After reading Chapter 3 in Frankie Perry's book about Rolling Meadows Community Hospital, (Perry 2002) I wanted to comment on a personal experience I recently had at my own workplace. I was promoted to supervisor after working as a staff pharmacist for three years. In my fourth year in that position, a male manager was hired to be my new boss. I had also applied for this management position, and after rigorous interviewing by a male director and male out-going manager, they offered the job to a male colleague. I accepted their decision and hoped that my new manager and I would have a mentor-type relationship. Things went very well for one year, and then he started to criticize my performance. During this time, he was also accused of sexual harassment by another female colleague, and she decided to leave the company rather than pursue her legal options. My relationship with him was never anything but professional, but I always had the feeling that he was not comfortable with me being female. After one more year of severe criticism, I resigned my position as supervisor. My manager went on to hire a male colleague in my place.
There are many more details to my story, but the bottom line is, I felt that I was being discriminated against because of my gender. There were many examples, but one that comes to mind is when I was told by my manager that it was easier for him to complete disciplinary action with two of my male direct reports "because men can talk to each other better when there aren't any women in the room". To this day, I still do not know what was discussed. I was just told that they had worked it out.
Before I resigned, I met with the Human Resource Director (a female) who completely took my manager's side. There was no support there at all. My manager handed her a completely false list of criticisms about my performance, and she asked me to sign them. I refused to sign the document, and she placed it in my personnel file. Thankfully, I was enrolled in the Human Resources class at the time and my professor advised me that I had two choices - leave the company or move back to a staff position.
My decision to stay on as a staff position has been good. I do not have any direct contact with my manager (who is now the director), but I still feel that I was coerced into resigning as supervisor. I am hopeful that there is a way for women to progress to higher levels of management with men as their bosses, but I also know that gender discrimination is a real problem that can derail a woman's career.
There is a light at the end of the tunnel for me since I am about to graduate with a MSHA degree, and I will be looking for a different position. Hopefully, I will find that mentor I have been looking for!
Reference:
Perry, F. (2002) Chapter 3, Gender discrimination: Rolling meadows
community hospital. The Tracks We Leave: Ethics in Healthcare Management. Chicago: Health Administration Press.
Thursday, July 24, 2008
Wednesday, July 16, 2008
Will reform come for the US Healthcare System?
The United States has a big problem. Equal access to healthcare for every US citizen is not considered a right. Millions have little or no access to basic care, and many middle class citizens can not afford the health insurance being offered by private insurers. (Thomasma 2001)
The reform of our healthcare system seems inevitable, but how (and when) will real change happen? Part of the problem is that there are two different (and opposite) reasons for revamping the system; 1. The ethical concern that basic care should be a right for all citizens and 2. the financial need to control the upward spiral of increasing costs. These interests seem to compete with each other, but other countries are figuring out ways to combine both interests. Greater coverage at less cost is the goal, but is it possible in the United States? (Thomasma 2001)
The most recent place where this debate has taken place is the current presidential election. According to some polls, a national healthcare insurance program is the top priority for many voters. Since we only have two candidates left, I believe my vote will depend on who convinces me that they will keep healthcare as an early priority and be able to carry through on their promises.
John McCain wants to provide affordable access to healthcare for all by "encouraging personal responsibility" and "promote insurance competition". (Henry Kaiser 2008) Families will pay for health insurance with a tax credit, but he does not know how his plan will be paid for. Barack Obama will require all children to be covered, and will increase public plans. Most of the money to pay for his plan comes from discontinuing tax cuts put in place by President Bush. (Henry Kaiser 2008)
Of course, there is much more to each plan, but the bottom line is that McCain is going to expect people to be accountable for their healthcare costs. Obama is going to make health access more available through more government involvement (public programs). I have to believe that Obama's plan has a better chance of implementation if the financing can be figured out. McCain's plan would require a culture shift that may in the end be the better way, but may take many tens of years to implement. I don't think we have that kind of time. Obama's plan will provide universal coverage for children which is so very important, and in my opinion, will be easier to sell to the American public then "personal responsibility."
I do believe we need to be more accountable for how we spend our money, but quality healthcare is going to need both personal and public effort to achieve.
Lynne
references:
Thomasma, David (2001). Access to healthcare. Managing Ethically: An
Executive's Guide. Chicago: Health Administration Press.
Henry Kaiser Family Foundation (2008). 2008 Presidential candidate
health care proposals side-by-side summary. Health08.org.
Retrieved July 16, 2008 from
http://pdf.kff.org/health08/compare_5_16.pdf
The reform of our healthcare system seems inevitable, but how (and when) will real change happen? Part of the problem is that there are two different (and opposite) reasons for revamping the system; 1. The ethical concern that basic care should be a right for all citizens and 2. the financial need to control the upward spiral of increasing costs. These interests seem to compete with each other, but other countries are figuring out ways to combine both interests. Greater coverage at less cost is the goal, but is it possible in the United States? (Thomasma 2001)
The most recent place where this debate has taken place is the current presidential election. According to some polls, a national healthcare insurance program is the top priority for many voters. Since we only have two candidates left, I believe my vote will depend on who convinces me that they will keep healthcare as an early priority and be able to carry through on their promises.
John McCain wants to provide affordable access to healthcare for all by "encouraging personal responsibility" and "promote insurance competition". (Henry Kaiser 2008) Families will pay for health insurance with a tax credit, but he does not know how his plan will be paid for. Barack Obama will require all children to be covered, and will increase public plans. Most of the money to pay for his plan comes from discontinuing tax cuts put in place by President Bush. (Henry Kaiser 2008)
Of course, there is much more to each plan, but the bottom line is that McCain is going to expect people to be accountable for their healthcare costs. Obama is going to make health access more available through more government involvement (public programs). I have to believe that Obama's plan has a better chance of implementation if the financing can be figured out. McCain's plan would require a culture shift that may in the end be the better way, but may take many tens of years to implement. I don't think we have that kind of time. Obama's plan will provide universal coverage for children which is so very important, and in my opinion, will be easier to sell to the American public then "personal responsibility."
I do believe we need to be more accountable for how we spend our money, but quality healthcare is going to need both personal and public effort to achieve.
Lynne
references:
Thomasma, David (2001). Access to healthcare. Managing Ethically: An
Executive's Guide. Chicago: Health Administration Press.
Henry Kaiser Family Foundation (2008). 2008 Presidential candidate
health care proposals side-by-side summary. Health08.org.
Retrieved July 16, 2008 from
http://pdf.kff.org/health08/compare_5_16.pdf
Sunday, July 6, 2008
The ultimate responsibility
As I read "Making Life-Ending Decisions" by Sister Irene Krause, I started to think about why more people do not make plans for their inevitable death. After being bombarded with the much publicized case of Terry Schiavo here in Florida, I am certain that most people are aware of the dangers of not accepting the responsibility of planning for their ultimate end-of-life decisions.
I can certainly understand why it is hard to think about your own mortality, especially if you are still relatively young and healthy. I myself did not draft a living will until after I had two of my three children and decided that I did not want them to have to make hard decisions about my health care. The kindest thing I think you can do for your family is to leave information about how you want to be cared for in a terminal situation.
Sister Krause kindly gives us 5 questions from an ethicist, Elena Muller-Garcia, to consider when trying to determine if a possible medical intervention is worth performing to sustain a life. The idea that we would be creating physical and emotional pain, suppressing mental capacity and spending too much money if heroic measures are used is a helpful guideline in making a decision to end life-support.
I can think of no harder decision that deciding to let someone you love pass away. Everyone's ultimate responsibility should be yto make this decision easier for their caregivers.
Lynne
reference cited:
Krause, Sister Irene (2001) Making life-ending decisions.
Managing Ethically. An Executive's Guide. Chicago: Health
Administration Press.
I can certainly understand why it is hard to think about your own mortality, especially if you are still relatively young and healthy. I myself did not draft a living will until after I had two of my three children and decided that I did not want them to have to make hard decisions about my health care. The kindest thing I think you can do for your family is to leave information about how you want to be cared for in a terminal situation.
Sister Krause kindly gives us 5 questions from an ethicist, Elena Muller-Garcia, to consider when trying to determine if a possible medical intervention is worth performing to sustain a life. The idea that we would be creating physical and emotional pain, suppressing mental capacity and spending too much money if heroic measures are used is a helpful guideline in making a decision to end life-support.
I can think of no harder decision that deciding to let someone you love pass away. Everyone's ultimate responsibility should be yto make this decision easier for their caregivers.
Lynne
reference cited:
Krause, Sister Irene (2001) Making life-ending decisions.
Managing Ethically. An Executive's Guide. Chicago: Health
Administration Press.
Thursday, June 19, 2008
Do the right thing
I have seen abuse of power during my career, and it is always extremely unfortunate when a trusted leader of an organization behaves in his own interest instead of for those he has been meant to serve. A "servant leader" is a term used quite often in healthcare literature lately to refer to a manager or anyone in a leadership position who puts the needs of others ahead of his own.
You would think it would be obvious to those who are trusted to be in charge of an organizatin that they have a moral responsibility to the organization. CEO's from corporations such as Enron have proven to the world that power can corrupt. In healthcare, it is less common to hear of a CEO being prosecuted for "cooking the books", but limited resources could lead to unethical decisions.
The use of a guide such as ACHE's Code of Ethics should be a requirement for every healthcare executive. By adhering to the guidelines set by this Code of Ethics, questions about how a healthcare executive should respond to an ethical delemma are answered.
No matter how hard a decision may be, or who may be disappointed by it, the bottom line is if a healthcare executive always does the right thing, he will never be accused of doing things in his own self-interest.
You would think it would be obvious to those who are trusted to be in charge of an organizatin that they have a moral responsibility to the organization. CEO's from corporations such as Enron have proven to the world that power can corrupt. In healthcare, it is less common to hear of a CEO being prosecuted for "cooking the books", but limited resources could lead to unethical decisions.
The use of a guide such as ACHE's Code of Ethics should be a requirement for every healthcare executive. By adhering to the guidelines set by this Code of Ethics, questions about how a healthcare executive should respond to an ethical delemma are answered.
No matter how hard a decision may be, or who may be disappointed by it, the bottom line is if a healthcare executive always does the right thing, he will never be accused of doing things in his own self-interest.
Thursday, June 5, 2008
Learning a hard lesson
After reading the "Qual Plus HMO" story in Perry's book, I couldn't help but wonder how often this happens in business today. Jim Goodrich had been a successful COO of Qual Plus for 10 years. Suddenly, a board committee makes a questionable ethical decision to allow a contractor to submit a rebid and Jim finds himself in disagreement with everyone, even his boss. Legally, the lawyer says the decision is OK, and even the ethics committee demured to the board's decision as being OK. Jim had no support for his uneasy feeling that a conflict of interest existed on the board committee which led to the final acceptance of the contract from the contractor who had ties on the board committee.
The old adage comes to mind "It's not what you know, but who you know" that matters. I hear this all the time when people use their contacts to win contracts, admissions to colleges, tickets to sporting events, interviews with high profile people etc. If Acme Construction did not have Joe Smith on the board committee, they would not have gotten the contract. Their initial bid was too high. There were no stipulations in the original bidding rules for allowing rebids. In this sense, it was very unfair to the other contractors who submitted the bids.
On the other hand, is there anything wrong with asking for a rebid from a contractor that the board really wanted to work with? Acme Construction did come in later with a competitively lower price, and assuming they met all the criteria for quality work, why shouldn't they get the job? As the lawyer stated, the board's actions were not illegal. Somewhat questionable, yes, but the board was in charge of making the decision. Even if the CEO stood up to the board and requested that a rebid not be offered to Acme, would the board have listened to him? Brent may have made matters worse, and may even have jeopardized his own job.
Hiring a contractor doesn't seem worth throwing 10 years of successful management away for, and Brent seems to be telling Joe just that. Brent obviously does not seem to be a good example of ethical conduct himself, so the option of him talking to the board was probably not going to happen. In my mind, Joe should be bothered by the events as they unfolded in the board room and the lack of support from the CEO, ethics committe and legal consule. As it states in the Epilogue, Joe should have resigned and kept his self-respect. His resignation now looks inevitable anyway.
Reference:
Perry, F. (2002) The Tracks We Leave: Ethics in Healthcare Management. Chicago:Health Administration Press
The old adage comes to mind "It's not what you know, but who you know" that matters. I hear this all the time when people use their contacts to win contracts, admissions to colleges, tickets to sporting events, interviews with high profile people etc. If Acme Construction did not have Joe Smith on the board committee, they would not have gotten the contract. Their initial bid was too high. There were no stipulations in the original bidding rules for allowing rebids. In this sense, it was very unfair to the other contractors who submitted the bids.
On the other hand, is there anything wrong with asking for a rebid from a contractor that the board really wanted to work with? Acme Construction did come in later with a competitively lower price, and assuming they met all the criteria for quality work, why shouldn't they get the job? As the lawyer stated, the board's actions were not illegal. Somewhat questionable, yes, but the board was in charge of making the decision. Even if the CEO stood up to the board and requested that a rebid not be offered to Acme, would the board have listened to him? Brent may have made matters worse, and may even have jeopardized his own job.
Hiring a contractor doesn't seem worth throwing 10 years of successful management away for, and Brent seems to be telling Joe just that. Brent obviously does not seem to be a good example of ethical conduct himself, so the option of him talking to the board was probably not going to happen. In my mind, Joe should be bothered by the events as they unfolded in the board room and the lack of support from the CEO, ethics committe and legal consule. As it states in the Epilogue, Joe should have resigned and kept his self-respect. His resignation now looks inevitable anyway.
Reference:
Perry, F. (2002) The Tracks We Leave: Ethics in Healthcare Management. Chicago:Health Administration Press
Saturday, May 31, 2008
Is it ever OK to hide a medical error?
As I was reading through the Paradise Hills Medical Center example in Chapter 1 of Frankie Perry's book, I was surprised that the option to hide the radiation overdose was even being considered. The text states that Paradise Hills has a reputation for "high-quality care", and "competent, caring staff". In my mind, that reputation would be severely jeopardized if anyone ever found out that a medical error like the one described was hidden from the patients who were affected by it. The text also mentions that Paradise Hills has "strong leadersship". Is hiding a medical error something a strong leader would do? The text mentions that the market share of the oncology division has been declining recently. Maybe the attitude of those in leadership positions has something to do with that.
The reasons given by the medical staff for not disclosing the error included not wanting to confuse terminal cancer patients and thereby destroy their faith in their physicians, frighten the patients unnecessarily which may lead to refusal of treatment, or inducing symptoms by telling the patients of potential ill effects. I think all these reasons are quite ridiculous and do not even begin to justify withholding the truth from these patients. The medical staff are probably more concerned with the potential of a lawsuit, but I would worry more about being sued for not telling them what happened.
The medical staff are assuming quite a lot about how these patients would react to the news that the equipment was not calibrated properly. I think most people would be worried if they knew and hope not to exhibit any ill effects, but would understand that every piece of equipment has the potential to malfunction. By not telling the patients about this, the hospital is opening itself up for lawsuits based on negligence. The physicians can not treat any ill effects of the radiation overdose unless the patient knows what is happening, therefore, if ill effects do occur, what does the doctor do? If he stands by and does nothing, he is committing medical malpractice. By not telling the patients, the hospital administration is banking on the fact that the patients will either die first or not suffer any ill effects that can be attributed to the radiation overdose.
In this case, I think that the CEO has no choice but to encourage the medical staff to "do the right thing" and disclose the error to the patients. He must support them through the consequences that may occur because of the disclosure, but in the long run, a climate of truth-telling will benefit the organization much better than one of hiding errors. The precedent can not be set that allows lying to patients to become justifiable. This time it may seem all right to hide a radiation overdose, but what about the next error that occurs? Having a clear, ethical position makes these types of decisions easy. Dealing with the consequences of an error is usually inevitable. Sooner or later, they will have to face them. I think I would like to do it sooner.
Lynne
reference:
Perry, F. (2002) The Tracks We Leave: Ethics in Healthcare Management. Chicago: Health Administration Press.
The reasons given by the medical staff for not disclosing the error included not wanting to confuse terminal cancer patients and thereby destroy their faith in their physicians, frighten the patients unnecessarily which may lead to refusal of treatment, or inducing symptoms by telling the patients of potential ill effects. I think all these reasons are quite ridiculous and do not even begin to justify withholding the truth from these patients. The medical staff are probably more concerned with the potential of a lawsuit, but I would worry more about being sued for not telling them what happened.
The medical staff are assuming quite a lot about how these patients would react to the news that the equipment was not calibrated properly. I think most people would be worried if they knew and hope not to exhibit any ill effects, but would understand that every piece of equipment has the potential to malfunction. By not telling the patients about this, the hospital is opening itself up for lawsuits based on negligence. The physicians can not treat any ill effects of the radiation overdose unless the patient knows what is happening, therefore, if ill effects do occur, what does the doctor do? If he stands by and does nothing, he is committing medical malpractice. By not telling the patients, the hospital administration is banking on the fact that the patients will either die first or not suffer any ill effects that can be attributed to the radiation overdose.
In this case, I think that the CEO has no choice but to encourage the medical staff to "do the right thing" and disclose the error to the patients. He must support them through the consequences that may occur because of the disclosure, but in the long run, a climate of truth-telling will benefit the organization much better than one of hiding errors. The precedent can not be set that allows lying to patients to become justifiable. This time it may seem all right to hide a radiation overdose, but what about the next error that occurs? Having a clear, ethical position makes these types of decisions easy. Dealing with the consequences of an error is usually inevitable. Sooner or later, they will have to face them. I think I would like to do it sooner.
Lynne
reference:
Perry, F. (2002) The Tracks We Leave: Ethics in Healthcare Management. Chicago: Health Administration Press.
Saturday, May 17, 2008
How should we make ethical decisions?
I don't know about you, but I took this class in healthcare ethics because I wanted to find out more about the dilemmas healthcare workers face everyday and how they come to terms with the inevitably difficult decisions they must make.
I am a pharmacist at Holmes Regional Medical Center in Melbourne, and I have worked there for 10 years now. Before that, I owned my own pharmacy and worked at a few different chain drugstores. As I have traveled through my healthcare experience, I have had occasion to discuss the seemingly heroic measures that many healthcare professionals provide in order to keep a patient alive. The question of whether to apply expensive therapies to patients who are determined to be "close to death" is an age old one and one I feel should be decided on by a case by case basis.
I had no idea until this week that there were helpful tools like the "Framework for Ethical Decision-Making" from the W. Maurice Young Centre for Applied Ethics. I guess I thought that there was some kind of decision-making guidelines out there, but now it is nice to finally see examples of them. Taking a difficult decision and breaking it down into the steps provided by this framework seems to help take the quess work out of whether your decision was "ethical" or not.
Recently, a 13 month old patient was admitted to our ICU because she was ventilator dependent since birth and electricity was cut to her home due to fire. She has multiple health issues including pulmonary hypertension which even an adult has difficulty surviving very long with. Our question in the pharmacy was "Is it ethical to keep this child alive due to her limited survivability and huge healthcare costs associated with her ventilator dependency?" Most of us felt that the child should be allowed to pass away peacefully due to the poor quality of life she (and her family) were experiencing.
I know there will be those that disagree wholeheartedly with my view. I am a mother and the idea that I would have to make this kind of decision is horrifying at best. The framework suggests that after you make your choice, you "Live with it" and "Learn from it". I only think that if this were indeed my decision to make that I would not only live with the knowledge that I did the right thing for the people involved but also learn that there is always pain associated with ethical decisions like this one.
I would love to hear your view if you have time to respond.
Lynne
I am a pharmacist at Holmes Regional Medical Center in Melbourne, and I have worked there for 10 years now. Before that, I owned my own pharmacy and worked at a few different chain drugstores. As I have traveled through my healthcare experience, I have had occasion to discuss the seemingly heroic measures that many healthcare professionals provide in order to keep a patient alive. The question of whether to apply expensive therapies to patients who are determined to be "close to death" is an age old one and one I feel should be decided on by a case by case basis.
I had no idea until this week that there were helpful tools like the "Framework for Ethical Decision-Making" from the W. Maurice Young Centre for Applied Ethics. I guess I thought that there was some kind of decision-making guidelines out there, but now it is nice to finally see examples of them. Taking a difficult decision and breaking it down into the steps provided by this framework seems to help take the quess work out of whether your decision was "ethical" or not.
Recently, a 13 month old patient was admitted to our ICU because she was ventilator dependent since birth and electricity was cut to her home due to fire. She has multiple health issues including pulmonary hypertension which even an adult has difficulty surviving very long with. Our question in the pharmacy was "Is it ethical to keep this child alive due to her limited survivability and huge healthcare costs associated with her ventilator dependency?" Most of us felt that the child should be allowed to pass away peacefully due to the poor quality of life she (and her family) were experiencing.
I know there will be those that disagree wholeheartedly with my view. I am a mother and the idea that I would have to make this kind of decision is horrifying at best. The framework suggests that after you make your choice, you "Live with it" and "Learn from it". I only think that if this were indeed my decision to make that I would not only live with the knowledge that I did the right thing for the people involved but also learn that there is always pain associated with ethical decisions like this one.
I would love to hear your view if you have time to respond.
Lynne
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