Financial crisis and ethical policy gaps at Faith Community Hospital

¶ … Pour

Faith Community Hospital has become sick and is currently in need of support and care. We currently face two significant problems that, if not addressed immediately, could undermine our work and could threaten our ability to offer quality care to the people in our community. The problems we face include the following main issues. First, our costs are increasing while our patient population is decreasing. In short, Faith is losing money. Although our mission revolves around healing, we cannot escape the fact that we must run an efficient organization. We must take care not to go into debt, even as patient care costs, insurance premiums and fixed costs rise. Our staff and employees as well as our patients depend on the smooth operations of a well-run health care organization.

Second, Faith serves the community by offering the best possible health care services to the greatest number of people at the most affordable prices we can provide. However, Faith Community Hospital has failed to clarify its ethical policies, the core guidelines that form the foundation of our medical care. We have also neglected to clearly outline hospital policy, rules, and regulations regarding potentially controversial medical and legal issues. Although we are united in a commitment to the core values of Faith Community Hospital, it seems that our diverse body of health care workers lacks a set of unifying principles by which we can work efficiently, ethically, and within the law. As executive assistant, I care about the fate of Faith Community Hospital and have outlined in this report a plan that should ensure our success in the future.

Analysis

The first problem we will address is outlined in the Faith Community Hospital financial reports. According to our accounting and finance departments, daily patient care costs have risen considerably: from $217 per patient, per day last year to $240 per patient, per day this year. In addition to the ten percent increase in daily patient care costs since last year, our patient population has dropped by seven percent. Faith Community Hospital is losing money and we need to do something as soon as possible. Our financial analyst claimed that we need to reduce our fixed costs by 15% if we want to break even by this time next year. Currently our fixed costs consume 28% of our total budget. However, reducing fixed costs is not the only way to ensure that Faith does not incur unnecessary debt. Some of our financial problems are also due to skyrocketing insurance premiums, a wave of bad press that might be causing a decrease in patient population, and the threat of lawsuits from patients and their families due to the second of our current problems: unclear ethical guidelines. Faith Community Hospital does not promote itself through the media, local schools, and other community organizations. Currently we maintain fixed costs in excess of our abilities, even though our mission statement allows for "collaboration with the partners who share the same vision and values." Many of Faith Community Hospital's costs could easily be shared among our partners.

Faith Community Hospital's Mission Statement reads as follows: "With the foundation and commitment of our spiritual heritage and values, our mission is to promote the health and well-being of the people in the communities we serve through a comprehensive continuum of services provided in collaboration with the partners who share the same vision and values." Our organization needs to more thoroughly explicate our mission statement to avoid some of the problems that have recently arisen on our hospital floors.

For example, many of our patients refuse treatment on religious grounds, which is fine until the patient happens to be a minor. Recently, we encountered a potentially problematic case in our Neo-Natal Ward. Members of our medical staff cooperated with the parents' wishes and refused to administer treatment to a child. As a result, Child Protective Services stepped in and is currently taking of taking custody of the baby. They are also threatening to file charges against Faith Community Hospital, a lawsuit that we can ill afford.

Doctors and nursing staff need to work on the same page, within the same ethical and legal guidelines. Occasionally, the written wishes of the patient conflict with the express wishes of the patient's family members. When the patient is compromised or unconscious, unable to make a decision regarding course of care, the families often step in and intervene. For example, two related controversies erupted in the ICU wing recently. In one case, three staff members initiated Do Not Resuscitate (DNR) directives in the absence of a written order in light of the family's wishes. In a separate incident, staff members failed to follow the written DNR directives because of a family member's request. Our health care staff is top-notch and offers the best possible care to our patients. Medical decision-making is rarely easy but a clear set of guidelines would make the decision-making process much simpler, more effective, and less contentious.

Recommendations and Conclusions

The future of Faith Community Hospital depends on our ability to respond to the problems we face today. Those problems are not overwhelming; yet they might be a year or two down the road if we don't take action soon. The two main problems we face here at Faith Community Hospital include financial issues and general agreements on hospital medical ethics policies. In the previous section I outlined possible courses of action we might take to solve current problems and prevent new ones from arising. This section lists my express recommendations and my reasons for presenting them.

First, Faith Community Hospital should cut its fixed costs by 10% by next year, at which point we will reassess our financial situation. The main way to cut costs at Faith Community Hospital will be through working more closely with our partners. Not only will working with our partners in the community improve our reputation and public relations, our teamwork will allow us to share equipment costs and services. Several organizations in the community share "the same vision and values" in offering optimal patient care. Therefore, we can trust our partners to assume their responsibilities, whether they include testing or care services. Specialists such as a hospice, burn center, addiction and recovery center, and midwifery services can all cooperate with Faith Community Hospital to prove a true "continuum of services." In fact, we might find that increasing our collaboration with community partners improves the health and well-being of all community members and thereby improves our ability to fulfill the primary goals of our mission statement. The stronger our relationship with our partners in the community, the more likely we are to communicate the needs of patients and the less likely we are to experience glitches or obstacles in providing care. Sharing costs, facilities, equipment, and services will enable Faith Community Hospital to survive and thrive. Rather than diminishing our locus of services, we will essentially be expanding our medical community to include partner organizations. Our reputation in the community will undoubtedly be bolstered through partnership endeavors.

Second, Faith Community Hospital should revise its current ethical policy and create an in-depth updated version. With the help of staff members, lawyers, and medical ethics experts, we can draft a sensible and thorough policy that covers procedural guidelines in as many care areas as possible including euthanasia and procedures involving children. We will post that policy online as well as offer one to each of our medical staff. Patients will be able to view our ethics policy whenever they please, to help them make informed decisions for themselves and their relatives. Staff should be periodically briefed in staff meetings to ensure that they understand our ethical policies and we should all feel free to ask questions in a safe and supportive environment. When a potentially controversial issue arises, staff members should consult administration for guidance.

Because staff members cannot be expected to memorize our rules and regulations, we need to have in place a set of ethics that guide our practice. We have that ethical code in place in our mission statement. The Faith Community Hospital mission statement accurately reflects the core vision of our noble medical team. Because we remain dedicated to providing the best possible care to members of our community, I do not believe we should cease our kindly practice of offering benevolent payment plans or the occasional pro bono treatment. Instead, Faith Community Hospital should investigate possible new insurance providers, new catering services, and other options that might help us to reduce costs and improve our overall efficiency. To succeed we will need the assistance of all our staff members and we welcome any and all input from staff members.