Organizational Ethics In Health Care

1
Organizational Ethics In Health Care

• What is it?
• What is unique about it?
• How to study it?
• Philip Boyle, Ph.D.
• Vice President,
• Mission Ethics
• www.CHE.ORG/ETHICS

2
Etiquette

• Press 6 to mute
• Press 6 to unmute
• Keep your phone on mute unless you are dialoging
  with the presenter
• Never place phone on hold
• If you do not want to be called on please check
  the red mood button on the lower left of screen

3
Todays goalWhat is organizational ethics?

• The nature of organizationstheir ecology
• How to study organizations?
• What is unique about organizations?
• What is unique about healthcare organizations?
• What unique about RC organizations?
• What is Ethics? OE? What is unique to OE?

4
Moral Ecology

• Cell
• Individuals
• Groups
• Regional Ecosystems
• Ecosystem
• Biosphere

• Individual acts
• Moral agents
• Departments
• Institutions
• Organizations
• Healthcare system

5
Moral Ecology

• Advantages
• Honesty--clear about perspective
• Which level is more important?

• Disadvantages
• Other levels obscured
• Can obscure differences between organizations

6
The Actors Risks

• Sponsorsclear role
• Boards--clear process
• Managers
• Senior managementdiscretion
• Middle
• Financeconflicts of interest
• HRhiring firing, promotion
• Marketingtruth in advertising
• Developmentnature of gift acceptance
• Environmental servicessafety
• IS--confidentilaity

7
The Actors Risks

• Employeescommon risks of agent-principle
  relationships
• Consumers/patientsparticipation appeal
• Purchasers/vendorsnature of cooperation
• Community
• External forces

8
How to study

• Formal
• Personnel arranged in a hierarchy of authority
• Those in policy making higher positions are
  regarded as professional managers
• Most relations can be described as
  principle-agent relationships
• Division of labor with each position having
  limited authorized actions
• Following policies and procedures
• Products are joint outputs

9
How to study

• Formal Risks
• Joint output--mission substitution
• Hierarchy --expert imperialism
• Clear roles--dithering, stalling, obstruction
• Managerial expertise--incompetence

10
How to study

• Informal
• Culture is the glue of the organization
• Values and beliefs of all participants and
  includes the internal and external interpretation
  of those beliefs
• Informal unstated ways of acting
• Difference between policy and actual practice
• Moral psychology
• Wendy Carlton In our Professional Opinion
• Charles BoskForgive and Remember
• Danial Kahneman and Amos Tversky Judgment under
  Uncertainty Heuristics and Biases
• Sandy Tannenbaum
• Michael Davis The Challenger Disaster

11
How to study health care organizations

• Determine what makes healthcare organizations
  different from others kinds of organizations
• Opportunistic rapidly changing
• Any organizations that participates in
  healthcare Purchaser/Vendor/Provider
• Industrialization process use of industrial
  techniques for predictable outcomes
• Move from a medical professional to managerial
  professional

12
Uniqueness of organizations

• What is unique about organizations/corporations?
• What is unique about RC organizations?

13
Nature, goal, method in ethics

• Ethics is good business
• Compliance
• Flourishing

14
Definitions

• Family resemblances
• Business ethics
• Management ethics
• Corporate Ethics
• Institutional Ethics
• Organizational Ethics

15
Definitions

• Nash The study of how personal moral norms
  apply to the activities and goals of a commercial
  enterprise. It is not a separate moral standard,
  but the study of how the business context poses
  its own unique problems for the morals person who
  acts as agent of the system.
• Boyle, et al. Focus on the choices of all
  individuals in an organization and on the choices
  of the organization as organization in bring
  fulfillment to individuals and the community

16
Moral agency of institutions

• Philosophersit is not a moral agent
• Theologiansit is a moral agent
• Mediatorsit acts as IF it were a moral agent
  helpful analogy

17
Moral Agency of Organizations

• Legal
• 19th century property
• 1978 Pinto criminal behavior
• 1978 Corporation have free speech rights
• 1991 Sentencing guidelines

18
Moral Agency of Organizations

• Sociologyplain language
• Organizations exist after an individual dies
• Said to hire and fire
• Said to pursue missions that override the mission
  of any individual
• Its actions are not reducible to actions of
  employees

19
Moral Agency of Organizations

• Moral
• Held accountable
• Praised and Blamed
• Decision makingnot on impulse
• Acts in rational ways--policies
• Creates culture

20
Mechanisms to address OE

• Subcommittee of ethics committee
• Ad hoc groups
• Senior management team
• Mission Effectiveness Committees

21
What are essential elements of VBDM?
22
(No Transcript)
23
Why use it?

• Consistent evidence of supporting Mission
• Evidence of Participation and Respect for Persons
• Evidence that the Spirit has guided
• Checks Balances
• Fosters habit of moral reasoning

24
When to use it?

• Formally
• Decision that affect significant interests and
  populations
• Opening Closing Services
• Significant HR issues
• Development of Strategic management tools
• Infomrallyall moral decisions

25
Phase I Preparation

• Number of persons/groups impacted
• Does it affect a department or the institution?
• Duration of the impact
• Does the impact last a few years or the span of
  the ministry?
• Depth or weight of impact
• Does the question affect the entire ministry or
  a portion of it?
• Closeness to Core Values
• Does the question directly jeopardize a value?
• Degree of complexity
• Past commitments
• Does the question positively or negatively affect
  past commitments?
• Relationship to strategic direction

26
Whose interests are affected?

• Based on the nature of the issue, what other
  individuals or groups need to be part of the
  process?
• What is the nature and frequency of the
  connection between the groups and the question?
• What departments will be affected?
• What departments might have insight?
• What other entities will be affected by the
  decision?
• Who would have insights to the Mission and
  tradition as it applies to this decision?

27
Phase II Decision Making

• Pray, reflect, identify question, and clarify
  authority of decision-making group.
• Prayer and reflection are necessary because the
  group believes that it is Gods spirit that is
  guiding and perfecting the many decision-making
  talents brought to the table. A spirit of
  prayerful reflection centers the group on the
  fact that they are continuing the healing,
  transforming ministry of Jesus.
• Identification of the question is essential
  because each decision maker will perceive and
  state the question differently. If the question
  is inaccurately identified at the outset of
  decision making, or not agreed upon, then the
  ensuing process will be counterproductive.
• The decision-making group should be clear about
  its scope of authority. Do they have the ultimate
  decision-making authority, or are they a
  consultative group that provides information to
  the ultimate decision maker(s)?

28
Phase II Decision Making

• 2. Determine primary and secondary communities of
  concern and their interests.
• While there may be a large community of concern,
  not everyone in that community has the same
  interests. The decision-making group should
  assess the manner and degree to which a
  sub-community will be affected positively and/or
  negatively.
• The decision-making group should consider how
  those who are poor and vulnerable will be
  affected by the decision.

29
Phase II Decision Making

• 3. Pinpoint and gather needed information and
  data.
• What essential data have been gathered already?
• What essential data have yet to be gathered?
• Once data are gathered, does the group agree on
  its relevance, accuracy, and completeness?

30
Phase II Decision Making

• 4. Identify key moral commitments and values, as
  well as conflicts among them.
• Identify the question in terms of trade-offs
  between one or more values. For example, consider
  your decision in terms of human dignity and
  identify the dignity trade-offs in the various
  options that you are weighing.
• Identify the major consequences of this dignity
  trade-off in terms of individuals and groups in
  terms of long- and short-term burdens and
  benefits or in terms of money, morale and
  relationships, etc.

31
Phase II Decision Making

• 5. Establish priorities among commitments and
  values.
• The moral commitments and values that deserve
  priority will flow from consideration of
  strategic goals/objectives, core values,
  historical commitments, the broader religious
  tradition, and special circumstances.
• List each priority and provide the rationale for
  why it is a priority.

32
Phase II Decision Making

• 6. Develop options that support the priorities.
• Identify options that promote the moral
  commitments and values deserving priority.
• Examine carefully the major options and evaluate
  the positive and negative consequences of these
  options on the identified priorities.
• Consider not only the burdens and benefits of the
  preferred option but all of the options.
• Do any of the options preserve and protect a
  majority of the identified priorities?

33
Phase II Decision Making

• 7. In silence reflect and then listen to
  viewpoints.
• To ensure that the Spirit has guided the
  discussion and to promote the voice of any
  reservations or opposition, a quiet time of
  reflection should be offered during which group
  members consider the discussion in light of the
  faith tradition and personal conviction.
• Consider the following reflective questions
• Have I listened to the facts and appreciated the
  viewpoints of others?
• Have I opened myself to the workings of the
  Spirit?
• Have I sought the good of the entire ministry and
  then the particular good of others?
• Has input been elicited from all decision makers?
  

34
Phase II Decision Making

• 8. Gain consensus on decision.
• Invite all members to express which option should
  be pursued and why. Discussion should be held
  until every member has had an opportunity to
  voice an opinion.
• At the conclusion of the participatory decision
  making, estimate if a consensus exists, and if
  not, identify the points of disagreement and
  allow for additional conversation for
  clarification.
• If a consensus is reached, identify the values
  that will suffer because of the choice. Discuss
  how to mitigate the harms.

35
Phase III Follow Through

• Assign accountabilities to specific persons for
  each component to be realized.
• Build a plan for monitoring and reporting with
  measurable outcomes.
• Build a communication plan for community of
  concern with key messages and methods.
• Build a plan that connects to the larger meaning
  and purpose.

36
Conclusions

• Moral agency of organizations
• How to study
• Formalpolicies
• Informalpractice
• Overlap between clinical and organizational
  ethics
• Dig in with low hanging fruit
• Different mechanisms