Why make nice with the doctors? That takes time and energy. It’s much more efficient to intimidate them as a bunch and be done with it. At many hospitals, the culture of fear is so pervasive that no one in his right mind will stand up and say that the behavior of the CEO is unacceptable. Unless you want to be blackballed or labeled as a “disruptive physician,” it’s much safer to keep playing the piano in the proverbial whorehouse than it is to do what is right for the institution and the patients.

It seems that in the fight for market share and shareholder value, patients have been forgotten. Gargantuan amounts of money are spent on construction projects for the “revenue-generating” departments—while patients are crammed into emergency departments so tightly that the docs have to go outside just to take a deep breath. Impressive advertising budgets are spent on billboards and television ads, but there is no money to add another shift to the ED coverage.

It seems that the CEOs of many institutions would rather talk about being the best instead of actually being the best. In their minds, saying it is as good as being it.

I’ve known two fantastic CEOs early in my career: Erie Chapman and Steve Caywood. These men were a joy to be around. Patient care was the top priority with them. Keeping physicians and hospital employees happy and engaged was a close second. When the priorities were kept straight, the profits seemed to naturally follow. Now, in many places, the patients almost are an afterthought and the employees are thought of as liabilities, not assets.

Toxic CEOs don’t work in a vacuum, so there’s plenty of blame to spread around. They work for a board of trustees. These boards were once populated by civic-minded people who saw the hospital as a community asset that required close stewardship. Now, many hospital boards are filled with cronies and insiders who are yes-men to the CEO. Contrarian views are frowned upon, and notions of what is right for the overall community are dismissed out of hand.

Worse yet, some of these board members have financial dealings with the hospital. The significance of these kinds of inappropriate alliances seems to go right over the heads of these cretins.

There are some bright spots out there, with enlightened CEOs and hospitals that understand that a toxic hospital culture is bad for everyone—especially the patients. The good hospitals have recaptured, or possibly never lost, the essence of their existence and the core of their mission. Consider yourself blessed if you work in such a place.