Why Don't People, and Organizations, Take Care of Themselves?

This Halloween marked the 18th anniversary of my quintuple bypass surgery. According to the measurements that have been regularly conducted, I'm doing well. I take no medicines, I have no symptoms, and I'm in good shape. All this has resulted from a lot of hard work--resistance training, aerobics and dietary discipline.

Recently, I spoke with a group of cardiologists who invited me to participate in their seminar. The subject was "creating a reliable organization," but we soon turned to the question of why their patients didn't take care of themselves after surgery. The compliance rate to the rules of prevention was less than 10 percent. Somehow, they thought, the patients got the idea that going through a treatment or surgery made them well again. Actually, they still had heart disease; they just had been relieved from some acute symptoms. Why couldn't they summon up the discipline to exercise, eat right, quit smoking and reduce stress?

I think the doctors expected me to give them some sympathy. However, I told them my lifestyle sprang from a decision I made on my own. My family, particularly my wife, encouraged me in this regard and followed the same diet and exercise regime themselves in order to provide visible support. They take great care to be good examples to me and to nudge me should I begin to stray from the right path. No cardiologist has even been the slightest bit interested in helping me along this route, except to mention it during my annual examination.

The medical world seems to be the problem, not the patient. It's very much like a business organization dealing with a culture of quality. If the doctors don't involve themselves in the patient's care after the treatment, the patient begins to feel that the care isn't very important. In my case, I have to manage it all myself, reminding the cardiologist's office when it's time for a checkup, thallium scan or lipid blood tests. They're all busy responding to phone calls about people who are having a heart attack and dealing with corrective action.

When an organization's management decides to improve quality, many changes take place. The employees and others associated with the company react to the decision and begin the healing process. However, if management then walks away in order to deal with things they consider more important, the dedication dies down. If the doctor doesn't call the patient in to at least get weighed and evaluated regularly, the patient won't consider that to be important. That's why they quit exercising and start sitting. That's why bypasses usually are good for only seven years or so. That's why patients return to smoking.

Care of the organization, whether it consists of one member or thousands, requires leadership involvement. Sending out lists of good, certified actions for a patient or employee to take doesn't guarantee that they will do them. Preparing notebooks of procedures doesn't mean any of them will be used. The philosophy of creating a reliable, healthy body-whether corporate or personal-is built around leaders' participation and visibility. The following must be in place: a policy that says we will do all the things we have agreed to do; an education that provides the philosophy of conformance to requirements; requirements and transactions that can be understood and accomplished; and insistence that provides the driving force behind the whole life-saving effort.

Don't blame the victim; blame the one who abandons the process.

About the author

Philip B. Crosby, a popular speaker and founder of Philip Crosby Associates--now PCA II--is also the author of several books, including Quality Is Still Free (McGraw-Hill, 1995) and The Absolutes of Leadership (Jossey-Bass, 1996). Visit his Web site at www.philipcrosby.com .