Transcript Advancement to Diplomate

Professionalism
and Ethical Knowledge
Irene Rostas, MHA, FACHE
Highlights
• 16 questions for 8 percent of exam
Professionalism and Ethics
The American College of Hospital Administrators (ACHA) was
established in 1933 for the following hallmarks:
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Public service orientation
Self-regulation
A code of ethics
Expectations, such as assuring competence of members through
continuing professional education
 Samaritanism
 Charity
These hallmarks can be found in the ACHE Code of Ethics
Professionalism and Ethics
• Ethical Policy Statements have also been
developed by ACHE to address specific
concerns of healthcare executives
• These are published on the ache.org website,
and included in the annual report.
Professionalism and Ethics
Ethics is often defined as a formal study of
morality.
Sociologists – mores, customs and behavior
found in a culture
Physicians – meeting the expectations of their
profession and society and acting in certain
ways towards patients
Professionalism and Ethics
Ethics to Healthcare Executives – special charge and
responsibility to:
• patient
• client
• others served
• The organization
• Its personnel
• Themselves
• The profession
• And ultimately, but less directly, to society
Professionalism and Ethics
ACHE’s Code of Ethics
• first published in 1939
• Several iterations since
• Major revision in 1987
• Code is reviewed and updated annually
• Primary and contextual focus of the Code is
protecting and furthering the interests of the
patient, client and others served.
Professionalism and Ethics
In the Code, special attention is given to such
issues as:
• Responsibility to those served by the
organization
• Obligations to the profession and the
organization
• Roles in providing health services to the
community and those in need of services
• Conflicts of interest
Professionalism and Ethics
The Code encompasses the concept of moral agency (or
advocate) which holds that healthcare executives are
morally accountable for the implications of their:
Malfeasance (wrongdoing or misconduct, especially by
a public official)
Nonfeasance (failure to do what ought to be done) and
Misfeasance (the performance of a lawful action in an
illegal or improper manner)
Professionalism and Ethics
• ACHE affiliates are obliged to bring to the attention of
the ACHE Ethics Committee any information that
reasonably causes them to believe there has been an
infraction of the Code.
• Alleged infractions of the Code are reviewed by the
Ethics Committee, with the help of other elements of the
ACHE governance structure.
• The Ethics Committee makes a recommendation to the
Board of Governors, which has final authority.
• The Code includes appeals and reviews, which provide
for substantive and procedure due process.
Professionalism and Ethics
American Medical Association’s Principles of Medical Ethics
• Based on work of a 19th century English physician, Sir
Thomas Percival.
• Subsequent revisions continue to incorporate portions of the
Hippocratic philosophy governing physician-patient
relationships.
• The Principles were last revised in 1980 – which moved away
from previous emphasis on benefits and harms, and adopted
the language of rights and responsibilities.
• The Principles direct members to “strive to expose those
physicians deficient in character or competence, or who
engage in fraud or deception”.
Professionalism and Ethics
American Nurses Association’s Code for Nurses
• Philosophy is that the goal of nursing is to support the
client’s responsibility and self-determination to the
greatest extent possible.
• Specific provisions set out the relationships among
nurses, and with nursing, clients, employers and the
public.
• Nurses are expected to act when healthcare and safety
are affected by the incompetent, unethical or illegal
practice of any person.
Professionalism and Ethics
Codes of Ethics for professional groups
• Provide for self-regulation
• Must be sufficiently precise so that guidance is meaningful,
both to the members of professional groups and societies and
to those who are charged with enforcing the code.
• Must be living documents that provide meaningful guidance to
individuals who want to do the right thing, but who are
uncertain as to what that is.
• Education about its ethical code and expectations should be a
part of any continuing education development program
undertaken by a profession
Professionalism and Ethics
Patient Rights and Responsibilities
Two moral philosophies are especially important as a
context for solving ethical problems:
• Utilitarianism – is a type of teleology that measures
the ends or results produced by a certain action; the
action producing the greatest good is that which is
morally correct.
• Deontology – based on duty; there are right and
wrong actions, regardless of the end produced by that
action.
Professionalism and Ethics
Four principles that can be used to guide
healthcare executives in developing a personal
ethic:
• Respect for persons (which incorporates
autonomy, confidentiality, fidelity and truth
telling)
• Beneficence
• Nonmaleficence
• Justice
Professionalism and Ethics
Principles guiding personal ethics should:
• permeate an organization’s philosophy
• be reflected in its mission statement and other
written expressions of values
• be reflected in all the policies, procedures and
rules used by the organization
• be part of the healthcare executive’s personal
ethic, as well as part of all decision making
Professionalism and Ethics
Institutional Ethics Committees
Interdisciplinary teams to provide
• advice
• Consultation
• Education
• Analysis
for physicians, patients, staff and healthcare executives.
Focused on biomedical ethical issues and administrative
ethics.
Professionalism and Ethics
Infant care Review Committees (ICRC) are
established in response to the Federal Child
Abuse Amendments of 1984.
1. Educate hospital personnel and families of
disabled infants
2. Recommend institutional policies and
guidelines as to withholding medically
indicated treatment
3. Offer counsel and review in such cases
Professionalism and Ethics
Institutional Review Board
• Established to meet the requirements of the
department of Health and Human Services, and other
federal and state agencies in various types of
research.
• Prospectively review proposed research that involves
human subjects to determine whether research
subjects will be at risk of harm and to ensure that
legally effective informed consent will be obtained
Professionalism and Ethics
Types of research in healthcare organizations
• Clinical trials – primarily performed in academic
health centers and other teaching hospitals
• Practice of Medicine research – performed in larger
hospitals and HMOs – use of previously collected
data and survey research to evaluate the practice of
medicine
• Patient satisfaction
• Outcomes measurement
Professionalism and Ethics
Patient Bill of Rights
• Suggest appropriate ethical relationships
between the patient and the organization and
its employees
• Emphasize maximization of patient autonomy
while recognizing the needs of the health
services organization
• Responsibility of patients in the care process
Professionalism and Ethics
Expectations of Ethical Conduct
• Statements or guidelines established by trade
associations
• Set out expectations for ethical conduct and
relationships with the community, and those served,
and organizational conduct in general.
• Health care providers are expected to accommodate
the religious and social beliefs and customs of
patients whenever possible.
Professionalism and Ethics
Cultural and Spiritual Diversity
Equal Employment Opportunity Commission
Create protected classes of persons against whom it is
illegal to discriminate
• Unlawful discrimination
• Sexual harassment
• Intimate or romantic relationships in the workplace
• Sexual orientation
• Affirmative action
• Diversity programs
Professionalism and Ethics
Provision of services based on values
• There is no expectation that the organization’s legally
compliant value system as expressed in its statement of
organizational philosophy or other guiding principles must be
breached to meet the demands of patients, clients, or others
served, or of employees.
• Governmental facilities may not enforce theologically based
positions since this constitutes an unconstitutional
establishment of religion.
• Thus, governmental facilities provide services that
nongovernmental facilities may not be forced to provide.
Professionalism and Ethics
Conflicts of Interest
Occur when one has conflicting duties or
responsibilities and meeting one of them
makes it impossible to meet the other
Example: a decision maker (manager or
corporate director) is also a decision maker for
an organization with which business is done.
Professionalism and Ethics
ACHE Code of Ethics
ACHE affiliates are expected to accept no gift or
benefit “offered with the express or implied
expectation of influencing a management
decision”.
An organizational policy that no gratuities can be
accepted is the cleanest and clearest approach
and leaves nothing to the potential recipient’s
judgment.
Professionalism and Ethics
Need more in-depth resources?
ACHE’s Code of Ethics
ACHE Ethical Policy Statements
Contemporary Issues in Healthcare Law and Ethics, 2nd ed. by
Dean M. Harris, J.D.
Ethics in Health Service Management, Kurt J. Darr, J.D., Sc.D.,
FACHE
Heath Care Ethics, John F. Monagle and David C. Thomasma
Organizational Ethics in Health Care, Philip J. Boyle Edwin R.
DuBose, Stephen J. Ellingson, David E. Guinn, and David B.
McCurdy
The Tracks We Leave: Ethics in Healthcare Management,
Frankie Perry R.N., FACHE
Professionalism and Ethics
Ready for some test questions?
Professionalism & Ethics
Test Questions
The major purpose of the code of ethics for members of
a healthcare executive’s association is to:
1. Enhance the image of the healthcare management
profession
2. Set forth standards of ethical behavior for
healthcare executives
3. Set ethical guidelines for the advancement of
members within the organization
4. Provide a forum for dialogue on healthcare policy
issues
Professionalism & Ethics
Test Questions
Healthcare facilities serving disabled populations might
wish to systematically review concerns by:
1. Adding specific questions to patient satisfaction
instruments
2. Consulting periodically with advocacy groups
3. Reviewing patient complaints raised by disabled
individuals
4. Reviewing their compliance with the Americans
with Disabilities Act.
Professionalism & Ethics
Test Questions
The healthcare executive with opposing duties
(obligations) – meeting one of which makes
it impossible to meet the other – has a:
1. Conflict of interest
2. Management ethical dilemma
3. Need for a consultant
4. Situation that is impossible.
Professionalism & Ethics
Test Questions
The ethical percepts (organizational philosophy)
that guide an organization’s activities are
found in a variety of sources that are:
1. Reflected in everyday actions
2. The sole province of senior management
3. Part of the governing body’s formal actions
4. Written and unwritten
Professionalism & Ethics
Test Questions
The most common and useful ways to overcome
resistance to change in organizations are:
1. Education and communication
2. Manipulation and co-optation
3. Committees and task forces
4. Inspirational leadership and managerial skill.
Professionalism & Ethics
Test Questions
Coordination among governance, management, and professional
staff is a major problem for most healthcare organizations.
A common way to solve the problem of coordination is:
1. Provide a local area network to leaders of each group using
personal computers
2. Have overlapping membership of committees that are part of
each group
3. Have quarterly meetings where issues of concern to the
groups are discussed
4. Provide copies of memoranda and policy statements to
leaders of each group
Professionalism & Ethics
Test Questions
In efforts to encourage licensed clinical staff to engage
in continuing education, healthcare executives are
given substantial assistance by the fact that these
professionals:
1. Are encouraged by significant peer pressure
2. Must meet requirements of their certifying group
3. Are often interested in opportunities to transfer
4. Must meet malpractice law continuing education
standards
More Question Areas
• Billing practices
• Patient confidentiality
• Ethics and foreign cultures
Need more in-depth resources?
• ACHE’s Code of Ethics
• ACHE Ethical Policy Statements
• Contemporary Issues in Healthcare Law and Ethics,
2nd ed. By Dean M. Harris, J.D.
• Health Care Ethics, John F. Monagle and David C.
Thomas