Intro to OE Boyle 040412
Transcript of Intro to OE Boyle 040412
Organizational Ethics In Health CareAn Overview
Philip Boyle, Ph.D.Vice President, Mission & Ethics
www.CHE.ORG/ETHICS
What is organizational ethics?What is unique to OE?The nature of organizations—their ecologyHow to study organizations? What is unique about • organizations?• healthcare organizations?• RC organizations?
Definitions Applied ethics family resemblances • Business ethics• Management ethics• Corporate Ethics• Institutional Ethics• Organizational Ethics
Definitions• Nash: “The study of how personal moral norms
apply to the activities and goals of a commercial enterprise. It is not a separate moral standard, but the study of how the business context poses its own unique problems for the morals person who acts as agent of the system.”
• Boyle, et al. Focus on the choices of all individuals in an organization and on the choices of the organization as organization in bring fulfillment to individuals and the community
Definition
• OE evaluates of moral choices of individuals and the organization itself in pursuit of the organization’s mission.
• OE focuses on organizations as moral agents.
• OE also examines decision-makers inside and outside the organization
Moral agency of institutions
• Are we drinking the cool aid?
• In what ways are organizations moral actors?
Moral agency of institutions• Philosophers—it is not a moral agent
• Theologians—it is a moral agent
• Mediators—it acts as IF it were a moral agent; helpful analogy
Moral Agency of Organizations
• Legal– 19th century property– 1978 Pinto criminal behavior– 1978 Corporation have free speech rights– 1991 Sentencing guidelines– 2010 Citizens Untied v. Fed Elction
Commission
Moral Agency of Organizations • Sociology—plain language
– Organizations exist after an individual dies
– Said to hire and fire
– Said to pursue missions that override the mission of any individual
– Its actions are not reducible to actions of employees
Moral Agency of Organizations Moral• Held accountable• Praised and Blamed• Decision making—not on impulse• Acts in rational ways--policies• Creates culture
Case of Len• 35-yr-old level 3 sex offender• Drunk & raped minor at age 19• Enters St. Dymphna Clinic after + drug screen• Alerts local division of justice per Megan’s law• Police alert schools and they inform families• Discuss
– What’s the issue?– Who is responsible?
Moral Ecology• Cell• Individuals• Groups• Regional Ecosystems• Ecosystem• Biosphere
• Individual acts• Moral agents• Departments• Institutions• Organizations• Healthcare system
Moral Ecology Advantages• Honesty--clear about
perspective• Which level is more
important?
Disadvantages• Other levels obscured• Can obscure
differences between organizations
The Actors & Risks• Sponsors—clear role• Boards--clear process• Managers
– Senior management—discretion– Middle
• Finance—conflicts of interest• HR—hiring firing, promotion• Marketing—truth in advertising• Development—nature of gift acceptance• Environmental services—safety• IS--confidentilaity
The Actors & Risks• Employees—common risks of agent-
principle relationships• Consumers/patients—participation &
appeal• Purchasers/vendors—nature of
cooperation
Range of issues
• Across all organizations– Discretion and control– Resource allocation– Conflicts of interest
• Organization specific– Home health v. acute
• Department specific– Finance v. development
How to study organizations? • Rational systems
– Formal—examines policies• Natural systems
– Informal—examines real practices• Open systems
– External systems—examines liability, laws, regulations, etc.
How to study Formal• Personnel arranged in a hierarchy of authority• Those in policy making higher positions are
regarded as professional managers• Most relations can be described as principle-
agent relationships• Division of labor with each position having
limited authorized actions• Following policies and procedures• Products are joint outputs
How to study Formal Risks• Joint output--mission substitution• Hierarchy --expert imperialism• Clear roles--dithering, stalling,
obstruction• Managerial expertise--incompetence
How to study Informal• Culture is the glue of the organization• Values and beliefs of all participants and includes the
internal and external interpretation of those beliefs• Informal unstated ways of acting• Difference between policy and actual practice• Moral psychology
– Wendy Carlton: In our Professional Opinion: – Charles Bosk: Forgive and Remember– Danial Kahneman and Amos Tversky Judgment under
Uncertainty: Heuristics and Biases; – Michael Davis: “The Challenger Disaster”– Jerome Groopman: How Doctors Think
Uniqueness of health care organizations
What distinguishes healthcare from others kinds of organizations?
• Opportunistic – rapidly changing• Any organizations that participates in
healthcare: Purchaser/Vendor/Provider• Industrialization process: use of industrial
techniques for predictable outcomes• Move from a medical professional to
managerial professional
Uniqueness of organizations
• What is unique about RC organizations?
– What is unique about RC education?
– What is unique about RC health care?• God is Love #31-33
Mechanisms to address OE
• Values based discernment process• Subcommittee of ethics committee• Ad hoc groups• Senior management team• Mission Effectiveness Committees
Conclusions• Moral agency of organizations• How to study
– Formal—policies– Informal—practice
• Overlap between clinical and organizational ethics
• Dig in with low hanging fruit• Different mechanisms