Paul Levy is the President and CEO of Beth Israel Deconess Medical
Center in Boston. Paul recently became the focus of much media
attention when he decided to publish infection rates at his hospital,
despite the fact that under Massachusetts law he is not yet required to
do so. For the past year and a half he has blogged about his
experiences in an online journal, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.
Last week, the Harvard Medical School Division of Medical Ethics
held a session on the ethical issues surrounding blogging by a CEO,
particularly the CEO of a health care institution. Local examples were
this blog and the one published by Charlie Baker,
CEO of Harvard Pilgrim Health Care. Unfortunately, I could not attend,
but I received a note from one of the attendees who told me about some
issues that had been raised. I’ll report on that and add the comments I
would likely have made if I had been present.One of the
discussants identified four domains that he thought of as important in
thinking about the ethics of a CEO blog, and about which he posed some
questions: 1. Voice: Is the CEO blogger blogging as an
individual or as the voice of the organization? Charlie’s blog is
hosted in the HPHC website and linked to HPHC marketing materials.
Yours is on Blogger and not linked to the BIDMC site. But when the CEO
speaks, what he or she says can’t be separated from the organization.
reply: Whenever I give a speech, or testify before a legislative or
regulatory body, or give a media interview, or write an article (for
this blog or a journal) people assume that I am speaking from a
position of authority and responsibility for the organization. That is
just something that cannot be avoided. I do my best to be aware of the
institutional consequences of what I say, regardless of the forum.
2. Authenticity: Who is speaking? Is it a real human being speaking, or
an avatar created by a ghost writer? Are comments posted as received or
are there schills setting up softballs and deletion of tough questions?
In other words, is it a real voice and a real discussion?
I think my readers know that the posts are mine alone. Certainly, the
media relations people and lawyers at BIDMC know that! Likewise, the
comments are yours alone. I post them all, unless they contain bad
language or personal medical information or private personnel
information. I keep looking for those softballs, but they are few and
3. Reliance: From a legal perspective, to
what extent does CEO blogging create obligations for the organization
or claims that outsiders can make?
See #1 above. Concerning claims, there is little I say on the blog that
does not exist in some other form in the hospital (or in my speeches,
articles, or elsewhere) and therefore could be used by attorneys as
discoverable information in a legal proceeding.
Privacy: When Charlie or you draw on communications from
patients/members, even if these are de-identified, should consent be
asked for from the person(s) involved?
I ask for consent from patients or their loved ones who write to me. I
also de-identify the stories, unless the person involved prefers
otherwise. I do not generally ask for consent to use material a staff
member sends me about an issue or a process (for example, this one), but I would of course ask permission to print anything related to the personal life of a staff member.
I am a regular reader of Paul’s blog and I can attest that he does get regular comments from staff. Some of them are signed anonymous but ID themselves as employees. Others will say something like “BIDMS nurse”.
The paranoid could say that his CIO could identify the source if they posted inside the hospital, but they could just as easily post from home.
My impression is that he gets an unusually high number of comments from staff, based on my experience. This is a good thing.
“I do not generally ask for consent to use material a staff member sends me about an issue…”
I wonder how many submissions he gets from staff? Can a staff member blog as, “anonymous”? A blog here by the CEO of a local hospital gets little if any use from staff for fear of retribution. Is a CEO blog a legitimate blog without the contribution of staff?