This case study examines the decision making process from a collective viewpoint. It attempts to resolve issues within a community hospital that have arisen due to failed organizational management, ethical considerations and a poorly established communication system.
Framing the Problem:
Identify the Problem-
The primary problems that exist within Faith community hospital center around the following as outlined by the CEO: (1) a lack of organizational processes that ensure uniformity, (2) a lack of standardized procedures with regard to ethical considerations working in a medical environment, and (3) lack of appropriate communication systems to ensure that everyone is thinking alone the same lines.
At this point in time Faith Community Hospital has developed a mission statement that clearly identifies the organizations mission which is among other things to provide a quality continuum of service to community members.
However variant interpretations of the mission have led to a chaotic management style and organizational foundation that does not allow these objectives to be carried out. In addition rising insurance costs have affected the ability of staff members to provide quality services given a fixed or declining population ratio.
2. Define Objectives, Goals and Criteria
At this point in time the goals and objectives of the management team include providing "a constant continuum of services to the community in collaboration with partners sharing the same vision and values." Specifically the common goals among Board members, staff, patients and family should be to ensure the best quality of service with appropriate consideration to personal ethical, moral and belief criteria. The criteria for determining whether or not these goals are met include measuring the efficiency of service, the quality of service delivered, and the ability of the organization to break even without impacting these factors.
The forces influencing the organization's ability to meet these goals include the variant thinking styles and collective perceptions that exist among the varying populations affected by care. For example, as the CEO points out there are a wide variety of clients served by Faith community hospital including the Board of Directors, staff, patients and their families.
The CEO reports that Faith "draws value lines and diverse junctures when it comes to applying rules, differences between ethics, laws and beliefs."
3. Evaluate Effects of Problem
The problem is worth studying because it impacts not only the hospital but also the patients it serves and their families, as well as the community at large. The costs associated with solving the problem are far less then the problem itself.
As the financial analysis conducted points out, at this time a drop in population by as much as 7% is occurring. Within the organization currently 28% of costs are fixed, not associated with population size, and in order for the hospital to break even costs have to be slashed by as much as 15%. In addition within the eyes of the pubic, if the internal problems with regard to organizational processes, ethical considerations and communication are not resolved, staff and patients will continue to disagree with regard to treatment outcomes, and the hospital could potentially face grave financial burdens resulting from potentially lawsuits stemming from the publics perceptions of adequate care.
If nothing were done, the hospital may face bankruptcy or worse, go out of business entirely because it is not able to keep up with the financial demands of running a community hospital, and may not be able to keep up with the legal requirements of assuring the best possible outcome for all patients.
Making the Decision
4. Identify Causes of Problem
The cause of the problems include a lack of sufficient organizational processes that outline specifically how staff members should act in certain situations, such as the case of a DNR (do not resuscitate). There is evidence to suggest that in some cases staff members do not adhere to patient wishes, and other evidence to suggest that staff members do not have adequate documentation to support their actions when they do respond to patient desires.
In other situations staff members are not acquiring proper authorization to carry out tasks including pro-bono work. The source of the problem is inadequate management directives and organizational procedures that firmly dictate what exactly employees and staff members should do in each of these situations.
In addition failed communication exists with regard to management objectives, and there is a poorly structured system for approaching the ethical and moral issues that arise in this type of setting.
Additional causes include various methods of operating in situations that are similar. There are no stringent guidelines that currently exist for delineating authority or what tasks should be carried out when with regard to individual patient circumstances. There is a lack of commitment from management to agree to a standardized set of rules and regulations given the diverse nature of the population that the Faith Community Hospital serves.
5. Frame Alternatives
The alternatives are many. The community hospital can first work toward establishing a stringent code of ethical conduct that could be widely adopted. In addition the hospital could work toward establishing a fixed set of steps and procedures that outlines documentation requirements for specific situations including DNR orders and caring for patients without insurance. This may require that in some cases certain patients may be denied access to certain services, or that in other situations patients wishes may go against the wishes of the family.
Humphreys, Moak, Reidenbach & Robin (1993) point out that with regard to ethical considerations, the most important thing for a business to do is attempt to build trust with the client. Ethical directives should be provided by managers at the top of the organization and shared with other staff members (Dolecheck & Dolecheck, 1989).
Organizations that deal with ethical consideration are susceptible to potentially debilitating and "disastrous" consequences if they engage in unethical behavior, thus it is important that the organizations perceptions of ethical practices coincide somewhat with that of the public/patients and their families (Humphreys, et. al, 1993). Thus it is vital that while the community hospital adopt a code of ethics, they do so in a manner that affords everyone the opportunity to enjoy a trusting relationshipo if possible with staff members.
Mattison (2000) suggests that the ethical decision making process can be linked to organizational decision making processes effectively if managers are able to conceptualize decisions as "related to one another over time" (p. 201). Decision makings should select the courses of action that are most in line with personal preferences, professional roles, a commitment to the laws and policies of the organizations in which they are working, their practice experiences as well as other "individualized perspectives" (Mattison, 2000: 201).
In addition organizational members including staff have an obligation to develop an awareness of the value preferences of those they are working with, and attempt to resolve ethical dilemmas in a sensitive way; the role of staff members will thus be to take the steps necessary to compensate for any discrepancies that exist between value preferences to ensure that ethical decision making occurs (Mattison, 2000; Reamer, 1995).
Staff members and organizational managers must also work to acquire purposeful intent and reflection or continuous reflection throughout the decision making process in order to assess each case detail and identify the differences that exist for different patients, as well as the varying ethical components that distinguish one case from another (Reamer, 1995).
6. Evaluate Impacts of Alternatives
There will be costs associated with implementing the alternatives selected. A more stringent system of organizational processes and formal code of ethics that dictates the procedures to be embarked upon given certain situations might in some cases impose on the belief systems of patients or staff members, and cause individuals to act in a manner that is contrary to their beliefs. A few staff members or even patients might be lost in the process.
However, it is vital to the livelihood of the hospital that a standardized system for care delivery be established to ensure that the hospital can continue to operate in a manner that provides quality service to the community it services. As Mattison (2000) points out while it is important to acknowledge the individual preferences and ethical considerations of others to build a trusting relationship, it is also vital for an organization to establish a standard modus of operation and communication pattern that ensures the highest quality service for all involved.
One thing that will help mitigate the impact of the decisions being made by top management will include open communication between all members of management and staff. The more communication that is provided, the less likelihood for confusion and distrust among staff members.
7. Make Decision
The most immediate and cost effective decision will be to establish a formal set of policies and procedures that delineates what actions should be taken in cases including DNR, lack of insurance and patient/family ethical conflicts etc. It will be vital that the organization also develop a somewhat standard code of ethics that…