Outpatient Clinic Center For all health care facilities, having a code of ethics is critical for establishing acceptable practices for everyone to follow. This helps to improve the quality of care and professionalism. (Bryant, 2012) To fully understand how this can enhance an organization requires examining an outpatient clinic in the United States.

This will be accomplished by looking at the Anxiety Disorder Outpatient Clinic at Johns Hopkins University. During this process there will be a focus on: the background of the facility, its organizational structure, two potential ethical dilemmas, how to implement the ethical code and consequences for violating different provisions. Together, these elements will provide specific insights as to the way the facility can address any challenges and enhance treatment options.

Background of Facility

Johns Hopkins University has two different outpatient clinics they are operating. These are located at Johns Hopkins Hospital and Bayview Medical Center. Established in 1913, the Department of Psychiatry has been focused on meeting the needs of the community and those who were suffering from a variety of mental conditions. The clinics were established to provide patients with different treatment options for a number of disorders. ("Psychiatry and Behavioral Sciences," 2012)

In 2011, the Anxiety Disorder Outpatient Clinic and the Department of Psychiatry were named as the number one program for clinical care. As a result, there is an emphasis on understanding different conditions from: providing ground breaking research to everyday treatment options. Evidence of this can be seen in the below table which is highlighting the total number of patients that were assisted over last year. ("Psychiatry and Behavioral Sciences," 2012)

Total Number of Outpatients for 2011

Facility

Amount

Johns Hopkins

50,483

Bayview

128,129

Total

178,612

("Psychiatry and Behavioral Sciences," 2012)

These figures are showing how the outpatient program is popular based upon the ground breaking research and care that is offered.

Organization structure of the facility and duties/responsibilities of those in management and professional staff

The organizational structure of the clinic follows that of the Johns Hopkins itself. This is designed to increase accountability and ensure that every team has the flexibility in determining treatment options. The way that this is achieved is through using a centralized approach that delegates duties. The Board of Directors is responsible for everything that happens at the hospitals. They have an Executive Committee that oversees different operations including: the commissions and agencies which run the organization. Next the CEO has the responsibility of running the entire entity. This is accomplished through the Office of the CEO. They monitor a variety of activities including: community affairs, finance, fundraising and marketing / communications just to name a few. ("2010 Manager's Survival Guide")

Further down are hospitals / facilities, physicians' organizations and the Department of Psychiatry. Hospitals and facilities have the responsibility for controlling different locations. Physicians' organizations are working to provide services to communities through various clinics. While the Department of Psychiatry, is helping professionals to bring these treatment options to patients in the form of outpatient therapy. The diagram is illustrating the chain of command for the facility and its structure. ("2010 Manager's Survival Guide")

The Chain of Command for Johns Hopkins and the Outpatient Clinic

Board of Directors

Executive Committee

CEO / Office of CEO

Hospitals / Facilities Physician Organizations Department of Psychiatry

This is showing how a controlled, but decentralized approach is used in providing various health solutions to patients. ("2010 Manager's Survival Guide")

As a result, management and the professional staff have a responsibility to ensure that everyone is delivering the best treatment options. This means making certain that they are embracing the highest ethical practices, following different provisions of the law and looking out for the clients best interests. The basic structure creates way of controlling and monitoring how staff is meeting these objectives. It is also providing them with the flexibility to work with patients and determine what treatment options are most effective. This is offering patients with cutting edge techniques and technology in the form of an outpatient clinic. ("2010 Manager's Survival Guide")

Two possible ethical dilemmas

Two possible ethical dilemmas that Johns Hopkins is facing include: should outpatient services be expanded to other communities and the impact of success on the organization. In the case of expanding services to other communities, Johns Hopkins has the ability to do this. However, the process of opening other clinics will require considerable...

(Leslie, 1999)
This could place added pressure on Johns Hopkins to continue providing services to these segments (even through there is no clear economic benefit). When this happens, it could hurt the quality of care and the ability to ensure that each location receives adequate funding. Moreover, the rising costs for health care services will mean that the facility must absorb more of these expenses. (Leslie, 1999)

This could affect the organization's ability to continue operating other programs. To avoid these challenges, Johns Hopkins has decided to keep their outpatient clinics at the current levels and concentrate on specialization. These issues are troubling, as different facilities are designed to serve the interests of the general public. (Leslie, 1999)

However, the current financial constraints and economic realities, are allowing staff to only work with a select number of patients. This means that certain individuals will not receive any kind of assistance. These decisions are creating moral conflicts as staff members want to help lots of people. Yet, they can only treat select communities and demographics. This creates a sense of frustration from not being able to make significant inroads when it comes to dealing with mental illness. (Leslie, 1999)

The impact of success an organization can become a self-fulfilling prophecy that will hurt them over the long-term. What happens is everyone will feel a sense of pride and excitement about recognition they are receiving. Yet, this can also create a certain amount of arrogance in employees. This is problematic, as these kinds of attitudes will cause staff to overlook critical errors and avoid continually learning new techniques. (Bonifeld, 2012)

Once this takes place, is the point that the quality of care will decrease. This can hurt the image of the facility and create practices that will adversely impact everyone's ability to innovate. The ethical challenges that Johns Hopkins is facing are identifying the best approaches in pushing staff members to want to do more. (Bonifeld, 2012)

This is difficult, as the clinic has an outstanding reputation for working with individuals who are renowned in their field. The problem is allowing staff to have a sense of accomplishment and criticizing them at the same time. If executives are too harsh, this could lead to a mass exodus of talent. However, if the staff is not monitored and required to do more, the overall amounts of quality and innovation will decline. The key for executives, is maintaining a balance where staff will feel as if they are respected and can go the extra mile. (Bonifeld, 2012)

Ways to implement the ethical code of conduct and ensure compliance

The best way to implement a code of ethics is to form a committee. Their objectives are to identify key problems at the facility and determine how the code of ethics can change behavior. Those individuals who will serve on this organization are: various levels of executives and staff members. (Corey, 2010)

They will create strategies which are focused on ensuring compliance with professional and legal guidelines. This is will be accomplished by taking different perspectives into account and understanding the mindset of employees. The information that is uncovered will help to create procedures that allow for acceptance of these guidelines. It is at this point that everyone will have a reason for following these provisions. (Corey, 2010)

Another possible strategy is to have executives explain to staff members that a series of ethical practices must be followed. Those who refuse to comply with these provisions will be subject to severe disciplinary action. This will create an atmosphere where everyone will abide by these guidelines. (Corey, 2010)

In the future, this will ensure that the staff is continuing to follow these provisions. When this happens, everyone understands that there are certain standards of professionalism which must be embraced at all times. This will create a transformation in the operating environment and how everybody interacts with each other and stakeholders. (Corey, 2010)

Consequences if there is a violation of the code of ethics

Like what was stated previously, once the guidelines have been implemented is when they will be strictly enforced. This will occur through a total of two written warnings for the individual to cease with a particular activity. If they fail to do so, a fine will imposed upon them with a notice that any other infractions will results in their termination and possible legal action. (Corey, 2010)

If this kind of approach is used, it will create a sense of urgency about ethical standards and how they are embraced. This is when there will be a transformation in the operating environment and the activities everyone is involved in. It is at this point that the staff will honor and respect the code of ethics. (Corey, 2010)

Summary / Conclusion

Clearly, the most admired health care facilities will face ethical challenges. This is because people are…