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Introduction to Organizational Ethics
Transcript of Introduction to Organizational Ethics
Ethics Why does organizational ethics matter to the ethics committee?
Our recent case is evidence that we will not always be consulted about patient care, but about other issues as well.
ORGANIZATIONAL ETHICS - 1990s
Two major definitions, based on the growing realization that quality of care is based on more than just allocation of resources...
Virginia Healthcare Ethics Network
"Organization ethics consists of a set of processes to address ethical issues associated with the business, financial and management areas of healthcare organizations, as well as with professional, educational and contractual relationships affecting the operation of the healthcare organization."
common themes - Quality of care depends on both the values of the healthcare organization and the relationships it has with its stakeholders
- The HCO must have a positive ethical climate
- The HCO must have a mechanism in place so that all stakeholders have an understanding of what that ethical climate means ethical climate 1) The "mission and vision" of our organization must inform the expectations for performance and are actually implemented in day-to-day activities
2) The climate of the organization must stand for a set of values that reflect societal norms for:
- what we as an HCO should value
- how we should prioritize our mission/goals
- how the individuals associated with an
organization should behave our mission statement(s) "The mission of the Medical Center of the Medical University of South Carolina is to provide excellence in patient care, teaching and research in an environment that is respectful of others, adaptive to change and accountable for outcomes." the hco is unique The payer (employers, gov't, insurance companies) is usually not the consumer.
- patients don't have much of a say in availability,
cost or quality of the treatments they receive
- patients are also a vulnerable population - they
may not be physically or emotionally capable of
- patients often lack the knowledge to make
decisions as well
organizational ethics integrates the stakeholders - Patient-Care Ethics
- Business Ethics
- Professional Ethics
patient-care ethics - based on patients' rights
- but this can't really be addressed without some organizational ethics issues, like....
"Questions concerning adequate disclosure of the economic factors that affect the availability and cost of a particular intervention."
"Real or percieved conflicts of commitment and interest among healthcare professionals." - Based purely on a "stakeholder" concept
- The business managers weigh the contracts and obligations the HCO has with everyone with an interest -- stockholders, employees, customers, community, society and specific to the HCO, payers)
- The job of the organization is to provide standards regulating this "reciprocal accountability."
to bring it all together - Patient-care and Professional Ethics alone cannot address organizational ethics issues.
- Business ethics, while possibly appropriate for the business side of the HCO, do not address the concerns of patients or providers.
Rather, the 3 ideas must be integrated, while the ethical climate of the HCO must be understood and supported by all involved. Healthcare Organizations must practice both business
and patient care in an "honest, decent
and proper manner." JCAHO, 1995 "The Medical University of South Carolina (MUSC) is a public institution of higher learning, the purpose of which is to preserve and optimize human life in South Carolina and beyond. The university provides an environment for learning and discovery through education of health care professionals and biomedical scientists, research in the health sciences and provision of comprehensive health care. The university is committed to fulfilling its responsibilities:
* To educate students to become caring, compassionate, ethical, and proficient health care professionals and creative biomedical scientists;
* To recruit and develop dedicated, scholarly teachers who inspire their students to life-long learning in the service of human health;
* To offer educational opportunities to graduates, faculty and staff, other biomedical scientists, practicing health professionals, and the public;
* To seek and welcome students, scholars, and staff regardless of gender, race, age, nationality, religion or disability, recognizing the benefits of diversity;
* To conduct research in the health sciences, advancing knowledge and encouraging new responses to health care needs;
* To provide excellence in patient care in an environment that is respectful of others, adaptive to change, accountable for outcomes, and attentive to the needs of underserved populations;
* To advance economic devlopment by introducing new technology and fostering research links with industry and other academic institutions;
* To optimize the use of all resources, including the financial support from the state and revenues generated from research, clinical operations, and philanthropy;
* To provide leadership for the state in efforts to promote health and prevent disease;
* To serve as a state resource in health policy, education, and related matters for other institutions and the general public." [limits to autonomy] supply/demand imbalance business ethics The very role of the HCO presents problems with this, however.
Roles are not as sharply defined as in the pure business world.
Organizational ethics activities must be applied to the role confusion, balances of power, divergent interests and social obligation. professional ethics - Based purely on the concept that healthcare professionals are advocates for each and every patient - individual obligations. In its purest form, there is little concern for the impact on the wider patient population.
- Difficult to maintain this advocacy as the patient load grows...
- Also dependent upon the characteristics of each healthcare professional.
implementation An organizational ethics program must be: - broadly representative
- reporting to the top leadership
- easily accessible Broad Representation Professional Staff
Board of Directors
Patient-Care Ethics Committee
"Enhance and maintain a positive ethical climate, and in so doing, to have influence on the morale, reputation, and eventually the competitive advantage of the healthcare organization." the mandate - Unbiased
- Without an agenda two possible roles A collection of individuals with technical knowledge and expertise who function only as a consult service, solving ethical problems and moral dilemmas.
A team that facilitates communication and discussion, clarifies moral positions and "[arranges] a safe moral space within which differences can be aired, understood and in some [if not all] cases resolved."
a mixture of both... Expertise is clearly needed, but the role of the organizational ethics committee is more to facilitate and recommend changes, rather than resolving and legislating them.
Challenges to Efficacy Compliance Quality Movement Basically mandatory under the Federal Sentencing Guidelines, which state that organizations are liable for any offense committed by their "agents" - i.e., an employee or representative.
The organization can decrease their culpability by proving that they had a mechanism in place to prevent and detect criminal conduct.
Hence - compliance programs.
Most HCOs devote copious resources to compliance issues and thus ignore the steps needed for a positive ethical climate, especially since compliance committees appear to have overlapping functions. Based on QI initiatives in the manufacturing sectors.
Emphasize standards, process control and accountability through measurement to reduce inefficiency and waste.
QI forms a rigid system that may not be flexible to accomodate diversity in patient population.
An example of the conflict between standards of care and individual patient interest is evidence-based medicine... evidence-based medicine 3 Components:
- Best Research Evidence: accuracy and precision of tests, power of prognostic markers and efficacy of treatment.
- Clinical Expertise: the ability of clinicians to take the best evidence and couple it with experience to best treat each patient as an individual
- Patient Values and Preferences: refer to the unique concerns and beliefs each patient brings to the table. to the future...and beyond - Society has not made up its mind as to what represents "quality" in care.
- Costs will continue to increase.
Organizational Ethics can address the problem of who will be making healthcare decisions and who will pay for the result.
There is also a role in developing the programs necessary so that patient populations can understand the changes involved. Interesting side note -- since the Enron scandal, the Guidelines have been modified to include language applying to ethics:
"The prevention and detection of criminal conduct, as facilitated by an effective compliance and ethics program, will assist an organization in encouraging ethical conduct and in complying with all applicable laws." RI.1.10
RI.1.40 JCAHO Standards The hospital follows ethical behavior in its care, treatment and services and business practices. The hospital addresses conflicts of interest. The integrity of decisions is based on identified care, treatment and service needs of the patients. When care, treatment, and services are subject to internal or external review that results in the denial of care, treatment, services or payment, the hospital makes decisions regarding the provision of ongoing care, treatment, services or discharge based on the assessed needs of the patients.