In the pages on this web site I have suggested that the entrepreneurs who found and grow health and aged care corporations so successfully share a number of characteristics which I have called extremely closed minded*. I have also used Robertson et al's concept of a successful sociopath to characterise them*.
This page attempts to explain what I mean by these terms - how and why these people behave so badly.
I have also applied the term successful
sociopathy to groups of people who adopt belief systems which cause
them to behave in a similar fashion.
Sociopathy and the Health System
Examining Corporate Founders and Cultures :: LINKS
By definition these people are at least temporarily very successful in society. They achieve their success by socially unacceptable means and at the expense of the community and its citizens. As Robertson et al pointed out in 1996 a number of entrepreneurs seem to have these characteristics.
These people tend to embrace a particular and often limited belief system to the exclusion of others. They have no doubts. Typically these belief systems have an internal logic. Actions based on the belief system often produces the desired and predicted outcomes. Their views do not stand up to criticism when alternative understandings are used. Views applicable to some activities in society may be given universal relevance and applied to activities where they are clearly inappropriate. These views or their application should not be acceptable to society but society frequently identifies uncritically with their logic and fails to challenge them.
Sociopathic individuals are extremely self-confidant, intelligent, charismatic and persuasive of others as well as themselves. They inspire those around them and create a dysfunctional culture, - often dizzy and disoriented by its success. Success is proof of the accuracy of any claim they make. Words and sometimes bizarre ideas become a substitute for reality. They surround themselves by supporters who worship them and believe they can do no wrong. These loyalties persist even when their world collapses around them. The community admires them. The system of justice seldom pursues them.
They have enormous drive and ambition but few qualms about how they accomplish their objectives. They are focussed. They deal with conflicting evidence, by selective perception, compartmentalising, rationalising, by attacking its credibility, or by demonising the messenger. They are more likely to develop patterns of thought which allow them to indulge in criminal activity or to disregard the interests of others. They can be very successful entrepreneurs.
They surround themselves with admirers. When a group identifies with dysfunctional ideas and adopts these patterns of thinking then they reinforce each other. Dissenters leave or are ostracised. A subculture or even a culture forms. When this culture is very successful, when there are adverse outcomes for individuals or for sections of society as a consequence of beliefs and actions, and when the culture is deaf to reason or facts then I call this process successful sociopathy. We have ready examples in apartheid and the holocaust. Once a successful culture is established it assumes an independent momentum and spreads rapidly. Its acquires a legitimacy and an unquestioned and self evident correctness, which few dare challenge. Nothing is as convincing as success.
The nature of these sociopaths make the empires which they create extremely fragile and vulnerable - a spectacular house of cards which at times comes tumbling down amidst revelations of misconduct.
When these people hold the floor they are persuasive but their ideas do not stand up to critical scrutiny or questioning. They talk only to the converted. They seldom engage in open debate or give press interviews where they are confronted by critics. They employ trained PR firms to present their point of view.
People like Tenet/NME's John Bedrosian,
Columbia/HCA's Richard Scott and Sun Healthcare's Andrew Turner who
"shoot their mouth's" usually regret this. Their critics readily
expose the barrenness of their arguments. Mostly they keep away from
the press.
My description may suggest that these people are different to the rest of us, are evil and a threat to society. This is not what I want to convey. I argue that very many of us have some of these characteristics. This charisma, the ability to persuade and lead, the ability to focus and not be distracted are all valuable assets for society. These are people who can accomplish great things for society. They often have a vision but are blinded by it. People like this have made some of the greatest advances in science and medicine. The critical issue is not so much their personality structure but the context in which they find themselves and the measure of social control in that context.
Problems arise when the patterns of understanding used in a particular situation are in conflict with the desired service - when status and rewards are based on success using those understanding rather than the actual success of the service provided. In this situation people are likely to identify with the understandings and the defined measures of personal success rather than the desired outcomes of the service. They will behave in a dysfunctional way.
Situations like this bring out the sociopathic tendencies many of us have and when our efforts are rewarded with success all our doubts disappear. Those who have these characteristics succeed and become leaders.
Power is also important. Most people can be
controlled by those around them. If they are not given too much power
sociopathic behaviour can be tempered. They may still provide a
valuable service. When people with these sociopathic characteristics
have too much power and are uncontrolled then we have a recipe for
disaster.
In health and aged care people are all too often vulnerable and unable to act in their own best interests. Because of this the health system has been based on trust. Funding is readily exploited and has also traditionally been based on trust.
Care and profit compete directly for the health care dollar and those who can bring themselves to compromise on care will be most profitable. This problem has been recognised for 2000 years. The system is very vulnerable for sociopaths to exploit. It is a set of fragile social structures which require constant identification and reinforcement, not only by the professions but by the larger society. In the past a cohesive community, strong professional associations and clear ethical systems have been moderately successful in controlling sociopathic tendencies.
This system has always been vulnerable to pressures within the community such as fascism, apartheid, commercialism and now corporatism. It has bent before the winds of change and then recovered when society has finally rejected the beliefs which caused the problems. Good examples of this are the way the not for profits health care providers have bent before the pressures of corporatisation, and the way in which university establishments have responded to the pressures from the corporate marketplace by abandoning their critical role in society.
Corporatised Health and Aged Care suffer from all of the problems I have described. The frames of understanding create a set of desirable outcomes that are in direct conflict with the services desired by society. They conflict directly with understandings that already exist. People who identify totally with these new frames of understanding are given unlimited power and credibility. The corporatised market is intensely competitive and those who are unable to compete in a sociopathic manner go under.
Because their conduct is so successful within these marketplace understandings corporate health care sociopaths are highly regarded and greatly admired. They have great credibility. Criticism is readily ridiculed.
This cauldron is stirred and heated by the fires of competition and the pressures from Wall Street. The witches of Wall Street dance in glee. The cauldron boils and bubbles. As the pages on this web site show the health care potion they brew is foul indeed!
Click Here - - to explore some of these ideas further
I list here the names of some of the corporate founders and managers. Click on the names to go to pages where their views and conduct are described and decide what you think of them for yourself.
IN THE USA
Richard Eamer and John Bedrosian -- Tenet/NME
Richard Scott and Thomas Frist -- Columbia/HCA
Richard Scrushy --- HealthSouth
Andrew Turner -- Sun Healthcare
Bruce Lunsford _- Vencor
Dr. Robert Elkins -- Integrated Health Systems
Michael Walker -- Genesis Health Ventures
David Banks -- Beverly Healthcare and its culture
Mariner Post-Acute Care - Corporate Culture
The Kovals - Kings Health Centre in Canada - a revealing example
Citigroup and the New York Stock Exchange - Examining the giant financial institutions
IN AUSTRALIA
Ian McGoldrick - Australian doctor and Medical entrepreneur
Tom Wenkart - Australian doctor and entrepreneur
Wallace Cameron - Tax schemes lawyer and entrepreneur
Mayne Nickless
Collusion years 1980-94
Dalziel/Catchlove 1994-2000
Peter Smedley background and at Mayne 2000 - 2001
Aged Care in Australia
Ted Sent - The founder of Primelife -- retirement villagesDoug Moran - Founder of a nursing home empire
Vladimir Martyniuk - and the Riverside scandal
Graeme Menere -- the majority owner of two nursing home companies
*In developing the ideas on
this page I have drawn on concepts propounded by Rokeach in his 1960
book "The Open and Closed Mind." I have also drawn on Robertson's
article "Successful Sociopathy" in the Med J Austr. 1996. What I am
describing does not fit exactly with their descriptions but the terms
express the ideas very well.
In writing about successful sociopathic behaviour I am referring to people who are very successful but who misuse others or the community in order to achieve that success. They do not display a proper sense of social responsibility to others. The people I am talking about are not simply uncaring. They develop strategies which allow them to ignore reason and evidence in the pursuit of some personal or group objective. These people may well believe that they display exceptional socially responsibility, and society often colludes in this. They lack the capacity to examine their own actions objectively or critically. My use of the term is consequently broader than Robertson et al.
