Health Administrator Ethics Issue

Ethics One ethical dilemma that arises in health care is with respect to quality improvement techniques (Lynn et al., 2007). While it is accepted that quality improvement activities are an intrinsic part of normal health care operations (Ibid), administrators are obligated to ensure that QI activities are conducted in line with ethical guidelines. An ethical dilemma arises, however, when faced with the opportunity to make a quality improvement based on techniques that seem sound but perhaps lack empirical backing. The dilemma would then feature two pathways.

The first is to opt to adopt the quality improvement idea before research has shown conclusively that it is effective, and the second pathway is to not adopt the QI tactic until it has been demonstrated effective. A specific example could be a radical new technique for a challenging condition -- it may not be proven but the situation may be so challenging that the use of a radical, unproven new technique to improve outcomes is considered.

The administrator may be faced with a patient and physician seeking approval for a new technique that is unproven but has a chance to deliver better results than known techniques. This dilemma qualifies under the category of "ethical issues in assuring quality of care." There are ethical considerations with respect to the use of peer review, for example.

Should a new innovation be faced with research results that are unclear, or have not been subjected to peer review, there is risk to both the patient and to the health care organization. That said, a new technique might be necessary in order to increase the odds of positive patient outcome. The health care administrator would need to resolve the ethical issue by whatever means are available.

There are several duties that the health care administrator must take into account in making a decision about a new, relatively unproven, technique for quality improvement. The duty of nonmaleficence is the duty not to inflict harm. In the described situation, this duty is central to the ethical dilemma. The new QI technique is believed to improve patient outcomes, but there is an unknown element if the technique has not been subject to adequate peer review.

The technique could cause harm, and the risk of causing harm might not yet be known. Yet, if the technique works then the effect will reduce overall harm. The reverse duty of beneficence is also valid, and it is precisely the unknown aspect of the new QI technique that creates the dilemma between these two duties. The article points out that the duty for QI lies in the duty of nonmaleficence, where the risk of doing harm is key to resolving the ethical dilemma.

QI methods should only be adopted when they are known to represent an improvement, which implies a peer review process and some other institution taking the risk associated with the new technique. I feel that this is probably the best approach for most institutions. They need to safeguard both the patient and the institutions. New techniques to improve quality are risky, because they introduce unknown potential outcomes to the patient care experience.

This is usually not acceptable, and may also violate the trust that the patient puts in the health care organization to receive the best possible care. There are issues as well with regards to informed consent, in that the patient is not likely to fully understand the risks associated with new techniques. They may focus on the potential positives (like quality improvement) and downplay the negatives. This is not the basis for informed decision-making.

Thus, the administrator of the health care organization needs to be the one guiding the decision-making process, balancing the interests of the patient and the organization. In most cases, it is imperative to wait for proper peer-reviewed research before changing techniques for handling situations. Part II. Ethical dilemmas arise in part because there are a number of different ethical guidelines, and a situation occurs where there is conflict between the actions or outcomes prescribed by different guidelines.

The situation described violates the principle of justice in that there is one trainee who is receiving all of the patients from one community, leading to discrepancies in care between different communities, and in workload between the practitioners. Evidence shows that the general public prefers practitioners strike a balance between meeting needs, maximizing outcomes and treating all patients equally in a pluralistic manner when there is an ethical dilemma relating to the rationing of care (Cookson & Dolan, 2000).

In this situation, the response of management needs to be to seek out this pluralistic approach. The first step is to determine the needs, which is for quality care to as many patients as possible. It appears that there is capacity within the clinic, so this is not strictly a rationing problem, but an allocation problem. There is no capacity constraint, merely an issue with resource allocation, so this makes it easier to resolve the dilemma.

The solution, then, is to randomize the patient allocations to the different social workers, dispersing patients among the practitioners in an even manner. There are two objections to this. The first is that there is unequal cultural training.