Managing Healthcare Ethically, Third Edition, Volume 1: Leadership Roles and Responsibilities

By ACHE Management Series

Healthcare leaders need to exemplify the professional values they expect from others throughout the organization. A strong ethical foundation is indispensable for making sound judgements and providing high-quality patient care.

Managing Healthcare Ethically: Leadership Roles and Responsibilities highlights the issues leaders encounter in ensuring ethical performance in both their organizations and the communities they serve. This book provides specific guidance for expanding leadership skills and details relevant character traits that contribute to maintaining an ethical culture.

The book features selected columns originally written for the American College of Healthcare Executives' Healthcare Executive magazine. Chosen for their relevance to today's healthcare environment, the columns share practical applications for leaders committed to ensuring an ethically grounded organization. Topics covered in this volume include:

Racial and ethnic disparities in healthcarePatient-centered careAn executive-driven ethical cultureOrganizational values statementsConflict management advice

Each column concludes with discussion questions to foster conversation among colleagues or students. An extensive bibliography offers suggestions for further reading on specific topics.

Whereas this book demonstrates the need for moral leadership and professionalism, its two companion volumes explore other ethical factors critical to an organization's success. Managing Healthcare Ethically: Organizational Concerns addresses the ethics affecting policies and management, while Managing Healthcare Ethically: Clinical Challenges examines ethical dilemmas in providing patient care. Collectively, these three volumes share lessons that help healthcare professionals ensure their organization stays ethically aligned with both professional standards and its mission and values.

• Language: English
• Publisher: ACHE Management Series
• Release date: Jan 6, 2022
• ISBN: 9781640552470

Book preview

Introduction

THE NUMEROUS AND COMPLEX issues that healthcare executives encounter every day are an intrinsic part of organizational life. Many of these issues have significant ethical dimensions. The three separate volumes that constitute the third edition of Managing Healthcare Ethically build on the two previous editions. The present book, Leadership Roles and Responsibilities, is the first of these three volumes. The second volume focuses on organizational ethics, management, and policies, while the third volume addresses ethical challenges related to clinical care.

Each of the three volumes gathers selected columns originally written for American College of Healthcare Executives (ACHE) publications between 2010 and 2020, along with a few earlier columns that remain as appropriate today as when they were originally published. The columns were selected because of their relevance to today’s healthcare environment and challenges, as well as their practical application for healthcare leaders committed to maintaining an ethically grounded organization.

In each of the three volumes that make up the third edition, we pose some provocative questions and offer other material useful for teaching purposes. Following each column, we provide two discussion questions related to the column that can be used to foster a discussion with colleagues or healthcare management students. Each volume also contains an extensive bibliography of books and articles for readers who wish to pursue particular subtopics.

Because healthcare executives play such a key role in leading ethical organizations, this first volume focuses on this crucial topic. It contains columns that highlight the myriad issues healthcare leaders encounter in ensuring ethical performance in both their institutions and the communities they serve. In this volume, we have collected columns that provide specific guidelines to expand skill sets, emphasize the relevance of personal attributes and character, and underscore the importance of maintaining an ethical culture. The content in this volume addresses the need for strong moral leadership and professionalism in guiding an organization to be ethically aligned with the organization’s mission and values.

We know high-reliability healthcare organizations are managed by executives who adopt best practices that ensure the provision of value-based and high-quality patient care, have clear performance indicators, and exemplify the professional values they expect of others. As a number of the authors in this volume emphasize, senior executives are expected to establish and maintain an organizational culture that consistently promotes patient-centered care and persistently mitigates potential staff burnout.

The likelihood of conflict, daunting dilemmas, and inevitable management mistakes requires executives to be candid in their communications with governing bodies, physicians, employees, and the community. Executives must be personally resilient to cope successfully with the challenges associated with making judicious compromises, preventing staff abuse, and meeting the needs of the underserved.

A strong ethical foundation is indispensable if executives are to make sound judgments under stressful circumstances. Taking timely action when a subordinate or physician underperforms, confronting a clinician staffing shortage, and reducing a workforce when required are just a few examples of such situations.

Two vital steps increase the probability of success. One is asking the right questions when making a hiring decision, to ensure a candidate’s values are aligned with those of the organization and the management team. The other is taking your ethical pulse periodically by completing ACHE’s Ethics Self-Assessment (www.ache.org/about-ache/our-story/our-commitments/ethics/ethics-self-assessment). The first section of this self-assessment addresses a variety of major areas related to leadership. The second section covers relationships with significant constituencies, including the community; patients and their families; the board; colleagues and staff; clinicians; and buyers, payers, and suppliers. Some executives have benefited by having their staff complete the assessment on them as part of a 360-degree performance review.

Our goal in producing the third edition of Managing Healthcare Ethically is to continue raising an appreciation for how and why ethical reasoning and professionalism affect your organization’s performance and success, as well as your own. We hope healthcare executives and health administration educators will use the book to reinforce the concept that ethical leadership, sensitivity, and engagement are not the sole purview of an organization’s ethics committee. Instead, ethical reflection should be an inherent element in daily decision-making processes and relationships.

Instructor Resources

This book’s instructor resources include PowerPoint slides, case studies, and lists of selected ethics center websites and selected ethics journals.

For the most up-to-date information about this book and its instructor resources, go to ache.org/HAP and browse for the book’s title, author name, or order code (2437I).

This book’s instructor resources are available to instructors who adopt this book for use in their course. For access information, please e-mail [e-mail].

The Ethics of Evidence-Based Management

Paul B. Hofmann, DrPH, LFACHE

THE ADVANTAGES OF EVIDENCE-BASED medicine have been demonstrated repeatedly. Indisputably, the adoption of clinical guidelines, pathways and protocols has contributed to improved clinical outcomes. Could the development and application of evidence-based management practices have a comparable benefit for patients, staff and, ultimately, healthcare organizations and their communities?

The succinct answer is yes, absolutely. Unfortunately, the slow and uneven adoption of best management practices is not recognized as an ethical issue. When economic resources are insufficient to acquire new technology, employ additional staff and expand or even maintain existing programs, the importance of using evidence-based management cannot be over-emphasized.

Failing to adopt documented best practices is ethically indefensible. We have an inherent fiduciary and moral responsibility to energetically pursue and implement improved management tools and techniques.

REASONS FOR SLOW ADOPTION OF BEST-DEMONSTRATED PRACTICES

There are a variety of reasons why leaders may not move quickly to replicate highly successful management practices. Four come to mind. First, some executives believe they are well experienced, know how to manage properly and do not need to invest time and effort to examine how others may be more successful in managing their organizations. They would not consider themselves to be egotistical or arrogant but, rather, confident that internal resources are sufficient to maintain continued improvement.

Second, other leaders not only are convinced they know most of the keys to effective management, but they also contend that, unlike medicine, which is primarily based on objective scientific findings, management is more of an art. Therefore, these executives view evidence-based management as an attractive academic concept but one whose value is relatively unproven.

Third, another group of executives do not feel compelled to make adoption of evidence-based management practices a high priority because the incentives for doing so are not obvious. The governing body has not expressed any concern about current practices, medical staff members continue to support the executive team and the organization is well respected by its community.

Fourth, many executives believe they simply do not have time to acquire and review potentially useful information concerning best-demonstrated management practices. These executives acknowledge the benefits of replicating best practices, but they feel overextended by confronting a seemingly unending number of crises and instead decide to delay action.

TAKING A PRAGMATIC APPROACH

The case for evidence-based management must be made more persuasively. We need to think systematically and creatively about how management best practices can be more rapidly and effectively promoted, disseminated and implemented. For example, we know many institutions have won significant state and national awards for superior performance in a wide variety of areas, including:

Improving patient safety

Preventing and minimizing never events

Decreasing healthcare-acquired infections

Making care more timely and patient centered

Increasing patient satisfaction

Minimizing employee turnover and absenteeism

Reducing the cost of services

Maximizing the value of information technology

Promoting accountability and transparency

Creating a learning culture

Improving community health status

Reducing healthcare disparities

Demonstrating community benefit

We also know there will be more hospitals recognized for their success in:

Lowering re-admission rates within 30 days of discharge

Adopting electronic health records

Expanding the cost-effective use of telemedicine

Reducing energy consumption

Undoubtedly, many of the institutions that have won the Malcolm Baldrige National Quality Award, the American Hospital Association-McKesson Quest for Quality Prize, the Thomson Reuters 100 Top Hospitals Performance Improvement Leaders award and similar honors are led by CEOs who learned from their peers. Consequently, these same executives are almost always interested in sharing their lessons with others. The key point is that right now in each of the above areas there are reliable management policies, programs and practices that are contributing to irrefutable improvements in organizational outcomes.

TIMELY AND INFORMATIVE RESOURCES

In addition to learning from successful organizations, a growing number of recent publications contain valuable insights regarding verified means and methods for achieving exceptional progress. Five of these are particularly noteworthy.

Evidence-Based Management in Healthcare by Anthony R. Kovner, PhD, David J. Fine, PhD, FACHE, and Richard D’Aquila, FACHE (Health Administration Press, 2009). The book explains how healthcare leaders can move from making educated guesses to using the best available information to make decisions.

Journey to Excellence: How Baldrige Health Care Leaders Succeed by Kathleen J. Goonan, MD, Joseph A. Muzikowski and Patricia K. Stoltz (ASQ Quality Press, 2009). The book describes how nine Baldrige Award healthcare winners approached their Baldrige journey and what other healthcare leaders should do to accomplish similar benefits.

What Top-Performing Healthcare Organizations Know: 7 Proven Steps for Accelerating and Achieving Change by Greg Butler and Chip Caldwell, FACHE (Health Administration Press, 2008). The authors researched more than 220 healthcare organizations to determine what differentiates high performers from organizations that fail to achieve lasting operational success.

Hospitals in Pursuit of Excellence [HPOE]: A Guide to Superior Performance Improvement (American Hospital Association, 2009). This guide comprises 28 case studies of hospitals that have made significant strides in one of AHA’s four initial HPOE focus areas: healthcare-acquired infections, medication management, patient throughput and patient safety. The guide is available on CD, and the print version was mailed to every hospital in the United States in 2009.

Better: A Surgeon’s Notes on Performance (Metropolitan Books, 2007). Written by the remarkable surgeon and acclaimed author Atul Gawande, MD, this book is both eloquent and inspiring. Gawande notes, Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.

ACCELERATING THE ADOPTION OF EVIDENCE-BASED MANAGEMENT

Hospitals and other healthcare organizations have a solid track record regarding