Question

What available options does a leader in a health organization have to develop an integrated system of ethics and moral practice? What would be the potential impact of each option regarding appropriate ethical adaptation across the organization? Is treatment by ability to pay moral? Are treatment decisions based on a patient’s age moral? Are ability to pay or age treatment decisions more or less moral? (must be atleast 300 word response).

Answer 1

Healthcare leaders and those aspiring to be leaders must recognize first and foremost that character and integrity constitute the very cornerstone of leadership. Organizations have failed and promising careers have been derailed when ethics have been relegated to secondary importance or, worse yet, ignored in the pursuit of more bottom-line considerations. Healthcare managers must understand their role and responsibility in creating an ethical healthcare environment that is honest, just, and always in the best interests of those being served. Whether you are the CEO, an assistant administrator, a department head, a program manager, or a clinician, if you are “in charge,” you have the ultimate responsibility for establishing the culture and setting the standards of conduct in your sphere of influence. This task is not always an easy one. Nor is it easy for well-intentioned managers to always make ethical decisions themselves.

BARRIERS TO ETHICAL DECISION MAKING

1.Failing to recognize that ethics and management decisions are interrelated. Management decisions are too often based solely on financial data, market share, and other bottom-line considerations without regard to ethical implications. Ethics and management are, in fact, closely related

2. Failing to recognize that management decisions directly affect clinical care. Operational decisions must take into account how actions affect patient safety and healthcare needs.

3. Failing to integrate ethics into the way of doing business. Ethical standards must be more than a well-crafted values statement published in the annual report. They must be incorporated into the work life of every staff member throughout the organization, from the boardroom to housekeeping.

4. Failing to understand that just because something is legal does not mean it is ethical. Pushing legal boundaries does not build leadership character. Wise leaders recognize that the role of the attorney is to advise regarding the law; the healthcare leader must decide what is mor ally right.

5. Believing you are above the rules and laws of “ordinary men.” Hubris is often at the root of unethical behavior. Leaders cannot operate by one set of stan dards and expect their employees to function under different, higher ones.

6. Rushing to judgment. Ethical mistakes are often the result of hasty decisions made without reflection and consulta tion with others. Aspiring leaders may mistakenly believe that rapid, independent decisions are expected of them and are the mark of a leader. Technology has further compounded our time crunch. Healthcare managers who are hard pressed for time suffer from information overload. Always-on, multitasking work environments leave little time for thoughtful analysis of ethical dilemmas and the implications of decisions (Dean and Webb 2011).

7. Believing that when everyone else does it, you can do it, too. The creep of moral relativism, in which the standards of right and wrong are mere products of time and culture, may have become more pronounced through the economic downturn and new challenges in healthcare. If everyone is bending the rules, don’t we need to do the same to remain competitive? Experienced healthcare leaders know that bending the rules for short-term gains may have long-term negative consequences. Inevitably, questionable

OVERCOMING BARRIERS TO ETHICAL DECISION MAKING

1. Establish ethical standards, expectations, and a written code of conduct. Rethink the code of conduct regularly, to ensure that it is current with ethical demands. 2. Hire ethical people. Consider presenting ethical dilemmas as part of your organization’s interview process. 3. Cultivate a relationship with a trusted colleague within or outside your organization who can provide candid, honest feedback regarding the appearance of your per sonal and professional conduct. Invite colleagues to continually review and enhance your ethical culture. 4. Serve as a role model of ethical standards. 5. Complete an ethics self-assessment from time to time and address areas that need improvement (see Appendix A for the “Ethics Self-Assessment” of the American College of Healthcare Executives). 6. Establish an ethics committee to address both clinical and business ethics issues. 7. Require ethics training and education of all employees and staff. Ensure that training and education are up to date and widely disseminated. Use of real-life cases has proven to be an especially effective teaching methodology. 8. Ensure compliance with ethical standards that includes enforcement, reprimands for improper actions, and rewards for ethical conduct. 9. Create an ethical environment with fair and equitable personnel practices and workforce reduction policies—one that is free from harassment, discrimination, or pressure to per form or ignore illegal or unethical actions. 10. Address impairment in the workplace with education, reporting mechanisms, counseling, and treatment options. 11. Integrate patients’ rights into operations. Implement patient advocacy and customer service programs as needed. 12. Adopt a framework for ethical decision making consistent with the mission, vision, and values of the organization.

ADOPTING AN ETHICAL DECISION-MAKING FRAMEWORK

The process suggested here to arrive at such decisions is a relatively simple one—a series of questions that the healthcare manager can ask to determine if additional time or resources need to be brought to bear on the decision-making process and the situation at hand. These questions focus on identifying the issues in any particular situation as well as the stakeholders, the organizational impact, the colleagues, and the resources surrounding those issues

Issues.

What are the ethical issues in this situation? Relatively few situations involve a single issue. More often, the ethical dilemma comprises a number of interrelated issues. Each issue must be isolated and thoughtfully explored. t Stakeholders. What persons or groups will be affected by this situation and the actions taken? What will each feel is in his or her best interest? t Organizational impact. What will be the effect on the organization that pays the executive’s salary and has expectations that the executive will act in its best interests? t Colleagues. Which trusted colleagues may have insights, experiences, and knowledge to offer and can be consulted about this matter? Can they be consulted in confidence? t Resources. What resources are available? Does the organization have a mission statement? Values statement? Ethics committee? Ethics officer? Code of conduct? Compliance officer? Guiding principles? Policies? Laws? Regulations? Decision-making models? Legal counsel?

Hosmer (1995) discusses ten ethical principles that healthcare executives can use to determine an ethical course of action: 1. Self-interests. Never take any action that is not in the long-term selfinterests of yourself and the healthcare organization to which you belong. 2. Personal virtues. Never take any action that is not honest, open, and truthful and that you would not be proud to see reported widely in national newspapers and on television. 3. Religious injunctions. Never take any action that is not kind and that does not build a sense of community. 4. Government requirements. Never take any action that violates the law. 5. Utilitarian benefits. Never take any action that does not result in greater good than harm. 6. Universal rules. Never take any action that you would be unwilling to see others take in similar situations. 7. Individual rights. Never take any action that abridges the agreed-on rights of others. 8. Economic efficiency. Always act to maximize profits, subject to legal and market constraints and with full recognition of external costs. 9. Distributive justice. Never take any action in which the least among us is harmed in some way. 10. Contributing liberty. Never take any action that will interfere with the rights of others for self-fulfillmen