Health care is not exactly the paragon of efficiency from an economic point of view, but a new analysis from PricewaterhouseCoopers puts the value of the waste sloshing around in the system at a whopping $1.2 trillion a year. 

What, if any, kind of policies do your organizations use to encourage "whistleblowing."  There is a difficult ethical dilemma that many employees are faced with.  Employees are torn between loyalty to the institution and loyalty to the public.  Should health care organizations encourage "whistleblowing," and what types of protection should be afforded to those employees who do bring a sensitive issue forward?

Just to understand more what's the real meaning behind this concept, has any of you guys face such kind of thing in his practice? how you did you deal with it?

Clinicians striking pose an ethical conflict. Have you experienced a strike in your HCO? How did management deal with the strike? How did the strike affect the non-bargaining units? How did the community react to the strike?

If you have not experienced a strike what are your thoughts on how a strike should be handled?

Here's a real-life situation, one that I did not put into the ethical framework until reading/reviewing this week's lesson.  I would appreciate comments from colleagues on this one: 

A hospital recently decided to not renew a Medicaid contract because they could not get better rates, citing that they only get paid 56 cents on the dollar.  They will continue to comply with EMTALA; however, Medicaid requires that, once a patient presents to the ED and is stable, the patient must be transferred to a facility with an active contract.  Is this hospital doing the fiscally correct thing?  Or just shifting low-cost care to other providers in the community?  What if the organization's mission is to take care of anyone who presents, much as our Temple colleague points out?  What if the organization, further, is a not-for-profit provider and is responsible for taking care of vulnerable populations in lieu of paying taxes.

I see so many intersecting/diverse stakeholders, here, including the IRS.  Which is priority, in your opinions?

 Much was written in the provided material, especially the paper by Ozar et al. about prioritization of ethics concerns in the healthcare institution. Patient care is first and foremost, but may directly conflict with fiscal responsibility is a department or facility is failing. How would one address this if the effects were not as direct? For example, accreditation of a facility may require that one of its departments maintain some level of quality or activity. However, keeping that department is a financial drain. I think an interesting comparison would be to see how individuals would answer this question when patient care is or is not directly affected.

The position paper was difficult for me to get through, but one of the issues I think it addresses is individual versus population ethics. It points out that we often consider individual rights/benefits and how we as individuals, professionals, and organizations relate to individual patients, consumers, ...

The article raises the question about what are the ethical responsibilities to organizations or to populations. I don't believe they provided any answers but raise the issue for dialogue.

Examples included in our materials or in our discussion threads are what are the organization/clinics responsibility to remain open despite being a financial loser? Do our ethical obligations to both society and the patients of the clinic outweigh the financial burdens on the clinic to afford to stay open? This is complicated. It is not just about a financial profit or loss, but could affect the ability of the organization to survive and continue to provide health care. The same question/obligation comes up in hosptials with alot of chartiy care. Our mission at Temple University is to treat all patients regardless of their ability to pay. But no margin, no mission. Alot of ethical questions.

Another example is end of life decisions. Do physicians give up on patients too soon or hang on too long to false hope? Do families do the same? There are many financial, social, and other factors involved. No good answer. No one answer. How do we as providers handle these situations and be ethical leaders?

The Policy Statement for Decisions Near the End of Life includes: "Healthcare executives have a responsibility to ensure their organizations provide support for patients and their families as treatment decisions are reached. Patient autonomy (the right of an individual to influence decisions affecting his or her treatment) should remain at the core of this process."

What tangible support have you seen in your organizations related to support for patients and their families as they make decisions related to end of life care?