Ethics in the management of health care organizations

This article introduces the topic of ethics in the management of health care institutions and provides a glimpse at how issues of ethics have grown in recent years and are apt to be applied in the future. Ethics and some of its basic conceptual and practical tools are defined. A brief history of the ethics of managing health care institutions, a crucial context for understanding the contemporary ethics of health care institutions, is provided. What has changed in the past 10 years and how those changes have resulted in the ethical heterogeneity of contemporary health care institutions is discussed. Finally, some preventive ethics strategies for the management of health care institutions are suggested.     

Is HRD in need of an ethics of care?

Human Resource Development (HRD) operates within competitive global environments and the changing expectations of societal moral values, which can be in conflict with organizational values, performance, and profit. These are underpinned by the unquestioning acceptance and ‘orthodoxy’ of free‐market economics, legalism, and codes of conduct that result in a lack of ethical analysis within HRD practice. In response to the forgoing, it will be argued that the ethics of care that espouses the values of human relationships, empathy, dignity, and respect is a legitimate approach to free-market lead ethical rule-based rationality that is often presented as the de facto position for HRD professional practice. It presents the ethical debates in which HRD operates within, before arguing for the ethics of care. Three case examples from practice are offered illustrating how HRD practice might respond through the lens of an ethics of care. Reflections and implications for HRD in the form of objections and responses are considered. It concludes that HRD professionals are faced with many difficulties when making decisions, and that the ethics of care offer is an alternative perspective for HRD practitioners.     

Public hospitals: an assessment and plan for the future.

We are currently living in very difficult times for most health care providers. Even though we have always known it, the fact that resources for health care are limited is now abundantly apparent to consumers, health care providers, fiscal intermediaries, government (local, state, and federal), health care planners, and policy makers. Hospitals, especially, are being severely pressured to reduce resource consumption and costs. Conditions that are difficult for nonpublic hospitals are critical for public hospitals in general and nearly fatal for rural public hospitals. Fortunately, nonpublic hospitals are beginning to realize for the first time that their future depends, to a significant degree, on a strong and financially healthy public hospital system. If the public hospital, the hospital of last resort, closes, medically indigent patients will have to be treated in nonpublic hospitals, with the resultant medical, financial, economic, political, and social consequences. Therefore, the importance of public hospitals has to be even better recognized and appreciated and these institutions actively supported in order for the private and total health care systems to be successful.     

Credentialing in managed care

Through the use of managed care techniques in recent years, the insurance industry has tried to bring the runaway costs of medical care under control. The result of this control effort is system access limitations, compared to the full choice indemnity plans of the past. This limited system access has now clearly moved HMOs and other managed care organizations into the category of "potentially liable health care entities," based on patient steerage, economic disincentives, and limited choices of the plan's participating providers and facilities. Just as hospitals have had to exercise rigorous care in the credentialing of members of their medical staffs, managed care organizations will have to ensure that the providers they use meet acceptable standards of competence.     

Health care's power brokers in the 21st Century. Interview by Donna Vavala

Health care has undergone turbulent change in the 20th Century. In addition to dramatic pharmaceutical and technological advances, the entire health care delivery system has been significantly improved. Through all the turmoil, hospitals have been at the center of the health care universe. But, as the 21st Century approaches, that may change, too. What will become of hospitals, which for most of this century have played a commanding role? Will managed care organizations and group practices come out on top? And, once the new power broker takes over, what will be the impact on providers, insurers, and the government, and how will their relationships to each other change? Jeff Goldsmith, PhD, President of Health Futures, Inc., Bannockburn, Ill., and health care futurist, examines tomorrow's health care delivery system and makes some eye-opening predictions.     

Nun sag, wie hast du’s mit der Ethik? – Menschenbilder und Ethik im Coaching. Eine Feldstudie

The integration of theory and practice in combination with ethical standards has been clearly defined as a scheme in the field of coaching, but there is still a long way to go. Within the scope of a field study and challenged by numerous perceptions, terms like ‘ethics’ and ‘idea of man’ in the context of coaching have been closely analysed, edited in a structured way and evaluated. These steps were followed by the examination and investigation of the websites of a selected number of providers and trainers of coaching, concerning the extent to which these websites include information on the meta model as well as on the theoretical level according to A. Schreyögg. Based on the rather sobering findings, our study concludes by specifying the cornerstones of a ‘check list’. This tool may help to classify providers and trainers.     

Credentialing, the most important function for success

After years of attempting to control costs by changing providers' behavior and practice patterns, it has become apparent that the solution lies in the study and cooperation of practitioners. Computers, reports, analysis, and payment reforms have discovered the truth: Many physicians and hospitals have always provided high-quality care efficiently. Costs will be controlled when these providers dominate the health care delivery system.     

The Ethics of Management Research: An Exploratory Content Analysis

Management academics have tended to rely on ethics codes developed by social researchers in related fields to inform their research practice. The point of this paper is to question whether this remains a viable approach in the current climate that is characterized by a significant increase in ethical regulation across the social sciences. We suggest that management researchers face ethical issues of a different nature to those most frequently confronted by other social science researchers, and argue for more explicit acknowledgement of contextual factors involved in management research. An exploratory analysis of the content of ethics codes formulated by nine social scientific associations is undertaken to identify the main ethical principles they cover and to analyse their underlying ethical tone. Drawing attention to the principle of reciprocity, which is found in very few codes, we suggest that an ethics code could be used to formulate new ways of thinking about management research relationships. Despite the risk that ethics codes may encourage instrumental compliance with minimal ethical obligations, we suggest they also have the potential to reflect a more aspirational agenda. The development of an ethics code for management research should therefore be seen as a potentially worthwhile project.     

Strategic issues requiring public accountability: food for thought

Although the exact outline of U.S. health reform has become fuzzy because of political events, it seems clear that major changes in the manner in which health care is delivered and financed are under way. The initiative for the most part has been assumed by state government and by the health care field itself, as managed care becomes ever more entrenched and the health care system becomes ever more integrated. An expected outcome of these changes will be demands for greater public accountability on the part of health care providers and organizations. In this article, the author discusses some of the issues--professional compensation, documenting community service, ensuring public input into planning efforts, economic credentialing and quality of care, and managing ethics under managed competition--that will have to be addressed at the local level as these shifts take place.     

针对灰色营销进行道德培训的实验效果

本文以道德培训为操纵变量,以工商管理专业的大学生为实验对象,研究了灰色营销的道德培训对人们灰色营销道德判断和行为倾向的影响.结果发现:第一,针对灰色营销的短期道德培训能够显著改进被培训者针对灰色营销的道义论评价和目的论评价,但是不能降低其灰色营销行为倾向;第二,尽管针对灰色营销的短期道德培训能够改进人们针对灰色营销的道义论评价和目的论评价,并且后者对人们的灰色营销行为倾向也有显著影响,但是它们不能中介短期道德培训对灰色营销行为倾向的影响.本文最后讨论了研究结果的理论贡献与实际应用.     

An organizational climate regarding ethics: the outcome of leader values and the practices that reflect them

In this article, we argue that the organizational climate regarding ethics — the shared perception of what is ethically correct behavior and how ethical issues should be handled within an organization — is an outgrowth of the personal values and motives of organizational founders and other early organizational leaders. We begin by arguing that one common label for the climate regarding ethics construct — “ethical climate” — is inappropriate. We also argue that climate regarding ethics has an impact on organizational outcomes, including organizational outcomes that do not have explicit ethical components. We propose that this impact largely occurs through the mediating mechanisms of organizational cohesion and morale. We conclude by discussing the variety of antecedents and outcomes related to climate regarding ethics.     

Business Ethics and Business History: Neglected Dimensions in Management Education

This article highlights two large gaps in the business school curriculum: the neglect of historical and ethical dimensions. An overview is provided of progress made so far in the UK in the evolution of business history as an academic discipline; and also of the take–up of business ethics in university teaching. Both have had some success, but overall the response to these areas has been somewhat lacklustre — at least in the UK. A justification is provided for adding both components to a fully relevant business education. When the two are combined, the result can be a highly rewarding combination that provides insights that may not be possible for management writers, who work only in the present. Corporate ethics, the social responsibility of companies, disclosure, the environment, the actions of multinational companies overseas, the dilemmas of whistle–blowing, the impact of lobby groups and health and safety issues can all be understood more fully by students if they approach these subjects from an ethical and historical standpoint.     

Managed care's Achilles heel: ethical immaturity

How can physician executives determine the prevailing values in the managed care arena? What are the consequences when values statements are ignored during decision-making? These questions can be answered using a process called ethical reasoning, which is different and more productive than making moral judgments, such as "is managed care good or bad?" Failing to include ethical reasoning in executive offices and boardrooms is a form of ethical immaturity. It fuels public suspicion that managed care's goal may be maximizing profit at all costs, as opposed to seeking reasonable profit through provision of dependable and accessible health care services. One outcome of ethical reasoning is rediscovering the basic truth that running one's business on competitive rather than altruistic principles is ethical whenever greater efficiencies and economic growth enlarge the size of the pie for everyone. Reasonable self-interest is a perfectly acceptable reason to act ethically. The time has come for physician executives to develop a basic understanding of pragmatic ethics, and to appreciate the value of adding ethical reasoning to the decision-making process.     

The Bonus Scheme,Motivation Crowding-out and Quality of the Doctor-Patient Encounters in Chinese Public Hospitals

Methods of paying health providers have been extensively studied in health economics. Bonus as a powerful incentive has been widely used to boost staff morale and improve productivity in hospitals. This may, however, also create unintended consequences. This study analyzes primary data collected from a physician survey in China and demonstrates that the extensive use of quantity-based bonuses has not only led to the provision of unnecessary care but also crowded out physician’s intrinsic motivations, resulting in a decline in the quality of services. More appropriate physician remuneration mechanisms must be introduced in China’s ongoing health reform.     

Rethinking the Concept of Sustainability

The role of business ethics in developing more sustainable societies is crucial, but we first have to review the concept of sustainability itself and its ethical roots. The objective of this work is to rethink the current concept of sustainability by providing it with a sound universalistic ethical rationale. We propose that ethics is the key by which disputes and conflicts among the economic, social, and environmental domains can and ought to be resolved. This work argues that if we fail to recognize the essential ethical grounding of sustainability, or if we take it for granted, then sustainability can easily lose its way and can end up unjustified.     

Transition to capitation. Aligning incentives for success

Horror stories abound about providers that have failed to modify their incentive systems and have exhausted their annual capitation budget in the first six months of the plan year. Aligning the business strategy and financial incentives in advance is the best way to ensure that your integrated delivery system's transition to capitation is a success story. Rarely are physicians or hospitals with experience limited to the fee-for-service arena prepared to jump into a managed care or capitated compensation system. The transition can be eased by implementing a "shadow" capitation or similar arrangement that will test physician performance under a risk arrangement in advance. The information can be used to restructure the compensation system to ensure that the behaviors being encouraged will promote successful care and fiscal management.     

Formatting and presenting quality data to medical staffs and hospital boards

A host of historical and practical precedents have made hospitals responsible for the quality of care rendered within their facilities. The medical staff and the board of trustees share in this responsibility. Increasing demands for demonstrative evidence of the quality of care in an institution have made the process data-based. There is no substitute for specific data on the performance of both the hospital and its providers in the delivery of care. The trick, however, is in presenting this information to the medical staff and the board in a fashion that will be understandable and that will still maintain confidentiality of provider and patient. The authors offer a presentation system that has met with success in their community hospital.     

Information technology, Part 3. The technology hierarchy

The era of the networked society--and medical care depending on networked intelligence--is dawning. Physicians need to plan for office practice information systems in common, with an eye to conveying data electronically between all the locations of care and all the providers involved in caring for defined populations of people. The shared database will become the most important asset of the collection of providers who make up the delivery system that creates it. This will be accomplished by layering technology on local and wide-area networks of group practices, hospitals, health plans, and payers and developing standards that make data accessible in the same format to all users, no matter where they are.     

Working Adults and Personal Business Ethics in South East Asia: a Comparative Study in Thailand and Vietnam

Global leaders and managers have been facing new challenges in the twenty-first century since globalization has created a much more integrated and borderless business environment. One of the key issues that they constantly deal with is business ethics. The global economy has made ethical issues become more complex and challenging. Businesses nowadays face urgent demands to act ethically and responsibly. In order for global leaders and managers to manage such a cultural diverse and complex workforce, they must have the ability to understand these complex issues and act ethically. They also need to possess adequate leadership skills to lead an ethical organization in a multinational environment. Thus, understanding and recognizing the cultural differences as well as the ethical standards of people in different countries are critical to the success of global leaders and managers. The purpose of this study is to investigate the perception of working professionals on business ethics in the two high-context cultures in South East Asia: Thailand and Vietnam. Using the Univariate Analysis of Variance method and adopting the widely-used Clark and Clark’s Personal Business Ethics Scores (PBES) measure, this study will compare the level of ethical maturity of the respondents based on a variety of variables including gender, business law course taken, code of conduct, ethics training, and government work experience. The authors will provide a thorough literature review on business ethics as well as the current ethical issues, i.e., bribery and corruption, in the two countries, together with practical suggestions and implications for educators, managers, and employees.