USES OF THE ETHICAL CONFLICTS & HOSPITAL STAY

Uses of the Ethical Conflicts & Hospital Stay

Uses of the Ethical Conflicts & Hospital Stay

EXECUTIVE SUMMARY

Ethical conflicts are a common phenomenon in today's healthcare settings. As healthcare executives focus on balancing quality care and cost containment, recognizing the costs associated with ethical conflicts is only logical. In this article, we present five case vignettes to identify several general cost categories related to ethical conflicts, including operational costs, legal costs, and marketing and public relations costs. In each of these cost categories, the associated direct, indirect, and long-term costs of the ethical conflict are explored as well.

Our analysis suggests that organizations have, in addition to philosophical reasons, financial incentives to focus on decreasing the occurrence of ethical conflicts. The cost categories affected by ethical conflicts are not insignificant. Such conflicts can affect staff morale and lower the organization's overall culture and profit margin. Therefore, organizations should develop mechanisms and strategies for decreasing and possibly preventing ethical conflicts.

The strategies suggested in this article seek to shift the organization's focus when dealing with conflicts, from just reacting to moving upstream--that is, understanding the root causes of ethical conflicts and employing approaches designed to reduce their occurrence and associated costs. Such an effort has the potential to enhance the organization's overall culture and ultimately lead to organizational success.

INTRODUCTION

Ethical conflicts are a common occurrence in healthcare facilities. Managing and responding to the ethical conflict can be challenging because inherent in all ethical conflicts is uncertainty or the question of what appropriate course of action to take. Ethical conflicts affect not only patients and families but also the facility's staff, culture, and overall Success.

In many healthcare facilities, conflicts are addressed by ethics committees or ethics consultation services (Fox, Myers, and Pearlman 2007; Milmore 2006). When an ethical conflict is recognized by a clinician or an administrator, the involved staff may call upon the organization's ethics mechanism to help address the situation. This reactive approach reflects the traditional manner in which ethics committees or ethics consultation services function when an ethical conflict occurs. While this approach can be helpful in complex and challenging ethical situations, it can be stressful and time consuming for members of the ethics committee or consultation service. In addition, this approach tends to accept the recurrence of ethical conflicts and, in so doing, ignores the underlying system or structure that may have caused the conflict (Forrow, Arnold, and Parker 1993; Nelson 2007).

Because addressing ethical conflicts demands investment of time and places stress on staff, such conflicts are clearly associated with financial costs. Little is known about the costs of ethical conflicts for two reasons. First, any analysis of costs associated with ethical conflicts is complex and does not have a framework that is specific to healthcare ethics. Second, historically, the costs of ethical conflicts were thought to be trivial or were simply an accepted part of the overall costs of delivering healthcare; thus, any analysis was not deemed worthy of the needed ...