Ethics in Health Care to promote Profits and Patient Care

November 27, 2008

Ethics in Health Care to promote Profits and Patient Care
~James Dunn

The Lovelace Healthcare System in Albuquerque, New Mexico is in tremendous trouble. An entire hospital (Lovelace on Gibson) is closing its doors. This very large hospital is closing the doors and displacing many hundreds of medical practitioners.

There is something very wrong! The surrounding hospitals are filled to capacity, which includes Presbyterian Hospital, University of New Mexico Hospital, and their satellite Clinics.

The Operating Rooms (OR) are constantly full and there is constant complaints of under-staffing. Surgeons and their patients do their cases until midnight and on the weekends, whenever they can get staffing.

The problem isn’t that there isn’t enough room, or enough staff ! The problem is that physicians do not make good administrators, and administrators do not exercise “Due Diligence”. Politics has superseded ethical credibility.

If you were to walk into any Administrators office and ask to see how much they lost last year due to incorrectly coded billing? They could not answer you. How often were the instructions in patients’ charts not followed by the nursing staff? They would not be able to answer you. Ask them how they motivate their staff? They would not answer you!

The entire Health care system is troubled by a lack of ethics! Most people do not even understand that Administrative Ethics is a set of tools for extensively evaluating resources, liabilities, and desired outcomes; working with the Big Picture. A lack of ethics should allow any business to make even more money, right? Wrong! “Due Diligence” is one of the significant factors for motivation that can not be taught in an unethical environment.

Some physicians may perform highly questionable procedures, or incorrectly document work performed, in response to poor billing and collection practices.

OR staff may put off ordering critical instruments and consumables because “It’s not my job!”, “I’ll get to it next week.”, or playing dumb “Oh, wasn’t that ordered?”.

Patients suffer for the same reasons because nursing staff may make excuses like “The doctor doesn’t know what they are doing.”, ”I’m too busy as it is.”, “That’s not my job.”. Meanwhile, the same nurse is chatting on the phone and numerous doctors have previously complained to hospital administrators about the staff member, but nothing is done and the nursing staff continues to ignore the physicians orders.

There is no incentive to do anything more than absolutely necessary to keep from being fired.

Administrators truly do not understand the complexities of the systems in which the work. Ask any administrator how to provide optimum health care for a patient based upon their insurance coverage so that they do not become liable for medical expenses they can not afford; they can not give you a reasonable answer! The hospital aborbs the losses in many cases.

Ask an Administrator how to get the nursing staff to consistently follow the doctors’ orders. You’ll get a blank stare! Nurses are relatively uneducated as compared to physicians, yet they independently make decisions about patient health care that directly contradicts the physicians’ orders, and the patient suffers. Weak and critically ill patients do not even get fed at times; and they may have died.

Outspoken persons of principal are weeded out by forcing them out. The unethical have more influence unless the system structure forces ethical practice. The present health care structure is innately unethical.

This is where a combination of well-trained Administrators, Performance Based Wages, an active Ethical Review Board structure, and a Continuous Improvement Process (ISO9001) provides the innate structure to continuously improve administrative processes and hospital procedures. Currently, complex relationships are governed by emotions, rather than by measurable metrics (data points).

Ethical Review Boards (Every employment and advocacy group should have one)
http://www.aapor.org/pdfs/AAPOR_Code_2005.pdf

Hospital Administration Training
http://www.epracticemanagement.org/

A few examples of deficient processes:

There is an inadequate number of Operating Rooms available to physicians. Physicians that consistently have cases to perform want “Block Time” so that they can schedule at least some of their surgeries around predictable times and days. Physicians often work more than 12 hours a day, so any savings in time is greatly appreciated. However, hospitals currently provide block time to certain physicians based upon the Good Ole’ Boys club mentality and prejudice. Not based upon ethical need. Rather than increasing the number of Operating Rooms, the OR staff could be trained to become much more efficient to provide for the needs of the physicians and their patients. Any wait time, is wasted time, and costs the hospital many thousands of dollars an hour.

Surgery provides the hospital with money. Insurance companies pay for surgeries at a reduced rate and pocket a large portion of the revenue from paid premiums. The health care system does not benefit from these revenues. Insurance companies do NOT build or maintain hospitals. Therefore, any hospital surviving on the edge can not improve its services.

The hospital has a Physician interface on its’ computer system to provide secure access to patient information. Each doctors’ interface can be customized based upon their user login. A simple tool for tracking staff performance would be to provide a page with all of the staff names in the hospital. If a physician has a good experience with a staff member, positive marks and notations can be made to improve a staff members’ performance rating; and negative marks and notations for deficient performance or neglect. This system can be directly tied into the employees Performance Based Wage. Similarly, every staff member, administrator, physician, and vendor can be rated and tracked in the hospital system. Physicians who are neglectful of their patients might lose their Block Time, obtain Block Time for helping to provide for uncompensated patient care, …

Create a State approved non-profit health insurance system. Disallow any for-profit health insurance from doing business in New Mexico. Use the excess revenue from paid premiums to build and maintain hospital support systems. Lovelace would not be competing with Presbyterian or UNM hospitals; they would ethically share resources and profits. Ethical as in reduced redundancy, competent health providers and staffing, efficient operations, and minimized opportunities for cases of liable.

Because of the increased revenue, all hospitals would make greater profits than at present.

Corporate management that deviates from ethical standards would be punished by fines and criminal prosecution. A defined structure for investor profits and rejuvenation of facilities would be a subject of on-going ethical debate. Ethical tools would be used to document the thought processes behind decisions.

In Tuscaloosa, Alabama the county charges a small amount on annual property taxes to provide health care for the uninsured. They have some of the lowest property taxes in the nation. Yet, every person in Tuscaloosa County has health care! And the hospital (Druid City Hospital) has a windfall of excess money every year. Admittedly, their Emergency Room has a four hour wait, but everyone is seen that needs to be seen. Those with paid insurance premiums are routed to other hospitals for care.Health care can be profitable and manageable, so long as sufficient resources are consistently dedicated to ethical administration.

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