Introduction
Healthcare administration faces ethical dilemma in providing prime health services and maintaining the economic status of the healthcare system concurrently. The administration must stringently balance health services and economic issues that are intrinsic to the healthcare system.
Hornbeak explains that, health care administrators have critical role “…in overseeing the moral conduct and missions of their institutions while at the same time maintaining the economic viability of those institutions, but these two major functions can clash and create dilemmas that complicate the practice of health administration” (2011, p. 1).
The ethical issue regarding economic viability of health care institutions elicits ethical dilemma where two views arise. The first view questions how health care institutions can ethically concentrate the administrative functions on the issues of health only and remain economically viable and sustainable at the same time.
The second view ethically doubts the administrative capacity to juggle both health care and economic issues, without compromising the primary role of offering quality health care in the society. Therefore, how does the health care administration resolve the ethical dilemma amidst demands of quality health care and economic constraints?
Ethical dilemma
Health care systems have a noble responsibility of ensuring that they provide quality health care services that are affordable and accessible to all people. Other responsibilities such as integration of business practices into the system seem to have encumbrance effect that would lead to compromised health care services.
The integration of business practices into the health care system has elicited ethical concerns that have resulted into ethical dilemma in the administrative responsibilities. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) “expanded its patient rights standards to include requirements for assuring that hospital business practices would be ethical in 1995” (Laura, Cherry, & Darragh, 2009, p.1).
JCAHO established ‘patient rights and organization ethics’ that classified two types of ethics involved in health care administration; clinical and business ethics. Clinical ethics govern the relationship between healthcare and patients while business ethics deal with the relationship between health care and its suppliers.
Currently, the health care system is struggling to resolve the ethical dilemma that threatens to stall provision of quality health services and sustainable utilization of health care resources. Ethical concerns root for the distinction and separation of clinical ethics and business ethics in order to avoid complications of the responsibilities in the health care system.
Laura, Cherry and Darragh argue that, “while marketing and admission practices are seen as issues related to ‘business’ they can lead to unneeded admissions or demand for unneeded services, both of which can unnecessarily expose the patient to the risk of side effects or complications” (2009, p. 2).
Without clinical and business ethics to streamline the relationship between essential and non-essential health care services, the business aspect would take precedence since profits is the ultimate objective. On the other extreme, stringent clinical ethics may render health care system economically unviable resulting into poor healthcare services. Therefore, health care systems have great challenge of resolving the ethical dilemma that threatens the quality provision of services and sustainability of resources.
Health Care Ethics
Historically, healthcare system has been focusing on the clinical ethics while neglecting the importance of business ethics. By doing this, the healthcare system erred because “…it sought to deal with specific clinical ethical issues before assessing the ethical organization life and ethical infrastructure of the whole system which has affected the resolution of the ethical dilemma” (Silva, 1998, p.26).
Clinical ethics govern the relationship between the healthcare system and the patient by ensuring that health professionals do not comprise the quality of health services that patients receive.
According to healthcare professional ethics, the primary goal of any health institutions is provision of quality, affordable, and accessible health care services that improve health standards of the people. However, integration of business ethics into the healthcare system is a threat to clinical ethics.
Although the primary goal of the health care system is provision of quality services, it is impossible to sustain the use of available resources without venturing into business.
Health institutions are in strategic position to conduct lucrative businesses aimed at improving the quality of services they offer to patients. Faced with this truth, healthcare administrators have a challenge of balancing the clinical and business ethics because there is tendency to neglect clinical ethics and concentrate on the business ethics.
Healthcare institutions have become business oriented in the United States since “…health care organizational culture has shifted from a service oriented one to a monetary oriented one characterized by product lines, stocks, profits, competition, megamergers and, ultimately, survival” (Silva, 1998, p. 3).
The survival of the health care system may entail increasing the costs of services, falsifying diagnoses, admitting or discharging patients unprofessionally with the prime objective of earning profits.
Solution to Ethical Dilemma
To address the ethical dilemma in the healthcare system involving clinical and business ethics, the administration should focus its attention on building cultural and ethical infrastructure to regulate all activities in a health organization.
In addition, the administration should instill ethical principles to healthcare professionals at all levels of the organization through education and strong leadership that advocates for the postulated ethics.
Silva argues that, “in any attempt to change the values of an organization … the contents of the existing organizational culture must be dealt with directly for positive change to occur” (1998, p. 4). Therefore, the issue of clinical and business ethics calls for cultural and ethical infrastructure for it to have a lasting solution.
The resolution of the ethical dilemma requires an overhaul of organizational culture and ethics. Change in cultural and ethical infrastructure is imperative as it provides professional environment where ethics guide all healthcare practices.
Corporate leadership is not enough to transform cultural and ethical infrastructure because “not only the leaders but also the followers must ascribe to common, sound, and shared ethical values, just as unethical leadership can taint followers, morally tainted followers can impede or stop the goals of ethical leaders” (Laura, Cherry, & Darragh, 2009, p. 7).
Therefore, transformation of the cultural and ethical infrastructure needs concerted efforts of both the administrative and health professionals.
Conclusion
The ethical dilemma in the administration of healthcare system is affecting the delivery of quality services and sustainability of the health resources available. The healthcare system administrators face the challenge of striking a balance between clinical ethics that seek to provide standard services to the patients and business ethics that take care of the sustainability of health resources.
Since both clinical and business ethics are critical in the healthcare system, cultural and ethical infrastructure is essential for the resolution of the long-standing ethical dilemma and the realization of defined administrative roles.
References
Hornbeak, J. (2011). Health Administration Ethics. Spring Journal, 12, 1-10
Laura, J., Cherry, N., & Darragh, M. (2009). Organizational Ethics and Health Care:
Expanding Bioethics to the Institutional Arena. National Reference Center for Bioethics Literature, 9(5), 1-14.
Silva, M. (1998). Organizational and Administrative Ethics in Health Care: An Ethics Gap. Online Journal of Issues in Nursing, 16, 1-11.