According to William Nelson, PhD (from the ACHE ethics power point on ethics):

Ethical Decision Making revolves around the following:

·         Common Morality

·         Personal  Values

·         Group Specific Morality (Professional Ethics)

Ethical decision making should be based on thoughtful reasoning and if one of the basic moral principles will be violated, then there should be a great deal of thought processing and evidence based decision making involved in this.

Key words for Professionalism and Ethics

o   Integrity

o   Patient rights

o   Positive reflection on your profession

o   Mission  before personal gains

o   Enhancing the future of healthcare

I have observed one healthcare organization which has really stressed to all new hires that ethical behavior is job #1.  This is done by requiring all new hires to review expectations via the organization's mission, vision, and goals.  Each employee must sign a statement that indicates that they understand and can fulfill these requirements as representatives of the organization. This is followed up by small group meetings with the CEO (and a board member) who again shares the vision and the ethical standard that is to be upheld.  These potential employees see the importance given to the issue as well as the mandate from the top of the organization. 

Any comments on how other organizations encourage ethical behavior?

When working in a multi-cultural environment, coming to an ethical decision when looking at national law and customs can be contradictory to what is established in your own culture.  Someone working for you may have strong ethical reasons based on their home country that contradict what is believed to be ethical in their work country.  How do you ethically treat that employee when their conduct (ethical in their country) does not meet the standard in their work country and actually can be considered illegal?  This has occurred in more then one instance in my tenure in the Middle East.  Do professional norms act as a moderator of sorts, where education of the staff member is used to enforce ethical conduct  that can have legal and work product ramifications for the organization?

There is no way for the average consumer to grasp the complexity of ethical decision-making in healthcare.  This is particularly true in light of increasing access barriers.  How often do you see this played out in the most basic of administrative meetings, where clinical leadership ("no mission, no margin) engages with financial leadership ("no margin, no mission:) in the making of difficult decisions? 

There is a strong correlation between ethical cultural and organization performance and quality per Dr. Nelson.  So here is the question...

Having a strong ethical foundation in an organization can lead to:

a) increased employee moral, decreased patient satisfaction and increased law suits.

b) decreased employee moral, increased patient satisfaction and decreased law suits.

c) increase employee moral, increased patient satisfaction, and decreased law suits.

d) decreased public relations, but meets The Joint Commssion Ethical standards.

What do you think the answer is?  Leave a comment.  I'll post the answer next week.

 

 

 

I recently experienced a similar scenario to the case in the readings.   We had an independent physician practice close its doors due to financial reasons without prior notice to the community and the patients.

From an ethical perspective, we needed to take care of those patients and their medical records - because it was the right thing to do.   There was a fair amount of discussion of the logistics of where to keep/store those records, the liablility of the records, and how to inventory/distribute those records.   The bottom line for us was to take care of the patients.  

This was a very good learning experience for me as a leader.   There are so many aspects that need to be considered.   The ethics of this situation was the over arching principle in working through this situation.

Our mission statement directly states that we will "provide the highest quality of primary health care to our patients while maintaining the highest ethical principles."  However, we have no formal written ethics codes nor do we have an ethics committee.  I asked our CEO about this and wondered if possibly we were simply using any ethical code that doctors are required to adhere to in order to be a part of the AMA, medical board, etc.  He agreed with the philosophy and added that our Executive Committee and Board would also provide oversight to ethical issues. 

For those of you that do have ethics committees (ex those that say they do not include senior mgmt) what does your committee accomplish?  What are some of the goals?