I have watched some version of this more than once.
A clinician has worked at the same facility for years. They take the late add-on or the late admission or the late shift. They come in when the call schedule falls apart. The nurses know which of them to call when a patient starts going the wrong way. Then something happens, a case or a complaint, and a review begins.
No one at the facility calls them. They hear about it secondhand. Action is taken before anyone asks for their account. The people who could have helped are not in the room, and some of them should have been. Not long after, the clinician quietly leaves for another facility. Even if someone tries to keep them, it is usually too late.
I should be clear where I sit. I am the chief clinical officer for an anesthesia company whose clinicians work in about 150 hospitals and surgery centers that we do not own. When a facility handles a review badly, we often lose the clinician, so I have a stake in how this goes. Before this seat, I was a chief medical officer at a facility, and I have seen this from that side of the table too.
Years against an instant
Years of good shifts do not register the way one event does.
Paul Slovic, who studies how people judge risk, put it plainly in 1993: “Trust is fragile. It is typically created rather slowly, but it can be destroyed in an instant—by a single mishap or mistake.” He asked 103 college students to rate 45 hypothetical news events about a nuclear plant in their community. Half of them gave a report that people living near the plant were less healthy than average a 6 or 7 on a seven-point scale of impact on trust. Fewer than one in five rated the matching good report that high.
His explanation fits a hospital as well as a power plant. Bad events are visible. Good ones, he wrote, “more often are fuzzy or indistinct.” A decade of covering the call schedule is fuzzy. A review has a date, a file and a committee.
A few weeks ago I wrote about the trust a leader can spend with one careless email (“Effective immediately”). This is the institutional version, and the cost is larger.
It is the how, not the finding
We tend to assume the clinician leaves because of what the review found. In my experience, that is rarely the reason. Many seasoned clinicians can live with a finding suggesting they could have done something differently, even when they disagree with that finding. What they cannot live with is what the handling told them about the organization or their value.
Joel Brockner and Batia Wiesenfeld reviewed 45 independent samples in 1996 and found the same pattern across them. How fairly a decision is made matters more when the outcome goes against the person. When the result is good, people forgive a sloppy process more readily. When it is bad, the process carries far more of the weight.
Each failure in the handling sends its own message.
Not calling the clinician directly says: you were not owed a conversation.
Acting ahead of the required process, when nothing required the hurry, says: we decided before we asked.
Leaving out the people who should have been there says: no one who knows your work was worth including.
Taken together, they answer a question the clinician may have been asking for years, which is whether the commitment ran both ways. The finding judges the case. The handling judges the person.
Why no one calls
It is rarely malice. Sometimes it is pressure to act fast after an event. Sometimes the call belongs to no one. When a facility has a concern about one of our clinicians, its chief medical officer often calls me, or calls the group. In all of those calls, no one has ever told me I was expected to call the clinician myself. The facility might assume the group will. The group assumes the facility already has.
More often than either, the conversation is hard, uncomfortable and messy, so no one has it.
Leaving ends the repair
Slovic found something else that matters here. Distrust, he wrote, “tends to inhibit the kinds of personal contacts and experiences that are necessary to overcome distrust.” A clinician who stops trusting a facility pulls back. They stop offering to stay late. They stop making the extra call. Eventually they stop coming.
Trust can come back. Maurice Schweitzer and colleagues ran 262 people through a repeated trust game in which a partner broke trust early. A steady run of trustworthy actions afterward restored it. A promise to change sped up the early recovery. An apology on its own did not help. When the broken trust came with deception, it “never fully recovers.”
That was a laboratory game between strangers, not a department, and I would not stretch it further than it goes. The direction still matches what I have seen. Repair takes a series of trustworthy acts, and a series needs the person to still be there. In the pattern I have watched, the attempt rarely comes. When the clinician leaves, the chance for one leaves too.
Our side of the table
It would be convenient to make this an essay about hospitals. When I was a chief medical officer, I watched my own committees do it.
The clinical committees in my current seat are young. They are still learning how to review a case well, and I want them to learn this part before they learn it the hard way. The wrong way. We can act before we call the clinician. We can let a good clinician go without once asking them to stay. We can follow every rule and still tell someone who gave us years that the years did not count.
If you are moving into a leadership seat, you will be the one deciding whether that call gets made.
What I try to hold to is simple, and none of it changes the finding. Call the clinician before you act, unless a patient is at risk in the meantime, or the call itself would put one at risk. Follow the process as written, including the parts that slow you down, every time. Put someone in the room who knows their work. And when it is over, whatever it found, tell them what happened and what comes next.
Most of the clinicians I have watched leave this way did not leave over the finding. They left over the phone call that never came.
Sources: Paul Slovic, “Perceived Risk, Trust, and Democracy,” Risk Analysis 13(6):675–682, 1993; Joel Brockner and Batia M. Wiesenfeld, “An Integrative Framework for Explaining Reactions to Decisions,” Psychological Bulletin 120(2):189–208, 1996; Maurice E. Schweitzer, John C. Hershey and Eric T. Bradlow, “Promises and Lies: Restoring Violated Trust,” Organizational Behavior and Human Decision Processes 101:1–19, 2006.
This is such an important piece for anyone stepping into leadership, David! A phone call costs so little and means so much to the person waiting for it.