Health organizations, theories, behavior development and ethical culture

Cultural Values and Ethics -- As the global economy becomes more of a reality, and as various developing countries increase the amount of business they do with developed countries, many cultural issues arise. Doing business is not the same worldwide, and as citizens of a global village, we must realize that there are different cultural norms and behaviors that are acceptable in some countries, unacceptable in others, and even expected in some. International companies are being pressurized by different groups of people, mainly from their stakeholders, regarding social and ethical issues. Issues revolving around what the United States government calls "bribery" may indeed be part of doing business, yet cause us to ask: "Is it moral or not, when trading in a foreign country, to participate in immoral actions to survive"?

Morality is typically the standard that a group has about what is right and wrong -- good and evil -- permissible or unacceptable. As trade barriers are falling around the globe, differences in morality are gaining more interest domestically regarding such issues as human rights, political behavior or even environmental conservation. And, this bleeds over into organizations of all types, necessitating the requirement of a sense of ethical wisdom that transcends one's field and looks more towards a sense of being (corporate responsibility, best practices, etc.) with the world. Morality cannot be put "on hold" during one situation, and then brought to the forefront on another -- it needs to be pervasive, fair, and in the long-run, fit with the needs of the organizational culture.

As President of the Pennsylvania Hospital, it would be incumbent upon me to balance the needs of the patient with the overall mission and sense of values of the hospital's mission statement. This is utilitarianism -- the needs of the many before the needs of the one. Sending a message to the community, staff and Board is important, in the sense that the patient with obvious bias should perhaps find a different avenue of care. I would ensure that the patient was treated with respect, but would explain that our hospital is based on care and professionalism, not the ethnicity of the care giver. One the patient was stable, if he or she could not abide by the standards of egalitarianism, then I would suggest we might not be the best hospital for their use.

Part 2 -- Styles in healthcare -- Oftentimes, newer managerial theories show that we can draw parallels between organizations and individual psychological pathologies. The great sociologist Emile Durkheim wrote a book called Suicide, in which he described the manner in which the individual feels repressed and alienated from society, and so despondent he or she kills themselves. As a parallel, Durkheim said the same things happen to organizations and states. Oftentimes, when a healthcare organization sees an issue or problem, the action is neurotic in that it either overreacts or tends to ignore the problem until it becomes endemic.

This is particularly true in centralized organizations where the top executives have a major impact upon organizational climate, structure, strategy and even the selection of the environment; and, where organizational recruitment and promotion processes ensure uniformity, or at least conformity, among the top ranks of executives. People often talk about the "feel of the culture," and this feel is transmitted from the top down and makes the organization either comfortable or discomfiting.

In the healthcare world, one has to balance out the trend towards patient care and the environment of open communication, adaptation, and more personalized care in helping the patient take some responsibility for their health. To prevent this from happening and overcoming the modern healthcare organization, we can see the trend in nursing moving to more a means are more important than the overall results -- Values in Nursing, for instance. For example, Justice in medical ethics focuses on fairness and equity in the allocation of limited healthcare resources. It represents the idea that people should receive healthcare based on their individual need, not on entitlement based on class, wealth, race, age, or other factors unrelated to their illness. Societal values, of course, reflect how decisions are made in regard to triage of resources, but the extreme of utilitarianism and deontology are less important as the thinking process in regard to fair care based on medical need. The nurses' role as an advocate is to facilitate, encourage or to enable patients to be involved in all aspects of their healthcare, and when unable to do so, act in their stead. This issue may blur, at times, when administering pharmaceuticals that may have potentially painful or negative side effects. However, while the nursing code of ethics echoes the Hippocratic Oath of "do no harm," the greater or long-term benefit to the patient may, at times, override brief discomfort in order to heal. Nevertheless, the overriding idea is to keep the utilitarian approach to management, care and especially patient needs.

Part 3 - The global pharmaceutical industry develops, produces, and markets drugs that have been tested and licensed for use as medications; either generically or as brand medications. The industry is both complex and competitive, and is subject to numerous laws (by country) regarding the patenting, testing, and especially the marketing of drugs.

Pharmaceutical marketing is probably more vital for the success of any drug than most other products since, for the large part, consumers need a third party to recommend and prescribe the drugs for use. For most pharmaceutical companies, this means spending more on marketing than even research and development. For instance, in 2005 researchers estimate that between $30-$50 billion was spent on pharmaceutical marketing within the United States alone. 56% was spent on free sampling, 25% on physician contact and support, about 13% directly on consumer advertising, 4% on hospitals and a paltry 2% in medical journals (Pharmaceutical Marketing to Medical Students, 2004).