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The Vice President, Mike Pence, toured the Mayo Clinic, without a mask, in the middle of a pandemic.

When questioned by reporters as to why he was not wearing a mask in line with hospital policy, a policy that the Mayo Clinic stated that Mr. Pence was aware of in advance in a now deleted tweet, the Vice President stated that he is tested regularly as are those around him and he wanted to be able to “look people in the eye.”

Footage of Mr. Pence’s visit can be seen below.

Later that same day, a question was posed on Quora (where I spend an inordinate amount of time) that got me thinking.

Why didn’t someone in authority at the Mayo Clinic stand up and tell Mike Pence, “If you don’t wear a mask, you are not entering this hospital.” Should that person who was in charge on that day be fired for failing to protect the patients?

A fair question, but one of the reasons the question gave me pause for thought, was that I had faced a similar dilemma a couple of days earlier.

Like most veterinarians, the animal hospital I am Hospital Administrator for is operating locked down – with clients being made to wait in their cars and only patients and staff allowed in the building. In addition, all staff have their temperature taken before entering the building and wear a mask for their whole shift. That policy worked just fine, until the day a client walked into the lobby and refused to leave when asked by staff members.

I was called into the lobby by one of my front desk supervisors. When I arrived, the unmasked client was defiant and refused to leave the lobby when asked multiple times. The client was upset that her dog was sick and currently hospitalized. She felt that it was too hot for her dog to be brought out to her in her car for her to visit with, and therefore was demanding entry to see her dog. I explained that I knew nothing of the situation, and that I would be more than happy to help in whatever way I could, but none of that was going to happen until she left our lobby and returned to her car.

I have had to ask clients to leave the premises in the past, and I have even had to call police to make it happen. As I was talking to this client it was running through my head that I might have to do this again, or at least threaten to, to protect the doctors and staff. However, it was also running through my head that we had a hospitalized patient who was in the middle of treatment. Could the forced removal of a client from the building be interpreted as denial of care? It is doubtful that the client is going to continue their pet’s treatment at our hospital if the relationship breaks down to this point. What happens to the pet? Is the pet well enough for an orderly discharge? What happens if the pet dies either directly, indirectly, or just shortly after being discharged?

All of this with raised voices in the lobby, out of the blue, with no time for refection or the advice of others.

Now, as it happens, the client did return to her car and a quiet chat with the doctor, car side, resolved the immediate issue. But what if we would have called the police and had the client removed from our property, her pet discharged before being even close to well, and things had continued to deteriorate? Review and social media warfare for sure. Local news and / or regulatory involvement? Quiet possibly.

Upon reflection, I would do the same thing again and I actually feel more than ever that even if I had ended up calling the police it would still have been the right call. But I’m sure others would have disagreed. And some of those may have been people that I report to – including the staff it was my aim to protect.

I don’t run an organization anything like the size, or complexity, of the Mayo Clinic and one can’t imagine what it must be like to hold that position, in human healthcare, in the middle of a pandemic. Having a dignitary like the Vice President means national news coverage. It is the kind of publicity that public relations departments were created for. It could mean government dollars, PPE, and access; all of which are sorely needed right now.

If, of course, it goes well.

If it goes wrong, all of that could be in jeopardy and a lot more; The reputation of the Mayo Clinic in the eyes of half of the electorate, for example. As Mike Pence has stated, the risk from him is probably minimal, given the protective bubble he currently finds himself in. The example that he sets, however, is awful. It is an example of “the rules don’t apply to me” because of XYZ – much like my lobby client.

I cannot condemn the administrators at the Mayo Clinic though. Standing up to people because it is the right thing to do, can have serious consequences. Embarrassing the Vice President of the United States would have had serious consequences for the hospital, the staff, and the administrators. Being right is not always a defense from consequence. To make that kind of decision in the heat moment, is an almost impossible. And it is certainly impossible to make it and to not double guess yourself.

The issue reminds me of the incident at University Hospital in Salt Lake City where nurse Alex Wubbels was arrested for not going against a policy agreed upon between the police and the hospital. She would not provide a blood sample without the consent of the patient. The clip below shows Nurse Wubbels on the phone with the hospital administrator, and the police officer concerned, right before her arrest. The arrest of Nurse Wubbels was national news.

All decisions have consequences. In the Alex Wubbels case, the arresting officer was fired, and his supervisor was demoted two ranks. The City of Salt Lake also settled a lawsuit for half a million dollars. But this took serious guts on the part of the hospital, and of course Nurse Wubbels. It would have been so easy to bend the rules for people who you work with routinely, want and need to have a good working relationship with, and even been seen as doing the right thing in many corners.

Being right can often be a balancing act. Second guessing decisions made in the heat of the moment, particularly when confronted by authority, or just someone who is confrontational, is often unhelpful. As managers, we have to fall back on integrity and the momentary weighing of risks.

But the balancing act is rarely black and white.