ethics for hospital administration

8/19/2019 Ethics for Hospital Administration

1/46

ETHICS IN

HOSPITALADMINISTRATIO


2/46


3/46

Nature & Characteristics ofHospital Administration Ethics

Locus and Responsibility spectrum o HospitalAdministration !

The ethics of hospital administration occupies a uni*ue position at the intertraditional patient-centered medical ethics and business ethics. +n t

the health care institution is to pro"ide ser"ice to patients. -t therefore follo(ethics of administrati"e decision ma)in must account for the impact of admdecisions on patient care. +n the other hand, the da to da operation of heainstitutions is similar to that of man lare non/medical 'usinesses. It emphmoral problems in economic transactions and in the relationships beemployers, employees and the consumers. The divergent role of hosadministration viz. patient ethics and prot results i n fre*uentl emer(hether the pursuit of pro0t can co/e!ist in a neutral or positi"e (a (ith the

ser"ice/0rst ethic of medical practice.


4/46

Nature & Characteristics ofHospital Administration Ethics

Impact o administrati"e decisions on patient care

Most of the administrative activities is said to directly or indirectly patient care. or e!ample, the hospital ad"ertisement can ha"e a persuasthe e!pectations of speci0c patient (ho choose that institution in response

ad"ertisement (ith the e!pectation of *ualit patient care. urther, if the hoadministrators ha"e created an institutional tone dominated ' impersonal treatment of emploees, the in turn e!hi'it the same attitude (hile pro"idpatient care. Thus the administrati"e ethos of the hospital ha"e morall releconse*uences for patients, e"en (hen there is no direct impact on patient clance.


5/46

Need of Hospital AdministratioEthics

Con#ict mana$ement ! The parado! presents ethical dilemmas at e"er le"el of the orani5ation. Tis e"ident in an contro"ers over allocation of health care resources.health care supplies are 0nite, and health care demand is in0nite, all patieneecti"el in competition (ith one another for resources.

Clinical education supplies another e!ample of the parado! of health car

orani5ation. Patients attendin hospital attend for the purpose of recei"inand the naturall desire the most s)ilful treatment from the most hihl *doctors. 6ut if hospitals are to 'e a'le to treat future patients, the must trdoctors. 7octors/in/trainin, of course, need patients upon (hom the can unde"eloped s)ills8 and the most hihl *uali0ed doctors, (ho miht other(time s)illfull treatin patients, must spend time teachin those s)ills to ot

an ethical organization has to balance the desires of current patienneeds of future patients.

6esides the a'o"e parado!es, the health care administrator needs to resol"-


6/46

Need of Hospital AdministratioEthics

Priority Settin$ % Resource allocations!

e"en factors that complicate ethical resource allocation decisions.

1. -nade*uate funds to support e*uall compellin re*uests.2. tron opinions e!pressed ' in9uential and politicall po(erful people.3. e"ere time constraints, ma)in it di;cult to conduct comprehensi"e and oof multiple "aria'les.4. ini0cant con9icts of interest.%. =ncertaint a'out potential outcomes and unintentional conse*uences.>. Competin professional and personal "alues.?. The possi'ilit that the decision could ha"e a neati"e impact on


7/46

Need of Hospital AdministratioEthics The essential *ualities of the health care administrator to e"ol"e an ethicallocation decisions. Acceptin accounta'ilit. @aintainin credi'ilit. ul0llin past commitments. 7emonstratin o'


8/46

Need of Hospital AdministratioEthicsPro$ram % Policy de"elopment!

The hospital administrators fre*uentl in"ol"e in de"elopment of speprorams in impro"in the performance of the emploees or tarepatient care. ince these policies and prorams are de"eloped ien"ironment #o;ce premises of administrators$ often articulatin the"alues and personal "alues of the hospital administrators, the often fthe "alues of the sta)eholders #patients & emploees in the i"en s6ecause of this approach, e"en a (ell structured proram and polimplemented. To e"ol"e a dnamic and eecti"e proram & polic dehospital administrators should involve in consultation sta!eholders who would inuence and will get inuenced by su" policies# and should reect their opinions and give due wevalues before ratifying such programs " policies


9/46

Need of Hospital AdministratioEthics Human resource mana$ement:

-n the present da human resource manaement polic i"much importance to the performance based variable sastructure with incentives " increments. +ften such deare 'ased on the performance appraisals of the immediatesuper"isor of the emploee. The hospital administrators (h

'e part of the promotion committee or performance scrutincommittee should ta)e in to consideration the potential for the immediate super"isor. impl statin the decisions onenhanced salar structure should 'e o'


10/46

Need of Hospital AdministratioEthics Ad"ertisement issues&

@an corporate hospitals are in"ol"ed in rampant ad"ertinformin the eneral pu'lic a'out pro"idin *ualit heaand other attracti"e oers in the arena of health caincreasin the e!pectation of the patients. As administrators ha"e moral obligation towards organizwelfare, they should balance the e$pectation of pand what the health care organization is really capdelivering health care services. +ther(ise it (ill result deception of the patient (hich is aainst the "asta)eholders


11/46

THEORETICAL PRINCIPLES OETHICS!

The frame(or) for the concepts of ethics has emered from the philosophical thcharacter and conte!t on (hich the indi"idual e!ecutes the 'eha"iour and is mu

Et(ics T(eory $rounded on COND)CT o t(e indi"idual! Deontolo$y *+ant,s P(ilosop(y-!

usti0es means to the end D the acts or means should 'e al(as riht and ood8

indi"idual has moral dut or o'liation of doin thins in riht (a irrespecti"e of cant states that moti"es attached to the means are critical in determinin the mo

rather than its conse*uences. The duties or actions of means should ha"e no cond

the conse*uences i.e the means should 'e an end in itself. This perspecti"e ant s

cateorical imperati"e or unconditional command of moralit


12/46

Perennial 7uties

These are 'asic o'liations (hich (e ha"e as human 'einsthe fundamental rules tellin us ho( (e should act.

6roadl, this roup of perennial duties falls into t(o sorts:

1. Duties to oursel"es

2. Duties to ot(ers


13/46


14/46

THEORETICAL PRINCIPLES OETHICS! Teleontolo$y *)tilitarianism-! Syn! Conse.uentialism

usti0es end to the means D %reatest good for greatesnumber . Emphasi5es the importance of net conse*uences means #end$ sometimes inorin the moral "alues 'ased othe means are e!ecuted. The strenth of =tilitarianism is thpro"ides the o'


15/46

THEORETICAL PRINCIPLES OETHICS! Et(ics T(eory $rounded on CHARACTER o t(e indi"id0irtue et(ics !

This theor emphasi5es the specic personal virtues anmoral character is central to logical reasoning that sas an essential tool for resolving ethical issues anddilemmas. The proponents of this theor 'elie"ed that the

of 1isdom/ coura$e/ temperance/ and 2ustice 1ere t(lo$ical c(oices to (elp people ac(ie"e t(is $oal.


16/46

THEORETICAL PRINCIPLES OETHICS!Et(ics T(eory $rounded on CONTE3T o t(e 4e(a"ior /Communitarianism& !

This theor endorses the moral perspecti"es o t(e comand society as central in sol"in$ et(ical dilemmas sin

indi"idual stands in direct unmediated relationship (ith theurther the communitarianism perspecti"e states that therecertain elements in the communities that form aecti"e 'oamonst people of di"erse social roups. These communitelements determine the "alues and the conte!t in (hich etdilemmas to 'e dealt (ith. T(is t(eoretical perspecti"epromotes en$a$ement 1it( 5ey sta5e(olders o t(ecommunity in et(ical decisions&


17/46

AMERICAN COLLE6E O'HEALTH CARE E3EC)TI0ES

*ACHE- CODE O' ETHICS!Responsibilities to t(e Proession o Healt(care Mana$ementT(e (ealt(care e7ecuti"e s(all!=phold the Code of Ethics and mission of the American Collee of Healthcare E!ecuti"es8

Conduct professional acti"ities (ith honest, interit, respect, fairness and ood faith in a manner that

the profession8

Compl (ith all la(s and reulations pertainin to healthcare manaement in the 2urisdictions in (hich

e!ecuti"e is located or conducts professional acti"ities8

@aintain competence and pro8ciency in (ealt(care mana$ement ' implementin a personal pro

and continuin professional education8A"oid t(e improper e7ploitation o proessional relations(ips for personal ain8Disclose 8nancial and ot(er con#icts o interest9=se this Code to further the interests of the profession and not for sel0sh reasons8espect professional con0dences8Enhance the dinit and imae of the healthcare manaement profession throuh positi"e pu'lic informaefrain from participatin in an acti"it that demeans the credi'ilit and dinit of the healthcare mana


18/46

AMERICAN COLLE6E O'HEALTH CARE E3EC)TI0ES

*ACHE- CODE O' ETHICS!Responsibilities to patients or ot(ers ser"ed or) to ensure the e!istence of a process to evaluate the &uality of care or ser"ice ren 'void practicin or facilitatin discrimination and institute safeuards to pre"ent discrimin

orani5ational practices

or) to ensure the e!istence of a process that (ill advise patients or others ser"ed of the r

opportunities, responsi'ilities and ris)s reardin a"aila'le healthcare ser"ices8

or) to ensure that there is a process in place to facilitate the resolution of con9icts that ma

"alues of patients and their families dier from those of emploees and phsicians8

Demonstrate zero tolerance for an a'use of po(er that compromises patients or others ser"

or) to pro"ide a process that ensures the autonomy and self-determination of patients or o

ser"ed8 and

or) to ensure the e!istence of procedures that (ill safeguard the condentiality and privacy

or others ser"ed

AMERICAN COLLE6E O'


19/46

AMERICAN COLLE6E O'HEALTH CARE E3EC)TI0ES*ACHE- CODE O' ETHICS!

Responsibilities to t(e Or$ani:ation

T(e (ealt(care e7ecuti"e s(all/ 1it(in t(e scope o (is or (er aut(ority!A& Pro"ide (ealt(care services consistent with available resources/ and 1(en t(ere are limited resou

t(e e7istence o a resource allocation process t(at considers et(ical rami8cations9

4& Conduct bot( competitive and cooperative activities in 1ays t(at impro"e community (ealt(care s

C& Lead t(e or$ani:ation in t(e use and improvement of standards of management and sound bus

D& Respect the customs and practices of patients or others served/ consistent 1it( t(e or$ani:atio

E& 4e truthful in all orms o proessional and or$ani:ational communication/ and a"oid disseminatin$ inalse/ misleadin$ or decepti"e9

'& Report negative nancial and other information promptly and accurately / and initiate appropria

6& Prevent fraud and abuse and aggressive accounting practices t(at may result in disputable 8na

H& Create an organizational environment in 1(ic( both clinical and management mistakes are mi

t(ey do occur / are disclosed and addressed e;ecti"ely9

I& Implement an organizational code of ethics and monitor compliance9 and


20/46

AMERICAN COLLE6E O'HEALTH CARE E3EC)TI0ES*ACHE- CODE O' ETHICS!Responsibilities to t(e Employees!Healthcare e!ecuti"es ha"e ethical and professional o'liations to the emploees the

that encompass 'ut are not limited to:

A. Creatin a work environment that promotes ethical conduct ' emploees8

6. Pro"idin a work environment that encourages a free e!pression of ethical concerns

provides mechanisms for discussing and addressing such concerns"

C Providing a work environment that discourages harassment , se!ual and other8 coerci)ind, especiall to perform illeal or unethical acts8 and discrimination on the 'asis o

ethnicit, creed, ender, se!ual orientation, ae, or disa'ilit8

Pro"idin a (or) en"ironment that promotes the proper use of employees# knowledge

E. Pro"idin a safe work environment 8 and

. Esta'lishin appropriate grievance and appeals mechanisms


21/46

AMERICAN COLLE6E O'HEALTH CARE E3EC)TI0ES*ACHE- CODE O' ETHICS! Responsibilities to Community % Society!

The healthcare e!ecuti"e shall:

A. or) to identify and meet the healthcare needs of the community 8

6. $ork to support access to healthcare services for all people8

C. %ncourage and participate in public dialogue on healthcare policy issues& and advocathat will improve health status and promote 'uality healthcare8

7. (pply short- and long-term assessments to management decisions aecting both comand society" and

E. Provide prospective patients and others with ade'uate and accurate information& enablingmake enlightened decisions regarding services.


22/46

AMERICAN COLLE6E O'HEALTH CARE E3EC)TI0ES*ACHE- CODE O' ETHICS! Responsibilities to report "iolations o t(e code!

An a;liate of ACHE (ho has reasona'le rounds to 'elie"eanother a;liate has "iolated this Code (as a duty tocommunicate suc( acts to t(e Et(ics Committee&


23/46

or)place 7e"iance

Workplace Deviance

Unethical behavior that violates organizationalnorms about right and wrong

Two dimensions

Degree of deviance

Target of deviant behavior


24/46

Tpes of or)place 7e"iance

ProductionDe"iance

ProductionDe"iance

PropertyDe"iance

PropertyDe"iance

PoliticalDe"iance

PoliticalDe"iance

PersonalA$$ression

PersonalA$$ression

Minor Seri

Organizational

Interpersonal


25/46

25

Production 7e"iance

Iea"in earl

Ta)in e!cessi"e 'rea)s

-ntentionall (or)in slo(

astin resources

==


26/46

Political 7e"iance


27/46

27

Political 7e"iance

ho(in fa"oritism

Fossipin a'outco(or)ers

6lamin co(or)ers

Competin non

'ene0ciall

??


28/46

28

Personal Aression

e!ual harassmentJer'al a'use

tealin from co(or)ers

Endanerin co(or)ers

@@


29/46

CIA-K-NF 6=-NE 7EC--+N


30/46

thical

Un thical

Illegal !eg

Ethical 'ut -lleal

=nethical and-lleal

Ethical and Ieal

=nethical 'utIeal




31/46

thical

Un thical

Illegal !ega


• Promotin PF rated mo"ies

to oun teens• Producin products that ou

)no( (ill 'rea) 'efore theirtime

• Em'e55lin mone• Enain in se!ual

harassment• Practicin collusion (ith

competitors• Encourain fraudulent

accountin

• Producin top *ualitproducts• e(ardin interit• Ieadin ' e!ample• Pro"idin emploee 'ene0ts• Contri'utin to communit• Esta'lishin recclinprorams

• Pro"idin roc)/'ottom pricesonl to distri'utors inunderser"ed areas

• Colla'oratin (ith other

medicalclinics to uarantee lo(

prices inlo(/income countries


32/46

Ethical 6eha"ior

Ethical 'eha"ior oes 'eond the leal re*uirementsplaced on a 'usiness, as it concerns discretionar

decisions and 'eha"ior8 in other (ords , what abusiness chooses to do, rather than what isforced to do.

6usiness ethics are rele"ant both to the conduct ofan individual within an organization and to theconduct of the organization as a whole.


33/46

@ths of 6usiness Ethics

-t is a more religion than management (ur employees are ethical so no need

-t is a discipline 'est led ' philosophers

-t is a matter of good person preaching to bad persons

-t is a ne( police-person in organization

Ethics can)t 'e manaed

*usiness ethics " C+ are same thing e obey to law so no need about ethics.


34/46

Ethical 7ilemma

There are situation (hen there is not simple choice'et(een riht or (ron

Ethical dilemma is comple!


35/46

Cont...

An ethical dilemma e!ists (hen one is faced (ith ha"ma)e a choice amon follo(in alternati"es: ini0cant "alue con9icts amon dierin interests,

eal alternati"es that are e*uall


36/46

Characteristics of 7ilemma

-t ha"e e$tended conse*uences -t has multiple alternati"es

-t ha"e mi$ed outcomes

-t ha"e uncertain conse&uences

-t ha"e personal implications

-t is easy to ma!e when a person is not directly involved

Hence E7@ are not simple choice 'et(een riht and (ron.


37/46

Paradims of 7ilemma

our such dilemmas are so common to our e!perience that theas models, patterns, or paradims. The are:

Trut( "ersus loyalty&

Indi"idual "ersus community&

S(ortGterm "ersus lon$Gterm&


38/46

histle 'lo(in

-t is methods can 'e contri'uted to identif and act o(ron in an orani5ation

Ii)e 'lo(in a (histle to call attention to a thief practitioner

6ut it is *uestiona'le (hen... 7issent M disaree / @ust spea) out aainst others in orani5ation

6reach of Ioalt / Percei"ed as one (ho "iolates con0dentialit

Accusation / inles out speci0c indi"iduals as threats to orapu'lic


39/46

histle 'lo(in

Care a'out (histle 'lo(in @a)e sure situation in"ol"es an imminent threat to societ or to

'usiness

7ocument all alleations

E!amine internal (histle 'lo(in 0rst

hould ou remain secret

%thics and )ior

Eects of

http://var/www/apps/conversion/tmp/scratch_2/Black%20list.pptxhttp://var/www/apps/conversion/tmp/scratch_2/Black%20list.pptxhttp://var/www/apps/conversion/tmp/scratch_2/Black%20list.pptxhttp://var/www/apps/conversion/tmp/scratch_2/Black%20list.pptx


40/46

EthicalM=nethical 6eha"ior


41/46


42/46

Ethical Test

1. -s it Ieal2. 6ene0t Cost Test

3. Cateorical -mperati"e

4. Iiht of 7a Test

%. 7o onto +thers Test

>. Jentilation Test


43/46

6ene0t & Cateorical -mperati

2.6ene0t Cost Test 7o the 'ene0ts e!ceed the costs to (homsoe"er the accrueQ3.Cateorical -mperati"e

Are ou (illin to allo( to e"erone to practice the proposed action(ant to 'e a special caseQ


44/46

Iiht of 7a & 7o onto +thers

4.Iiht of 7a Test D hat (ould 'e our reaction action (ere 'rouht out into the open for pu'lic scrutin%.7o onto +thers Test D Folden ule D -f ou (ou

others to do the same to ou / passes the test

>.Jentilation Test D ee) out others "ie(s. 7iscuss ttests (ith them. -f others feel it is + D passes the test


45/46

A Jenn 7iaram @odel for Ethica7ecision @a)in

1

3

2a

2b


46/46

ETH-CAI 7EC--+N @A-NF TK

•

Individualists• Driven by natural reason, personal survival etc. Self is the source of allactions

• Altruists• oncerned !ith other people. "elin#uish their o!n security for others

• $ra%&atists• oncerned !ith situation at hand, not !ith the self or other. 'ases of

&oral authority is the perceived need at the &o&ent and the potentialconse#uences of a decision in a specific conte(t.

• Idealists• Driven by principles, rules and values. "eason and relationships !ill no

substitute for idealist)s adherence to principles.

ethics for hospital administration

Documents