Essay \"Ethical dilemmas for health care administrators\" - grade A PDF

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ethical dilemmas for health care administrators...

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Code of Ethics MHA 622 December 3, 2012

Introduction

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Two ethical dilemmas that an acute care hospital may encounter are 1) the ethics of avoiding non-beneficial care, and 2) the issue of the uninsured or underinsured. Administrators have to face the dilemma of allocating resources appropriately. They must deal with the financial responsibilities of going forth with certain types of treatments and procedures while taking into account the cost-effectiveness ratio and the ethical code of conduct. There must be sufficient value of the resources spent in the delivery of care by health care organizations. Administrators cannot permit unnecessary treatments and misuse resources. This is both morally and financially unacceptable. There must be regulatory instruction put in place to mend this issue. Also, the issue of the uninsured/underinsured is an ongoing problem that administrators have to face. They are forced by law to treat uninsured patients but then medical staff is left underpaid for their services. Kanekolan Medical Center is an acute-care hospital located in Midwest, USA. They treat emergency situations such as heart attacks, infection control, severe illnesses requiring fast response, etc. The Kanekolan Medical Center has been running for twenty-seven years and is a 120-bed, state-of-the-art facility. It is a highly ranked medical center and known for its innovative discoveries through medicine.

There is a CEO, an executive board, and a senior management team. They must all carry out the fiduciary responsibilities of their positions, and abide by the code of ethics (“The role”,

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2012). They must keep up standards of good medical practice in dealing with matters of staff appointment, credentialing, and the disciplining of medical staff for particular things, such as criminal actions, incompetence and overstepping of boundaries (Pozgar, 2012).

Ethical standards for those in governance, management, and professional staff

The American College of Healthcare Executives (ACHE) provides a Code of Ethics that describes the behavioral actions that all healthcare employees and organizations should uphold in serving the community. Healthcare workers should strive to maintain or enhance patients' quality of life, dignity and overall well-being. Organizations have the obligation to create an effective and quality health care system. Administrators should promote trust and respect amongst healthcare professionals and the community. They should instill confidence in healthcare professionals so that they will be able to work efficiently. They should display model behavior as well. Hospital professionals and administrators should be patient advocates. They should promote patient's rights and interests. All decisions should be carefully evaluated before the effects take place. Healthcare professionals should be compliant with the law and also act in the best interest of their counterparts and their patients (Nelson, 2012).

Staff should always be professional in manner, display honesty, fairness, and respect for others. They must comply with the laws and regulations explained in the code of ethics. They

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should respect authority, as in, anyone in the position above them in the hierarchy of their organization or any outside authority working as a service to the community. Professionals should display competence and engage in continuous professional education and training (“Code of”, 2012). Conflicts of interest should be avoided but if encountered, they should be reported. No action should be taken simply for personal gain but in the interests of everyone, especially the patients. Healthcare professionals should respect patient privacy (“Code of”, 2012). Employees should promote a safe and healthy work environment. Abuse of power and abuse to patients should not be tolerated or condoned. Promote autonomy of patients. Avoid discrimination of patients or fellow employees based on race, color, gender, socioeconomic status, creed or position in work.

Respect the different cultures of patients served. Work in

ways to improve the organization's place in the community (“Code of”, 2012). Any financial discrepancies found should be reported. Also, financial and accounting information should be made available to all employees if requested. The CEO should promote communication and employee voice (Adelman & Stokes, 2012). Healthcare administrators should allocate resources in a manner that is cost-effective. They should use proper business practices. Provide accurate documentation. Fraud should be avoided (“Code of”, 2012).

Patients and prospective patients should be provided with accurate information regarding their care and any other issues or concerns they may have. Free expression should encouraged

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by all (“Code of”, 2012). Overall, healthcare professionals should promote equality, sound reasoning, safety, respect, honesty, dignity, integrity, quality of care, accountability, knowledge, skill enhancement, and legal and ethical acts and behaviors.

Ways to implement the ethical code of conduct and ensure compliance

The ethical code of conduct is used in attempt to explain the management's expectations for employee's actions while in the workplace. It is used to generate a culture of cooperation, organization, and honorable behavior. Collaborative efforts of the entire medical staff team is most desirable in creating this workplace culture (Osowski, 2012). The medical center may have an outside attorney hired in to take care of or prevent any legal risk actions from taking place. Employees at all levels should be able to understand the expected code of conduct particularly dealing with legal risk areas, which can at times be daunting for anyone who does not have a law degree (Osowski, 2012). The CEO, executive board, and senior management team should initially review a draft of the code so that they all have a chance to bring forth any feedback and suggestions for the final draft that will thereafter circulate to the rest of the medical staff. Communication is of importance and the key message of the code of conduct should be clearly stated and well-written out (Osowski, 2012).

The code of conduct should be written in a generalized way, though informative enough so that employees do not have many questions that they feel went unanswered, but not too

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detailed and descriptive that the employees do not feel like taking the time out to read it in its entirety (Osowski, 2012). A cover letter may be included or an introductory section with a personalized message from the senior management team,the CEO, or the executive board. This may help to reinforce the overall importance of the code and the necessity for the employees to take heed to the instructions. It should be made plain that all of the hospital administrators assisted in developing the code and believe that themselves will uphold the standards described and that the entire medical staff should do so as well. Printed copies should be distributed. Training materials should be provided. Posters with messages pertaining to the code can be very valuable as well (Osowski, 2012). The code should be displayed on the company web site in a section that everyone, including medical staff, management, and also the public, can easily access it. There may be a special ethical code of conduct hotline that all employees can refer if they have any questions or issues. This reduces conflict of interest issues. This also is an alternative choice for those employees who may have a feeling of fear when the need to question upper level management about certain issues arises (Osowski, 2012).

The Ethics of Avoiding Non-beneficial Care A great challenge that healthcare executives face is allocation of resources. Resources are

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limited and the dilemma about where the resources should be apportioned and how the organization can contain cost is an issue that is top on the list of concerns for administrators. Healthcare executives should play a big role in reducing non-beneficial healthcare. They should keep themselves knowledgeable of already existing practices that have been shown to be costeffective. At times, “innovative” care can be confused with “risky” care. All care should be given while maintaining the goals of the organization. Physicians should not partake in using “risky” treatments and writing prescriptions for experimental drugs at whim. The hospital administrators are inevitably the leaders of the organization and should establish what is and what is not in line with the mission of the organization (William, 2012). The Choosing Wisely campaign at www.choosingwisely.org provides a list of five treatments and tests that are used regularly within each medical specialty. This is information given in attempts to prevent spending waste and promote physician-patient communication. Howard Brody's proposal, “Medicine's Ethical Responsibility for Health Care Reform-The Top Five List” was what brought on the concept behind creating the medical specialty “list of five”. Wasting resources on one or some patients is unfair to those patients who could better use those resources. Organizations should promote fairness and efficiency. Therefore, a system must be created with clinical practice guidelines in order to prevent the administering of non-beneficial care. Non-beneficial care giving goes against the code of ethics because it is misleading to the patients. Care should only be given that is within patient's interests and does not cause harm (William, 2012). Unnecessary use of medical equipment, prescriptions for unnecessary drugs, and unnecessary overly invasive procedures should be explained by administrators to medical staff to

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be detrimental to the organization. The www.choosingwisely.org website explains that using medical equipment for preventive medicine or health screening is an exception. The main drive behind the Choosing Wisely campaign is ethics however, not necessarily economics (William, 2012). The efforts behind the Choosing Wisely campaign are also on emphasis of effective communication between physicians and patients. It promotes patient empowerment through knowledge and access to information. This allows for more honest and accountable dialogue between the patient and the physician (William, 2012). Researching allows physicians to be more aware of what is and is not beneficial care. It also allows them to keep themselves abreast with information regarding the mission of the organization. That is the basis of the Choosing Wisely campaign; knowledge is power. Clinicians should review outcome measurement data, clinical practice guidelines, methods for documentation and implementation of practice guidelines (William, 2012). Administrators should promote discussion amongst medical staff, continuous training on cooperation, collaboration and moral obligation. They should promote a knowledge-driven culture in order to better service the community (William, 2012).

The Issue of the Uninsured and Under-insured

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The increase in uninsured and underinsured patients creates an ethical challenge for hospital administrators. The mandate to obtain insurance especially for those who cannot afford to pay the deductibles still creates an issue because it does not necessarily give patients access to quality care as needed. There is a need for patients to avoid having to make choices out of desperation due to underinsurance. Care must come first before finances. There is never an excuse for giving less than quality care to patients. Healthcare professionals should be committed to maintaining a quality standard of care regardless of the situation and keep in mind the code of ethics. The patients should never be put at risk for any reason (“Underinsured patients”, 2012). A big problem is that uninsured or under-insured citizens tend to hold off and accessing care for the illnesses or injuries. There is a growing need for acute care due to this issue. Availability of acute-care facilities like Kanekolan Medical Center are currently on the decrease even though the need for them is on the increase. These patients tend to go to emergency departments of hospitals and/or have to be admitted to acute-care hospitals because of the severity of their condition. This has resulted in overcrowding and made it very difficult for resources to be efficiently allocated (“Underinsured patients”, 2012). Physicians have to explain to patients how much care really costs and promote preventive healthcare visits instead of waiting for their illnesses or injuries to worsen before getting treatment. On the other hand, patients with great insurance tend to over-utilize resources. This is another problem healthcare managers regularly face (“Underinsured patients”, 2012). Physicians have the responsibility of ensuring that appropriate care is given to those who may or may not be insured. They also are responsible for informing patients of all of their

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options, the risks and benefits of each option, the cost of each option, and also the cost of doing nothing. Less expensive alternatives should be explained to patients that will not cause harm and sufficiently treat the condition. Patients should also be informed about access to financial assistance. The patients should feel that the hospital's concern as well as the physician's concern is the get the patient's medical needs met despite any unfortunate circumstances (“Underinsured patients”, 2012).

Consequences Healthcare executives should look to ACHE's Code of Ethics for their concerns. It has been available to healthcare executives since 1941 but it has evolved over time and healthcare professionals should regularly review for their practice. Every healthcare executive, management staff member, and medical staff member should be held accountable for their actions (Voges, 2012). Violations against the Code of Ethics should be reported to the Ethics Committee. The complaint must be made within three years of the alleged violation. Administrators are encouraged to report any violation findings to the committee as soon as possible. Proper documentation is key. Formal and informal grievances however are accepted (“ACHE Code”, 2012).

Depending on the severity of the violation, the committee can have an educational consultation with the accused, give a stern reprimand, suspend their membership, or expel the

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respondent (“ACHE Code”, 2012).

Conclusion

Kanekolan Medical Center is an acute-care hospital located in Midwest, USA. They treat emergency situations such as heart attacks, infection control, severe illnesses requiring fast response, etc. The CEO, an executive board, and a senior management team must all carry out the fiduciary responsibilities of their positions, and abide by the code of ethics. They must keep up standards of good medical practice in dealing with matters of staff appointment, credentialing, and the disciplining of medical staff for particular things, such as criminal actions, incompetence and overstepping of boundaries (Pozgar, 2012). The ethical code of conduct is used in attempt to explain the management's expectations for employee's actions while in the workplace. It is used to generate a culture of cooperation, organization, and honorable behavior. Collaborative efforts of the entire medical staff team is most desirable in creating this workplace culture. Two ethical dilemmas that may be encountered are 1) the ethics of avoiding nonbeneficial care, and 2) the issue of the uninsured or under-insured. Administrators have to face the dilemma of allocating resources appropriately. They must deal with the financial responsibilities of going forth with certain types of treatments and procedures while taking into account the cost-effectiveness ratio and the ethical code of conduct. There must be sufficient value of the resources spent in the delivery of care by health care organizations. Administrators cannot permit unnecessary treatments and misuse

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resources. This is both morally and financially unacceptable. There must be regulatory instruction put in place to mend this issue. Also, the issue of the uninsured/under-insured is an ongoing problem that administrators have to face. They are forced by law to treat uninsured patients but then medical staff is left underpaid for their services. Overall, healthcare professionals should promote equality, sound reasoning, safety, respect, honesty, dignity, integrity, quality of care, accountability, knowledge, skill enhancement, and legal and ethical acts and behaviors.

References

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Adelman, K., & Stokes, Charles D, BSN,M.H.A., F.A.C.H.E. (2012). Promoting employee voice and upward communication in healthcare: The CEO's Influence/PRACTITIONER APPLICATION. Journal of Healthcare Management, 57(2), 133-47; discussion 147-8. Retrieved from http://search.proquest.com/docview/963769072?accountid=32521

American College of Healthcare Executives. (2012). ACHE Code of Ethics*. Retrieved from http://www.ache.org/abt_ache/code.cfm

Osowski, B. (2012). Health care industry codes of conduct - A must have? Journal of Health Care Compliance, 14(5), 61-64. Retrieved from http://search.proquest.com/docview/1080974789?accountid=32521

Pozgar, G. (2012). Legal aspects of health care administration (11th ed.). Sudbury, Massachusetts: Jones and Bartlett Learning.

The role of the healthcare executive in a change in organizational ownership or control. (2012). Healthcare Executive, 27(5), 106-107. Retrieved from http://search.proquest.com/docview/1039378023?accountid=32521

Underinsured patients will need cost-effective options. (2012). Hospital Access Management, Retrieved from http://search.proquest.com/docview/1170523001?accountid=32521

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Voges, N. D. (2012). The ethics of mission and margin. Healthcare Executive, 27(5), 30-2, 34, 36. Retrieved from http://search.proquest.com/docview/1039378086?accountid=32521

William, A. N. (2012). Comparing ethics and compliance programs. Healthcare Executive, 27(4), 46-49. Retrieved from http://search.proquest.com/docview/1026801762? accountid=32521

William, A. N. (2012). The ethics of avoiding nonbeneficial healthcare. Healthcare Executive, 27(6), 48-51. Retrieved from http://search.proquest.com/docview/1118709843? accountid=32521...