Health Care Management

Health Care Labor Force One of the challenges that can arise as organizations become more complex is that oversight is more difficult. With more people and more divisions, there are more transactions, and more opportunity for unethical decision-making. In many cases, it will also be more difficult to identify unethical behaviors. Another challenge is that one of the main methods of preventing ethical violations is to have training, and an organizational culture, that rejects unethical behavior.

People within the organization who receive training are in a position to understand when they may be involved in an ethical dilemma, and they will also have better tools for addressing such as dilemma. So in theory, it is entirely possible that there could be more ethical issues in larger, more complex organizations. Just on raw numbers, the more people are in an organization the more likelihood that there will be some sort of ethical violation.

But there is not likely to be any evidence of a relationship between organizational size and ethics. In smaller organizations, there are not enough people to have adequate checks and balances, and the principles hold too much formal power. In that sense, there is actually better opportunity to guard against ethical violations in larger organizations. But dishonest people occur everywhere, and on a per capita basis, there is no reason why a larger organization should be any worse than a smaller one.

Indeed, if an organization ends up with a bad apple, a larger organization will see its per capita incidence of unethical behavior lower than in a smaller organization, where the one bad apple is a bigger part of the organization. What is likely is there is going to be more publicity with respect to larger organizations; when they transgress, it makes the news, while that would not be the case in a smaller organization.

The text also makes the argument that "an industry characterized by high cash flow and insufficient accountability is predisposed to financial malfeasance." What I would take issue with here is the assumption that there is insufficient accountability. There should not be. At a larger organization, even though there is a need to recruit more people, the organization should be able to recruit and train people who are competent because the cost of such training can be spread out among more employees.

There is no evidence presented other than the rhetorical that larger, more complex organizations are more predisposed to ethical violations. The author cites a common type of violation, which is in the billing process, for unnecessary interventions or services not delivered. These things could occur in any organization. A larger organization has better opportunity for managerial oversight to identify where such things might have happened. There are unscrupulous people in organizations of any size.

Whether an organization is predisposed to it depends more on what the organizational culture of the organization is, and whether or not the organization is able to.