Ethics and Governance - Assignment Example

ETHICS AND GOVERNANCE Introduction The study of ethics has intrigued the faculties of scholars since early philosophers and ethicists during the times of Plato, Socrates, and Aristotle, to name a few. Johnson (1965) defined ethics as “the systematic inquiry into man’s moral behavior with the purpose of discovering the rules that ought to govern human action and the goods that are worth seeking in human life”. These ethical standards governing the existence of human life also encompass the realm of business entities. In health care, like in any other enterprise, ethical issues that affect the relevant structures of the health institution are ultimately governed by the CEO or the board of directors. ”. Policies and strategic management are responsibilities of the chief executive officer (CEO). A major task under these responsibilities is corporate governance which is simply defined as “controlling, restraining and directing the making and administration of these policies” (Webster 1997). It is in this regard that this paper is written to present relevant contemporary issues in business ethics with actual experience and application in a health organization, St. Luke’s Medical Center. Company Background St. Lukes Medical Center (SLMC) is located in the Philippines and has provided high-quality healthcare for over a century. Founded in 1903, its mission is to provide outstanding out-patient care. Today it is the foremost and most admired hospital in the Philippines and an acknowledged leader in Asia. SLMC receives patients from around Asia, Micronesia, the Middle East, Europe and the United States. (SLMC About Us 2009 par. 1) Established in 1975 as an important part of the reorganization of St. Lukes into a non-stock not-for-profit charitable corporation, the board provides overall leadership and direction for the organization. It is responsible for all professional and policy issues that arise in the course of managing the hospital. Ethical Scenario A patient had been confined in a private room in this health institution for almost one month due to chronic illness with diverse complications. Due to her long stay and numerous laboratory, diagnostic and therapeutic examinations, her statement of account reached a staggering amount which could not be immediately covered by the funds of the patient and her family. She had been accompanied by her daughter who helps by providing physical, emotional and financial support. However, due to the critical condition that her mother experiences, their account was classified as “red tag”. Patients with red tags are immediately referred to the Customer Relations Department who monitors their status and closely coordinates with the Accounting and Cashier Department for settlement and collection purposes. Once a patient has been classified as “red tag”, any procedure (therapeutic, diagnostic, laboratory, etc.) need to be immediately settled prior to the administration of the procedure, regardless of the necessity and the kind of the procedure to be undertaken. The rationale for this is to prevent further increases in the amount due to the hospital which might not be collected nor paid. The patient regularly needs any of the abovementioned procedures to monitor her health progress and to identify and assess whether present medications need to be adjusted (increase or decrease in dosage and frequency of administration). However, since this patient was already classified as “red tag”, and since the daughter still needs to look for alternative sources of funds to settle the staggering amount, the required regular procedures could not be undertaken. In this regard, being a hospital with medical and ethical responsibilities to their patients, does their red tag policy contradict conformity to ethical standards? Possible Ways in Which Dilemma Can Be Managed Based on the underlying definition of ethics, one should examine the rules that govern human action and the goods one is seeking in life. The hospital has the obligation to render appropriate medical service to ensure that their patients receive the necessary treatment to improve their health conditions. However, it is also the responsibility of the patients and their families to pay for all the medical services to ensure that the hospital would sustain their resources for the efficient delivery of health care in the present and in the future. If the hospital would consistently allow patients to accumulate amounts payable for services that were already rendered, eventually, the resources of the hospital would not be enough to sustain the delivery of future health care of other patients. The recording of financial obligations of patients is responsibilities of the accounting, cashier and customer relations department to prevent further damage and avoid legal cases if medical problems occur. The ethical dilemma was immediately reported by the Nurse Manager. Every nursing unit in the hospital is headed by a nurse manager who is assigned as the chief head nurse on duty. Her job responsibilities entail patient care as the primary task. The officers, members of the board of directors, and the CEO of the hospital deemed it appropriate to hire non nurse unit managers who possess graduate degrees in business, to head the different nursing units. These unit managers have the sole responsibilities of ensuring compliance to reportorial requirements, human resources issues, facilities and equipment, budgeting, and other aspects of the units’ operations – except patient care. Once the issue was brought to the attention of the Unit Manager, she immediately reported it to their Department Manager and finally, to the Vice President for Nursing. The Vice President for Nursing conferred with the Vice President for Customer Relations, the department in charge of red tag accounts. They outlined the following alternative courses of action for both the hospital and the patient: 1. Immediately transfer the patient to a room with the least cost (a ward or semi-private room) without compromising health benefits. By transferring the patient to a room with lower cost, all other hospital costs associated with the room transfer would be decreased. 2. Seek the necessary financial assistance from health insurance (Medicaid, Medicare) as appropriate in her case. 3. Arrange an amicable agreement with the senior management of the hospital in terms of forging payment schemes which are amenable to both parties. Analysis In resolving issues pertaining to ethics and governance, it is pertinent that problems are properly and accurately identified. Leaders are assigned and employed to do their tasks. Systems, policies and procedures are installed to implement the necessary changes. However, when a gap still exists between knowing and implementing the solution, the top honcho should take the helm and assume responsibility in decision making. In this case, the Vice Presidents of the departments concerned took to responsibilities in initiating the appropriate action necessary to manage the predicament. The red tag policy was designed to prevent further accumulation of amounts to for payment to the hospital. If this remains unchecked, the very existence of the hospital would be endangered. Accumulation of unpaid bills would reverberate to financial losses. The hospital funds would eventually be depleted if these accounts are allowed to persist. Inasmuch as the status of human lives might be at stake, both family members of the patients and the administration and top management could design ways and means to accommodate ethical concerns without compromising the quality of health care and the standards that the hospital upholds. This ethical dilemma falls under deontological ethics in terms of holding that at least some acts are morally obligatory regardless of their consequences for human welfare. (Encyclopædia Britannica 2009) The mission of St. Luke’s Medical Center is to improve the delivery of quality health care conforming to the strict standards of the Joint Commission International (JCI). This includes ensuring that patients also comply with their obligations of paying for the services rendered by the hospital to sustain its future operations. Conclusion Health care organizations have a great responsibility to ensure that patients receive the best possible treatment within their respective budgets or finances. Problems occur when one party fails to deliver what is expected by the other. Apart from financial problems brought about by hospital bills, patients and their families are faced with the burden of finding out possible outcomes from the delivery of health care. Another relevant ethical concerns faced by health organizations are medical errors. This is broad topic with legal implications. According to O’Rourke, “errors can be prevented by designing systems that make it hard for people to do the wrong thing and easy for people to do the right thing.” However, despite clearly stated policies and rules that ensure that management does the right things in compliance to ethical standards, inevitable events still occur which seem to contradict business ethics. In the end, by establishing a harmonious relationship and by ensuring that the health care organization has complied with the high standards of safety and efficient delivery of patient care, no ethical problem could remain unresolved. References Deontological ethics. (2009). In Encyclopædia Britannica. Retrieved May 11, 2009, from Encyclopædia Britannica Online: Johnson, O.A. (1965). Ethics: Selections from Classical and Contemporary Writers. Holt, Rinehart and Winston, Inc. New York. O’Rourke, K. (2004). Medical Error: Some Ethical Concerns. Catholic Health Association of the United States. Retrieved on April 30, 2009 from St. Luke’s Medical Center. (2009). One of the World’s Best. Retrieved on May 12, 2009 from The Merriam-Webster. (1997). Definition of Governance. Merriam-Webster, Incorporated. Springfield, Massachusetts, USA. p. 327. Read More