The application of the above helps to explain much of what is happening around us, the failure (or success) of the state, society, you name it.  Another addition would be Hoppe’s description of time preference and its influence on human behavior.  

Awareness of the above has helped us avoid the natural course of events, according to Nock.  

We have kicked surgeons out of our partnership who would have rendered large profits, but with whom we did not want to be associated.  They either were no good, no damn good, or jerks.  

This has allowed more than anything for continuous improvement in the quality at our facility and staff.  When we get busier, the staff clearly prefers to work harder, rather than “hire warm bodies,” as this actually makes their jobs even harder.  

When we try out a surgeon who is no good or no damn good (unethical) we pull the plug on their ability to schedule cases and politely inform them that this is just not going to work out.  I never saw a hospital do this in the years I worked there.  In fact, working with jerks who were no good or no damn good (or all three!) was a big part of Dr. Lantier’s and my decision to walk away and start our facility.  

“Why isn’t Dr. X working at your facility?  I know he would like to and he would make you a lot of money.”  Not sure how many times I have heard that.  While we value our reputations, we have always thought that this short term “hit and run” business mentality was not consistent with our desire to always ensure a mutually beneficial environment.  

“Are you crazy?  Get what you can while you can!  Why would you charge one penny less than what you can get away with?”  Not sure how many times we have heard this, as well.  Demonstrating and providing value to our patients is not only right thing to do, but unlike acting in the mainstream health care way, is not sustainable and therefore not stable, making our job situation tenuous.  Our competitors are beginning to feel the heat of our success, having criticized us for years, seeing patients make the move our way, instead of endure the usual mill.