Chapter 5: Who gets the liver?

What the hell does a liver have to do with management?  Well, here is a story about liver transplants, who gets them, who doesn’t, and how the values of the people that make the decisions, i.e., people like you, influences decision making.

Now you may never be involved in such life-or-death decisions in your work life, but you certainly will be called upon to make a call at some point in your professional life that isn’t simply a clear-cut “this is right, and that is wrong” type of choice.

Back in the late 1980s, the State of Arizona decided to eliminate liver transplants for their residents who were receiving Medicaid benefits.  If you don’t know, Medicaid is the Federal program that provides medical benefits and services to people with physical, intellectual, and, more pertinently, for this conversation, financial challenges.  Poor people.

They made a willful decision to specifically defund these procedures.  They were too expensive; they only served a small number of people each year, and that money could be used to provide more and better care for many others if those funds were redirected.  Those were just some of the rational arguments they used to conclude that they should make this decision.

Of course, if you lived in a neighboring state, you were eligible for the transplant.  And if you could pay for it, or had the right insurance coverage, then you certainly could get one.

Here was the leading paragraph from an editorial in the Arizona Republic newspaper –

“Dianna Brown, who will be buried this morning in Yuma, was the first person to die under Arizona’s new death penalty law.  She was 43 years old.  She had committed no murder.  No conspiracy.  No theft.  No parking violations.  No crime.  Dianna Brown’s only offense was to be poor and sick.  Under Arizona law, that is now punishable by death.”

So, can you see how the differing values are at play here?  And who can say which one is right or which is wrong?

In a little closer-to-home decision, I used to ask Parks and Recreation professionals to tell me who gets the trophy?  Just the winners?  Or everyone that shows up?

Why were programs for children subsidized by tax dollars, but those for adults were not?  Or why were expensive services like pools only costing the participants a couple of dollars to get in to use them while equally, expensive golf courses charge 10 to 20 times more than that to play golf?

Not that you are involved in Parks and Recreation but ask yourself to answer those questions and defend both sides.  Then try to relate it to a work situation you may be in or had been in and see how your values, the lens that you view the world through, weighs heavily on how you make decisions.

The key takeaway is to be able to recognize it and then use it to make what is the best choice for your organization.  One based on the facts, differing viewpoints, and yes, values, and armed with that knowledge, go do your thing.

And the good part, is that you are really not “wrong” no matter what you decide.  BUT you will need to defend your decision to the boss, the owner, the customer, etc.  If you are not able to articulate a clear rationale, you will only get so many chances to make decisions before they move on from you.  And you will either be out or left to whither in a meaningless job.  Don’t be that!

Hope you are enjoying your summer! 

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    Meet the Author
    Joe Stout is the former Commissioner of the Westchester County Department of Parks, Recreation and Conservation. In that capacity, Joe oversaw an operating budget of $55 million and a capital budget of $250 million. He supervised a staff of more than 340 annual employees, over 1,000 summer staff, and the operation of more than 44 parks encompassing over 18,000 acres of parkland. Read more about Joe >