Paul Hammant's Blog: Risk And Responsibility Should Be An Exchange

Risk and responsibility are an exchange. At least, they should be.

This came up in questions at the end of my QConLondon presentation (March 2nd, 2020). That was about being “on-call”, and whether management was fair to those on call. The question from the attendee was nuanced and I forget what it was precisely at this time. I also kicked myself for not working this risk:responsibility into the main presentation.

Worked example: COVID-19 risks and the responsibility of being a medical professional right now

Some hospitals (in the USA and elsewhere) have handed you, the medical professional, the risk of contracting COVID-19 by not providing adequate personal protective equipment (PPE). If that is true then, in turn, they should take responsibility to:

1. get you better at all costs if you catch COVID-19 and fall ill
2. compensate you adequately for loss of earnings while you are ill
3. compensate your surviving relatives adequately if you die: Say $1M and upwards

You see Risk and responsibility are an exchange. The worst hospitals with inadequate PPE instead think that their responsibly is limited:

1. if you catch COVID-19 and fall ill you take your chances like everyone else, but maybe prioritized for a ventilator over members of the public (no promises)
2. uncertain continuation of salary for the duration of your disappearance from the workforce
3. a death in service benefit that is $NNN to $NN,NNN only, or $0 depending on your contract

So there’s a sense that some hospital administrators are “sticking it” to medical professionals by handing them risk AND responsibility, instead of that being an exchange.

I’m sure the right thing will happen, but it may involve lawsuits with or without union assistance to force the right protections/comp. If hospitals want to avoid the responsibility of putting medical professionals at risk then they have to supply PPE whatever the expense, and set up multiple supply lines with many contingencies too.

There’s even been a case in the USA of at least one hospital telling a medical professional that she was not allowed to use her own N95 mask. She duly insta-quit, which handed responsibility right back to the hospital (responsibility to find someone else to fill those shifts). The hospital no doubt shit themselves and put four more administration staff (they themselves not necessarily medical professionals) onto the task of getting PPE (including contingency) into the storeroom and ensuring they don’t run out again. Same for a UK National Health Service (NHS) healthcare assistant.

Interestingly, I wore a cloth facemask for much of the conference. This because QCon not accepting responsibility (as above) while handing me risk that I might catch COVID-19 at their conference. Not that I’d discussed it with them upfront. But I fixed it myself anyway by bringing my own amateur PPE. QCon - way ahead of the curve - changed a lot about the event to decrease risks (hand sanitizer everywhere, totally changed food prep and delivery), but the attendees were still breathing each other’s exhaled breath, so I wore a mask. As it would happen, two attendees or speakers later tested positive for COVID-19 and I had to self-quarantine (work from home - no big deal).