How Health Administrators Can Uphold Ethics in Healthcare

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Healthcare workers attend ethics training.Healthcare leaders, including administrators, often deliberate on challenging ethics in healthcare issues involving access, patient privacy, technology use and inequities among racial and ethnic groups.

Take, for example, the millions of Americans who lost their healthcare during the COVID-19 pandemic. According to the Commonwealth Fund, about 14.6 million individuals — 7.7 million workers who became unemployed between February and June 2020 and about 6.9 million of their dependents— lost their employer-sponsored health insurance.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act helps hospitals and healthcare organizations cover the costs of providing COVID-19 care for uninsured individuals. However, other issues involving ethics in healthcare may come to the fore, including the following:

  • How to ensure that uninsured individuals get fair, equitable access to care not related to COVID-19
  • How timely care can be given to these patients when healthcare systems are already strained under the pressure of the pandemic
  • How healthcare providers can inform uninsured individuals about assistance programs that can help address their medical needs not related to COVID-19 care

In this and other critical scenarios, health administrators can play a central role in helping healthcare systems, facilities and workers uphold high ethics in healthcare. For example, health administrators or executives can implement policies that address top-of-mind ethical concerns. This can include technology and data, fairness and equity, financial management, and racial justice.

What Is Ethics in Healthcare?

Hospitals aiming to maintain high standards and a trustworthy reputation must ensure that ethics are core to their operations. What is ethics in healthcare, and what role does it play in healthcare settings?

Ethics in healthcare is a set of principles that guides decision-making. For example, healthcare administrators can establish guidelines for frontline healthcare workers to dictate when and how to relocate patients to different wards as their care necessitates.

From an administrative perspective, a hospital administrator may establish procedures to guide how healthcare practitioners perform tasks such as entering information into electronic health records (EHRs). Clear guidance enables nurses to follow protocol to ensure that patient information is safe and protected.

Policies that healthcare administrators set also help:

  • Give patients peace of mind
  • Boost staff confidence and minimize mistakes
  • Enable the healthcare facility to meet regulations such as the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule

It must be emphasized that healthcare in ethics focuses on doing what is right for patients, healthcare professionals and society at large. In exploring what ethics in healthcare is and the different ways it can be applied, healthcare leaders should consider four core ethical principles.

1. Autonomy

Autonomy in healthcare refers to the right of patients to make decisions about their own bodies. In a healthcare setting, a physician can educate the patient about a health condition and present the best course of care. However, coercing a patient into making a choice violates the autonomy principle. In the end, patients must have the freedom to decide the next steps in their health journey.

2. Beneficence

The principle of beneficence establishes that a moral obligation exists to act in the best interest of patients. This principle can simply be described in two words: Do good. Beneficence means that the actions of a physician, a nurse or other healthcare professionals should always benefit the patient. Kindness, compassion and understanding are at the heart of this principle. An example of a beneficent act is a nurse holding the hand of a dying cancer patient. Healthcare administrators who promote a climate of caring, compassion and respect toward patients and colleagues help set the stage for a healthcare environment focused on beneficence.

3. Nonmaleficence

Nonmaleficence is often associated with the medical maxim “Do no harm.” It means that healthcare practitioners should never purposely cause harm, such as acting with malice toward a patient. Nonmaleficence also includes prescribing ineffective treatments that do not offer any known benefit. While this principle’s directive is clear, its application is not always straightforward. For example, a treatment, therapy or medication may have serious risks or side effects; the ethical challenge is to determine whether the benefits outweigh the risks.

4. Justice

The concept of justice is centered on fairness and impartiality. It considers whether healthcare decisions are equitable, aligned with patients’ rights and compatible with healthcare laws. Justice also involves the equal distribution of resources and treatments. For example, justice in healthcare ensures that all residents in a community meeting the requirements to receive a COVID-19 vaccine have fair and equal opportunity to access a vaccination site.

Importance of Ethics In Healthcare

Ethics in healthcare focuses on addressing healthcare dilemmas through decisions based on morals and values — for example, how patients are treated and how healthcare operations are run. Consider the financial aspects of care. Healthcare administrators have to balance the cost of care with the quality and effectiveness of treatments to equitably meet the needs of as many patients as possible. This also requires knowing how to address the healthcare needs of underserved and disadvantaged patients.

This example highlights the importance of ethics in healthcare in ensuring that people receive the care they need. Ethics in healthcare are also essential to ensure compliance with regulations such as HIPAA. Other legislation with ethics considerations include the following:

  • Occupational Safety and Health Administration requirements. OSHA is focused on the prevention of workplace injuries and illnesses.
  • Health Information Technology for Economic and Clinical Health Act. HITECH legislation promotes the use of EHRs to improve care efficiency and facilitate secure sharing of patient data among caregivers.

Current Ethical Issues

Healthcare leaders are responsible for addressing various ethical issues, from access to healthcare to malpractice and negligence. The following are examples of common ethical issues in healthcare that healthcare administrators face:

Big Data and Artificial Intelligence

Digitization offers opportunities to improve access to healthcare information, and technology companies like Google are developing AI to enable doctors to search for useful patient information more easily. Google’s health data initiative, “Project Nightingale,” could help resolve issues that have long plagued the healthcare system, improving data integration and knowledge sharing and reducing medical errors. However, the project raises ethical concerns. According to the Wall Street Journal, Google employees have access to millions of patient health data records, and many patients and doctors have never been notified.

Healthcare leaders can help facilitate technological advancements in healthcare while ensuring adherence to the laws and ethics regarding patient privacy and consent.

Compassionate Force

One ethical concern with acutely ill patients is determining whether there is an appropriate time to use force to save a patient’s life. The AMA Journal of Ethics presents a case in which ethical principles are at odds: A mostly nonverbal 25-year-old patient with a history of mental health issues arrived at an emergency room involuntarily. After assessing the patient, the doctor decided to treat the patient’s potentially fatal condition with oral benzodiazepines. The patient refused the treatment; the patient’s mother, however, agreed with the doctor’s recommendation. They decided that forcibly administering the medicine was necessary to save the patient’s life.

When does compassionate force take precedence over “harm minimization” or “Do no harm”? Healthcare leaders can play a critical role in establishing policies to guide decision-making in these scenarios.

Malpractice and Negligence

Malpractice lawsuits can affect a healthcare facility’s revenue and reputation. Fear of litigation can result in an overcautious or defensive approach to practicing medicine, potentially resulting in suboptimal care. Practicing defensive medicine to reduce the risk of malpractice suits can result in negligence claims, which can lead to litigation.

How can a medical practice safeguard itself from malpractice and negligence lawsuits while ensuring high-quality patient care? Health administrators can proactively resolve these issues before they escalate, identify improvements in practice operations and determine where training can help staff provide exceptional service.

Creating an Ethical Culture

Healthcare leaders are responsible for creating a culture of ethics in their organizations. They can:

  • Establish ethical standards of behavior across all levels of their organizations
  • Promote practices to improve the quality of healthcare
  • Provide resources that offer clarity on ethics standards

For example, they can elevate the importance of ethics in healthcare by identifying nurse leaders willing to take on an extra layer of responsibility to help meet every patient’s individual needs — ensuring that patients are addressed in their native language, for example. By appointing nursing staff members as point people to assess unforeseen ethical challenges, they can help ensure that the unique needs of every patient are met.

Healthcare leaders can also indirectly elevate the importance of ethics in healthcare by ensuring that healthcare providers have the resources and support to do their jobs effectively. Failure to do so may cause a loss of job satisfaction and low performance among nurses, resulting in ethical standards not being met. Additionally, by meeting the needs of healthcare staff, healthcare administrators can help ensure optimal patient care delivery and outcomes for every patient in their facility.

Ethics Committees in Healthcare

Hospitals have different departments with various areas of focus and healthcare services, such as emergency services, surgery, pediatrics, trauma centers and urgent care. Each department has a different leader, but issues often cut across these divisions. How does a single department make decisions on hospital-wide matters? Enter the critical role of committees.

Committee members are elected or selected to debate and address specific issues relevant to the committee’s focus. Ethics committees in healthcare have become increasingly common, established to lay out the vision and foundation for a facility’s ethical culture. They make collective decisions about ethical issues related to healthcare, patients, families, physicians and other healthcare professionals.

Healthcare practitioners face a barrage of clinical decisions while ensuring adequate care delivery and favorable outcomes for their patients. They also regularly ask themselves ethically challenging questions, including the following:

  • “How do we demonstrate transparency and truthfulness with information about a patient’s condition while maintaining the patient’s right to privacy?”
  • “How do we decide on proper treatments and interventions while being sensitive to a patient’s spiritual beliefs?”
  • “What is the best approach to dealing with end-of-life issues with patients who cannot make rational decisions on their own?”

In these scenarios, how can a healthcare practitioner know the most appropriate or preferred course of action? Ethics committees can help in the decision-making process by establishing guidelines to help practitioners make proper decisions and ensure compliance with the law.

Who Participates in Ethics Committees in Healthcare?

Different stakeholders offer unique perspectives about a healthcare organization’s most pressing ethics concerns, including the following:

  • Physicians. Ethics concerns may include addressing disagreements with patients’ families or disclosing errors in care.
  • Nurses. Ethics concerns may include reporting safety concerns in work areas and dealing with patients who refuse treatment or vaccines.
  • Healthcare administrators. Ethics concerns may include balancing the cost of resources with quality of care and improving administrative processes that delay care delivery.
  • Social workers. Ethics concerns may include effectively advocating for patients.
  • Attorneys. Ethics concerns may include legal advice to avoid malpractice litigation.
  • Community representatives. Ethics concerns may include addressing different communities’ unique needs.

Roles and Responsibilities of Ethics Committees in Healthcare

A primary aim of ethics committees is to promote patient rights, which protects their autonomy and privacy. Ethics committees also advocate for fair policies to achieve good healthcare outcomes regardless of a patient’s socioeconomic background.

However, it isn’t enough for a committee to settle for minimally addressing patients’ ethical concerns. An effective program continuously strives to improve ethical standards and commits to elevating the importance of ethics among health professionals.

The role of ethics in committees with a different nominal focus must also be considered, including the following committees:

  • Safety committee establishes safety protocols and ensures adherence through regular reviews
  • Grievance Committee, addresses complaints and grievances from internal and external stakeholders, including staff and patients
  • Technology committee resolves ethical issues concerning data collection in EHRs and the use of AI

Code of Ethics for Healthcare Administrators

In a clinical setting, physicians face life-or-death decision-making scenarios. For example, in the early stages of the COVID-19 pandemic in Italy, physicians had to determine which patients had access to a limited supply of ventilators, according to a BBC report. Who receives care when the number of patients requiring vital equipment and supplies exceeds a hospital’s resources?

This question may not always have an easy answer, but the decision must be made. However, guidelines from healthcare administrators — in collaboration with other healthcare executives; individuals serving on ethics committees; and public health groups, such as the World Health Organization — can help physicians make the appropriate decisions.

Healthcare administrators’ ethical obligations and responsibilities also include how their decisions and policies lay the groundwork for improving the well-being of patients and staff. Alternatively, developing policies without a moral compass may result in an environment where patient safety is at risk and staff performance falters.

Healthcare administrators can turn to the Code of Ethics of the American College of Healthcare Executives (ACHE) for guidance. First, the ACHE Code of Ethics emphasizes that executives should exemplify character, integrity and trustworthiness. These traits will help them succeed in laying the foundation for an ethical organization.

A Healthcare Administrator’s Responsibilities

The ACHE Code of Ethics also offers a framework for healthcare administers interested in developing ethically centered policies. It details a healthcare administrator’s ethical responsibility to the:

  • Healthcare management profession. In performing their duties, healthcare administrators must comply with laws and regulations, avoid exploiting relationships for personal benefit, and be transparent about conflicts of interest.
  • Patients or others served. Healthcare administrators must aim to ensure a process “to evaluate the quality of care or service rendered” and implement policies to prevent discriminatory practices.
  • Healthcare administrators should provide leadership on “prioritizing patient care” and be truthful in all communications.
  • Healthcare administrators should establish “a work environment that promotes ethical conduct” and that encourages inclusivity.
  • Community and society. Healthcare administrators should strive to “identify and meet the healthcare needs of the community,” champion public dialogue, and advocate for improvements.

Advance Ethics in Your Healthcare Organization

The scenarios, data and examples discussed here highlight the vital role of ethics in healthcare. Elevating ethics in healthcare requires balancing business and technology objectives with protecting patients’ rights and well-being.

Healthcare administrators are responsible for setting the policies that help achieve these aims. They also set the example of high ethics for others to follow.

Duquesne University’s online Master of Health Administration (MHA) program can help individuals acquire the knowledge and skills to promote and uphold ethics in healthcare organizations. The curriculum integrates ethical problem-solving and decision-making to explore and address ethical issues.

Students enrolled in Duquesne’s online MHA program can choose from three concentrations:

  • Health Informatics and Data Analytics. Students learn to design and develop systems that promote value-based care and protect patient data from falling into the wrong hands.
  • Healthcare Compliance and Risk Management. Students explore the link between patient privacy and quality care and learn skills to protect healthcare organizations.
  • Population Health. Students learn how to use the power of data and population-based medicine to identify gaps in care and help improve health outcomes for individuals.

By promoting ethics at every level, healthcare administrators can build exemplary healthcare organizations and help transform the healthcare industry. Learn how Duquesne’s online MHA program can prepare you to become an ethical leader in healthcare.

Recommended Readings

Doctor-Patient Confidentiality: Tips and Resources for Health Administrators

Quality Improvement in Healthcare: What Health Professionals Need to Know

Ethical Issues in Nursing: Explanations & Solutions

Sources:

AMA Journal of Ethics, “How Should Clinicians Execute Critical Force Interventions With Compassion, Not Just Harm Minimization, as a Clinical and Ethical Goal?”

AMA Journal of Ethics, “Organizational Ethics for US Health Care Today”

American College of Healthcare Executives, ACHE Code of Ethics

American College of Healthcare Executives, Creating an Ethical Culture Within the Healthcare Organization

American College of Healthcare Executives, Ethical Decision Making for Healthcare Executives

American Medical Association, Ethics Committees in Health Care Institutions

American Medical Association, “The Top 10 Ethical Issues Medical Students Should Be Taught”

American Society for Bioethics and Humanities, ASBH Statement on Racial Injustice and Professionalism in Bioethics and Health Humanities

BBC, “The Heart-Wrenching Choice of Who Lives and Dies”

Electronic Health Reporter, “First Do No Harm: The Ethics of Healthcare in 2020”

Healthcare Financial Management Association, “The Most Pressing Ethical Issues in Healthcare”

HIPAA Journal, What Is the HITECH Act?

Houston Chronicle, “Legal & Ethical Issues That Health Care Professionals Face”

Houston Chronicle, “What Is the Importance of Good Ethical Standards in Health Organizations?”

Medical Economics, “COVID-19 Raises Ethical Dilemmas for Many Physicians”

Medscape, “Money, Patients, Romance: Physician Ethics 2020”

Medscape, What Is Medical Ethics, and Why Is It Important?

National Association for Healthcare Quality, NAHQ Code of Ethics for Healthcare Quality Professionals and Code of Conduct

Occupational Safety and Health Administration, Compliance Assistance Quick Start

The Commonwealth Fund, “Update: How Many Americans Have Lost Jobs with Employer Health Coverage During the Pandemic?”

The Hastings Center, “Why Health Care Organizations Need Technology Ethics Committees”

The Medical Futurist, “The Most Pressing Issues in Bioethics”

The Wall Street Journal, “Google’s ‘Project Nightingale’ Gathers Personal Health Data on Millions of Americans”

U.S. Department of Health and Human Services, Your Rights Under HIPAA

U.S. Department of Veterans Affairs, National Center for Ethics in Health Care

Vermont Ethics Network, Medical Ethics