Influence of Negative Issues like Labor Shortages and Socio-Demographic Changes on Organizational Responsibility
Nobody will argue the fact that at the present moment the system of the US healthcare delivery has become not a social institute that is aimed at the provision of the nation’s welfare but a business organization that has to respond quickly to the changing market needs. Many institutions are catering for the needs of the US nation in cases they have problems with health, but their cooperation is based solely on the contracts they conclude, and it was a strange inference to understand that the government does not carry any responsibility and does not have any obligations concerning the provision of healthcare services to its citizens (Harris, 2007).
This discovery brought about much dispute about the level of organizational responsibility that has to be imposed on the medical institutions, the standards they have to comply with as well as the procedures they are guided by while making ethical decisions. Now the question is raised not only about benevolence and nonmaleficence – here comes the general dilemma between being guided by the law or by principles of ethics and morality. These issues are the subject of the present paper; it is necessary to understand what issues the subject of concern for healthcare organizational responsibility are, how they are kept to, and how the ethical dilemmas occurring in the day-to-day practices of healthcare executives are treated and solved.
Surely, there are many approaches to considering any healthcare establishment as a system that has to subdue certain rules, regulations, and standards. The question of compliance acquires special relevance when speaking about the accreditation by the JCAHO. But Boyle et al. (2001) note that the glance at the way the organization functions is not enough to assess the real level of its ethical culture, organizational responsibility, etc.
There are often many secondary factors that have to be thoroughly considered in the assessment process and that may turn out to produce a negative influence on the whole organizational functioning, thus needing elimination. Judging from the perspective of the rational systems approach, only the formal structure of the organization is assessed. Coming closer to the non-formal structure is possible through the natural systems approach – it studies both of them in their synergy at the working place. The open systems approach is the most efficient one under the conditions of the change, as it gives a chance to assess the level of success with which the healthcare organization has adapted to the change, which is needed for the present research (Boyle et al., 2001).
In the current situation of reforming healthcare and introducing new laws, such as amendments to the ADA prescribing medical institutions to accept citizens with disabilities even in private hospitals, adoption of the Antidumping Law commonly known as AMAVALA and other legislative acts produce a huge socio-demographic impact on the organizational responsibility of medical institutions. For this reason, a timely and constructive reaction is needed from hospitals and other medical institutions to comply with the innovative regulations. The worst in such a situation is that alongside the adoption of legislative regulations is usually not supported by financial support from the state, thus causing the paradox on how to comply with the new rules if there are no resources to do this.
One more burning issue in the sphere of organizational responsibility is the question of staffing. As noted by Garrett et al. (2001), the change in the staffing system brought about the inflow of a huge number of medical personnel representatives who are not specifically trained for this function and come from the assistance, even cleaning staff. Thus, nurses who used to perform the daily operations with analyses and treatment, patient care are now supervisors over those who were not educated to be healthcare executives on the whole. A binary problem comes from this change that was initially aimed at reducing costs for keeping the staff in a medical institution.
Those who do not have medical education are now performing medical operations, and those who were not taught to supervise someone have now got the managerial positions for which they do not fit (Garrett et al., 2001).
These issues, as well as the changes taking place in the market of medical services, taking into consideration the growing concern about the vulnerable categories of patients and the optional choice for doctors to accept the patients in the state of emergency or not, have created a bunch of issues to be analyzed. First of all, the problem is with which rules to comply – with ethics or with the law (Harris, 2007). Secondly, it is necessary to decide how to solve ethical dilemmas that arise from the discrepancies in the code of ethics and the legislative prescriptions which medical executives face every day. Scarce resources also have to be wisely allocated to serve the human needs as well as the needs of a medical institution properly.
Allocation of Resources
Proceeding to the discussion of resources allocation, it is necessary to first mention the idea voiced by Garrett et al. (2001) about the mortality rates and the overall level of the nation’s well-being not depending on the quality of healthcare provided by the state medical care system. It was even found out that the mortality rates were lower at the times when doctors arranged strikes and did not work (Garrett et al., 2001). What is important to understand is that the reason for human well-being lies beyond the measures of medical care, but the situation can be worsened if the resources are allocated improperly.
Thus, the authors suggest that the main necessity in the medical sphere is not performance but research: they state that if the government allocated more resources for bacteriological studies it would become clear which diseases are caused by the natural environmental conditions and should be treated separately and at which ones medical care should be aimed:
Hospital utilization review procedures are concerned with the allocation of hospital resources to provide high-quality care cost-effectively. Their focus is on cost considerations, such as overutilization, underutilization, and inefficient scheduling of resources, rather than directly on the quality of care (Garrett et al., 2001, p.148).
In addition, continuing the topic of research, it is relevant to suppose that more resources should be allocated to the training of healthcare executives, as continuing education is one of the major preconditions of each professional’s success (Garrett et al., 2001). Only through the provision of a sound theoretical basis created for all employees of any medical institution, it will be possible to ensure the long-term success and efficient operation thereof.
Returning to the issue of staffing, it is also possible, to sum up, that the human resources should be allocated in the medical care sphere not to show high-performance standards but to assure the quality of care. The usefulness of the former cleaner working in the acute care unit would be no more than none, thus proving the inconsistency of the idea to provide nurses with supervisory rights and cleaners with quickly done medical training. The results will yield only raising customer dissatisfaction and the failure of the medical care system to fit the needs of people with health problems.
Associated Ethical Dilemmas
As it has already been started at the beginning of the work, the main reason for ethical dilemmas’ emergence in the medical practice is that doctors have two systems to which their actions have to correspond – the legal system and the code of professional ethics. Starting from this binary approach, one should have a look at several healthcare-related issues. For example, according to AMAVALA, the federal Antidumping Law, no hospital has the right to neglect a patient in a state of emergency and is not entitled to send him or her to another hospital.
Even in case that particular hospital to which the patient turned cannot service the patient, they are obliged to provide him/her with proper transportation to another hospital where the patient can receive medical help (Harris, 2007). But even if the hospital can provide emergency care, the issue of payment comes to the fore – no federal resources have been allocated to fit these needs, so the doctors are reluctant to serve such patients knowing that the hope for payment is vague.
Another point for ethical consideration is the amendment to the ADA – Americans with Disabilities Act that has been adopted in 1990 and obliges all medical institutions, even private hospitals and dentistry departments, to service-disabled people (Harris, 2007). However, here comes the dilemma of who to consider disabled, since the measures of disability are also vague and do not oblige any doctor to take action without the unanimous decision on the point. Harris (2007) also mentions the human organ transplantation issues as highly important ethical dilemmas concerning bias, discrimination, and dumping.
Unfortunately, there are still not many laws that can stipulate the rights and responsibilities of both parties – patients and healthcare providers, so there is some hope that the legislation will be changed for the better to suit the needs of both consumers and providers.
Conclusion
Despite the active interest towards ethical issues, it is necessary to admit that the system of ethical standards and organizational culture is too underdeveloped so far, allowing us to speak about the absence of unified standards and, logically, the inability to comply with them. To make the medical care system fair, logical, and coherent it is necessary to unify the legislative innovations and the ethical code into a single, constructively working system. Thus, meanwhile, healthcare executives are advised to solve their ethical dilemmas using their approach to every single matter.
For example, Boyle et al. (2001) offer a set of guidelines to be kept to while solving ethical controversies. They have worked out a strategy for the simplification of the decision-making process including ignoring possible outcomes and consequences, judging risk, perceiving the cause of the problem, etc. They also offer a set of actions to eliminate stereotyping, ethnocentrism, and favoritism arguing that these drawbacks play a major role in the formation of ethical dilemmas.
References
Boyle, P.J., DuBose, E.R., Ellingson, S.J., Guinn, D.E., & McCurdy, D.B. (2001). Organizational Ethics in Health Care: Principles, Cases, and Practical Solutions. San Francisco: Jossey-Bass.
Garrett, T.M., Baillie, H.W., & Garrett, R.M. (2001). Health Care Ethics: Principles and Problems (4th ed.). Upper Saddle River, New Jersey: Prentice Hall.
Harris, D.M. (2007). Contemporary Issues in Healthcare and Ethics (3rd ed.). Washington, DC: AUPHA Press.