Posts Tagged ‘ethics’

In a follow-up to last week’s post on CPR and quintessential leadership regarding the action of a Brookdale Senior Living nurse refusing to do CPR on 87-year-old Lorraine Bayless, I saw this news article today where Brookdale Senior Living, which initially backed up the nurse’s refusal to do CPR as being consistent with company policy, has now reversed their position.

The statement says that the incident “resulted from a complete misunderstanding of our practice with regards to emergency medical care for our residents” and that the nurse had “misinterpreted the company’s guidelines.”

This further shows the unquintessential leadership in place at Brookdale Senior Living. First is the “reversal” of a policy that the company defended and stood by several days. Second is the subtle shifting of the blame to the nurse for the lack of medical attention. And the third is the minimalizing language Brookdale Senior Living uses in their reversal statement. To characterize this incident as “misunderstanding” or “misinterpretation” is to basically say it’s not a big deal, even though that misunderstanding and misinterpretation led to somebody’s death.

All of these show just how entrenched the unquintessential leadership is at Brookdale Senior Living. As I said before, it would be naive to believe this is the only senior living company where practices and policies like these are in place and unquintessential leadership is extant through the ranks within the corporation.

But it should serve as a warning and a caution to those of us entrusted with being quintessential leaders in helping our parents as they age to ensure that we’re providing the best and most care for them, as they did for us when we were babies, helpless, and completely dependent on them. These companies, despite their claims, really don’t have “our residents” as their priority. It is about money (greed) and the law (minimum legal liability).

These are driving forces that the unquintessential leadership in these companies come from, along with the lack of character, integrity, ethics, and moral responsibility that many of the individuals that are employed by these companies possess.

No doubt by now everyone has read and/or heard about Colleen, the nurse who Brookdale Senior Livingrefused to do CPR on an 87-year-old woman who collapsed in the dining room of Glenwood Gardens, a Brookdale Senior Living facility located in Bakersfield, CA. The elderly woman later died at a local hospital.

The partial transcript of the 911 call is almost unbelievable, especially in the nurse’sGlenwood Gardens - Brookdale Senior Living - Bakersfield, California refusal, with her boss concurring with her refusal, to let the dispatcher talk someone – anyone – else through doing CPR – saying it was against company policy – to aid the elderly woman, who was barely breathing.

After reading this story, I contacted a friend of mine who is the director of nursing at the Brookdale Senior Living facility where my mom lived until she came home to live with me until her death. I asked if this was really company policy. She confirmed that it was.

Even though my mom had a DNR, so this would not have applied to her, I told my nurse friend that I didn’t remember anyone telling us that during the admissions process, since that would be something that should be clearly stated at the outset for people considering a Brookdale Senior Living facility as a choice for themselves or a family member.

She said she had brought that up to the admissions person there who basically said that telling people wasn’t required because it was explicitly stated in the mountain of paperwork that was signed and given at the time of admission. I admitted I hadn’t read every word of mine because my sister and I asked all the important questions we needed answers to during the admissions process, but that I didn’t think that was a responsible answer, because that, for a lot of people, would be a deciding factor in determining living arrangements.

I then asked my nurse friend what she would have done. She said she didn’t care what the legal issues were because this was a moral and ethical issue and she would have broken the company policy and put her employment in jeopardy to do the CPR. She made an interesting statement about how she would not be able to live with her conscience if she could help someone and didn’t. She also reminded me that in nursing school, she took The Florence Nightingale Pledge, which is similar to the Hippocratic Oath that doctors take, which includes the intent of doing no harm to those in their care. 

So what does this have to do with quintessential leadership or the lack of quintessential leadership? Everything.

We’ll start with the nurse because it’s the easier of the two to clearly see a lack of quintessential leadership. As a nurse, she took the same pledge my friend did. The welfare of that 87-year-old lady – even if any efforts at CPR didn’t, in the end, save her life – should have been her only concern. The dispatcher gave her an opportunity to let somebody else do CPR and the nurse refused everything. She lost – or maybe never had – the vision of what being a nurse means. At the very least, her nursing license should be immediately and permanently voided in all 50 states.

Brookdale Senior Living is also being operated and run by unquintessential leadership. That this policy is in place at all, in assisted living facilities, is not only absurd, but reprehensible and irresponsible. But the company’s unquintessential leadership goes far beyond this one incident.

It is important to take a big-picture look at this company – and all others like it – to see what their priorities are (I know a lot about Brookdale Senior Living, which is why I am singling them out, but it would be naive to say they are the only senior community company that has these policies and operating models). While seniors and their families are encouraged to believe that these companies care about them and put “our residents first,” that is, in fact, not the truth. What these companies care about most is profit (the monthly charges, for the bare minimum of services, start around $5000 in the south, so it makes sense that it’s much higher in other parts of the country) and no legal liability. If the residents happen to fall in the mix pleasantly, that’s okay, but if they don’t, then the company comes first.

The lack of honesty and the greed and self-interests of the companies are all unquintessial leadership traits. So, buyer beware, which quintessential leaders don’t have to worry about, applies to anyone considering one of these facilities.

Brookdale Senior Living lacks quintessential leadership in many areas beyond this, based on my experience with them and subsequent first-hand knowledge that I have had of their activities. They have policies in place that don’t protect the residents, the interests of the residents, and the families of the residents. And the puzzling part of this is that some of these policies leave them wide open for lawsuits, if someone wanted to pursue them.

In my mom’s case, while she was living there – and this precipitated (among other things affecting her health that I had discussed and been promised over and over would be done and never were), after Mama emphatically told me she wanted to live with me and didn’t want to go back there, Mama coming home to live with me until her death in August of last year – she had a very bad fall in the middle of the night.

(I don’t know what happened in Mama’s brain during the month between her diagnosis with vascular dementia and the hospitalization in a geriatric psychiatric facility after a couple of the most bizarre weeks of her life and my twin sister’s and my lives, but the first thing I noticed on my first visit with her there was that she was suddenly turning around counter-clockwise. Because of that, she would lose her balance. That became her way of turning her body, and as the diseases – Lewy Body dementia was also present – worsened and her balance in general got worse, she was more prone to falling.)

The problem – and quintessential leadership failure – was that I didn’t hear about the fall until 8:30 the next morning when I called Mama to tell her I was on my way (I was there every day, often for hours at a time, just to keep an eye on things and make sure she was okay) and she told me she’d fallen and her ankle was hurting badly. I was livid as she told me that a CNA had come in and found her on the floor, asked her if she was okay, and when Mama said she was, lifted her up and put her back in bed.

The unquintessential leadership in this scenario abounds. The first is asking someone, who, by the way, had a serious hearing loss and did not have her hearing aids on, with dementias and Alzheimer’s Disease to accurately assess her condition. The second was not calling EMS to take her to the emergency room to check for broken bones (fortunately, she didn’t break anything, but she had a serious ankle sprain), then call me to tell me to go to the ER. The third was the CNA moving her without confirmation that nothing was broken.

I got calmed down enough to go in and talk with the director of nursing, because I had explicitly said early on that if anything happened to Mama, I wanted to know immediately, no matter what time of the day or night it was. It was in the record and it wasn’t done. I got a lot of excuses about why the CNA didn’t call – also unquintessential leadership – but finally the director of nursing agreed that she should have and told me she’d get mobile x-rays done just to make sure Mama was okay.

I ended up spending almost two weeks pretty much living there with Mama to ensure she was healing and safe (I understood that it was assisted living, so I couldn’t expect someone other than me to be there 24/7).

About a week after that, I went in early one morning – several people had been in and out of the room and Mama had gone to breakfast, so a lot of people had an opportunity to observe her – and I immediately noticed she was having a really hard time breathing. The fact that no one else saw it or said anything to me about it was unquintessential leadership. I got her to the doctor and the determination was either pneumonia or the beginnings of congestive heart failure.

The doctor treated it as pneumonia since the chest x-ray seemed to indicate that, but it was in fact congestive heart failure, which landed Mama in the hospital a week after that (she’d been staying with me that week and I grew more concerned as I saw her breathing getting more and more labored). It was after that hospitalization that Mama came to live with me for good.

I didn’t blame all of Mama’s issues with high blood pressure and congestive heart failure on the Brookdale Senior Living facility. It wasn’t all their fault. However, the lack of quintessential leadership at the facility definitely contributed to Mama’s condition.

Her doctor had ordered a very strict diet to try to deal with blood pressure and weight and I had talked to everyone there for about a year trying to ensure that the diet was followed.

Everybody from the top down gave me lip-service that they would follow the doctor’s orders, but no one followed up and no one ensured it was done. I saw time and again, with my own eyes, that it wasn’t being done. Each time I brought it to the attention of those in leadership positions there, I heard blame and then the same old promises, which were never kept.

That was unquintessential leadership on so many levels.

But the most unquintessential leadership story that I heard about this particular facility was recounted to me (and I will not recount the details here to protect the person, who is a good friend, who told me in excruciating details one of the most horrific stories I think I’ve ever heard in my life) months later and it is damning evidence that Brookdale Senior Living is under unquintessential leadership from the very top down.

This story involved a serious medical emergency with a resident – whom Mama and I both knew and who was vivacious, healthy, and said to me every time she saw me, “I just love your little mama” – brought on by a criminal act by another resident, that occurred on a Sunday morning. The registered nurse was asked to call 911, but instead of calling 911, the RN started trying to call the executive director and the director of nursing. Finally, because the RN wouldn’t call 911, one of the staff members did.

The resident with the serious medical emergency was transported to the hospital, where she died a week later. The staff member told 911 what had happened, but immediately the RN started disputing her story. The executive director finally came in and the cover-up of what actually happened began in earnest. The staff member was put on notice because she’d “broken the chain of command,” which she had not, but the RN, who was at the top of the chain of command, didn’t do what she should have done, which was to have called 911, and then called facility leadership to let them know what happened.

The family was lied to about what happened and the circumstances under which it happened. No action was taken against the resident who committed the criminal act, which jeopardized every other resident still there. And eventually the staff member who did the right thing was fired for insubordination.

You might wonder why and what all this has to do with us as quintessential leaders. The answer is “everything!” This is both a strong caution for those of us who are now the quintessential leaders who are entrusted with our aging parents’ care and for those of us who are striving to be quintessential leaders in every aspect of our lives.

This is what unquintessential leadership looks like in action, with specifics that have broad application throughout our professional, personal, and spiritual lives. As quintessential leaders, we have the responsibility to ensure we are not following in the footsteps of the examples given above. Please be sure to read an excellent companion blog article to this one entitled “Quintessential Selfishness.”

That requires us to have the commitment, the determination, and the courage to do the right thing all the time, no matter what the personal cost is to us. It requires us to have an immovable and unshakable moral and ethical foundation that is the basis of everything we are, we do, we say, and we think. It requires all the components of Building Trust and Being Trustworthy to be an active and living part of our very beings all the time.

It’s prudent to look in the mirror quite frequently and make sure we are the quintessential leaders we say we are and are striving to become better at. Too often, we can all get lazy or complacent and believe, as Paul Simon so eloquently wrote, “that we’re gliding down the highway when, in fact, we’re slip slidin’ away.” 

“Whosoever desires constant success must change his conduct with the times.” The Prince – Niccolo Machiavelli 

While the exact phrase “the end justifies the means” is never found in Machiavelli’s renowned 1532 work, The Prince, there is absolutely no doubt this is one of the distilled philosophies that you come away with after reading it. I remember reading it in high school and being bothered by it, but in rereading it a few years back, perhaps because this is just the way the world – individually and collectively – with very very few exceptions does things now, my sense of bother had deepened to disgust and a conscious rejection of all the tenets and principles in the book. Machiavelli, it seems, would have fit right into the 21st Century with his promotion of situational ethics and relative morality or total immorality in every aspect of life.

This post is about ethics and process. Ethics is defined as “a system of moral principles;” and “the rules of conduct recognized in respect to a particular class of human actions or a particular group;” and “that branch of philosophy dealing with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions.” By “process,” I mean how and why we, individually and collectively, do things to achieve a desired outcome.

Let me say at the outset that ethics and process is a constant struggle, and many times we’ve absorbed so much of what’s going on around us – “that’s what everyone else is doing,” – and we live in an ADHD world that leaves us little free time – unless we make the conscious choice to create free time – to think through our processes – and we have adapted to a world philosophy that justifies being unethical to achieve goals (the mantra of this is “well, it’s not hurting anybody,” which we’ll discover is absolutely untrue, except the people getting hurt are not the ones we might think). Additionally, we’ve fallen into the trap of believing that the outcome of something is what is most important, not how we got there – that the end justifies the means.

It is my belief that how we got there is far more important and significant than the end result. If the process is wrong, flawed, faulty, deceitful, or in any other way dishonest, the end result is nullified. Because defects of character, a lack of integrity, and disregard for ethics characterizes the process. Some examples of this process-ethics problem on an individual level are things that as I read them I continually ask myself “is this something I’ve done, am doing, or would do?” I believe that being very aware of all my processes – and asking myself “is this right or is this wrong?” and “is it at its very core honest or dishonest?” – in life is critical to having right character and unimpeachable integrity, because, when it’s all said and done, those are the only things I will leave this life with. As Marc Antony so eloquently says in his eulogy of Julius Caesar, “The evil that men do lives after them; The good is oft interred with their bones:

A story last week in The Atlantic about the housing bust had these two quotes from one of the investigators with Digital Risk, a company that exists solely to catch mortgage fraud. The first quote is a bit surprising: “pastors—dozens of them—who doctored bank statements, bought houses they couldn’t pay for, and then filed for bankruptcy. “’…The nice thing about pastors is that their church shares information when asked,’ Alpan says. ‘Pastors are always an easy [fraud] claim.'” The second quote seemed, to me, to sum up, in general, society’s, individually and collectively, default process: “‘It’s not just lawyers and pastors and CEOs who lie and scheme. It’s nurses and schoolteachers, too,’ he says. ‘Everybody’s guilty; no one’s up to any good.'”

How about the educators in Atlanta, GA who were involved in cheating on the state’s standardized testing, in which more federal funding – and teacher and administrator jobs – were at stake for low test scores? This is the epitome of a unethical and dishonest process being employed by individuals for a “good” – although in my opinion, keeping these educators in their jobs would not have been good for the students – goal. What kind of example did they set for the kids they were entrusted to educate? They taught them that cutting corners, cheating, and lying were acceptable if those behaviors achieved the end goal. Am I the only one who believes these kids took that lesson – and process – to heart and everything they do from here on out will be suspect, process-wise?

On an even more personal level, how many of us have fudged the deductions on our income taxes to either avoid paying or to pay less than what we legitimately owe in taxes? Many non-monetary charities – furniture, clothes, etc. – simply allow you to tell them the value of your donation and they sign it and give you the receipt. If we donated to one of these, were we honest about the value of our donation? Did we take other deductions that we weren’t allowed to or inflate the amount of other allowable deductions? That’s an unethical, deceitful, and dishonest process.

Our individual unethical and dishonest processes aggregate in the organizations we are members of professionally, socially, and religiously. Common and frequently-used examples  of how these processes look at the organizational level (and because I’ve been in technology – and often that includes being in the inner workings of organizations, especially as they have become inextricably linked over the course of time – since the beginning of my career, there isn’t much I haven’t seen and heard, but a lot I’ve had to say “no” to or, with time because my process, which is, to the best of my ability, to be honest and ethical no matter what, to simply not be asked even though the people who are asked and say “yes” end up talking to me about it and I tell them “don’t expect the people you’re doing this for to visit you in that federal penitentiary”) include:

  • Encouraging members of the organization to access the organization’s web site from as many unique IP addresses as they can on a regular basis to artificially drive up the traffic statistics and boost the organic search engine rankings
  • Encouraging members of the organization to post favorable online reviews of the organization’s products to create the illusion that lots of people want and like the products
  • Creating fictional web sites that purport to objectively compare your organization’s products with competing organizations’ products where your organization’s products are rated higher than all the others
  • Encouraging and/or having members of the organization to use social media contacts (who may or may not actually be interested in the organization or its products) to “like” the organizations’ social media pages to boost their search rankings

And technology is not the only area where we see the ever-increasing trend toward unethical, deceitful, and dishonest processes. There is rampant federal and state tax fraud. I know of one example where at least a year’s worth of financial documents was fabricated using PhotoShop to hide what had really been the true financial documentation of the organization. Even some charitable contributions have the dark shadow of unethical and dishonest processes behind them. A recent account was given by the chairman of an organization in which he detailed how he circumvented “the system” – which included evading costs and time doing it the honest and legal way would have required – to get a piece of medical equipment to a someone in a foreign country and it was all justified – Jeremiah 17:9 – because it was a “good deed.”  And this is just the tip of the iceberg.

It’s not hurting anybody, right? Wrong! There may not be identifiable victims of the fraud being perpetrated, but people who are counting on veracity are being defrauded. Additionally, the person/people executing the unethical, deceitful, and dishonest processes are definitely hurting themselves. Right character, good character, and integrity are much more easily destroyed than they are created. The first time we use an unethical, deceitful, and dishonest process, there is usually a pang of conscience that accompanies it – if indeed, we’ve developed any kind of conscience at all.

I’ve found that if I have to spend a lot of time debating on whether I should do something or not, process-wise, and there’s a knot in my stomach to accompany the indecision, then the wisest thing is stop and review my process for integrity, honesty, and ethical correctness. However, if we ignore the pang of conscience and do it the way we want to anyway, our character is damaged. The next time the wrong way to do something to achieve a goal presents itself, it will be easier to do, because the pang of conscience has been diminished. 

So why does it matter what the process is as long as the outcome is achieved? Because once this way of doing things comes into and is accepted in just one of our processes, it eventually spreads to all of our processes. We become what we think and act on: unethical, deceitful, and dishonest from the core outward. We become unreliable, untrustworthy, and unconscionable. We also become teachers, by our examples, that any means justifies the end, and we contribute to the declination of a society that we all resoundingly lament and criticize as being what we’ve become.

Take the time to examine your processes. The good that will come of that – including all the immediate gratification that you’ll have to forego to do things the right way – will be worth it now and in the long run.