Applying Ethical Principles

In any capacity within a healthcare organization or business, working in the field is seen as both extraordinarily gratifying and occasionally challenging. However, every choice, action, and use of resources can result in conflict. This begs whether each choice or decision is ethically proper, a crucial consideration for healthcare professionals navigating dangerous situations. This article discusses the ethical case study provided in the “Ethical Case Studies media piece” of assessment 1.

Summary of the Case Study

    The ethical case study chosen is Incident 2 Repeat Admissions to the Emergency Department (ED) – A Question Concerning Resource Use. The case study focuses on emergency department resource utilization and how overuse impacts the hospital’s bottom line. The case study begins by describing how Matt Losinski completed reading an article on the over usage of emergency services in Central Texas hospitals. County General Hospital combines urban and suburban services, and Matt serves as the facility’s Chief Executive Officer. County General Hospital has 300 beds and is located in the south-central United States. Before its transfer to a non-profit organization, the county government operated the hospital. However, the hospital was transferred to a non-profit organization due to the expense burden. Matt considered the paper to study the organization’s current situation. The study thoroughly examined hospital readmission rates, their financial implications, and resource use. Matt submitted the document to Mary Scott, the chief financial officer, expecting she would recognize its importance for CGH. Scott visited Matt’s workplace to talk about the piece. Scott noted that she did not consider the situation problematic, given that Medicaid covered 75% of emergency department charges for qualified patients. However, Matt was irritated with Scott for not comprehending the matter. Anisha Patel, the administrative resident, was requested by Matt, who believed that the ED at CGH was inadvertently wasting too many resources to submit information on patients who were repeatedly admitted to the ED. It was found that the article’s conclusions and CGH’s data were nearly identical. Matt observed that the CGH ED readmits patients with mild and nonspecific medical conditions. The results were subsequently submitted to the board of directors, who had differing opinions regarding the preliminary review data.

Nonetheless, the board was adamant about modifying the ED’s resource allocation. The article titled “Recurrent Emergency Department Users: Two Categories with Different Risk Profiles” (Slankamenac et al., 2019) shows that readmissions in an ED cause financial loss. The article also highlights the reasons for readmissions. This article is linked to the case study I discussed, which addresses the rate of hospital readmissions. In another article titled, “Correlation between hospital finances and quality and safety of patient care,” it has been mentioned that the quality of care is affected in a hospital if the hospital goes through financial issues (Akinleye et al., 2019). 

Model of Ethical Decision-Making

Moral awareness, moral discernment, and ethical conduct are the three aspects of ethical decision-making. Matt exhibited moral awareness by recognizing the risk to the hospital posed by readmission rates and how these impacted the facility’s cost expenditures about its resources and bottom line. In addition, he displayed moral judgment by examining the level of resource use at CGH and using the resulting data to bring the issue to the board’s attention so that it might be remedied. Even further, he demonstrated how resource usage would only have long-term effects on the business if nothing were done. Matt also exhibited ethical conduct by being forthright with the board and other staff about the excessive use of resources and fairness and equity. Using research initiatives, he demonstrated how overutilization would impact the future of the business. The Utilitarian and Deontological Ethics approaches can be considered adequate here as they focus on providing happiness to a large group of individuals. These approaches are outcome and duty based, respectively. The ineffective ethical approach would be when the hospital’s CEO wanted to get funds for the hospital, and he was rejected. It shows that the stakeholders were not ethically bound to their duties. 

Contributing Factors to the Ethical Problem

     The recognized ethical concern is justice, which advocates for fair and equitable resource distribution. In the provided case study, one aspect contributing to the overutilization of resources is the readmission rates, which Matt assumes are too high, resulting in excessive overhead expenses. As a result of the readmission of patients, physicians and nurses will need to allocate more resources to care for them. Another highlighted issue was the readmission of patients with non-emergency medical conditions, which included using resources for no purpose even though Medicaid coverage covered the expenditures. According to Matt, these two factors explain why the concurrent readmission rates were too high, leading to an increase in resource utilization without regard for economic consequences.

Journal of Academic Review Analysis of Ethical Problem

     The key premise of the case study is justice, which is defined as the fair, equitable, and suitable distribution of resources. According to Varkey (2021), justice in the distributive principle is the justification of the use of resources based on the availability and need of patients. Feuerstadt et al. (2020) examine the impact of fair use of ED resources and observe that the expenses incurred can be too high for most hospitals, resulting in closure in the worst-case scenario. In the case study, it is evident that Matt is aware of the excessive use of resources due to the admission of patients who do not require care. Feuerstadt et al. (2020) explain that in accordance with the fundamental principle of justice, physicians and clinicians must evaluate the ethics of fairness in the knowledge that clients may, at some point, use the resources during a crisis. The sources of information given above are credible since they have all been peer-reviewed and are pertinent to the material supplied. The credibility was determined by the recent study published within the last five years, the authors’ nursing-specific competence, and the amount to which each source discusses the justice principle and resource utilization within the context of the principle.

Communication Strategies’ Efficiency

Kevin Roberts’s correspondence with Mary was courteous, formal, and professional. He employed evidence-based research to support the changes he proposed for the workplace. Further, Matt questioned Mary’s comprehension of the essay and its influence on the organization. In addition, he does preliminary research on the organization’s activities and puts the findings in a concise format for presentation. Utilizing direct article information and transferring it to other administrators is a kind of communication that should not be used. It would have been professional to convene an impromptu meeting to discuss the article’s concerns. Effective communication ensures that all information is delivered, whereas, as Mary Scott shows, ineffective communication leads to conflict.

Effectiveness in Dealing with Ethical Issues

The ethical challenge was the organization’s unfair distribution and use of resources. Matt has shown care for his organization and whether it created ethical resource usage rules. He shared the article’s perspective with Mary Scott, the Chief Finance Officer (CFO). Matt’s approach to the moral problem involved an additional internal study determining if resource exploitation was ongoing. He confirmed the information and transmitted it to the board, which terminated him. Matt was professional in conveying the information to the CFO by providing the article and articulating his concerns over the article’s impact on the firm. Matt proved proficiency to the board by acknowledging that he required a fact-based, evidence-based argument to modify how the hospital spent its resources. The approach’s most important lesson is constantly arguing with evidence-based facts and evaluating how laws and regulations affect business operations.

Ethical Principles

Seven principles revolve around ethics. They include justice, fidelity, autonomy, maleficence, non-maleficence, efficiency, and health maximization. The case study discussed above aims to reduce the number of times a non-critical patient is admitted and uses the resources. The goal is to apply ethical principles and find solutions for hospital readmissions. The board and stakeholders do not consider it a problem that resource utilization is occurring excessively (Grady, 2018). 

The ethical principle to be considered here is justice. It is a vision of the hospital to provide everyone with equal care, but if a few people use the resources, then there will not be any left for those who are actually in need. The hospital should reform all its laws and regulations to solve this issue. Standard operating procedures (SOP)s can be formed based on ethical principles. A department in the hospital can be formed that deals with all the ethical concerns, which could benefit the hospital. A triage system can be implemented in the hospital to help screen the patients who need medical help urgently and those who are not. This will help save millions of dollars and reduce the usage of resources. The Electronic Health Record (EHR) system can be implemented to help identify risk factors that may lead to readmissions. In the case study, Matt is concerned about the legal or financial ramifications the organization will face if these transgressions are found; the tactic makes the professional appear more effective. He worries about the organization and is committed to improving it because ACA reimbursements are not routed via the hospital. The remedy is less likely to be applied because the board does not see the anomalies of resource mismanagement. The ethical duties can be identified if four (justice, nonmaleficence, beneficence, and autonomy) biomedical ethics principles are applied from the seven abovementioned principles. The hospital can provide just and fair care to all the patients, and they can be transparent about their access to hospital resources. Nonmaleficence implies that patients will be safe in healthcare institutions; beneficence shows that care will be provided to those in need. If the hospital fails to do so, it is not properly meeting ethical requirements (Raus et al., 2018). 

References

Akinleye, D. D., McNutt, L. A., Lazariu, V., & McLaughlin, C. C. (2019). Correlation between hospital finances and quality and safety of patient care. PLoS One, 14(8), e0219124. https://doi.org/10.1371/journal.pone.0219124

Feuerstadt, P., Stong, L., Dahdal, D. N., Sacks, N., Lang, K., & Nelson, W. W. (2020). Healthcare resource utilization and direct medical costs associated with index and recurrent Clostridioides difficile infection: A real-world data analysis. Journal of Medical Economics, 23(6), 603–609. https://doi.org/10.1080/13696998.2020.1724117

Grady, C. (2018). Ethical principles in clinical research. In Principles and practice of clinical research (pp. 19-31). Academic Press. https://doi.org/10.1016/B978-0-12-849905-4.00002-2

Incident 2: Emergency Department Repeat Admissions- A Question of Resource Use.

Raus, K., Mortier, E., & Eeckloo, K. (2018). The patient perspective in health care networks. BMC Medical Ethics, 19(1), 1-8. https://doi.org/10.1186/s12910-018-0298-x

Slankamenac, K., Zehnder, M., Langner, T. O., Krähenmann, K., & Keller, D. I. (2019). Recurrent emergency department users: two categories with different risk profiles. Journal of clinical medicine, 8(3), 333. https://doi.org10.3390/jcm8030333

Varkey, B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119