CPA Australia:
What happens when you ask if a CPA has ever been disciplined?
 ITS A SECRET...
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

Y0133609 1999 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.
http://www.ccspartners.com.au/Home

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:

Y0133609 Journal 1995 #2

Y0133609 Journal 1996 #4

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...

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

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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

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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.

FoSiM: Motivations of Founders and Members. It doesn't add up...

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The more I've researched the field of Medicine and Healthcare Reform, the more I've come to wonder:

Just why did Dwyer and his Famous Five setup the ISM "mini-me", Friends of Science in Medicine (FoSiM) in the first place?

and

Why have over 500 practicing and former Medical Practitioners and Researchers publicly identified as supporters of FoSiM?

The usual rubric is "Follow the Money!".

But from what FoSiM tell the world, there's no (real) money involved.

The problem is, I find that either an altruist, hobby/amateur or volunteer organisation just doesn't make sense in one of the largest, most important sectors of the economy, with the most powerful/aggressive vested interests (think Big Pharma) of any Industry including Tobacco, with so many powerful Political and Industry Lobby Groups already extant it makes your head spin and with the decades of research, published material and competing proposals from many sources, each highly funded and staffed with Academic, Practitioner and Maths/Stats experts.

The "Science in Medicine" movement is Ideological not rational, not theory-based, only values based. Insisting that their one model is all that can be and they'll just keep changing the goal-posts so all non-Medical Healthcare is deemed wrong and hence they'd like it to be illegal.

The very process they tout, "Follow the Scientific Method" and "Show me the Evidence", they do not apply to themselves nor their Reform Agenda. There is a huge body of Evidence and prior work out there on what the real problems are with Healthcare and what the implementable solutions to them are: none of that work calls for "More Science".

The fact that FoSiM do not reference the established Field of Healthcare Reform, nor cite the Evidence, screams "This is an Ideological Jihad/Crusade against the Non-Believers, they shall be brought to heel or we will die trying". Anything but "Scientific" or "Evidence Based", which is wonderfully ironic...

The Retired folk - yes, it's a way to spend time and energy, to be involved, to still be relevant, perhaps even to make a difference. I can image Dwyer has a lot of pent-up frustration, regret and resentment resulting from feeling impotent to act against people, well intentioned and not, who attempted to treat his early HIV patients with "non science".

So I 'get' the four Academics: they believe they have are Right and want to change the world in their image.

I 'get' those who practice or research in Medicine: they know their field of practice and can't envision any alternative approaches.

For those still working, it may even be useful in advancing their career, even securing project funding.

But Marron, a non-medical, non-Academic in retirement, what's driving her?

More importantly, what does she get out of this gig, both personally and professionally?

So if she's spending her own time and money, what does she get back in return, especially as she's retired, this 'work' can only only be done For Personal Interest.

This is Psychology 101: Humans need Motivation to continue engaging in an activity.

I can't figure Marron's motivation - it isn't anything Professional nor about helping Individuals, which leaves Internal emotional-defiicit drivers, as far as I can see.

ISM/FoSiM: The irrelevance of more "Science" in Healthcare Reform

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ISM (Institute of Science in Medicine) and their Australian "mini-me", FoSiM (Friends of Science in Medicine), are advocating a rather extreme version of Healthcare reform:

Medicalisation of all Healthcare, under the guise of advancing "Science in Medicine".

These extreme views are published in an ISM Policy paper on the Licensing of non-Medical Healthcare practitioners. They advocate changing world-wide statues/regulation to only allow "science-based" Healthcare (code for Only Medical Care) and finish with:

Unscientific practices in health care should further be targets of aggressive prosecution by regulatory authorities. [italics added]

They don't just want to wind the clock back to The Grand Old Days of the Fifties, but a whole Century. The authority they cite is the 1910 Carnegie Foundation report on Medical Education by Flexner.

Flexner tossed around a bunch of concepts, many more than the State Regulation of Medicine and Medical Schools on which ISM/FoSiM base their calls for increased Healthcare Regulation, a.k.a. "Science in Medicine", as the definitive solution to all the ills of all Healthcare Systems in the world.

In the second half of this piece, Flexner's original thesis and concepts are examined - and not wholly surprisingly they support the opposite position of ISM/FoSiM.

Firstly, What do the world's best experts in Healthcare Reform identify as the local and/or common challenges to Healthcare?

And, How do the proposals of ISM/FoSiM address these Medical Millennium Challenges?

Dr James is also quoted in a forum organised by his University, PANEL ON HEALTH CARE REFORM – FALL 2008, Continuum, Utah University.

This is what he has to say on the Challenges facing Healthcare around the world:

JAMES: Another point is that we’re getting exactly what we pay for. We tend to pay for procedures and rescue care, so we get lots of procedures and lots of rescue care. This is a key factor.

Another thing you need to know is that other countries have exactly the same problems. So don’t look for solutions in Europe. Don’t look for solutions in Canada.

I get a ton of those guys coming through visiting to see how care’s delivered in Utah, believe it or not, because they face exactly the same problems.

There’s a standard working list of the top five problems within health care, and nobody’s solved them.

Travel the world and it’s the same list of five things:

1. The first problem is variation in care on a geographic basis.
It’s so high that it’s impossible that all Americans are getting good care, even with full access.

2. The second biggest problem is high rates of care directly judged to be inappropriate.
This is where the medical risk treatment outweighed any potential benefit to the patient and we did it anyway . . . usually in a rescue setting.

3. The third problem is unacceptable rates of care-associated injury and death.
This is where the care delivered actively killed somebody, whose death was judged to be preventable upon review.

4. The fourth problem is that the system does it right only 55 percent of the time.
There are things that we know for a fact should be done every time but the system does right only 55 percent of the time.
Now, that’s better than zero, but it’s not nearly 95 percent or 98 percent, where it ought to be.

5. And the last one is that there’s at least 50 percent waste in the system.
This is non- value-adding from a patient’s perspective, and that’s where the opportunity exists.

Conclusion:

From the hard-data evidence presented by Dr James based on more than 3 decades of successful Healthcare Reform, we know:

• The ISM/FoSiM proposals address the least important, least useful areas of change. 

• Addressing Lifestyle Issues and Environment/Public Health would have six times the impact of attempting to improve "Health Care Delivery" through more "Science".  

• Even then, ISM/FoSiM are either vague or silent on just what benefits their proposals, if adopted, can deliver. If they want to turn Healthcare around the world inside out, with considerable disruption, cost and upheaval, then they need to first inform us of the exact benefits we can expect.

• The ISM/FoSiM proposals are irrelevant to the common "Top 5" Challenges faced by Healthcare Systems around the world: None benefit from more "Science", they are all about Quality of Care and Effectiveness of Delivery and Implementation.

• All successful and effective Healthcare Reform, since and including Flexner, has been Patient-centric. The ISM/FoSiM proposals aren't just wrong, but exactly the opposite of what is documented to have worked. Practitioner- and Profession-centric reforms, such as "More Science in Medicine" do not deliver better outcomes for Patients.

ISM/FoSiM consistently demand high-quality Evidence and rigorous Science from those in its sights, yet fail to apply the Scientific Method and their Rules of Evidence to their own proposals and assertions.

To be consistent and credible, ISM/FoSiM must:

• Meet the same standards of "Evidence", Research and adherence to the Scientific Method as they demand of others.
• Demonstrate and Quantify how more "Science" will improve Quality of Care, Patient Safety, Equity of Access and Systemic Waste and Cost-Effectiveness issues identified as "Top 5" Healthcare Reform Challenges by the leading experts in the field.
• First define their own "Top 5" Healthcare Challenges, and
• provide research backed by verifiable, hard-data on the Efficacy of their own proposals, their own favourite criticism of non-Medical Healthcare.

If ISM/FoSiM criticise the Effectiveness of non-Medical Healthcare, we must in turn ask them to demonstrate the Effectiveness of their own proposals. If they set Rules and Standards for others, they need to follow them themselves, even better, demonstrate by superior example.

---

The Flexner report doesn't just say "Regulation and Licensing is necessary" as ISM/FoSiM seems to think, it also says many things still relevant today:

• it asks for common standards and basic clinical education with laboratory practice,
• suggests the 'Best Practices' as used by the Europeans,
• says that Medicine is a Performance Discipline [my words] - that Theory and Practice/Experience together are needed by competent Professionals ("Head and Hands"),
• that Medicine is not primarily a commercial enterprise, but has a very large "Public Service" component, with a Duty of Care not just to individuals treated, but the larger Community,
• and explicitly recognises "all medical sects", and they be based on good clinical education.

It also contains an implicit commentary that demands:

• As part of good Professional conduct, the systematic elimination of Known Errors, Faults and Failures, ("To Err is Human", but repeating preventable mistakes is malpractice of the highest order) and
• From the Flexner principle of "licenses bear a uniform value":
• Continuing certification retesting of all license holders, not a lifetime grant of license.
• the adoption of practices that have been demonstrated to have value in assuring Professional competence and skills/knowledge currency at every point in time for all license holders. From Aviation, we know these techniques work:
• Frequent (2 monthly) "Check Pilot" assessment of the in-situ performance of every Practitioner,
• Simulator checks of "worst-case" situations. (Quarterly)

Why would we expect Medicine to have lower Quality and Practitioner Certification standards and processes than other fields? Heatlhcare should be the leader in Practice Efficacy, Quality, Safety and Cost-Effectiveness.

In conclusion, Flexner talks of Duties, Ethics and the need of the Medical Profession to guard against the corrupting effects of commerce. Exactly the same "Conflict of Interest" message that Arnold Relman and Marcia Angell started writing about in the New England Journal of Medicine in 1980.

Like the army, the police, or the social worker, the medical profession is supported for a benign, not a selfish, for a protective, not an exploiting, purpose.
The knell of the exploiting doctor has been sounded, just as the day of the freebooter and the soldier of fortune has passed away.

It's fitting to end with a quote from Arnold Relman ("A Drumbeat on Profit Takers"):

“It’s clear that if we go on practicing medicine the way we are now, we’re headed for disaster.”

If the things the best and brightest minds in the world of Medical Science are writing, researching and talking about, and have been doing so for 3 decades, are completely different to what ISM/FoSiM started advocating in 2009, then who should we give credence to?

My vote goes to the existing experts who can provide hard-data to back their stories, not mere puffery, exaggeration and "spin" as offered by ISM/FoSiM.

FoSiM: The local "mini-me" of Institute of Science in Medicine: Same Bull, different faces.

[Post moved to other blog.]

Dr Harriet Hall and her 26 "Founding Fellows" created the "Institute of Science in Medicine" [ISM] in mid-2009 as a "501(c)(3) organization for US federal tax purposes" registered in Colorado.

It self-describes as:

ISM is a non-profit educational organization dedicated to promoting high standards of science in all areas of medicine and public health.

and in PDF files includes:

Institute for Science in Medicine, Inc. (ISM) is an international, educational and public-policy institute, incorporated in the State of Colorado, and recognized as a 501(c)(3) organization for US federal tax purposes.

The local Australian variant, "Friends of Science in Medicine" [FoSiM] self-describes as:

 Our Association was formed at the end of 2011 out of concern about the increasing number of dubious interventions, not supported by credible scientific evidence, now on offer to Australians.

• Dr Hall appears in the first list of "Friends", January 2012.
• The "mini-me" relationship extends further with their DNS names:
• Dr Hall's group has the obvious website name:
• www.scienceinmedicine.org
• Where the local "mini-me" has a website name unrelated to it registered name, "Friends of Science in Medicine", but exactly congruent with being the local arm of ISM.
• www.scienceinmedicine.org.au 
• There is a test/development site at:
• www.loretta.fosim.org

Why does this matter?
If you read the first policy document of ISM [PDF] as a Declaration of Intent, it finishes with some very worrying 'Recommendations':

NEEDED POLICY

The world’s health care systems need to be rooted in a single, science-based standard of care for all practitioners.

Effective, reliable care can only be delivered by qualified professionals who practice within a consistent framework of scientific knowledge and standards.

Practitioners whose diagnoses, diagnostic methods, and therapies have no plausible basis in the scientific model of medicine should not be licensed by any government, nor should they be allowed to practice under any other regulatory scheme.

Any statute permitting such practices should be amended or repealed as necessary to achieve this policy.

Unscientific practices in health care should further be targets of aggressive prosecution by regulatory authorities.

 This unambiguous Declaration of Intent gives the ISM, and it's mini-me, FoSiM, a specific Agenda:

1. It is an explicit recognition that this is a Political not Academic or Scientific 'debate'. In no way are either of these bodies "Educational" or "about Science". They are only Political Lobby groups, yet aren't registered as such.
2. ISM/FoSiM want nothing less than making the practice of "Alternative" Medicines illegal ["change of statues"] and practitioners subject to "aggressive prosecution".
3. Who will judge what has, and has not, a "plausible basis in the scientific model of medicine"?
   • They don't define either "Science" or it antithesis, "Pseudo-Science", i.e. on the formal, strict basis for this rather extreme decision.
   • There seems to be no idea of Professions being able to defend themselves on any other grounds but an undefined "scientific model" and seemingly without means of Appeal or cause for Redress.
4. What isn't spelled out here, but is noted on the FoSiM site, is the assumed Dawkins Appropriation: anything ISM and their "mini-me"s decide is "Medicine" is automatically included in their Field of Practice. Which, by definition, makes that practice or technique now illegal for any other Profession to practice.

Given the extreme published position of ISM and the close alignment of ISM and its "mini-me", FoSiM, comments like this from Australian apologists strike me as ignorant, uninformed or disingenuous in the extreme:

Having an organisation like FSM to kick-start a public debate about the value of science in healthcare is invaluable. 

So to the extent that FSM can get the media and the general public thinking about how much they might value science as opposed to pseudoscience in their healthcare it can only be a good thing. That’s why I stopped sitting on the sidelines of the debate and signed up when I found out about them.

No, this is not a "debate", this is not something of little concern, an effort of well-intentioned, altruistic experts. It is anything but that.

ISM and their clones want any type of Healthcare they declare "not science" to be illegal, and practitioners "aggressively pursued". Once started, this is a very slippery slope.

Ultimately, internal Politics reliant on funding and 'connections' will determine what treatments are allowed and which will be deemed "unscientific".

The world of Medical Politics is already riven with such extreme dysfunction and violent internecine warfare that few outsiders understand how bad it is.

This campaign by ISM is hard-core Political Lobbying by the dominant Healthcare Profession for exclusive control of the domain.

They seem to not be happy with having captured over 99% of the Healthcare Dollar and now want everything, presumably in anticipation of making a grab for a much larger slice of our income.

After all, you wouldn't want to die from poor Medical care, would you?

Your money and your life: What the AMA and Friends of Science in Medicine won't tell you.

[Post moved to other blog.]

This piece in Business Spectator has a bunch of 'interesting' facts that both Friends of Science in Medicine and the Medical Industry body, the AMA, ignore.

Why is this??

I'd have thought it was in the Medical Profession's interest to run their operations as efficiently as possible in order to maximise their result and the benefit to individuals and to the community. That is, if that's what their Prime Mission is.

As Don Berwick formulated in 1996 with his Central Law of Improvement:

Every system is perfectly designed to achieve the results it achieves.

So, if Medical Healthcare and Hospitals aren't run efficiently and 'accidentally' kill far too many people, Why is this so?

Just what is the current system designed to achieve, if its not Patient Safety, Quality of Care or Efficient, Effective use of Public Monies?

A superficial, simplistic analysis can't tell us...
But we do know that incumbents must benefit from the system: How?

Failed Professions: Definition, Impact, Consequences

I'd like to assert that (Australian) Medicine, Banking and Finance & Investment Advisors and Information Technology (I.T.) are Failed Professions.

The fields of Management and Politics, whilst notable for their egregious actions and errors and not just failing expectations of good governance, but actively harming or exploiting the general public, are not Professions: they fail the basic tests of "Body of Knowledge" and "Entrance Requirements".

What do I mean by a "Failed Profession"?
How do I support that view?

An answer: Why not an NTSB for Healthcare? II

[Post moved to other blog.]

Continuing this topic: In the seminal Institute of Medicine (IOM) report, "An NTSB for Healthcare", a central question is posed:

Not Why an NTSB for Healthcare ... Why Not?

Medical Healthcare is often compared to Aviation on Quality of Care and Patient Safety, but the comparison is wrong and ineffectual: the story is poor and we're not yet ready to hear the message.

We, as travellers, wouldn't step onto any airplane if Safety and Quality were as variable and haphazard as Medical Healthcare in Hospitals, Primary Care Physicians, Specialists and other facilities.

So why, as individuals and a society, do we accept, seemingly without comment, 1000-fold worse Safety from Medical Healthcare than Aviation?

Medical Error, or "preventable harm", is the leading single cause of death in US Hospitals and seems to be heading in the wrong direction. Which, because Medical Healthcare is a universal, not optional, service, should be causing concern and outrage, instead it goes unremarked and unnoticed in the Media and hence with the General Public.

The more subtle cause is: Preventable Deaths and Serious Injury from Medical Error as not centrally collated and reported.
Even the more complex story, the decline in Medical Quality of Care and Patient Safety, cannot be told because there are no data.

Should then Media report the statistics?
No, as even Stalin knew: A Single Death is a Tragedy; a Million Deaths is a Statistic.

We are our own worst enemies as a society, when we need to address endemic problems:

• Without "something out of the ordinary", stories have no "news value".
• We suffer boredom and "compassion fatigue" from long running stories, no matter how terrible.
• Statistics are not personal, there is no emotional connection, hence little "news value".
• Nobody is forcing Medical Healthcare to report and categorise 100% of Medical Errors. This removes the possibility of even a larger, investigative story.

What the estimable brothers Heath, authors of "Made to Stick", don't make much of is a zeroth requirement:

There is nothing more powerful than an idea whose time has come, and
there is nothing less interesting than idea before its time.

The efforts being made to report and address the epidemic of Medical Healthcare Error are earnest, "real", well-crafted and creative. In another time they'd succeed, wildly.

The Public, and hence Politicians and legislators/regulators, are not yet ready to hear this message.
Perhaps we'll hit a tipping point when Healthcare either becomes generally unaffordable or 30% of people are directly affected by serious Medical Harm.

Until then, I hope those fighting this Good Fight can keep their spirits up and continue in the face of disinterest.

An answer: Why not an NTSB for Healthcare?

[Post moved to other blog.]

In the seminal  Institute of Medicine (IOM) report, "An NTSB for Healthcare", a central question is posed:

Not Why an NTSB for Healthcare ... Why Not?

We believe that the question regarding an NTSB for healthcare is not why...but why not!

The Safety Leaders site has more great material than you can believe - its carefully selected, well structured and crafted; and finely targeted to various interest groups. It doesn't rely on assertion and dogma, but forceful and compelling hard-evidence from Healthcare and other high risk fields.

In response to "Why not an NTSB for Healthcare", answers come from Change Management with insight form Human Behaviour and Organisational Dynamics.

The primary answer is:

• What's in it for me?
• What's the upside of doing this, of changing how I work?

and the concomitant:

• Are there consequences for not doing this?
• What's the downside of ignoring or not doing this, or continuing "Business as Usual"?

Without changing the rewards and penalty structure, there not only won't will be, there can not be any systemic change.
"There is no reason we can't do that in Healthcare"

The first answer to the most of the "Why not" questions, the practitioner, manager and Board answer is simple:

• Why not? Because we don't have to.

A more insidious, subtle and ultimately deciding, not even pivotal, factor to consider is:

What are the blocks, active and passive, to change?

Reframing this question:

• Who has the most to win or lose from maintaining the current Status Quo?
• Who are the gatekeepers, individual, organisational and political, that can either enforce the current Status Quo, or prevent/limit change?

To stop rewarding behaviours and practices that are dysfunctional or not supportive of Societal goals and to start rewarding those things that fix the system, that address known problems. The O'bama administration has attempted to change the Healthcare system, but with extreme opposition from 'conservative' interests. It is unclear that anything will be accomplished from this initiative.

To underline this point, consider the insights in, and impact of, the seminal article by IHI CEO, Don Berwick, over 15 years ago:

Berwick D. A primer on leading the improvement of systems. BMJ 1996;

Good systems are designed deliberately to produce high quality work.
By eliminating waste, delay and the need to redo substandard work, they achieve long-term cost effectiveness." 

The Central Law of Improvement: every system is perfectly designed to achieve the results it achieves

What has changed since 1996? Was there a revolution?

Quality Improvement is still an outlier activity. Medical Healthcare continues to kill and maim more people each year without seemingly garnering attention or comment. The "Doctor as God" Medical Culture continues unabated and new entrants are sill inculcated into it.

But the worst thing of all, the cost of Medical Healthcare, in absolute and relative terms, continues to rise unchecked.

The AMA is the primary gatekeeper to Medical Healthcare in the USA: it has the resources and ability to block any and all changes. At some point, there will be a showdown: the current Status Quo versus Change and Improvement.

There is another important difference between Aviation and Healthcare than must be addressed before there can be any systemic changes in the US Medical Healthcare system:

There are very few personal consequences of "poor performance" or "failures" for Doctors.

As a community, there has to be consensus support and a willingness to hold all Medical Professionals to the basic Professional standard:

• There is never an reason for a Professional to repeat, or allow, Known Errors, Faults and Failures.

Until the community embraces this as a minimum standard, nothing can change.

While this happens, all the incumbents that profit from maintaing the Status Quo will remain as active, vocal and trenchant Roadblocks to Change.

The path to "an NTSB for Healthcare" lies through Politics and a broad social demand for change, not empty promises and window dressing.

A Theory of Professions

Here I attempt to lay out a Theory of Professions that can be used to guide and inform practitioners, Professional Bodies, Regulators, Governments and the general Public.

The original contribution here is an attempt to layout a framework to categorise Professions by their Duty to Others and suggest that these duties apply at multiple levels: Practitioners, Organisations, Whole Profession.

Describing Professions in this way makes discourse easier and more focussed, allows reasonable expectations to be set and may inform Policy makers and Regulators when judging if Professions or their parts are succeeding or failing.

Good Democracy needs Strong Media: What impact the Fairfax sackings?

Yesterday, Fairfax Media, the publishers of some of the oldest, most respected newspapers in Australia announced it would radically downsize and move its prime business on-line. More video, Lateline and a detailed timeline.

"The Fourth Estate" is a fundamental to strong Democracy - in Economics terms, it (notionally) provides "full/perfect information" for the Market. It's how the Public become informed of Things That Matter.

I posit that the "Golden Age" of Democracy of the 20th Century co-incided with a strong newspaper, newsreel and later "electronic media" culture:

• there is strong public demand for "information" coupled with a willingness to pay.
• "Fresh" news and stories are a competitive advantage: News 'Scoops' made money.
• Strong competition amongst providers for "fresh news" funded a lot of technology, a lot of research and stimulus to "look under every rock".
• Under this pressure, the News Cycle shrank from weeks, to days, to hours and minutes. Twitter with its 'news cycle of seconds' may be the end-game.

Media companies had a sound Business Model for around 100 years because they filled a fundamental human need: curiosity and concern.
They had worked out a great way to place a tax on that, far better than just paying for 'a' paper: advertising.

But is this Value Proposition of "Fresh News" dissolving in the New Media?

Newspapers used to be "News", i.e. the facts of {Who, What, Where, When, How and if known, Why}, not "Opinion" - the stuff that I'm writing.

After the Vietnam War, TV took over the immediate delivery of "News", as in "What's New(s)?".

Newspaper couldn't 'break' fresh stories because TV would always beat them with the 6PM or 10Pm bulletins, unless stories were non-obvious and required unusual research.

Newspapers found new niches with Opinion, Analysis and Entertainment and Informing (vs 'News' of delivering new facts).

Woodward and Bernstein's "Watergate" investigation happened precisely because:

• Post Vietnam, TV had taken over as "where Fresh Stories break" forcing the paper to "dig deeper" for stories,
• the Washington Post had the resources and editorial judgement and nerve to fund the research and publish the results "without fear or favour",
• "sources" respected the paper and its journalists enough to speak, with an implied contract that they'd be treated fairly and respectfully and their identity would be protected if needed, and
• the public trusted the facts were real, correct and checked, and trusted that any fraud, confabulation or misrepresentation would be outed and all those responsible would "suffer consequences".

The Washington Post had an owner that was interested and engaged, and would back their Editors and Journalists. The people on the coal-face trusted they would be defended if they told the truth and acted in Good Faith.

What evolved with News reporting was a delivery pipeline with well-known "rendezvous points", Trust, Respect, and "Reputation" that took decades to build and a moment to destroy, and diversity with competition.

Who kept the Media Honest? Their competitors!

Who prevented complacency, sloppiness and indolence? Their competitors!

And the Media, "the Fourth Estate", with its insatiable appetite for News and Fact, kept those in positions of power and trust, Politicians and Business leaders, accountable.

For a hundred years, the public could (mostly) trust what the papers said and trust them to hold those in power accountable on their behalf.

Without a vibrant, competitive and highly professional News Reporting disciple, this half of the democratic system dissolves...

In a Democracy, the citizenry has a duty to care, to actively maintain their Rights and hold those in positions of power to account. We're not going to see riots in the streets over this, it seems like an inevitable, and minor, business failure or restructure.

But what can and will replace a strong, free Press?

The Internet does Change Everything, but where's the business model that will fund good News Reporting? None has yet to emerge, and after ~15 years of "The InterWebs", if it was going to appear, it should be apparent.

On Being a Professional: 3 Axions. Right Reasons, Attitude, Aptitude.

I've stated for a time my rubric of Professional Practice as a rhetorical question:

When it is ever acceptable for a Professional to repeat, or allow, a Known Fault, Failure or Error? [A: Never]

Some larger questions arise but won't be dealt with here, but they imply a meta-level, the "Profession":

• Define 'Known' (which needs a means of transmission), and
• What are, or should be, the Consequences of unprofessional conduct or performance?

Healthcare, Medicine and the Learned Professions (eg. Law) have a special (higher) onus of responsibility on them. In the scale of Professional Duty, they are the most stringent and demanding:

• Fiduciary Duty or Trust:
•  "involving trust, esp. with regard to the relationship between a trustee and a beneficiary" [Oxford American Writer's Thesaurus]
• Fair Go, Fair Treatment.
• No Rules, Buyer Beware.

I argue that the Fiduciary Duty implicit in the Practitioner/Patient contract and relationship is demonstrated in the Hippocratic Oath, "First, Do No Harm,..."

This is a very high standard.

I take it to mean that Practitioner always places the Patients' welfare and health above their own concerns and needs, and those of their employer, supervisors and Professional Bodies.

Internal to this, I assert that the more radical or extreme the effects or possible adverse outcomes of the treatment/procedure are on the patient, they higher the duty of care. A variation of "Your Life in Their Hands".

• A surgeon or Intensive Care Physician can trivially cause immediate death or terrible permanent injuries. They have the highest level of Fiduciary Duty towards their Patients.
• Whilst the maker of a prosthetic device needs to avoid transmission of diseases, the use of toxic elements and have the device work safely. There is still a Fiduciary Duty towards the Patient, but it is much closer to the "Fair Go, Fair Treatment" level.

I'm positing three axions of Professional Practitioners, especially those with a Fiduciary Duty to their clients:

• Clean Motivation of Entry into and Practice in the Discipline: not Money, not Status, not Power/Prestige/Influence.
• If a Clinician is practicing because of the money, not primarily for providing good Patient Outcomes, they will routinely fail in their Fiduciary Duty.
• This is counter to the best interests of the Patient.
• A focus on pecuniary rewards will not sustain a Professional for their full working life. Once immediate goals are satisfied, what then? More of the same, or Just Cruising, not Caring?
• Caring for others outcomes is the first requirement for Quality and Continuous Improvement.
• Those who espouse, or act out, "Care Factor Zero", will not and cannot provide good Quality practice. If they have a Fiduciary Duty to others, they should be relived of duty without delay.
• Continuous Active Learning and Improvement.
• This isn't the 20-hours/year of mandated CPD (Continuing Professional Development).
• It's an inherent self-monitoring, self-examination of process, procedures and outcomes leading to Improvement in Quality of Care and Process (efficiency and effectiveness) and Adaptation and Improvement of Practice.
• A trusting and safe environment, "The fundamental Clinical Requirement", for the patient to "open up" into a full, frank and unstinting clinical communication.
• As human beings, we have 90 seconds to make a first impression. Recovering from a poor or antagonistic first impression is possible, but lengthy and time-consuming.
• Within that time, any clinical professional has to establish a basis of communication with the patient where they can be fully open, honest and complete in the clinical dialogue.
• "Why didn't you tell me before/when I asked" is the calling card of failure in this fundamental clinical requirement.
• Patients are both fully informed experts and ignorant. They know absolutely the experience of their own bodies, but can not be Clinical experts, even if they are trained in the field. This contradiction requires the clinician to both respect, not discount or ignore, what the patient is telling them and to fully draw out the patient experience. The patient will not be aware of apparently trivial or obvious details that are critical for swift, correct diagnosis by the clinician.

Lastly, there's the matter of Talent.

Some people are gifted in a field and given the same degree of training and practice, outperform us "mere mortals" by many times. Some might say "orders of magnitude".

The proof is Elite Athletes and Professional Sports. Talent counts, not just perseverance, determination and desire. Professional teams pay massive amounts for their stars, not 'the pack'. In professional tennis and golf, it shows up in earnings, both tournaments and sponsorship. The notional performance differences between #1 and #100 are small (<1% or 0.01%), but earnings are different by powers of ten. Talent counts as much in the clinical setting as on the sports field - and the results are similarly different.

Professions don't do themselves favours by allowing those of limited Talent to practice.

It diminishes the field and fails the patients.

Ironically, through the Dunning-Kruger effect (tone-deaf performers self-assess as virtuosos), this can institutionalise perverse selection and assessment regimes:

   when the professors are tone-deaf, they reward those like themselves and remove all others.

Exemplified by the claim: "I'm the Best XXX in the South-West/North/Area/City/State/..."

It's an error of logic of the kind: "compared to what? by whom?"

Root cause of the GFC: systemic failure in fiduciary trust/duty

Watching a Lateline interview with a British politician last night on the British Leveson Inquiry into the behaviour of the Murdoch media, crystallised my thinking on the root cause of the GFC:

A systemic failure in both fiduciary duty in the global financial community and a concomitant failure in governance and oversight by the regulators, public service and politicians.

---

The New Oxford American Dictionary defines "Fiduciary" as:

involving trust, esp. with regard to the relationship between a trustee and a beneficiary

Princeton's Wordnet defines "Fiduciary Duty" as:

the legal duty of a fiduciary to act in the best interests of the beneficiary.

---

The critical piece for me in the Lateline interview was that the politicians driving one of the most important Inquiries in recent times let their personal fears override their duties as representatives of the Public:

... Rebekah Brooks [chief executive], who rejected our invitation [to give evidence] on three occasions ... but the committee then decided not to invite Rebekah Brooks, [seen as surprising] ... And I think it is very clear now that the individual fears that committee members felt led to them ... basically losing the will to do that.

The GFC did not arrive unheralded nor without the involvement of many actors through the whole investment "food-chain".

• The front-line sellers of retail "sub-prime" loans that lied, deceived and failed to disclose to victims what they were actually buying, especially A.R.M.'s (Automatically Resetting Mortgages: a low-rate "honeymoon" period (2-3%?) before repayments were increased to the underlying rate (12-15%?).
• The churning of these sub-prime loans as if they were prime-quality loans by Banks through the Mortgage Underwriting houses, Freddie Mac and Fannie May and those underwriters accepting high-risk loans as low-risk.
• The "repackaging" of sub-prime loans from the Mortgage Underwriters as CDO's (Collateralised Debt Obligations) without fully disclosing or properly insuring the embedded risk, instead using CDS's (Credit Default Swaps).
• The complete operational failure and dereliction of duty by all Ratings Agencies in declaring these packaged "toxic loans" in CDO's backed by CDS's to be the lowest risk asset possible, AAA-rating.
• The relentless, high-pressure wie-spread sales of these complex instruments to inappropriate and uninformed consumers, with extraordinary levels of deception, misleading statements and since documented, complete fabrication and wilful dissembling (lying).

But it could only have happened if there was not only widespread failure of agents Fiduciary Duty to investors, but also criminal behaviour.
There were a slew of interlocking system failures that were necessary to translate the "zero-cost" money being thrown around by the US Federal Reserve into systemic rorting (fraudulent gaming of the system) - and none of them was ethical, moral or legal.

The GFC was fuelled by an seemingly infinite pool of zero-cost money being used to "stimulate" the US economy after the "Dot Boom" became the "Dot Bust" circa 2000.

There were many schemes to take this money and convert it into "high return, safe vehicles".
The contradiction inherent, returns are the inverse of safety (higher rates of return compensate for higher risk), went unnoticed, unchallenged and generally uncommented, except towards the inevitable collapse.

Yet, despite, the massive consequences of the GFC, the "socialisation" of the crystallised losses, which for decades will haunt the mug punters, or average taxpayers paying for these bailouts through their governments, nothing has substantially changed. More importantly, almost nobody has gone to jail.

Many banks and financial institutions declared record profits (and hence record internal bonuses), the year after they were bailed-out by the very people they were again relentlessly gouging - the average taxpayer.

There is a fundamental inversion at work in the financial and managerial world that the regulators and legislators have been ignoring for the last 30-40 years:

• CEO's and fund-managers/investment advisors want all the upside of ownership, and none of the downside. They want a large fraction of any gains when the market goes up, and suffer nothing when it goes down. They can bankrupt a company an/or destroy all your investment, and still demand a bonus, let alone compensate the owners for their reckless, irresponsible behaviour.
• Institutional Investors, in the form of Banks, Insurance companies, Retirement Funds/Investment houses give their small, anonymous investors all the downside of ownership and little or none of the upside. Risk is transferred from the Institution to the Individual investors, while they retain all or most of the benefits when the markets improve. The small investor, often forced into compulsory investment, takes all the losses of the gambles and speculation by the Institution, whilst being charged a fixed percentage of their assets and a proportion of "excess gains".

This state of affairs is consistent with the causation of the GFC and stems from a very simple thing:

Politicians, and hence Regulators and Government Bureaucrats, confuse CEO's and Institutional Investors with Owners, when they are merely employees or agents.

How I can prove these assertions:

• The GFC was inevitable from the documents released or surfacing afterwards.
• CEO, 'senior management' and Board salaries have spiralled upwards at a compound rate of 30%pa since ~1975, without any comment, constraint or Inquires by Governments worldwide.
•  while real wages of employees have remained static or declined since ~1985, and
• "big business" especially continues it outrageous calls for "more flexible working arrangements" from those employees to "lower costs" and "increase productivity" when decades of decline in real wages show that none of the savings and improved profits are passed onto those long-sufferring employees.
• Institutional Investors and Governments still pass wide-scale losses onto the general public, who were not responsible for the decisions, had no control and no 'internal information'.
• The unemployment rate is most countries is (very) high, but those people out of work, receiving lower "benefits" and paying higher taxes are exactly not the people who created the GFC.

Then there are the many studies into "Mergers and Acquisitions" of large, publicly owned companies.
They all say the same thing, despite the very expensive and detailed "Due Diligence" processes, the vast majority of Mergers not only fail to create value, they destroy substantial amounts of owner value, which is ultimately the small, anonymous investors funding Institutional Investors.

A case in point from my field (I.T.):

Unisys (UIS): Formed from the 1986 merger of Burroughs and Sperry/Univac (numbers 2 and 3 in turnover and CapEx behind IBM), not only never became #1, but has declined four-fold in share value and declined from $10.5B revenue/year and 120,000 employees to $5Bn/year and 30,000 employees in 2010.

It was never going to be a good idea due to the radically different, and incompatible, corporate cultures and that there were no great synergies in their product lines, rather the reverse, they were direct competitors in most of their markets.

Yet the deal was struck and The Great New Giant Company was formed.
Within two years, the extent and scale of value destruction to both brands was obvious, and in a rational world would've been cause for a rapid demerger and unwinding of the still incomplete "integration".

Yet this didn't happen. The Board, the CEO and all the "management team" kept resolutely destroying the company. Now, decades on, it is a mere shell of its former self, and both brands struggle. Both organisations were successful, growing and sound before the merger. The market or "externalities" didn't change significantly at the time, rather the reverse, IBM grew its business very well for the next 5 years.

At the very least, the CEO and senior management team should've been placed "on notice" by the Board at the end of the first year when they comprehensively missed all their targets, and summarily sacked after the second year when the value destruction and failure to grow was incontrovertible.

Why didn't this happen, and why wasn't the Board sacked for a gross dereliction of duty? Institutional Investors are the majority shareholders and have a general policy of "we don't interfere". It's almost like they don't care about protecting their small, anonymous contributors from the downside...

Those who caused all this carnage at Unisys, the active destruction of shareholder value and the massive opportunity losses from both brands failing to keep growing, have never been held to account or suffered dire economic or civil penalties for their actions and inaction.

The resulting questions are:

• Who pursued and benefited from the Merger? Presumably the two Boards, CEO's and combined "senior management team". Those who stayed got bigger salaries and bonuses, those who left got their "golden parachutes" (outrageously generous severance packages unavailable to the rank-and-file workforce).
• Why was this massive market failure not investigated nor pursued by Regulators and Legislators? I guess because nobody that mattered complained. No Institutional Investor would complain ("we're uninvolved"), nor did they act on behalf of their plethora of small investors, rather handing them back a slightly smaller dividend without explanation.

It seems that Politicians, those we have elected to represent us against the more powerful, have become the captives of Big Business (CEO's and Boards) and servants of Media.

Unsolicited advice for the new Queensland Government

Last night in Queensland, the Liberal National Party (it could only happen in QLD), won in a landslide, led by Campbell "Can Do" Newman, son of Federal Politicians and with 13 years distinguished service as an Engineer in the Army.

One of the candidates I graduated with from school, 40 years ago has a very successful legal practice, I'm an underemployed I.T. consultant.

I sent him this unsolicited advice.
Not very original of me I know, but I hope it gives a useful insight to them.

---

First, from my profession of I.T.

 A piece of ~1,000wds on the cost to Govt. of essential infrastructure (IT) not fulfilling its promise (slanted more to CBR than QLD):
"The Triple Whammy - the true cost of I.T. Waste"

And a way out of the hole (600wds):
"Controlling Waste in Government I.T. - An Immodest Proposal"

Summary:

Create two bodies like Aviation has, ATSB/CAA. One to investigate, identify root-causes and write detailed recommendations for remediation, and another to implement and enforce those recommendations...

It means making the Audit Office do more than check for fraud/broken regulations and develop real, on-going expertise in essential disciplines, starting with I.T.

And establishing an Independent Authority with real teeth... One of the first actions has to be "start collecting performance and outcome data", like the 15yr old CHAOS report that reports on I.T. project outcomes in the USA.

If people and firms are assessed as incompetent or worse then, like in Aviation, the Govt has the right to de-licence them, only they aren't licenced. But they can be put on a public "not to be employed by Govt." register , which others will know if it is lawful currently or not.

Most importantly the "Authority" has to focus on Change and Improvement, not disciplining and "handing out consequences" (which is part of its remit) or it becomes counter-productive. (900 wds)
"The Accountability Paradox: Personal Consequences and Blame"

It comes down to a basic proposition:

Is it ever acceptable for a Professional to repeat, or allow, a Known Error, Fault or Failure?

I'd argue that a number of professions owe a Fiduciary Duty to their clients/patients and professional failures in this way should result in the most serious penalties.

In Aviation, not repeating mistakes is taken very seriously, but not in I.T. nor seemingly in the medical world.

In any Engineering profession, a professional who fails in this way, causing fatalities or allowing preventable economic failure, not only loses their license to practice, but is open to criminal, not just civil, charges.

---

Secondly, on Public Health and Hospitals.

Urgent reform is needed within Queensland Health, at many levels, but what's been tried over the last 20 years hasn't worked. A radical approach is needed, and one that is known to work.

This is not my area of Professional expertise and I wouldn't know where to start...

But I know who does and how to do it:

Adopt the Aviation model of Systemic Quality and Deliberate Change Implementation.

A recent article in the Journal of Patient Safety proposes exactly this:
"An NTSB for Healthcare, Learning from Innovation: Debate and Innovate or Capitulate",

What they don't say is that Systemic Quality (my term) isn't just free, but because it embraces active, intentional learning and improvement, it is better than free:

20% cheaper is well documented.

1. Dr Brent James of Intermountain Healthcare. You can read his 2001 ABC interview "Minimising Harm to Patients in Hospital" and his "its 20% cheaper" data.

2. Dr James' work is reflected in a major report by the US Institute of Medicine:
   "To Err is Human: Building A Safer Health System" (1999).

3. Donald Berwick and the "Institute for Healthcare Improvement".
    Here is a landmark article by Berwick from 1996:

"A primer on leading the improvement of systems"
BMJ VOLUME 312 9 MARCH 1996
Institute for Healthcare Improvement, Boston, MA 02215,USA
Donald M Berwick, president and Chief Executive Officer.

I'm sure you've read the 500 page QPHCI report and possibly Margaret Cunneen SC's "The Patel Case – Implications for the Medical Profession" (which as a layperson I found astounding).

The inherent problem with Commissions of Inquiry is that they cannot oversee or enforce the implementations of their recommendations. The responsibility gets handed back to Govt. which delegates the Change and Improvement process to the organisation that has the problems.

This fails a basic sanity test:

If the organisation could've changed itself, it would've.

Continuing systemic problems are not the result of lack of knowledge or insight.
Berwick formulates this problem exactly with:

every system is perfectly designed to achieve the results it achieves.

The Organisational Rules have to be changed to create more than cosmetic change because the incumbents have both an investment in keeping the status quo (its worked for them) and if they could've changed the system within the existing Rules, they would've.

Changing Organisational Rules, and making them stick, can only come from above.
This is exactly why Dr Demings' "Quality Circles" (and his teachings) worked in Japan and failed in their country of origin, the USA. Deming was hired by the heads of Japanese industry and they were able to mandate the changes.

Some things to kick off reform of QLD Health are:

• assess the degree of compliance with the QPHCI recommendations within 2 weeks.
• Any good bureaucratic will attempt to stall efforts like these for months or years. Think of the HSU Inquiry by Fair Work Australia as an outstanding example.

• look to new laws addressing Patel's deliberate action in harming patients.
• There is also a lesser offence of ' professional incompetence', proven by the statistical outcomes of a doctor. Individual victims cannot be identified, but that there are victims is proven by the stats.

Censorship in 300 words or less. What's up at Fairfax?

[Post moved to other blog.]

An article in the Fairfax media entitled "Homeopathy | Alternative Medicine | Ian Gawler" drew my attention. I went to the effort of registering and making a comment. It didn't appear, having been "moderated", presumably breaking the Fairfax Rules for Commenting on articles and blogs :-

... any comments that can be reasonably considered offensive, threatening or obscene will not be allowed.

• Do not post material that may incite violence or hatred.
• Gratuitous abuse - be it of the author, subjects of the story or other commentators - will not be accepted.
• Please keep your comments relevant to the discussion at hand.
• Do not use the comments section for commercial purposes or spam.

Herewith my comment and the original article... [See full post]

Australian Medicine as a Failed Profession. #1

[Full post moved to other blog.]

Australian Doctors practice medicine as if it was a cottage-industry craft supported by a 'Guild', not as a modern, accountable Profession practised for the Public Good.

Guilds limit new entrants, protect and control 'the secret craft knowledge' and vigorously defend their turf. A monopoly on the practice designed for restraint-of-trade, not the benefit of clients nor the community.

• We are entering the second decade of the doctor and specialist shortage here.
• How can there be a shortage? It's not because its not needed nor not possible here.
• Why aren't doctors picketing every Parliament in the land on behalf of their patients and the wider community? Letting known dangerous conditions for patients and doctors continue is neither Ethical nor Professional behaviour.

• Five plus years on from "Dr. Death" in Bundaberg, is anything different? Is there any excuse for that?