BP - Health Care Compliance Association

Standing at the crossroads ...continued from page 43
alternatives. Finally, by practicing such
discernment, a health care organization can
clearly identity its motivations by having a
deeper understanding of its actions.
This integrated operating model cannot be
achieved by a single department or ethic
component. Instead it involves an integrated
structure (as described above) that, through
a broader ethics mechanism, builds capacity
within the operating functions 6 of a hospital.
Creating capacity throughout such a broad
ethics mechanism includes building tools
as uncomplicated as a simple checklist for a
single decision maker to ensure that he or she
is considering all the relevant dimensions of a
complex issue.
Also, and more importantly, it integrates ethical
discernment into the organizational decision
making process. For example along with
financial, legal, and market share analyses,
an organization’s management team that is
practicing an integrated ethics model would
also consider the following when evaluating a
project or course of action:
n Is the action consistent with the organization’s
basic duties?
n Does the action respect the rights and
other legitimate claims of the identified
stakeholders?
n Does this action reflect a “best practice?”
n Is the action consistent with the organization’s
mission, vision, and values? 7
These questions elicit minimal considerations
that address the organization’s duties and
the moral rights of others. However, it also
raises considerations beyond the minimum
standard and emphasizes an ethic demonstrative
of leadership organizations.
Leadership
Once a health care organization has achieved
an integrated ethics model, the final barrier
to achieving Next Generation status is
shifting the organizational culture from one
of individual responsibility for compliance
and ethics to one in which the organization
is committed to achieving operational
excellence in ethics. The compliance officer
cannot serve the roles of both oversight and
owner of corporate compliance. Similarly,
ethicists should not be the sole decisionmakers
when evaluating an organizational
situation. Instead, leadership should embrace
the integrated model under the framework
that everyone is responsible for pursuing the
institutional ethic. Success in building such
an integrated model requires leaders across
all disciplines who have a clear conception of
the organization’s values, talent management,
mission, and community commitment.
Leaders must learn and build ethical awareness
into the culture of the organization.
This type of compliance and ethics strategy
cannot be guided by one ethics officer, but
requires a multi-dimension strategy built
from each ethical component that facilitates
values-based decision-making at every level
of management on a day-to-day basis. Such
a strategy is based upon having a culture
of openness, organizational responsibility,
and a commitment to ethics within each
business goal. Successfully implementation
of this strategy requires not only intellectual
commitment of leadership and all employees,
but also a sense of shared values and purpose
throughout the organization. The end result
is leadership committed to problem finding,
not merely problem solving, and to accepting
responsibility at all levels.
Finally, an organization’s compliance and/or
ethics failure cannot be viewed as a programmatic
failure or individual shortfall. Instead,
it is an organizational opportunity to reflect
upon the entire ethical situation as opposed
to scrutinizing the situation. For example,
after screening employee applications and
qualifications, interviewing candidates,
background checks, and calling references,
the department of an organization hires a new
employee. After the first six months, which
included training and later a remedial workplan,
the employee continues to have below
average productivity. During this period, it
is evident the new employee is becoming
frustrated and angry at his situation. Finally,
the new employee gives-up; but rather than
resign from his position, he/she commits an
act of workplace violence, nearly injuring his
supervisor and co-worker. His actions result
in a criminal charge of attempted murder.
Afterwards, a compliance investigation is
conducted. The investigation concludes that
all actions taken to “help” the new employee
were in accordance with the organization’s
formal published policies. The investigation
further includes that no one was hurt and
the wrong-doer will be punished not only
by immediate termination, but also in his/
her upcoming criminal trial. The investigation
is completed and documented in the
Compliance log. Overall, the situation was a
near-miss, but considered a success.
An organization that practices the integrated
ethics model would examine the incident
beyond the facts/legalities and consider
whether or not this one instance is reflective
of a larger organizational ethic. The organization
would identity and explore its motivations
and the new employee’s, and thereby
have a deeper understanding of the actions
of all parties involved. More specifically, the
organization will take accountability and ask
if it failed the new employee.
n Did the organization’s screening process
fail?
n Did the organization fail to develop the
new employee appropriately?
Continued on page 50
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45
March 2009