Curbside Consult with Dr. Jayne 4/22/24

I recently spent some time in Silicon Valley, meeting with both existing and potential new clients. I have to say, this is the greenest landscape I’ve seen in this part of the world in a long time. The area has had a lot of rain in recent months and the vistas look very different when they’re not painted in shades of brown. I’ve worked with a number of startups over the years, some of which are headquartered here and others in other tech-heavy parts of the country including Austin, Atlanta, and Las Vegas. It’s been interesting to see how the places have changed and the nature of the business has evolved in recent years. Some of the players, however, don’t seem to have evolved much.

When I first became involved with healthcare technology, it was definitely male dominated. My health system had one or two women analysts, but none in IT management or executive positions. Our ambulatory EHR project was led and managed entirely by women who had a reputation for taking charge – especially since we were the organization’s first technology project that was run by the customer rather than by IT. We opted to lease IT resources from the organization rather than having them run things, since we had several years’ experience with ambulatory EHRs and practice management systems and they had none. Even though we had a bit of friction due to that project structure, everyone was professional, and we were able to get an amazing amount of work done.

Our vendor had a bit more of a boys’ club vibe, with nearly all executive functions held by men. There were a few women in management positions, mostly in more supportive departments like training and accounting. This was my first exposure to what we now call “bro culture,” but at the time, the bros were more outliers and it seemed like executive leadership humored them because they drove results, but only to a point. The guy who took clients to a strip club disappeared from the company shortly after the incident, and people who made inappropriate comments were quickly sidelined. Fast forward half a decade and I was introduced to my first real “bros” – who espoused not only the culture but who somehow brought leadership under their spell and convinced them to spend millions of dollars on projects with questionable merit and even more questionable management. It was the first time I saw people throwing money around with abandon and marginalizing the people who were actually experts in the field and who were doing the work but who didn’t buy in to the culture.

Over the years, we’ve seen the rise of tech bros and pharma bros, and lots of bros behaving badly. Especially after my recent travels, it’s clear that bro culture is still going strong. There are numerous articles out there about the phenomenon, including in the human resources literature. There are some common features seen as people define the issue – including a culture that places winning (and hustling) above all and that excuses the bad behavior that often happens along the way. Bro culture often includes excessive partying, bullying, and harassment of colleagues who don’t play along. If you’ve been in an environment where coworkers make comments because you’re not drinking alcohol or not drinking as much as everyone else, you might be in a bro culture. If you’re hearing snide comments about parental leave, blocked time for breastfeeding, or colleagues being “no fun,” you might be in a bro culture.

I find the phenomenon interesting, because some of the most hustling, winning people I’ve ever worked with are distinctly not bros. At one company, the teetotaling sales reps who were eager to get home to their families did some of the best work, closing deals all over the place. They won by understanding the voice of the customer, prioritizing customer and prospect needs, and valuing the people who worked with them. When working in those environments, I never experienced the level of malicious gossip, toxic commentary, or foul language that I’ve seen in recent times. Don’t get me wrong, I’m not afraid to drop the F-bomb when it’s warranted, but it’s all about knowing your audience and the situation. But if you’re in a situation where inappropriate comments are the norm and not the exception, you might be in a bro culture.

In some organizations I’ve worked with, investors play a role in supporting the bro culture. The New York Times ran an article about this back in 2017, and there are many things about this that haven’t changed. The piece noted that change will only come “… if the people in charge of Silicon Valley – venture capitalists, who control the money – start to realize that the real problem with tech bros is not just that they’re boorish jerks. It’s that they’re boorish jerks who don’t know how to run companies.” I felt validated when I read other comments in the Times piece. As a physician, I’m often one of the only “licensed” people working with a company – the other area being legal. Physicians working in clinical informatics are highly attuned to regulatory and legal requirements and use that knowledge to keep stakeholders out of trouble. If you’re working with people that push you to ignore regulations, you might be in a bro culture. Recent settlements between the Department of Justice and various tech vendors tell that story.

The Times piece uses Uber circa 2017 to make many of its points, with some of those being that “toxic workplace culture and rotten financial performance often go hand-in-hand” and that “bros do best when they hire seasoned executives to help them out.” The author referred to “adult supervision” and “institutional restraints” as essential to avoid a situation where bro “vices end up infecting the culture of the workplaces they control.” One thing not mentioned in any of the articles I found but that I’ve heard about from a couple of people is what we might call the “girl bro.” She definitely has bro tendencies but also functions as an enabler for bad culture and sometimes as a “fixer” trying to clean up messes as they occur. Most of the girl bros I’ve heard of have been in sales roles, but I’ve also heard of them filling an HR function, and if you identify one of the latter rare creatures in the wild, you’re definitely in a bro culture.

I agree with the Times piece that sometimes it takes the business cratering before you start to see a change. That’s unfortunate for the people who work at those companies and who are just trying to get by. Especially in healthcare technology, it’s important to remember that not only are workers there because they’re trying to support their families, but also because they’re often “true believers” who want to do the right thing for patients and their loved ones. I think for those types of individuals it’s especially difficult to be in a bro culture and they often vote with their feet.

What do you think about bro culture in healthcare, and in healthcare technology in particular? Leave a comment or email me.

Email Dr. Jayne.