The Houston Astros' sign-stealing scheme, in which the baseball team used video cameras to decode opponents' hand signals, offers a stark reminder for healthcare boards.
What's that? Think it's a stretch? Can't see the connection? Well, think again.
It's because the circumstances surrounding Major League Baseball's sign-stealing scandal are quite relevant to the healthcare industry and to the board's obligation to preserve a culture of compliance. That's why MLB's recent investigative report and associated penalties, and the related ripple effect throughout the game, offer an important teaching moment for healthcare industry boards and their executives.
First, let's start with the obvious similarities. Baseball and healthcare are iconic American industries regularly in the public spotlight. Both are subject to multiple rules and regulations, dependent not on the production of products but rather on the skills of individual employees. Both operate in extraordinarily competitive environments that heavily incentivize individual performance.
And then there are some not so obvious similarities. Both are grounded in a commitment to integrity and compliance, without which public confidence in their services would suffer, and both foster incredible awareness of the actions of their competitors. And while reliant in large part on the skills of elite professionals, both also depend on a sense of teamwork and trust.
OK, great you say. You see some similarities. But the relevance...wasn't this just a little horseplay by some ballplayers, in the grand tradition of the game? No, actually, it wasn't. It was a failure of corporate culture that permeated all organizational levels of a sophisticated business enterprise, from senior leadership through line executives to the primary workforce. It's about elite, intelligent and highly compensated employees actively deciding to either do what simple diligence would have told them was "the wrong thing," or turn a blind eye to those they knew to be doing it.
And that goes right to the heart of the healthcare board's obligation to maintain an organizational culture of compliance. Because it could happen on their watch, too.
For the MLB scandal speaks — loudly — to those difficult situations when teams (and corporations) are confronted with attractive business options for which the legal rules aren't clear but the optical risks are more obvious. When does a hard slide, a scuffed ball or a brush back pitch, cross the line from "good baseball" or "sending a message" to cheating, or to the physically dangerous?
When does a business transaction or compensation arrangement cross the line from legitimate arrangement to an illegal inducement to refer? The fog of interpretation. Pressure and temptation run high. Everyone else is doing it, why can't we? And who within the organization makes that call?
What makes this scandal so particularly relevant to healthcare is the presence of nuance, like with the application of MLB rules. According to media reports, there was a "broadly written rule" in place in 2017 that prohibited the use of electronic equipment for purposes of conveying information that would give one team an advantage over another. Yet it apparently fostered some uncertainty. Did it mean that a coach's own eyes, or a pair of binoculars, was OK, but a camera system linked to a TV monitor in the dugout was not? How best to guide decisions? To direct in-game strategy? Questions were begged, but apparently not asked too strenuously.
Apparently, MLB has recognized the ambiguity for it reportedly released new rules earlier this year (not available to the public) designed to clarify sign-stealing rules, especially those relating to the use of technology and replay systems. But these kinds of nuances pop up all too frequently in the corporate world as well. Healthcare statutes and regulations tend to be murky as well. But that's why there are general counsel and compliance officers, to help clear things up.
Indeed, from the broader commercial perspective, the MLB situation is not that unique. Management (or a coaching staff) will from time to time identify business options that promise great upside, but their "optics" look bad. Like sign stealing, these are options that fall into the confounding "gray area" of legal uncertainty (they're not clearly right, but they're not obviously wrong). These can be circumstances in which the pressure to "win," to achieve greater business success or personal gain, may trump measured judgment or inquiry.
In these circumstances, the expectation is that a strong culture of compliance will carry the day; when an inbred sense of integrity will serve as a firewall to the embers of malfeasance. When employees are oriented to do "the right thing."
But, for whatever reason, that firewall crumbled in the MLB situation. And there was no "fail safe" mechanism that would have alerted team ownership — here, the ultimate organizational authority; there, the governing board — to the problem.
So the sign-stealing scandal provides an unusually recognizable platform for some serious corporate accountability reflection. Are our incentives out of whack with our mission? Would our executives know to first reach out to counsel or the compliance officer with their questions? Would our line employees report their concerns upstream or feign ignorance? Would our culture hold?
Preservation of the organizational culture is squarely a responsibility of the governing board, no matter what the industry. But it's especially so for healthcare, with its many similarities to the business of sports. The board would do well to recognize the connection, and to ask the ultimate question — could it happen here? — and do some digging to find out. Because so much could be at stake.
The sign stealing scandal shows boards that optics count. And more importantly, ethics matter. Boards must take seriously their obligation to nurture an organizational commitment to corporate ethics.
Michael W. Peregrine, a partner at the law firm of McDermott Will & Emery, advises corporations, officers, and directors on matters relating to corporate governance, fiduciary duties, and officer and director liability issues. He is outside governance counsel to many prominent corporations, including hospitals and health systems. His views do not necessarily reflect the views of the firm or its clients.
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