Building an Ethical Organization Albuquerque Health Care - Case Study Example

Introduction: Albuquerque Health Care has traveled many a mile since its inception in July 2006. We began as a non-profit organization devoted to community help in Albuquerque, Los Lunas, Belen, and Peralta. In the past two years we not only delivered what we promised but also set new benchmark standards in health care. Today, the reputation of Albuquerque has spread all over the province as and organization known for its conformance to ethics, putting service before self and as an organization committed to social reform. Our social services in checking substance abuse, Aids Prevention and Case Management, Counseling and Outreach Programs are making a positive difference in the lives of increasing number of families. We have yet not become the largest health care organization in Albuquerque, Los Lunas, Belen, and Peralta area as envisaged earlier, but we have woven an organization culture based on core ideas stated in our Mission Statement and Values Statement and adherence to ethics and keeping service before self. This has been possible only with the unflinching support and leadership of the management and dedication of the staff. Albuquerque Health Care has earned commendations from the government, the people, the patients, community and our suppliers for being organization that has never compromised on ethics, our values, commitment of purpose and quality in dispensing our services. . It is worth mention that we have not only delivered quality health care to the people of but have also earned many an honor for being an organizations committed to ethics and integrity. However, in these two years we also encountered difficulties in our functioning, which has made us introduce changes in our policy. We will discuss these changes in the points below: Description Albuquerque Health Care is today organized into eight health care departments: 1. Emergency and Trauma Care 2. Medicine including Out-patient Department 3. Behavioral Health Services 4. Psychiatric and Substance Abuse 5. Gynecology, Neo-natal Care and Paediatrics. 6. Social Service. 7. Dental Clinic All the 16 health care activities mentioned in Organizational Report 1 are being carried out in these seven departments. Each department is headed by a senior member of the staff, who directly report to the Director (Health Services) once a week. The Administrative work is looked after by a General Manager, who reports once a week to the Director (Admin and Finance). The Ethics Committee is headed by Director (Ethics) and has the General Manager as the permanent member. Three heads of the department serve in the Ethics Committee for six months on rotational basis. The Ethics Committee has formulated an Ethics Book. Every three months there is an Ethics Audit and a Compliance Report is generated, which is discussed in the specially called Board of Directors meeting on Ethics. The Ethics Booklet is a ready made dossier to be consulted in case an ethical issue arises. There are 36 staff members including doctors, nurses, para-medics, technologists, social workers and helpers. On any given day we receive an average of 76 cases related to all the departments. The Emergency and Trauma Care has five bed admission room where patients are admitted for day and night care. The department has a mini-Operation Theatre attached to carry out minor surgeries. The patients of Psychiatric and Substance Abuse Department also use the same facility in case an overnight admission is required. As a non-profit organization devoted to community health and social welfare we charge only token amount from the patients. On the other hand we have to canvass hard for institutional, governmental and social support to keep the organization’s head above water. Scarcity of funds dogs our organization. All our staff members are underpaid and the Directors are entitled to token honorarium money. If our staff is well-paid, they would always make an extra-effort to deliver par excellence services. On the other hand the chance of falling prey to corrupt practices can never be ruled out when the staff members don’t get enough remuneration to make both ends mean. As an example, we need to establish a full-fledged Surgery Department equipped with an Operation Theatre and Post-operative Care Unit. We also need to set-up diagnostic facility and pathological laboratory in the hospital. As of now, cases are being referred to other centre who charges exorbitant sums of money. Due to scarcity of resources, money, and staff sometimes we have to refer patients to other hospitals. This is an obstruction to our earlier envisaged mission of Albuquerque Health Care “that everyone should have the right to obtain health care whether or not they have the financial means to do so.” Taking the above mentioned factors it is strongly recommended to the Board of Directors to effect a change in the constitution of Albuquerque Health Care from a non-profit making body to a profit-making institution. By profit-making it is not intended that we change the institution into a money-spinner but make it self-sustaining organization that fulfills its core values while generating enough resources to grow and look after the monetary needs of the staff. The charges should be kept lower than that of other hospitals in the region. Children, old men and women, and unemployed can be exempted from hospital charges. The Board of Directors too should be suitably paid for the time they devote towards the institution. It is suggested that we charge our well-to-do adult patients for the health services in keeping with Baker Baltimore System quoted Baker (37) that “physicians have a right to require and expect” from their patients since physicians make so many sacrifices. This is certainly more practical approach to fulfill the ideals stated in our Vision and Mission statements. 3. Mission Statement: Albuquerque Health Care has fulfilled its mission as far as providing equal quality of health care to all age-groups regardless of their financial position or community background is concerned. All four half-yearly Ethics Committee Reports have mentioned it prominently. Randomly the patients are surveyed by the Ethics Committee and not a single complaint of non-compliance has been noted. At the very first stage of implementation “we have collaborative professional ethics” (Baker and Latham, introduction) in place. However, we have severely lacked in providing services as advanced surgery, research and outreach education. It is strongly suggested that we improve upon these areas in order to make services Albuquerque Health Care compatible to its deemed mission. 4. Values Statement The Values Statement of Albuquerque Health Care is built around Quality, Integrity and Respect. It is expected of the management and staff to carry out their duties with quality while showing highest integrity to professionalism and ethics. It is heartening to note here that our Behavioral Health Service and Social Service Departments have gone a bit further to include integrity in the patient-doctor relationship on reciprocal basis. Our experts through their mentoring a feeling of ‘implicit reciprocity amongst the patients to obey the prescription’ (AMA cited by Baker, 38). The role of our staff members in invoking a feeling of respect and obedience amongst the young substance abusers, the old and those suffering from behavioral disorders is certainly commendable. This is the single greatest achievement that makes Albuquerque Health Care stand apart from the rest. The result is there for all of us to see. 93% of the substance abusers left their addictions. 75% of those who sought treatment for behavioral or psychiatric disorders are continuing their medication holding the sanctity of the prescription slip. This group of patients is especially vulnerable to ‘walking out of the treatment.’ Our social workers keep an active tab on this group and motivate them to adhere to the prescription. 5. Code of Ethics While developing the Code of Ethics the AMA Code of Medical Ethics, as well as the Code of Hospital Ethics, University of Kansas Medical Center were consulted. The Ten Items that form the backbone of our code considers the physician, the patient and the Albuquerque Health Care as three distinct entities. Whereas the physician and the Albuquerque Health Care are expected on their own to meet the ethics, in case of non-discerning patients counseling by the hospital staff is highly recommended and carried out. Ethics Committee Rule Book clearly states that for achieving an end howsoever benevolent the means will not be justified. Thus the Code of Ethics is Utilitarian in principle. 1. Communication: The patients, their immediate relatives are motivated to reveal their case-history, symptoms and problems thoroughly leaving nothing to chance. It is impressed upon the patients that open communication helps the physician to pinpoint and diagnose a disease early. From the physicians and the Albuquerque Health Care side the diagnosis and prognosis is thoroughly explained to the patient and the relatives and their consent is sought before beginning the treatment. 2. Confidentiality: The physicians and staff members are instructed clearly to safeguard the confidentiality of a disease and treatment from all except those authorized by law. All aspects of the treatment and disease shall only be revealed to immediate relatives, friends, with consent of the patient. In case the patient is comatose or unconscious such information will be shared only with parents, spouse or children of the patient. 3. Consensus on Diagnosis: In case any serious disease, the physician is only allowed to proceed with the diagnosis after having consulted his/her immediate senior. In case of clash of ideas a full meeting of the Albuquerque Health Care’s physician is to be called and a unanimous opinion will be formed. 4. Record-keeping: All records of the diagnosis, treatment, and the disease of a patient will maintained with the hospital. A copy of this record can be provided to the patient on request. However, government bodies especially those requiring it on grounds of legal matters will have access to case records. 5. Compassion, Dignity and Human Rights: All physicians are required to carry out their duties by protecting human rights, dignity of the patient and handling the case with utmost compassion. 6. Reporting/ Whistle-Blowing: In case of a non-compliance of ethics, any staff member working at any level can blow the whistle and inform the Ethics Committee. The identity of the Whistle-Blower will be kept secret. However, in case a witness of an infringement of ethics, chooses to stay silent while not being in complicity with the malpractice being committed, he or she will not be held culpable to a wrong. All such matters that require the intervention of law will be reported to police without delay. 7. To Disclose the Truth: Even in case of the gravest of diseases the relatives and the patient will be disclosed about the actual physical condition of the patient. Nothing important in the case will be concealed from the patient. 8. Discontinuation of a Treatment: A patient who seeks to discontinue the treatment including those suffering from substance abuse will be allowed to do so. 9. Religious Concerns: All religious and cultural concerns of a patient will be taken care except those that stand in way of treatment. For such looking aside such concerns no consent from the patient would be sought under grave circumstances where the patient’s life is under threat. 10. Financial Constraint: No financial constraint will be allowed to obstruct the treatment. The treatment will go on with or without patient providing the money for it. The Code of Ethics will be part of the training manual of an employee. Every employee will be asked to appear before the Ethics Committee after six months and answer a few questions in a viva-voce. In case the Ethics Committee so desires the employee will be asked to take suitable training again. In case of a dilemma the matter will be decided by the Ethics Committee. Ethics Committee will have two permanent and three non-permanent members. The Committee will meet every three months to determine Compliance. The Ethics Compliance Report is to be annexed with the Annual Financial Report and made public on the Albuquerque Health Care website. With Ethics Committee as the watchdog it is assumed that the Code of Ethics will provide tangible outcomes. The Role of the Code of Ethics is to fulfill the ideals of Mission and Values Statement. The Code is intended at creating a perfect environment for patient care while upholding the dignity of the patient and promoting an atmosphere of mutual trust and integrity. The Code will go a long way in establishing the reputation of the Albuquerque Health Care as not only an organization that cares but cares with ethics. 6. Organizational Culture: The organizational culture that we wish to propagate is of selfless service. At Albuquerque Health Care everybody will be required to keep his/her personal interest subservient to that of the organization. As the organization will foster ethical values, non-discriminatory policies on terms of community, colour or nationality the staff will ingrain these ideals in their work-style. However, it should not be implied from this that the Albuquerque Health Care will remain oblivious to the needs of the staff. The staff will be paid for their service and their well-being and that of their families will be of primary importance to the organization. The work culture will be semi-formal where individual space and dignity will be protected. 7. Leadership: As a Member of the Board of Directors, I will always be in authority to look after day to day functioning of the Albuquerque Health Care. In my capacity as a Director, I will ensure as much presence in the hospital as possible. I will not opt for a office in the hospital rather I will always keep myself on the move checking routine matters, talking to patients, eliciting their views about their health condition and treatment. My role would be much like that of a leader who leads the battery from the front. I will not shy away from giving a hand to a stretcher or moving the wheel-chair rather than asking some one else to do it. Small actions do make a big difference. I will also ask other members of the Board of Directors to always keep their presence being felt in the hospital. An exemplary role definitely has the ability to evoke followership than a thousand words. I will lead by personal example. 8.Oversight: Oversight issues will be addressed by the Ethics Committee. The Ethics Committee due to its unique formation of permanent and non-permanent members is the be the most dynamic Committee of Albuquerque Health Care. Besides, the quarterly ethic audit, will informally meet once a week to seek opinion of the members about the working of the hospital. Secondly the working of the hospital will be looked after by two heads—Medical and Administrative. Both will be reporting independently to the Board of Directors. Any disparity in reporting by the two heads can be scrutinized. The hierarchical order will further help to keep a check on the juniors. The Board of Directors will meet from time to time to review the working of the hospital. The Administrative staff will be asked to conduct random surveys amongst the patients and elicit their views about the hospitals. I think with all the above mentioned systems in place there will not be a chance of breach or infringement of ethics or routine duty. 8. Conclusion: We have come a long way from a new organization spreading its wings to a health care unit with a difference. Actually it is our systems that make all the difference. Good hospitals are definitely manned by honest, upright and enterprising staff. Our goal is much wider than that. We have to make our presence felt in our region by making a meaningful difference in the social set-up. Our institution will be a role model for the young, a shelter and a crutch for the helpless and an opportunity for the enterprising. By combining health care with academic research and social work we can emerge as an institution without parallel. References: Baker, Robert B. The American Medical Ethics Revolution, Ed. Baker Robert B., Kaplan, Arthur. L, Emanuel, Linda L., Latham Stephan R. The American Medical Ethics Revolution, How the AMA’s Code of Ethics Has Transformed Physicians Relationship to Patients, Professionals, and Society. John Hopkins University Press, Maryland US Baker B. Robert, Caplan, Arthur L., Introduction The American Medical Ethics Revolution, How the AMA’s Code of Ethics Has Transformed Physicians Relationship to Patients, Professionals, and Society., John Hopkins University Press, Maryland US Hospital Ethics Handbook, (2002) The University of Kansas Medical Center, 5th Edition, Accessed July 23rd 2008, http://www.kumc.edu, “The Kansas University Medical Center Website” http://www.kumc.edu/hospital/ethics/ethics.htm Principles of Medical Ethics, Preamble (2001) American Medical Association, “The American Medical Association Website” Accessed July 23rd 2008, http://www.ama-assn.org/ama/pub/category/2512.html Read More