Business Ethics in Healthcare: Beyond Compliance

Introduction: Beyond Compliance, Beyond Integrity, Beyond Clinical Ethics

Introduction Beyond Compliance, Beyond Integrity, Beyond Clinical Ethics Healthcare business ethics is, in many ways, the meeting of medical ethics and business ethics. There has been much interest in medical ethics in the United States during the last three decades, an interest much more focused on patient care issues and on medical research than on the management of healthcare organizations. The interest in business ethics is also very strong. The attention given to the responsibilities of management has not often been focused, however, on the speci¤c issues of healthcare organizations. The extensive ethical re®ection about medicine and business over the years provides signi¤cant insight and wisdom for application when we turn our attention to the nature and meaning of healthcare business ethics. Healthcare business ethics is getting increased attention, but there is no common articulation of the perspectives and principles that the healthcare manager should have and apply. There is no common understanding of the topics to be included in education on healthcare business ethics. It may be useful to begin, then, with a brief description of the approach taken here. Beyond Compliance In some healthcare organizations today, business ethics is closely identi¤ed with corporate compliance. Hotlines established to encourage employees to report questionable practices are sometimes called “business ethics hotlines.” Efforts are sometimes made to implement compliance programs in the context of a broader sense of “organizational ethics,” but if the primary focus is on compliance, ethics tends to be de¤ned as compliance. In compliance programs, the emphasis is on conforming to laws and regu- lations. The Federal emphasis on preventing healthcare fraud and abuse has provided a strong incentive for healthcare organizations to get their own programs in place to ensure that nothing illegal is occurring. Compliance is obviously important and is related to ethical business practices , at least as a minimal standard of what should not be done. It may be unfortunate, however, that there is a need to establish corporate compliance programs at the very time that business ethics in the organization is beginning to get more attention. If business ethics is identi¤ed with compliance, business ethics has much too narrow a focus. One danger of such an identi¤cation is that a compliance model of ethics might get adopted—as long as the organization is not doing anything illegal, the ethical issues have been addressed. When the primary emphasis in business ethics efforts within the organization is to prevent persons from, knowingly or unknowingly, violating any rules or regulations, there is much missed opportunity. Business ethics as discussed in this work is not compliance oriented; it is not focused on regulations or on doing what is minimally required. Rather, the emphasis is placed on a variety of issues unrelated to fraud but de¤nitely related to the organization’s mission and values and related to management’s responsibility to patients, employees, and the community. The emphasis is on trying to understand what it means to manage the healthcare organization according to high ethical standards and ideals, not on complying with regulations. Beyond Integrity Theologians have had to acknowledge, frequently over the centuries, that bad things happen to good people. Ethicists have to acknowledge that good people sometimes do bad things. Well-intentioned persons, committed to personal honesty and fairness, can do harm. Before anyone with management responsibility in an organization can be legitimately described as a person characterized by high ethical standards, there need to be two different traits present. The ethical manager is a person of integrity and a person who takes responsibility for consequences. A person of integrity can be trusted to be honest, puts doing right by others before personal advantage, puts doing right by others before the organization ’s advantage, does not exploit power advantage in relationships, and tells the unwelcome truth to persons in positions of power. These are very demanding expectations. Even someone of good character may not live up to these standards at all times, but integrity remains the goal, what we strive to achieve in our relationships in the workplace. A person who takes responsibility for consequences seeks to understand the impact of business decisions and policies on all affected and makes or recommends decisions designed to minimize the potential negative impact on Introduction xii others. She or he listens to others to understand possible harmful consequences , and accepts responsibility for unintended negative consequences by taking corrective action when...