Monday, June 19, 2006

Snakes in Suits: The Book

A while ago, we posted about research by Robert Hare and Paul Babiak about psychopaths in business management. They have just published a book, Snakes in Suits, which may help explain the prevalence of concentration and abuse of power in health care.

I confess to not having read the book, which so far has been reviewed mainly in Canada. However, quoting from a recent review on from the Saskatoon Star Phoenix should give a sense of what it's about:

Snakes in Suits (Regan Books/Harper- Collins) examines the phenomenon of white-collar psychopaths.

Most people associate psychopathy with serial murder and other violent crimes, but the majority of psychopaths are non-violent. Psychopathic executives do share common characteristics with thrill-killers, however.

They are manipulative and controlling, lack emotional depth, and care nothing about harm done to others as they go about their business. Often they are charming and likeable, although they're more likely to turn the charm around those who in positions of power, and act ruthlessly to those who are not.

'Think of a psychopath as a social predator who's attracted to areas where there is some sort of advantage to be obtained,' says Hare in an interview.

They go where the action is, and the action is where you can get power and prestige and control.

'If you have somebody who has all the social skills, is fairly intelligent, attractive and raised in the right environment, this person isn't going to rob a bank, he's going to get in the bank.' Hare, professor emeritus of psychology at the University of British Columbia and president of Darkstone Research Group, states that about one per cent of the general population fit the psychopathy profile.

'It's almost certainly higher than one per cent in the corporate world,' says Hare.

'Many of these psychopathic traits can actually be advantageous and useful in business.'

A psychopath with proper social skills and intelligence and who's reasonably good-looking can easily fake out any personnel manager. It's not very difficult to get in.

'We go by first impressions, and quite often if the impression is very favourable we don't go beyond that.' Psychopaths thrive in chaotic situations.

In business, they do well in companies that have upsized or downsized or restructured, where the rules fall into a grey area.

'When things are changing so rapidly, nobody has a chance to keep track of someone,' says Hare. 'In the old days, you had a stable corporate structure where everyone knew everyone else and you worked your way up. Nowadays, people are parachuted in. There are corporate takeovers. You don't know who's doing what. That's a good environment for (psychopaths).' We hear of those with psychopathic tendencies who have crashed and burned -- Enron executives, for example -- but too often psychopaths continue to thrive.

The chronic instability, chaos and ambiguity of many health care organizations are thus likely to act as a magnet for psychopathic managers. And a high prevalence of psychopathic managers could explain the prevalence of mismanagement, conflicts of interest, and corruption in the leadership of health care organizations that we have often discussed on Health Care Renewal.

The question is whether Hare and Babiak's analyses can help us fix things. I intend to buy the book and find out. If anyone has read it and wants to comment, please feel free.


Anonymous said...

I have not read the book, but what does come to mind is a nonmedical situation where I had to deal with a bright, well educated, articulate person who, per a psychiatrist, had a passive/aggressive personalty with control issues. This person made a very good presentation and knew all of the right things to say. The problem was job performance and the very real, and sometimes physical danger, this person place not only people they were dealing with but also their family.

This describes some of the doctors I have encountered.

Steve Lucas

Anonymous said...

I have been fascinated by this research on corporate sociopathy, primarily because many of us (even without clinical training), have known this all along!

What I didn't know in the past was that it is very prevalent in the healthcare industry. I got my rude awakening when I answered an ad for a claims rep job in the state of Illinois for a young startup that just got into business in the year 2000, although I think the top execs had worked in the industry for many years.

At this company, you would start out brand new, with no prior experience in working on claims, and after only a week of very general introductory training, you would go to your unit. Now, NO ONE can start out brand new and touch thousands of accounts once every 30 days, but we had over a thousand accounts dropped into our queues from the very beginning, and they were always yelling at us that the claims weren't being worked fast enough. Our whole department knew we had too many claims, too little training, and too few people, but yet upper management (these people are HFMA members, too, mind you) were calling meetings to repeatedly try to scare everyone into thinking they were right on the verge of being fired, or something. After a year of this abuse, I just up and quit of my own free will, although I have to smugly state that I snagged a fabulous scholarship package so that I was able to attend college full time and concentrate on my studies instead of having to work part-time and just pay my way through, so that worked out very very well for me in the end.

But we would see many faces come in the front door and then walk right back out (turnover was very high here, as only the top managers had even been around longer than a couple of years). Most reps left within a year to go to other companies, because they just could not stand working for these people.

The managers tried to get employees to do maid tasks in the company kitchen, even if you never ate in for lunch and were not the one making a mess in there without cleaning up after yourself, their computer system was a problem for no shorter than 6 whole months during which we were always down and unable to work, sometimes for as long as an hour at a time while the techies were trying to fix the problems, and yet even with their server/computer issues, guess who they felt wasn't working the claims fast enough? Yes, you guessed it. The reps.

Also, they spent no money on proper pre-employment screening, so you would see these elderly women get hired and then promptly fired when they realized the person wasn't a good fit for the job, and yet that person had to go to her next job interview stating that she got let go, which is very embarrassing (one would imagine), and all because they didn't even screen people properly in the first place! One elderly woman had never even used a computer, but they asked her "Can you point and click?" when they hired her. Point and click is one thing, but then they were yelling about speed, so we had this poor old woman crying in the ladies room because she was made to feel like she was underperforming. Meanwhile, the computer screens kept freezing up when you tried to post a note, so you couldn't do your work, and on top of it, we've got this old woman who has very little computer experience and thousands of claims in her queue. This place was run by complete jerks.

Finally, to really get across how sleazy these snakes were, there were always these mistakes (cough cough) with how the commissions were paid. They accidentally applied money incorrectly, and so it just ended up going to the house instead of the employee. And they did this to my manager, who was the company Operations Manager, too! I mean, they were screwing over middle managers, too, not just line staff. Oh, and someone burned something in the kitchen once, which set off the smoke alarm, but instead of commenting that it was great that it was only a false alarm and that no one got hurt, the managers were complaining that it would probably cost them a couple hundred bucks to pay the fire department.

Oh, and one more thing. They turned the heat down so low in the winter (over the weekend) to save on heating costs, but the employees would be freezing for half the day on Mondays until the place heated up. The CEO would just be out until later in the week, so it didn't affect him one bit. And when employees were catching colds due to it being so cold inside, they would threaten to write them up for unexcused absences. But it was the company's fault that it was freezing inside! This was just unbelievable what this low class company was doing (this was a firm that handled pending/denied claims, as well as some consulting, and they also had a collection agency as part of the parent company).

And if you complained about this absurd and utterly dysfunctional working environment run by a CEO who raked in millions, they would tell you they didn't want to hear about it. They would lie to other employees and spread rumors about people just not doing good work, and so that's why they were complaining about things, but we all knew that it was totally true that the company was just engaged in psychologically manipulative abuse of their employees. Total slimepit.

Glad to see that many insiders are now after reform, as well as the fact that this has all come to a head in Washington what with the charity care issue and the possibly excessive non-profit hospital CEO compensation issue in the news all the time.

Looks like the party is over in healthcare, and so the snakes need to reform or find another line of work to slither off into.

Anonymous said...

I work in a consulting company which serves the healthcare industry--providers, payors, life science companies--and our division is lead by a Quaker psychopath and our HR department has had no less than 12 people register complaints against him. They have done nothing but "counsel" him, for the past 10 months!!
He's still here and we are continuing to lose good workers and executives while HR looks the other way. I guess they figure we'll all go away and all hail the reigning psychopath.

Anonymous said...

Psychiatrist's are the biggest 'Snake's in suits'. They reap billions per year for no cures but laud how marvellous ECT and lobotomies are in 'helping ' people... Oh, and they like giving young children drugs more addictive than cocaine and opium. Their time has come, their demise is imminent. I guarantee it.

don joe

Anonymous said...

I had a female "Snake in a Suit" manager when I worked in aged care.
When I returned to work after receiving radiotherapy treatment for breast cancer, people I knew came into the office to ask how I was. (There wouldn't have been more than six people over a three week period.)
This woman then took me to a private room and screamed how she was "sick and tired" of my talking about "breast cancer" and "never wanted to hear another word."
I was put on the drug, tamoxifem which ushered in a fast menopause and I experienced really hot flushes followed by feeling freezing cold. "Fire and ice" is the correct description.
This awful woman told me I was not to "bring private items" like a towel into the office. (I was having to try and mop up my perspiration with my hands.)
However, one morning she approached me screaming, "What did I tell you about bringing personal items into work? I found a tissue, a tissue in your drawer last night!!"
The screaming was so bad, she had what appeared to be an epileptic fit and rolled her eyes backwards so that only the whites showed.
I ran from the office and returned a few days later.
She would then only speak to me in a hissing type of voice, and I noticed she showed a lot of the whites of her eyes.
There was another incident when a very young male colleague mistook my shaking my hand for a "bird" gesture and apparently told the manager that I was "giving her the bird".
She came rushing at me with her mouth open screaming, "You fisted me, you fisted me!!!"
I told her she was a mad woman and left and later resigned.
This woman has remained in her position and the organisation is failing badly. When I was there, she was fudging the client stats to make the office appear to be successful. She has lodged successful complaints against the women who were her supervisors and they were both fired. I have also found that she has gone through a large number of staff.
Whoever meets her will no doubt believe she is an attractive, articulate, lovely woman and will be smitten.

Anonymous said...

I work for the State with a Health Care Manager and physician who hides his voltile abusive angry explosive behavior behind exceptionally well crafted charm when surrounded by those in power. He has blatantly committed financial fraud in the millionsand in full view and knowledge of hundreds of staff, has EEO complaints against him from secretaries to nurses to physicians (all female of course), has been seen drunk and throwing up in public, and is nothing short of an abusive bully to all he feels are beneath him (which are most). Yet he remains in command and is actually being considered for promotion to a newly created position of command. An obvious graduate of the Ted Bundy Charm School, the man is phenomenal in his seductive dance of charm and flirtation with the authorities up at headqurters. His ability to manipulate is almost inspirational. Yet the toll of dedicated people who have abandoned his ship of destruction is tragically reflected in the patients who so desperately need care. Working with the Monster in healh care, leaves a horrific wake of both staff and patient victims, with so few options for terminating the real disease.

Anonymous said...

I was nearly murdered by a nurse practioner who claimed to be a doctor. I'm very lucky to be alive. I contacted everyone all the way down to DHEC telling them my story and she is still in business. She works for a doctor who is never in his office. Word is, she's killed several other's. Nobody in this small town will take the proper legal methods to arrest her. She walks free and I live a life of pain not to mention being financially strapped to her medical mishap! What a shame! I trusted her to give me medical care. When I found out she was not a real doctor I thought I was literally going to loose my mind. I'm not the crazy one! SHE STILL WALKS AND KILLS!I know in my heart, one day she will be caught and I can only then, be heard. Everyone knows about it but won't do a thing. RD :)

Anonymous said...

Snakes in suits everywhere.
I am an Ob/Gyn. There are 3 of us in this moderately large hospital and I am the only female. This Egyptian doctor has come to us after working in UK and likes to call himself British though his looks and accent gives him away. What is the harm in saying he is an Egyptian who has worked the last 10 yrs in UK? Very charming around people in authority - including nurses if they are white and manipulated himself to the role of Director saying to the authority that the three of us have agreed among us that he should be the Director. Never! I didnot protest for sake of peace and not compromising patient care at all. But his manipulation and tricks continue.