H374 Exam 1

Family's decision to withdraw life support for clinically ill patient. Clinical Ethics or managerial ethics?

clinical

Patient have difficulty understanding informed consent information. Managerial Ethics or Clinical Ethics?

clinical

Core components of professionalism

• Disciplined

• High ethical standards

• Special knowledge and skills

• Education and training at a high level

• Interest of others

Professionalism

Ability to align personal and organizational conduct with ethical and professional standards that include a responsibility to the patient and the community, a service orientation, and a commitment to lifelong learning and improvement

Professional Values

• Public service

• Respect for others

• Self regulation

• A calling and meaningful work

• Autonomy

stages of professionalization

• Stage 1: Full time occupation

• Stage 2: Formal training

• Stage 3: Professional association

• Stage 4: Self-regulation and possibly licensure

• Stage 5: Code of ethics

Profession

body of knowledge shared by a group of individuals with specialized education and training and common values

Two common characteristics of professionals

• systematic knowledge and adhering to professional norms

Values important to professionals

public service, self regulation, a sense of calling and meaningful work, and autonomy

Professions evolve through what?

a multistage professionalization process

Claims

itemized request that a provider submits to a payer for reimbursement services

false claims act

can not make false claims

Altruism

sacrificing oneself for the public good

Referent

entity, such as a professional association, to which its members look for guidance

Systematic knowledge

facts, tools, and theories of a field organized into a unique body of knowledge

Lincoln Law

•  American federal law that imposes liability on people and companies that post fraud on the government 

• You can not upcode, submit medicaid for patient you did not see, can not claim you did care when you did not

Descriptive ethics

the study of people's beliefs about morality

normative ethics

• the study of ethical theories that prescribe how people ought to act

applied ethics

• putting moral knowledge into practice

  • Bioethics

  • Business ethics

  • Organizational ethics

  • Profession- specific ethics

moral psychology

moral reasoning and judgment in decision making

Consequentialism (teleology

The right action tends to result in good consequences, the wrong action tends to result in bad consequences

Utilitarianism

• Ethical choices should be based on consideration of the consequences of those actions and not “duty”

• The greatest benefit to the greatest number affected

• Focus on best outcome for all people, not the individual

Virtue ethics

• Determine rightness by the quality of a person's character rather than a person's individual acts or their consequences

• Aristotle’s cardinal virtues:

• Prudence (practice wisdom)

• Fairness (justice)

• Courage

• Temperance (self-control)

Deontology (“ethics of duty”)

• Doing the right things for the right reasons

• We all have duty to ourselves and to others

• The only true good is goodwill

• All human beings have worth

• An act is right because it is inherently honest, just or fulfills a duty, regardless of its eventual outcome

Rawls

People agree to organize themselves based on justice, fairness and mutual cooperation

Ethics of care

• Emphasis on care as an end in itself, and caring practice as imperative to human life

• Ethical actions are evaluated based on interpersonal interactions and how they are - not based on rationally or universal behavior norms

Ethics

• system of beliefs and behaviors that people value and use to control their conduct

four branches of ethics

descriptive ethics, normative ethics, moral psychology, and applied ethics

Healthcare manages use applied ethics, which includes what?

bioethics, business ethics, organizational ethics, and profession- specific ethics

including health professionals use ethical theories such as?

consequentialism, deontology, principles of justice, and the ethics of caring

what are the core ethical principles?

• Autonomy

• Beneficence

• Nonmaleficence

• Justice

Autonomy concepts

• Based on the idea of self-rule or self determination

• Means that there is freedom from others control and the capability to make choices

• There is freedom to comply or not without penalty

• Autonomy is concerned with treatment of patients by the overall system

What threatens a person's autonomy in healthcare?

• Level of health literacy

• Ability to understand and make informed decisions

• Access to information (not everyone has a PC)

• Languages or cultural differences

• Pressure-influence from others

Autonomy: Informed consent

• Legal and ethical obligation

• Risks, benefits, and alternatives

• Informed consent must be based on patient competence, voluntary, and include disclosure

Autonomy: confidentiality

• HIPAA (protection of your own healthcare information) 

• Electronic records

• Anti-gossip effort

Autonomy: Truth-Telling

• Social interactions are based on a presumption of truth

Autonomy: Fidelity

• keeping your word

• It meets the categorical imperative

• Business deals rely on it

• includes employees

• Conflicts do exist

Patient Culture

• What is normal and routine for a practitioner may be deeply embarrassing for a patient

• Patients must trust the competency and compassion of practitioners 

• Patients now have greater access to health information from a variety of sources

• Both practitioners and healthcare administrators need to be prepared to work with the patient culture in an ethical manner 

What is nonmaleficence?

• An obligation to not cause harm to others

• Or to intentionally refrain from the things that cause harm

What is our obligation as healthcare administrators?

• Know about the patient experience

• Develop best practices and standards to prevent problems

• Listen and respond to patient concerns

• Ensure policies for safety and protection of patients’ physical health and dignity

• Infection control practices

Beneficence

• It is acting with charity and kindness, even when there is no direct benefit to you

A boy scout helps a little old lady cross a busy street. Maleficence or Beneficence?

Beneficence

Review of organizations charity care policy. Managerial or clinical ethics?

managerial

How can healthcare administrators show beneficence

Treating employees well, equal and with respect

What is cornerstone of professionalism

ethics

Conflict of interest

If a radiologist owns a diagnostic center, he can not recommend his patient to his other center

What is active patient justice?

• Practice positive consistency

• Education of the staff is key

• Watch compassion fatigue through scheduling

• Role modeling is important

Moral duties for justice

• Respect everyone as a human being

• Explain the reasons for giving or not giving treatments

• Give options; respect patient decisions

• Know and use a patient bill of rights

Distributive Justice

• The appropriate and fair distribution of benefits offered by a society

• The appropriate and fair distribution of burdens

• Based on society's expectations

• Market-driven economy makes it difficult

Ways for you to provide staff justice

• Know your power

• Watch your practices and attitudes

• Ask the staff

• Learn to be an effective writer

• Become an active observer

What is it called when a citizen sues on behalf of government

Qui Tan

Health care managers can determine what works best through a practice known as what? Physicians make it based on what?

• Evidence Based Management 

• Evidence Based Medicine (EBM)

What is self rule or self determination?

autonomy

Can a healthcare provider withhold any relevant information for informed consent?

no

Why is confidentiality considered an important ethical principle in healthcare?

• Needed to establish a trusting relationship between patient and provider

• There is an underlying assumptions that patients own their own data related to health

Latin for hippocratic oath, which ethical principle does this relate to?

Maleficence because it says “first do no harm”

If a hospital administrator asked the materials management department to buy a certain device (handheld scanner that detects objects left in patients)(using it post op), what ethical principle are we guarding against? beneficence or nonmaleficence?

nonmaleficence

What principle is “Acting with charity and kindness”?

beneficence

What is a Riff?

another word for layoff

What do we called is you are doing what is perceived as “fair” or “deserved”?

justice

When the physician decides what is best for a patient without consulting them, what is it called?

paternalistic

How we should treat a patient at any given situation is called what?

Standard of care

What is it called when all  patients with the same condition are all treated the same way? What are the upside and downside for these?

• Single standard of care

• Downside: can seem impersonal and that you are going through the motions 

• Upside: it is effective, improves clinical outcomes across the population

What minimizes passion fatigue? What are strategies that can minimize passion fatigue?

• When they are not as compassionate toward the patient

• Caring for an ill person for a long period of time and eventually it starts to wear off after a long time

Who has ultimate authority to set charity care policy for a not-for-profit healthcare organization?

board of trustees

What are some advanced directives? And what ethical principle does this help to support?

• Living will 

• DNR order

• Supports Autonomy

If there is an unintended outcome in a hospital that is severe (injury, sickness, death), what is this called? If you almost have that event what is it called? Are these obligated to be reported and why?

• Sentinel event

• Near miss

• Yes- opportunity to improve

model for disclosure in hospitals that are recognized across the US, what is it called?

Lexington Model

stark law

Physicians cannot refer patients to a place where they have financial involvement

Competency areas of professionalism

• Understanding professional roles and norms

• Working with others

• Self- management

• Contributing or giving back

• Achieving competency in these four areas is a step toward professionalism 

Professionalism can be defined as what?

the knowledge, skills, ability, and conduct expected of practitioners of a profession

Corporate social responsibility is the…

 “context-specific organizational actions and policies that take into account stakeholders expectations and the triple bottom line of economic, social, and environmental performance”

Evidenced based management-

a practice whereby the approaches that consistently yield desirable results are examined, tailored to need and strategically applied

Interprofessionalism

 healthcare professionals working together to improve patient care

HIPAA

 Health Insurance Portability and Accountability ACT of 1996 sets the standards for protecting the privacy of patients information

ADIET

• Acknowledge

• Introduce

• Duration

• Explain 

• Thank you

 stewardship

• The act of putting first the best interests of stakeholders that leads to building and maintaining trust

• In healthcare “the careful and responsible management of the well-being of the population”

The role of stewardship in managers duties

• Identify and prioritize stakeholders

• Support and sustain the organization's mission 

• Maintain organizational integrity through reciprocity

MAMA

Meeting, apologize, monetary compensation, action plan

Transparency

policy of sharing information and communicating directly, and in a timely manner

Lexington, kentucky VAMC model

risk-management program for disclosing errors that was instituted in lexington veterans affairs medical center following a patient's death

The three responsibilities of fiduciary

 duty of care, duty of loyalty, and duty of obedience

How do healthcare organizations know what is the best practice

Evidence based management

If a patients struggles to understand details of informed consent, is that clinical or managerial ethics

clinical

Family debating on whether to withdraw life support, managerial or clinical ethics?

clinical

A physician did not complete their document in the medical records, clinical or managerial ethics?

clinical

Making sure a hospital has a clear charity care policy, managerial or clinical

managerial

What must be present for there to be valid informed consent

• Explain RBA (risks, benefits, alternatives)

• Must be voluntary

• Have to be of age and competent

What do we call non profit healthcare organizations?

Sovereignty free

Stipulates what people should or should not do in certain situations

Normative ethics

Importance of data and decision making, Data must have 3 specific components to it

• Aggregated (All the data, relative), objective (Without bias), measurable (relevant)

What are internal market forces?

• Geography and service area

• New medical discoveries/ technologies

• Inflation input prices

• Labor shortage

• Revenue growth expectation for professional healthcare administrators

• Profit motive

• Managed care shifting cost burden to patients

• Competition between providers

• Health system integration and mergers

What are external market forces?

• Changes in the economy 

• Local, state, and national political decisions

• Societal changes

Managed care

• a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care, for organizations that use those techniques or provide them as services to other organizations 

What if you work for an MCO?

• HCAs must market only what the organization can deliver. No false promises

• HCAs ensure salespeople are not making inflated claims

• HCAs must make clarity of coverage a priority

• Cost information must be available/ accessible/ accurate

• Network provider list must be up-tp-date and accurate