Friday, May 28, 2021

The Case for Professional Quality Boards as a Solution for Organizational Dysfunction


The Case For A Professional Quality Board In Professional Organizations

Executive Summary

Large organizations, both private and public, are necessary to achieve large scientific and technical goals, but as these large organizations come to house both scientific/professional personnel and administrative/business personnel, internal dissonance will inevitably arise. Keeping these goals in balance is required for success. If business/administrative goals and mores that come to predominate, product failures can result. The failure can be chronic, as when profit or organizational advancement comes to trump product quality, or acute, as when imminent disaster is overlooked and crucial knowledge ignored.

To avert this sort of organizational decline, this paper suggests the establishment of Professional Quality Boards. This Board would be composed of highly respected senior scientific and technical professionals, who would safeguard the scientific quality of the enterprise. The PQB's would be quasi-independent entities with wide investigatory powers. They would communicate primarily to the CEO and Chairman of the Board or governmental unit Director, but would also be empowered to address the legislature and higher executive officials in the case of a public entity, or stockholders and regulatory authorities for non-governmental entities, and even to make public their point of view. The mission of these PQB's would be to be the professional scientific conscience, the professional scientific safety valve, and professional scientific corrective conduit for the organization. This idea is explored in the context of NASA, Boeing, the CDC, and medical organizations, and is contrasted to other proposed solutions.


The Problem

Modern life and modern technology often demand very large organizations. Big objectives -- go to the moon, build a modern jet plane, prepare for and fight a pandemic – require thousands of scientists and engineers, as well as thousands of administrative personnel and managers. Organizing all these specialists into a coherent whole has become, just like the technologies they seek to harness, a modern innovation in its own right. The successes have often been amazing.

But along with successes have come failures, some necessary, but some avoidable. There was NASA's Saturn V rocket, but there was also the Challenger. There was the Boeing 747, but also the 737 Max. There was CDC's Smallpox eradication, but there are also the great COVID-19 fumbles in testing, ventilators, truthfulness, and leadership. And there are the ongoing violations of rationality and humanity in our medical care enterprises.

The successes and the failures have a common heritage – the merging together of technology and administration, and the aging of organizations. New technical organizations tend to be vibrant, staffed with innovation believers, intent on achievement, sometimes messy, places where righteous failures are expected and tolerated as learning events advancing the mission. These new organizations are Achievement Organizations. But as victories are won and the organizations mature, they inevitably tend to lose their initial fire, less adventurous personnel are attracted to join them, and eventually errors become sins and achievement becomes less important than avoiding blame. These are Blame-Avoiding Organizations. As Eric Hoffer says, "Every great cause begins as a movement, becomes a business, and eventually degenerates into a racket." And as Elon Musk observes about organizational degradation, “So, I think it’s kind of sad that we were able to go to the moon in ‘69 and here we are 2020 can’t even go back to the moon.

As with human bodies, each organization ages with common patterns, but each in its unique way. In some the scientific innovators are replaced by those with less vision and more focus on process than end result. Administrators may come to predominate over the technical side, profit may come to dominate thinking in a private organization, or growth of domain and continued funding might dominate in a governmental organization. Business and bureaucratic creep can lead the original visionary organizations astray.

The illnesses of aging organizations can be both chronic and acute. Chronic misdirection of the organization can occur, as when the objective of profit trumps that of product quality, or when the obsession of management bogs down the professionals with incessant needless paperwork. Acute misdirection also occurs, as when something dangerous is about to happen and the technical personnel know it but the administrators don't, and the message doesn't flow through the organization properly. Instead of a tight connection of administration with scientific point of view, it is common to see conflict of creative people vs. the suits, the administrators vs. the doctors, the managers vs. the scientists. The imbalance of points of view can make the organizations less functional, more prone to these chronic and acute dysfunctions.

But that is not to say that the productive life of organizations cannot be preserved and successfully resuscitated. When dysfunction is manifest and a company's viability threatened, as happened at Ford, a great leader can be called in to ream out the arteries and resuscitate the company. That's a late remedy. Others have tried to institute continuous renewal – General Electric CEO Jack Welch's brutal solution was to aim at firing the bottom 10% performing managers each year. It's not clear that it worked.

The reform I am suggesting in this paper is a structural change that would both help to keep companies and agencies on the right track in balancing the scientific and administrative strands, and to intervene directly to remedy acute problems.

A Proposed Solution - The Professional Quality Board

In brief, I am suggesting the creation of a Professional Quality Board (PQB), which would be composed of senior scientists, engineers, physicians and others, maybe even administrators, all widely respected, and with personal histories that bind them closely to the success of the institutional mission of the organization. Administratively, the PQB would lie outside the usual hierarchic organizational chart, off to the side at the top, attached to the CEO and the Board or to the head of the governmental unit, with long terms for members. The PQB would be quasi-autonomous. The mission of the PQB would be to be the professional scientific conscience, the professional scientific safety valve, and professional scientific corrective conduit for the organization.

Standing outside the regular organizational chart and privy to extensive information with the ability to investigate, the PQB would examine the agency or company for evidence of chronic misdirection, a severe deviation from the scientific objectives of the organization – identifying when the organization was in the process of becoming too much of a business and not enough of a calling, or worse yet, a racket. The PQB would also act as a safety valve for acute misdirection, when something was all set to go horribly wrong, and when internal efforts to alert supervisors and leaders of the need to right the ship have proved unavailing. In that way, the PQB would be responding to a whistleblower, in effect, but on scientific and technical matters, not legal ones.

I will say more about the PQB below. But first, it will be helpful to look at the organizational disasters I have picked out, and see how a PQB might have helped avert them.

Disasters in American Technical Agencies and Companies

The Challenger Disaster

The Challenger disaster of 33 years ago displayed a stark contrast between what the professional engineers at NASA contractor Morton Thiokol knew was about to happen, and the decisions made by the project managers.

On January 27, 1986, Bob Ebeling, a rocket engineer, drove home from the office with a dreadful feeling. He told his wife that they should prepare to watch a terrible tragedy unfold.

The night before the launch, Ebeling and four other engineers at NASA contractor Morton Thiokol had tried to stop the launch. Their managers and NASA overruled them. ...The data showed that the rubber seals on the shuttle's booster rockets wouldn't seal properly in cold temperatures and this would be the coldest launch ever.”

Why did the NASA hierarchy reject the engineers’ plea of caution about the rubber seals, known as the O-rings? Space Safety Magazine's account is telling:

The disaster could have been avoided. The issues with the O-Rings were well known by the engineering team working on the SRB, but attempts to notify the management had been constantly held back. The phenomenon of abnormal O-Ring erosion had been observed in previous flights. Instead of requesting an investigation, NASA Management ignored the problem and chose instead to increase the tolerance.

The night before the launch, NASA had a conference call with Morton Thiokol, manufacturer of the SRB. A group of Morton Thiokol engineers, and in particular Roger Boisjoly, expressed their deep concern about a possible O-ring failure in cold weather and recommended postponing the launch.

NASA staff opposed the delay. “My God, Thiokol, When do you want me to launch — next April?” said Lawrence Mulloy, one of the shuttle program manager attending the teleconference.

With the pressure from NASA, Thiokol management gave their approval to the launch, and Challenger was on its way to disaster. This failure in communication, combined with a management structure that allowed NASA to bypass safety requirements, was the organizational cause of the Challenger disaster.

(See also an in-depth exploration in the Teaching Company course on decision making given by Michael Roberto.)

The Boeing 737 Max Disaster

Boeing had long been an expert and profitable engineering organization. Even in my field of medicine, when we doctors protested how cumbersome our electronic health records were, we cited Boeing as the company to emulate, since they spent thousands of hours sitting with pilots to design their software to fit what pilots naturally do (see Wachter.)

Yet that very issue was at the heart of the two scandalous Boeing 737 Max crashes, where the controls to handle a flawed takeoff pitch problem were intricate and non-intuitive; where the pilots were poorly trained for handling the pitch problem; where the software depended on a single sensor with no back up; and where the procedures for handling problems when the nose pitched downward were buried deep in the instruction book. Was this really the fabled Boeing?

The complicated explanation has become apparent. Internal problems at the company, pushed to perform quickly to counteract the challenge of a new efficient Airbus model, led to shortcuts, and actual lies. Boeing described the new model as simply a revision of its traditional 737, but this was untrue, since the engines had to be placed higher on the wings and the software was changed, which led to many consequences and a substantially different plane. But as a declared model revision, monitoring was shifted from the FAA to Boeing itself, long hours of expensive and time-consuming training could be skipped. The intended result was a must faster time line to completion to better compete with Airbus.

The business people within Boeing may have been satisfied with the results, but the engineers and test pilots weren't. The most experienced aviators, leery of the revisions, were excluded from the final decisions that minimized attention paid to the potential problems, and the engineers and pilots were not even informed of the final decisions on these design and training elements.

Emails and interviews discovered by the New York Times revealed their disquietude:

Would you put your family on a Max simulator trained aircraft? I wouldn’t,” one said to a colleague in 2018, before the first crash. “This airplane is designed by clowns, who are in turn supervised by monkeys.” “I still haven’t been forgiven by God for the covering up I did last year,” one of the employees said in messages from 2018, apparently in reference to interactions with the Federal Aviation Administration. ...Stan Sorscher, a former Boeing engineer who then worked with a union representing company engineers, said priorities had shifted over the past two decades, with profits mattering more than quality.”

Despite challenges by line supervisors who blamed the pilots, Congress issued a report invoking these severe organizational problems. The report clearly cites the problem of Boeing's seeking profit over safety, and the connivance of the FAA, a captured agency in this case, whose own leaders neglected the recommendations of their own technical experts. “It illustrates how Boeing’s management prioritized the company’s profitability and stock price over everything else, including passenger safety. Perhaps even more alarmingly, the report shows how the F.A.A., which once had a sterling reputation for independence and integrity, acted as a virtual agent for the company it was supposed to be overseeing.”

While the 737 Max problems were clearly acute, chronic company problems were evident as well. “Jerry Useem, a veteran business writer, argued in The Atlantic, last year, that the 737 MAX calamity can be traced back to Boeing’s move from Seattle, and the decision to 'divorce itself from the firm’s own culture.'” Others have traced the transition from engineering-centric to business-centric culture to the 2001 Boeing takeover of McDonnell-Douglas, which paradoxically resulted in McDonnell-Douglas executives in charge and subsequently the move of headquarters to Chicago, 1,500 miles away from the company's engineers.

It is not hard to conclude that over the years Boeing had migrated from a corporation guided and populated by engineering to a company guided and populated by business-centricity, and the 737 Max disaster was a distal result of the prior cultural shift.

The CDC – Striking out on COVID-19

This mishandling of COVID-19 by CDC is already legendary, and we have only understood a small part of it. What ProPublica summarizes as “the botched COVID-19 tests, the unprecedented political interference in public health policy, and the capitulations of some of the world’s top public health leaders,” came as a shock to the world at large, which until then regarded the CDC as a world-premier organization. Although we will soon know much more about the CDC implosion, we can already discern the outlines of chronic decay that foretold the acute failures.

The now almost forgotten panic over ventilator shortages gives an indication of possible chronic loss of initiative at CDC. As detailed by the New York Times, when the Biomedical Advanced Research and Development Authority (BARDA) was established under President George W. Bush's personal enthusiasm for an anti-pandemic capability, they foresaw a need for ventilators and moved to fill it. They let a contract to develop cheaper ventilators, were making progress, but then private business bought the development company and slow-walked the project, which would have undercut their own prices. When private business asked that the project be abandoned, the CDC did not protest, and the foreseen need was not fulfilled. That is typical bureaucratic passive behavior, not the behavior of a vibrant, achievement-oriented, admired institution. We can only be grateful, that ventilators did not prove to be very effective for COVID treatment, and that the potential need did not become manifest.

Insiders at the CDC were aware of the shortfall. The New York Times story alludes to disappointed employees, and to CDC Chief (2008-2017) Tom Frieden, who said he was excited by the progress in 2013, just before the sale of the company, but then we hear nothing about his attitude toward the subsequent failure. There is more to be learned here; the CDC has proved very adept at organizational self-protection.

The first pandemic sin of CDC, of course, was failure to connect the dots early, as Michael Lewis documents, and as he also documents that non-CDC people were actually doing in the organizational wilderness. CDC then acceded to political influence from the Trump Administration to soft pedal the expectations, hoping that COVID-19 would go away as SARS and MERS had done – despite indications that the infectivity of symptomless patients would make a significant difference. The memory of apparent overreaction to Swine Flu in the 1970's, that had cost Director David Sencer his job, no doubt remained fresh.

Then came the test kits debacle. Test kits were vitally, urgently needed as an initial step to contain the virus's spread. But the CDC, despite huge nationwide resources to produce tests, decided to produce its own and to ban the use of any others, abetted by FDA, which would need to certify each test. CDC then failed to produce a workable test. “'We have the skills and resources as a community but we are collectively paralyzed by a bloated bureaucratic/administrative process,' Marc Couturier, medical director at academic laboratory ARUP in Utah, wrote to other microbiologists on Feb. 27 after weeks of mounting frustration.” It is possible that this simple episode of bureaucratic hubris cost tens of thousands of lives, or more.

It is well known how CDC was compromised in allowing wholesale politicization of their organization and their public communications, involving specific health directions and specific language and specific data concerning COVID-19. Books are already being written about the sharpest decline of reputation of a public agency in our lifetime. As explanation, making the Director of CDC a political appointment is cited. Lewis's observation is also acute: “The root of the CDC's behavior was simple: fear. They didn't want to take any action for which they might later be blamed.” And in fact, despite a change of leadership and administrations, as of the very finishing of writing this paper – just this week! – the CDC has once again committed a sin of ultra-caution by claiming that outdoor transmission of COVID is “less than 10%,” and recommending continued wearing of masks outdoors, when the true number is no doubt less than 1%, and maybe as low as 0.1%.

But let me stop here. The case is clear enough.

Medical Care Organizations

No sector has shown more vividly the parallel growth of science and administration than health care. Evolving from the past era of smaller organizations and professional dominance when doctors called the shots, the modern era of corporate rationalization is dominated by large medical organizations with a strong administrative component, including hospitals and insurance companies. Instead of one large event, in this section I will cite small but representative events that my friends in medicine and I have experienced personally.

A friend of mine who later became president of the American Academy of Pediatrics led a program at Cincinnati Children's Hospital that enhanced connections between community physicians and hospital physicians. They succeeded in increasing efficiency and reducing admissions. Seeing reduced occupancy, however, the hospital board declared themselves not in the business of producing unfilled beds and promptly axed the program. The board's narrow view of their mission, even though they are non-profit, differed from the objectives of hospital doctors and enlightened medicine in general, but that made no difference. There was no appeal possible.

When I headed Bayside Medical Group, we were members of a locally-based Independent Physicians Association (IPA) – an independent payer group sitting between insurance companies and medical practices. In an effort to bolster practice quality, the IPA decided to use their in-house billing statistics to measure each practice's use of inhaled corticosteroids for chronic asthma, with fines or bonuses to follow. Our practice had 55 cases judged out of compliance. I investigated each case individually and demonstrated unequivocably that in 52 of the 55 cases, their measurement did not reflect reality. The IPA administrative staff rejected our findings on the basis of gobbledegook. I appealed to the medical director, a physician in practice who also worked for the IPA, and he rejected our claim on the basis that the IPA program had good intentions. As an IPA employee, he had been captured.

Hospital forms require attesting that a three year old is a non-smoker. World class British neurosurgeon Henry Marsh recounts being illegitimately brought to heel in the National Health Service by the administrators, who utilized a physician-administrator whose major qualification was he ability to agree with administration, and to admonish fellow-physicians in behalf of administration. A young American doctor recounts how he could only be properly diagnosed and treated when he found a primary care practitioner who would buck the organizations strictures to achieve “productivity.” These everyday examples reflect a medical enterprise widely polluted by administrative predominance, which forces doctors to stifle themselves and soldier on with blinders to ensure their own survival. The experience of many doctors resembles that of engineers with O-ring problems, or with airplanes that they fear will crash.

The Proposed Solution – The Professional Quality Board

As I alluded to above, the mission of the PQB would be to be the professional scientific conscience, the professional scientific safety valve, and the professional scientific corrective conduit for the organization. Sitting as a permanent body with quasi-independence, they would routinely assess the direction and decisions of the unit (chronic function,) and would be constantly alert to internal tipoffs about specific situations (acute function.) The PQB would look for signs of chronic organizational disorder where professional standards are being compromised, and would be available for intervention in acutely dysfunctional situations, especially dangerous ones.

Communication with members of the organization would be confidential. Access to information would be guaranteed, although trade secrets would be protected. The primary communication between the PQB and the unit would be Chairman of the PQB to CEO and Chairman of the Board in non-governmental companies, and Chairman to leader of the unit in question in government. The PQB would have the option of communication with higher officials or the legislature in the case of government agencies, or regulatory agencies in the case of a company, or in both cases, should internal communications fail, with the media. The PQB would be the ultimate conscience of the organization.

The PQB would be composed of senior, respected former members of the unit or recognized experts in the field, all tightly bound to the declared mission of the agency or company. Being named to the PQB would be viewed as an honor and a responsibility. Their charge would be to put the institutional mission first, and they would take a solemn oath of professional idealism, similar to the still-revered Hippocratic Oath. Profit of a company or advantage to the governmental unit would explicitly not be their charge.

Funding would come from the companies or governmental units themselves. To cushion the threat of reduced funding which could be used as a weapon, a specific governmental unit would be assigned to arbitrate PQB funding disputes of both governmental and non-governmental units. After the initial establishment of the PQB, further membership additions and subtractions would be proposed by the PQB itself, with the agency or company having a veto that could be overridden by a preponderance of the PQB membership.

To some extent, the PQB could be viewed as an institutionalization of preemptive troubleshooting. The PQB would be a constant resource for leadership course correction. For specific problems they would be empowered to receive whistle blower complaints, and they could themselves pursue specific issues with their investigatory power, including the “L6 approach.” (Lewis, page 231) “L6” refers to the fact that in bureaucracies, the person who knows the most important details for specific problems is usually found in the bowels of the bureaucracy, perhaps at the 6th level down from leadership. The PQB thus would have some of the qualities of an Inspector General, but with a specific scientific bent, and more of a general mandate for policy and acute interventions.

Alternative Solutions

The difficulties of integrating professional expertise and values into large organizations is a well-known problem. Various solutions have been tried. One is to bring representatives of the expert community into the management chain as engineer-administrators or physician-administrators. These bi-skilled personnel can better understand both intricacies of the problem being attacked and the thinking process of their personnel. They might also bring the values of the profession into practice better than lay-administrators.

Bringing professionals of the home discipline onto the board is similar. In all these cases, it is assumed and reinforced that the professional's primary loyalty is owed to the company and that everyone needs to be rowing in the same direction. The goals of the company are to be paramount; the ideals of the profession are more of a constraint than a goal.

In some agencies and companies the task of scientific legitimacy is solved informally. The counsel of “elders,” most often retired and respected former officials, may be sought. Thus, when the Chairman of the Joint Chiefs and the current Secretary of Defense joined President Trump clearing peaceful demonstrators on a march from the White House through Lafayette Square to St. John's Church, they both were moved to apologize after they had received substantial pushback from retired generals and others. The FDA has a respected advisory committee. Five former FDA commissioners jointly suggested that President Biden name a new FDA commissioner promptly. Former CDC director Tom Frieden wrote an impassioned if fruitless letter to then-current CDC director Robert Redford to reject the importunities of the Trump Administration and stand up for science and the independence of the CDC.

The obvious scientific and procedural deficiencies and political influence on the CDC and FDA in the COVID response has provoked a flurry of suggested reforms to protect science, here in JAMA, here again in JAMA , and here in The New England Journal of Medicine. All look for ways to insulate science from politics, each considering making the CDC and possibly the FDA independent on the model of the Federal Reserve. The NEJM source suggests that: legislators could consider a broad reorganization of public health functions and create a superagency, whose purview would include everything from the approval of drugs and devices to the maintenance of national stockpiles of protective equipment. ...These agencies share important features, including protection of executives, multimember leadership, established qualifications and confirmation processes for executives, political balance, and budgetary stability.”

While all these approaches have made their contributions, I suggest that they are insufficient. Having personnel with mixed motives will generally make the primary motive predominant. Older, revered personnel might carry the scientific and medical ethics strongly, but the informality of the connection makes quick intervention very problematic, their information may be deficient, both of which attenuate the strength of any intervention or influence, and both of which make the intervention late, and only in major cases. Instead, the proposed PQC would use the prestige and weathered viewpoint of august personages, but would ensconce them in positions with some power, albeit not line authority. The existence of a PQC would give concerned people a place to go.

The most recent proposals responding to the CDC shortfall would involve a huge restructuring of health agencies, which would be attended by the usual bureaucratic deficiencies, and which would be very difficult to achieve, given congressional and executive investment in oversight and turf. Enlarging the circle of responsible agencies and inviting a diversity of interests to help stir the pot is more likely to lead to confusion than a sharper focus. Independence of already-troubled agencies is unlikely to promote reform. Instead, appending a PQB to each agency and company would be much easier to implement and would afford more specific expertise and accessibility for each problem as it arose, and would provide a beneficial filter between concerned outsiders and the agencies themselves.

Could PQB Interventions Have Averted the Problems in our Examples?

Challenger. The engineers who knew the O-rings could lead to disaster had nowhere to go with their worries when they were dismissed by the regular line of authority. If NASA had had a PQB, the engineers could go there on an emergency basis and present their evidence. The PQB would have an emergency protocol in place. If they found the evidence convincing or concerning, they would place a call to the NASA Administrator. If he were concerned enough, he would be able to supersede the decision of the project manager and disaster would be avoided. If not, other venues would be available.

In addition, if NASA were becoming overly bureaucratic and chronically making bad scientific decisions, a PQB would be a perfect vehicle to report this belief to Congress, the Inspector General, or the President.

737 Max. The engineers who were emailing each other, telling each other that they wouldn’t risk their family being on a 737 Max flight, could go to the Boeing PQB with their concerns. The PQB could then call a meeting with the CEO and make a presentation to the Boeing board. If they made no progress, they could demand a presentation to shareholders, or they could go to Congress or the FAA. As consummate professionals, they should have the ability to make a top quality determination.

In addition, Boeing is alleged to have tilted strongly toward the business-orientation for profits rather than the professional-orientation traditional at Boeing. The PQB staff should be sensitive to this as they make their continuous assessments looking specifically for this. Interviews and access to internal documents should be revelatory. The PQB would take their concerns to the CEO and the board, and they would be empowered to present their findings to shareholders in their annual report to the board that would be shared. Their governmental contractees would then be informed and be able to act appropriately. The engineers within the company would have no other formal way of working for that rebalancing, and failure in the marketplace works too slowly, and too dangerously.

CDC. The long running problem with ventilators would be exquisitely amenable to an PQB intervention. The COVID lab test issue happened so quickly that it might not have been avoidable – bad decisions under pressure are hard to avoid. But one can picture an alert PQB, activated for the acute problem of an impending pandemic, playing a very active role where the organization was clearly failing. A PQB would have been a strong protection against the political pressures of the Trump Administration, although it would have involved going to Congress and the press, and it may not have worked.

The chronic decline of the CDC is a different story. As detailed by Lewis, like many once-proud organizations, the CDC had migrated from an agency guided and populated by audacious disease fighters, to scientists who were excellent in their quality, but who looked more toward academic achievement in their writings and support of other actors in giving data of what had already happened, rather than an agency geared to active combat with the current problems of people and death. The CDC had been bureaucratized and encrusted in righteous isolation from battle. At the very least, however, the tradition of the CDC could speak through the PQB and wage a fight to be activist.

Actually, given the history of the CDC and the history of the rise and fall of the Bush pandemic alert efforts, it seems obvious that a major review of our structures and objectives has to be pending.

Various Medical Issues. A PQB would give medical professionals somewhere to go to with their concerns. The PQB could go to the Board and CEO, to higher governmental officials, to Congress. They could issue periodic reports. Transparency rather than obscurity would give professionals a chance to regain some traction in their concerns. As health care institutions continue to consolidate, major changes are needed at the highest governmental levels, and PQBs would be excellent sources for innovation ideas and continuous monitoring, and a prescient blogpost has indicated.

In running companies and government, nothing is assured. In the end, one can arrange administration into many different configurations, but in the end it is high character and skill that is telling. Nonetheless, properly arranging units and explicitly seeking high character and skill can increase the chances for justice to be done; transparency likewise.


It is worthwhile to consider possible objections to the PQB proposal. They would be generally that one is not necessary, or that they would probably fail.

Not necessary

Some might say that senior ex-officials already serve some of the PQB goals informally. But such interventions are sporadic, disorganized, and ad hoc. The possibility that ex-leaders will intervene as a deus ex machina solution to a dangerous situation or chronic displacement of goals seems quite unreliable. Informal influence worked to get Esper and Milley to recant their participation in the Assault on Lafayette Square – ex post facto – but it was ineffective with Redfield at the CDC.

Others say that having a professional voice all through the organization by having the professionals in administrative positions should serve to inform organizational actions with professional ethics. Unfortunately, that is rarely true. Most often, the professionals are seduced by the business mission of the organization and by the lure of their own advancement from conforming to organizational norms. They are told that their role is to bring along the professionals and pacify them. In short, it is common experience that professionals in administrative positions to be most often representing the organization to the professionals rather than vice-versa.

Some might say that the market should be the proper disciplinary force for a company. If we are dealing with television companies or computer companies or toaster companies, yes, true. But if we are dealing with large companies and institutions, or local monopolies like the ones that hospitals often enjoy, then no, the market will be inapplicable. Something else is necessary.

Some might go further and say a PQB would unnecessarily burden and distract a management team that needs support in its mission rather than further encumbrances. After all, the natural tendency of organizations is to become “blame organizations,” where the main motivational incentive for personnel is to stay free of blame and thus keep their jobs safe, while the best leaderships seek to make their organizations into “achievement organizations,” where failure in pursuit of aggressive goals is acceptable. A conservative PQB could be a hindrance rather than a professional quality corrective; the old guard can be anti-progress. The answer to this objection lies in the selection of excellent and experienced personnel for the PQB, but it has to be admitted, mistakes will be made. The PQB would not be a universal cure-all.

Could fail

While we hope for the wise views of seasoned veterans with high ideals and professional values, a PQB could easily find itself composed of overzealous, oppositional, regressive types seeking to promote their own pet projects, favoring personnel within the agency for personal reasons, and pursuing narrow idiosyncratic objectives. The PQB might be more trouble than it is worth, and seek to insinuate itself in areas where it should be intrude, and thus become more of a pest than a salutary corrective force. The PQB might become a haven for those who were passed over and have grudges to pursue. It would not be unusual for an administrative leader to be more invested in professional excellence than ensconced professionals, as in a hospital. The administrators could be the ones who know how to mount successful operations to instigate change (here).

The PQB might come to see its task not as upholding technical standards and being sensitive to the concerns of technical staff, but as supporting the company and reinforcing their business objectives. The backgrounds of the members of the PQB might actually be more pro-business than pro-professional standards.

The PQB could be captured, just as industry captures regulatory agencies. A difference here might be that regulatory agencies are often staffed by personnel weaker than the leadership of the company. The PQB leadership would be senior, and besides having the knowledge that comes with long experience, it would have no further aspirations for advancement or fears of losing a source of personal security.

Likewise, the company or agency might actively oppose the findings and attitude of the PQB, and be inured to its calls for change, and simply sideline them. From the initial appointment through many other points of vulnerability, the PQB can be disrespected and neutralized. The PQB could be subject to bad-will by the leadership of the unit. Having a PQB foisted upon an unreceptive agency or company leadership could be a recipe for conflict and failure, and should not be tried.

In all these instances, the key to the PQB effectiveness would be its membership, how they are selected, how they view themselves, and how active they are willing to be. Organizational structure can convey possibilities, but it cannot ensure personal actions. Any PQB would require the strictest attention to membership, and a common understanding of the role of the PQB.

In the end, perhaps the key point of leverage of the PQB would be transparency. Internal struggles could become more visible. Arguments could be widened to include more participants. Management would be forced to make tougher choices with the knowledge that their decisions could well be publicly reviewed. Even if the PQB members missed the mark on occasion, public knowledge of points of contention would be salutary. With transparency, if the administration were virtuous and the PQB in error, the truth would out, and the PQB reformed.


The science-based technical large enterprise is a distinctly modern creation. Their achievements have been immense; there is no escaping their necessity in the future. Thus, we should look at their failures and deficits with a mind to supporting them and enabling them to do better.

It is obvious that organizations change with time, although individual paths of growth and decay will vary. A very common pattern, however, is for the bureaucratic and administrative functions to overtake the influence of the basic scientific mission of the entity. I submit that a Profession Quality Board would be one solution to the problem.

The objections are not without merit. But, in the right organization and with the right people, the PQB could be just what the doctor ordered.

Budd Shenkin

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