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  • BIOETHICS FORUM ESSAY

Turfing Major Hasan

“Turfing” is a practice that passes for problem solving.  To turf your problem is to reclassify it as someone else’s problem, and then to get it off your turf and onto their turf. As an organizational practice, turfing is a cousin of the workaround, in which workers encountering a system bottleneck or flaw – a poorly designed piece of equipment, a confusing policy, a difficult colleague – work around the disruption through informal fixes. These fixes can be innovative, pointing toward problem solving, but workarounds themselves do not solve problems, and may worsen them.

In their 2005 study of workarounds in “error-prone” organizations,  Steven J. Spear, of Harvard Business School, and Mark Schmidhofer, a cardiologist at the University of Pittsburgh Medical School, concluded that an organizational culture that confuses workarounds with problem solving is a culture that tolerates ambiguity about safety and danger even when clear distinctions can be made.  In such organizations, small mistakes lead to big mistakes, and eventually, to that catastrophic mistake that seems so bewildering in retrospect.

As strategies for avoiding problem solving in organizations, turfing and workarounds differ in that turfing relocates the problem, while a workaround leaves the problem in plain sight. Workarounds may be more characteristic of workers on the receiving end of orders, while turfing requires sufficient authority to take action to relocate the problem. And while workarounds may be informally rewarded by peers – thanks for figuring out how to override that annoying alarm! – permitted by supervisors, and confused with efficiency by leaders, there’s some moral queasiness attached to turfing.

In health care, it’s unlikely that a professional will state, first-person-singular, that “I turfed that undocumented patient with end-stage renal disease.” When turfing is acknowledged, it’s more likely to take shelter in collective deliberations and evasive maneuvers. So that patient might be handed a bus ticket or a plane ticket, in the sincere hope that things will work out better somewhere else. This hopefulness may edge into magical thinking: that some other state is financially flush, that some other hospital has ample funds for charity care, that moving the problem will make the problem go away.

Which brings us to Major Nidal Hasan and the massacre at Fort Hood. Reporting by Daniel Zwerdling of National Public Radio suggests that Hasan was turfed by physicians and medical school faculty at the Uniformed Services University of the Health Sciences, who suspected that the psychiatrist was psychotic. One source, also a psychiatrist, told Zwerdling of the military’s “long tradition” of dealing with “somebody who is a loser or is a failure or you’re worried about” by assigning that person to a job “where they can, you know, do as little harm as possible.”

So, according to Zwerdling, “they decided, let’s send him to Fort Hood.” Their reasoning: Fort Hood already had “lots of psychiatrists.” Hasan would be, at worst, superfluous, and his new colleagues could “monitor” his worrisome behavior.

But what confirms this as turfing is the wishful thinking a psychiatrist expressed to Zwerdling: “We were sort of hoping he’d go to Fort Hood and disappear.”  The massacre at Fort Hood is a reminder of Spear and Schmidhofer’s observations that catastrophic events can be traced back to patterns of ambiguity within the organizations in which they occur.  In this case, the clear distinction between “psychiatrist” and “psychiatric patient” may have become blurred, with tragic results. And this event reminds us of why it should make us queasy when we spot something troubling on our turf and are tempted to move it far enough away that we can’t see it anymore.

Published on: November 17, 2009
Published in: Professional Ethics

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