ETHICS IN

HOSPITAL
ADMINISTRATION

Contents :
1.
2.
3.
4.
5.

Nature & Characteristics of Hospital Administration Ethics

Need of Hospital Administration Ethics
Theoretical Principles of Ethics
American College of Health Care Executives (ache) Code of ethics
Responsibilities towards various stakeholders

Nature & Characteristics of

Hospital Administration Ethics
Locus and Responsibility spectrum of Hospital
Administration :
The ethics of hospital administration occupies a unique position at the intersection of
traditional patient-centered medical ethics and business ethics. On the one hand,
the health care institution is to provide service to patients. It therefore follows that the
ethics of administrative decision making must account for the impact of administrative
decisions on patient care. On the other hand, the day to day operation of health care
institutions is similar to that of many large non-medical businesses. It emphasizes the
moral problems in economic transactions and in the relationships between the
employers, employees and the consumers. The divergent role of hospital
administration viz. patient ethics and profit results in frequently emerging theme of
whether the pursuit of profit can co-exist in a neutral or positive way with the traditional
service-first ethic of medical practice.

Nature & Characteristics of

Hospital Administration Ethics
Impact of administrative decisions on patient care :
Most of the administrative activities is said to directly or indirectly impact the
patient care. For example, the hospital advertisement can have a persuasive effect on
the expectations of specific patient who choose that institution in response to the
advertisement with the expectation of quality patient care. Further, if the hospital
administrators have created an institutional tone dominated by impersonal or callous
treatment of employees, they in turn exhibit the same attitude while providing hand-on
patient care. Thus the administrative ethos of the hospital have morally relevant
consequences for patients, even when there is no direct impact on patient care at first
glance.

Need of Hospital Administration

Ethics

Conflict management :

The paradox presents ethical dilemmas at every level of the organization. This paradox
is evident in any controversy over allocation of health care resources. Because
health care supplies are finite, and health care demand is infinite, all patients are
effectively in competition with one another for resources.
Clinical education supplies another example of the paradox of health care
organization. Patients attending hospital attend for the purpose of receiving treatment,
and they naturally desire the most skilful treatment from the most highly qualified
doctors. But if hospitals are to be able to treat future patients, they must train future
doctors. Doctors-in-training, of course, need patients upon whom they can practice their
undeveloped skills; and the most highly qualified doctors, who might otherwise use their
time skillfully treating patients, must spend time teaching those skills to others. Clearly,
an ethical organization has to balance the desires of current patients with the
needs of future patients.
Besides the above paradoxes, the health care administrator needs to resolve conflicts

Need of Hospital Administration

Ethics
Priority Setting & Resource allocations:
Seven factors that complicate ethical resource allocation decisions.
1.
2.
3.
of
4.
5.
6.
7.

Inadequate funds to support equally compelling requests.

Strong opinions expressed by influential and politically powerful people.
Severe time constraints, making it difficult to conduct comprehensive and objective analyses
multiple variables.
Significant conflicts of interest.
Uncertainty about potential outcomes and unintentional consequences.
Competing professional and personal values.
The possibility that the decision could have a negative impact on job security

Need of Hospital Administration

Ethics
The essential qualities of the health care administrator to evolve an ethical resource
allocation decisions.
Accepting accountability.
Maintaining credibility.
Fulfilling past commitments.
Demonstrating objectivity.
Showing respect for legitimate differences of opinion.
Distinguishing between rhetoric and reality.
Acquiring reliable and comprehensive information.
Recognizing the inability to satisfy all proponents despite the validity of their
requests.
Developing a defensible rationale for the decision.
Obtaining support from key stakeholders.
Communicating effectively.

Need of Hospital Administration

Ethics
Program & Policy development:
The hospital administrators frequently involve in development of specific policies &
programs in improving the performance of the employees or targeting quality of
patient care. Since these policies and programs are developed in a controlled
environment (office premises of administrators) often articulating the organizational
values and personal values of the hospital administrators, they often fail to articulate
the values of the stakeholders (patients & employees in the given setup) at large.
Because of this approach, even a well structured program and policy fails to get
implemented. To evolve a dynamic and effective program & policy development, the
hospital administrators should involve in consultation of all the
stakeholders who would influence and will get influenced by such programs
& policies; and should reflect their opinions and give due weightage their
values before ratifying such programs & policies

Need of Hospital Administration

Ethics
Human
In

resource management:

the present day human resource management policy gives

much importance to the performance based variable salary
structure with incentives & increments. Often such decisions
are based on the performance appraisals of the immediate
supervisor of the employee. The hospital administrators who will
be part of the promotion committee or performance scrutiny
committee should take in to consideration the potential for bias by
the immediate supervisor. Simply stating the decisions on
enhanced salary structure should be objective based on prespecified criterias and not according to the prejudices of the
immediate supervisor or the hospital administrator. The same
strategy should also be followed in the issues of downsizing staff
strength.

Need of Hospital Administration

Ethics
Advertisement
Many

issues.

corporate hospitals are involved in rampant advertisement

informing the general public about providing quality health care
and other attractive offers in the arena of health care thus
increasing the expectation of the patients. As hospital
administrators have moral obligation towards organizational
welfare, they should balance the expectation of patients
and what the health care organization is really capable of
delivering health care services. Otherwise it will result in undue
deception of the patient which is against the values of
stakeholders

THEORETICAL PRINCIPLES OF
ETHICS:
The framework for the concepts of ethics has emerged from the philosophical theories on conduct,
character and context on which the individual executes the behaviour and is mutually overlapping.

Ethics Theory grounded on CONDUCT of the individual:

Deontology

(Kants Philosophy):

Justifies

means to the end the acts or means should be always right and good; in other words the
individual has moral duty or obligation of doing things in right way irrespective of consequences.

Kant

states that motives attached to the means are critical in determining the moral worthiness
rather than its consequences. The duties or actions of means should have no conditional command to
the consequences i.e the means should be an end in itself. This perspective Kant states as
categorical imperative or unconditional command of morality

Perennial Duties
These are basic obligations which we have as human beings; theyre
the fundamental rules telling us how we should act.

Broadly, this group of perennial duties falls into two sorts:

1. Duties to ourselves
2. Duties to others

Duties to Our self

To

develop our abilities

Duty to do ourselves no Harm

Duties to Others

Avoid wronging others

Honesty
Respect Others
Beneficence
Gratitude
Fidelity
Reparation
Fairness (According to Aristotle, fairness is treating equals equally and
unequal's unequally) veil of ignorance

THEORETICAL PRINCIPLES OF
ETHICS:
Teleontology
Justifies

(Utilitarianism): Syn: Consequentialism.

end to the means Greatest good for greatest

number. Emphasizes the importance of net consequences of the
means (end) sometimes ignoring the moral values based on which
the means are executed. The strength of Utilitarianism is that it
provides the objective way of resolving conflicts of self interest and
serves to be impartial; on the other hand, application of this
principle shall sometime ignore the actions that appear to be
wrong in them.

THEORETICAL PRINCIPLES OF
ETHICS:
Ethics

Theory grounded on CHARACTER of the individual,

Virtue ethics :

This

theory emphasizes the specific personal virtues and

moral character is central to logical reasoning that serves
as an essential tool for resolving ethical issues and
dilemmas. The proponents of this theory believed that the virtues
of wisdom, courage, temperance, and justice were the most
logical choices to help people achieve this goal.

THEORETICAL PRINCIPLES OF
ETHICS:
Ethics Theory grounded on CONTEXT of the Behavior ,
Communitarianism. :
This

theory endorses the moral perspectives of the community

and society as central in solving ethical dilemmas since the
individual stands in direct unmediated relationship with the society.
Further the communitarianism perspective states that there are
certain elements in the communities that form affective bonds
amongst people of diverse social groups. These community
elements determine the values and the context in which ethical
dilemmas to be dealt with. This theoretical perspective
promotes engagement with key stakeholders of the
community in ethical decisions.

AMERICAN COLLEGE OF
HEALTH CARE EXECUTIVES
(ACHE)
OF
ETHICS:
Responsibilities
to theCODE
Profession of
Healthcare
Management

The healthcare executive shall:

Uphold the Code of Ethics and mission of the American College of Healthcare Executives;
Conduct

professional activities with honesty, integrity, respect, fairness and good faith in a manner that will reflect well upon
the profession;

Comply

with all laws and regulations pertaining to healthcare management in the jurisdictions in which the healthcare
executive is located or conducts professional activities;

Maintain

competence and proficiency in healthcare management by implementing a personal program of assessment

and continuing professional education;
Avoid the improper exploitation of professional relationships for personal gain;
Disclose financial and other conflicts of interest;
Use this Code to further the interests of the profession and not for selfish reasons;
Respect professional confidences;
Enhance the dignity and image of the healthcare management profession through positive public information programs; and
Refrain from participating in any activity that demeans the credibility and dignity of the healthcare management profession.

AMERICAN COLLEGE OF
HEALTH CARE EXECUTIVES
(ACHE)
CODE
OF
ETHICS:
Responsibilities to patients or others served

Work to ensure the existence of a process to evaluate the quality of care or service rendered;
practicing or facilitating discrimination and institute safeguards to prevent discriminatory
organizational practices

Avoid

Work

to ensure the existence of a process that will advise patients or others served of the rights,
opportunities, responsibilities and risks regarding available healthcare services;

Work

to ensure that there is a process in place to facilitate the resolution of conflicts that may arise when
values of patients and their families differ from those of employees and physicians;

Demonstrate

zero tolerance for any abuse of power that compromises patients or others served;

Work to provide a process that ensures the autonomy and self-determination of patients or others
served; and

Work to ensure the existence of procedures that will safeguard the confidentiality and privacy of patients
or others served

AMERICAN COLLEGE OF
HEALTH CARE EXECUTIVES
(ACHE)
CODE
OF
ETHICS:
Responsibilities to the Organization

The

healthcare executive shall, within the scope of his or her authority:

services consistent with available resources, and when there are limited resources, work to ensure
the existence of a resource allocation process that considers ethical ramifications;

A.

Provide healthcare

B.

Conduct both

C.

Lead the organization in the use

D.

Respect the customs and practices of patients or others served, consistent with the organizations philosophy;

competitive and cooperative activities

in ways that improve community healthcare services;

and improvement of standards of management and sound business practices ;

Be truthful in all forms of professional and organizational communication, and avoid disseminating information that is
false, misleading or deceptive;

E.

F.

Report

G.

negative financial and other information promptly and accurately , and initiate appropriate action;

Prevent fraud and abuse and aggressive accounting practices

that may result in disputable financial reports;

Create an organizational environment in which both clinical and management mistakes are minimized and, when
they do occur, are disclosed and addressed effectively;

H.

I.

Implement an

J.

Provide

organizational code of ethics and monitor compliance ; and

ethics resources to staff to address organizational and clinical issues.

AMERICAN COLLEGE OF
HEALTH CARE EXECUTIVES
(ACHE)
CODE
OF
ETHICS:

Responsibilities to the Employees:

Healthcare

executives have ethical and professional obligations to the employees they manage
that encompass but are not limited to:

A.

Creating a work environment that promotes ethical conduct by employees;

B.

Providing a work environment that encourages a free expression of ethical concerns and
provides mechanisms for discussing and addressing such concerns;
Providing a work environment that discourages harassment, sexual and other; coercion of any
kind, especially to perform illegal or unethical acts; and discrimination on the basis of race,
ethnicity, creed, gender, sexual orientation, age, or disability;

C.

Providing

a work environment that promotes the proper use of employees knowledge and skills;

E.

Providing a safe work environment; and

F.

Establishing appropriate grievance and appeals mechanisms

AMERICAN COLLEGE OF
HEALTH CARE EXECUTIVES
(ACHE)
CODE
OF
ETHICS:
Responsibilities to Community & Society:

The
A.

healthcare executive shall:

Work to

identify and meet the healthcare needs of the community ;

B. Work to support access to healthcare services for all people ;

C. Encourage and participate in public dialogue on healthcare policy issues, and advocate solutions
that will improve health status and promote quality healthcare ;

D. Apply short- and long-term assessments to management decisions affecting both community
and society; and

E. Provide prospective patients and others with adequate and accurate information, enabling them to
make enlightened decisions regarding services .

AMERICAN COLLEGE OF
HEALTH CARE EXECUTIVES
(ACHE)
CODE
OF
ETHICS:
Responsibilities to report violations of the code:

An

affiliate of ACHE who has reasonable grounds to believe that

another affiliate has violated this Code has a duty to
communicate such facts to the Ethics Committee.

Workplace Deviance
Workplace Deviance
Unethical behavior that violates organizational
norms about right and wrong

Two dimensions
Degree of deviance
Target of deviant behavior

Types of Workplace Deviance

Organizational

Production
Production
Deviance
Deviance

Property
Property
Deviance
Deviance

Minor

Serious

Political
Political
Deviance
Deviance

Personal
Personal
Aggression
Aggression
Interpersonal

Production Deviance
Leaving
Taking

early

excessive breaks

Intentionally
Wasting

working slow

resources

1
25

Property Deviance
Sabotaging

equipment
Accepting

kickbacks
Lying

about
hours worked

Stealing

from
company

2
26

Political Deviance

Showing

favoritism

Gossiping

about

coworkers
Blaming

coworkers

Competing

non

beneficially

3
27

Personal Aggression
Sexual

harassment

Verbal

abuse

Stealing

from coworkers

Endangering

coworkers

4
28

Doing the Right Thing

College
College students
students who
who cheat
cheat are
are likely
likely to
to cheat
cheat again.
again.
70
70 percent
percent of
of students
students dont
dont see
see cheating
cheating as
as aa problem.
problem.
People
People who
who cheat
cheat and
and cheat
cheat again
again see
see their
their
behavior
behavior as
as normal.
normal.

DOING THE RIGHT THING

If
If You
You Cheat
Cheat in
in College,
College,
Will
Will You
You Cheat
Cheat in
in the
the Workplace?
Workplace?

60
60 percent
percent of
of people
people who
who cheat
cheat their
their employers
employers dont
dont feel
feel guilty
guilty for
for doing
doing so.
so.
29

CLASSIFYING BUSINESS DECISIONS-I

Ethical

Ethical but Illegal

Ethical and Legal

Unethical and
Illegal

Unethical but
Legal

Un Ethical
Illegal

Legal

CLASSIFYING BUSINESS DECISIONS-II

Ethical

Providing rock-bottom prices

only to distributors in
underserved areas
Collaborating with other
medical
clinics to guarantee low
prices in
low-income countries

Producing top quality

products
Rewarding integrity
Leading by example
Providing employee benefits
Contributing to community
Establishing recycling
programs

Embezzling money
Engaging in sexual
harassment
Practicing collusion with
competitors
Encouraging fraudulent
accounting

Promoting PG rated movies

to young teens
Producing products that you
know will break before their
time

Un Ethical
Illegal

Legal

Ethical Behavior

Ethical behavior goes beyond the legal requirements

placed on a business, as it concerns discretionary
decisions and behavior; in other words, what a
business chooses to do, rather than what is
forced to do.

Business ethics are relevant both to the conduct of

an individual within an organization and to the
conduct of the organization as a whole.

32

Myths of Business Ethics

It is a more religion than management
Our employees are ethical so no need
It is a discipline best led by philosophers
It is a matter of good person preaching to bad persons
It is a new police-person in organization
Ethics can't be managed
Business ethics & CSR are same thing
We obey to law so no need about ethics.

33

Ethical Dilemma
There

are situation when there is not simple choice

between right or wrong
Ethical dilemma is complex judgments on the balance
between the economic performance and the social
performance of an organization.

Have two interests - cannot purse one without having negative impact on
other

Private

Interest Conflicts with Corporate

Business

Interest Conflicts with Public.

34

Cont...
An

ethical dilemma exists when one is faced with having to

make a choice among following alternatives:
Significant value conflicts among differing interests,
Real alternatives that are equally justifiable,

Significant consequences on "stakeholders" in the situation .

35

Characteristics of Dilemma
It have extended consequences
It has multiple alternatives
It have mixed outcomes
It have uncertain consequences
It have personal implications
It is easy to make when a person is not directly involved
Hence EDM are not simple choice between right and wrong.

36

Paradigms of Dilemma

Four such dilemmas are so common to our experience that they stand
as models, patterns, or paradigms. They are:
Truth

versus loyalty.
Individual versus community.
Short-term versus long-term.
Justice versus mercy.

37

Whistle blowing
It

is methods can be contributed to identify and act of disclosing

wrong in an organization
Like blowing a whistle to call attention to a thief or unethical
practitioner
But it is questionable when...
Dissent / disagree - Must speak out against others in organization
Breach of Loyalty - Perceived as one who violates confidentiality and loyalty
Accusation - Singles out specific individuals as threats to organization or the
public

38

Whistle blowing
Care about whistle blowing
Make sure situation involves an imminent threat to society or to the
business
Document all allegations
Examine internal whistle blowing first
Should you remain secret

Ethics and Our behav

ior

39

Effects of
Ethical/Unethical Behavior

40

41

Ethical Test
1.

Is it Legal

2.

Benefit Cost Test

3.

Categorical Imperative

4.

Light of Day Test

5.

Do onto Others Test

6.

Ventilation Test

42

Benefit & Categorical Imperative

2.Benefit Cost Test

3.Categorical Imperative

Do the benefits exceed the costs to whomsoever they accrue?

Are you willing to allow to everyone to practice the proposed action or do you
want to be a special case?

43

Light of Day & Do onto Others

4.Light of Day Test What would be your reaction if the

action were brought out into the open for public scrutiny
5.Do onto Others Test Golden Rule If you would like
others to do the same to you - passes the test
6.Ventilation Test Seek out others views. Discuss the 5
tests with them. If others feel it is OK passes the test

44

A Venn Diagram Model for Ethical

Decision Making

2b

2a

45

ETHICAL DECISION MAKING STYLES

Individualists
Driven by natural reason, personal survival etc. Self is the source of all
actions

Altruists
Concerned with other people. Relinquish their own security for others

Pragmatists
Concerned with situation at hand, not with the self or other. Bases of
moral authority is the perceived need at the moment and the potential
consequences of a decision in a specific context.

Idealists
Driven by principles, rules and values. Reason and relationships will not
substitute for idealists adherence to principles.