Ethics applies to business, too

Philosophy goes beyond written policy

(Editor’s note: This is the second of a three-part series on ethics in the 21st century. Last month, Medical Ethics Advisor offered tips and ideas on fostering truth-telling among physicians and staff. Now we take a closer look at organizational ethics. Next month, we’ll examine the bioethics field professionally.)

There’s no doubt your hospital has developed a patient bill of rights and a myriad of policies and procedures for various ethical scenarios, but how devoted is your hospital to its own ethical business practices? Whether the ethics committee itself is tackling the issue or forming a task force to oversee development, hospitals across the nation are taking a closer look at the issue of organizational or, in many institutions, business ethics.

The impetus for the development of a code of ethics for hospitals is the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations. The 1998 Accreditation Manual for Hospitals, published by the accrediting body, requires that hospitals implement a code of behavior. The code must address the relationship of the organization and its staff members to other health care providers, educational institutions, and payers, according to the manual.

According to standards RI 4.0 to 4.2, the code must address marketing, admission, transfer and discharge, and billing practices.

The good news is that there’s help in developing a code of ethics tailor-made for your hospital. The Chicago-based American Hospital Association announced in late 1997 it was offering a three-day training session for hospital and health system leaders in developing a policy that helps in operational and business decisions that align with the values and ethical standards of their institutions. (See sources, p. 29, and Medical Ethics Advisor, February 1998, p. 23, for more details.) Some hospitals and health systems, however, are choosing a different route. The Cleveland Clinic Foundation, for instance, formed a task force last fall to develop a code of ethics for the facility.

"We were appointed by the hospital ethics committee and asked to address four specific areas," says the Rev. Patrick Persaud, associate director of pastoral care at the foundation and chairman of the task force.

Called the Business Ethics Task Force, the five-member group consists of representatives from administration, bioethics, admissions, and pastoral care. The task force was not given a deadline to address the issues, but it already has met three times, Persaud says. Specifically, it was asked to do the following:

1. Investigate and define organizational ethics or business ethics.

2. Inventory the perceived need of issues at the Cleveland Clinic Foundation.

3. Propose structures, such as committees or task forces, to address these needs.

4. Communicate findings to the various levels of administration.

"The second item relates to the requirements set by the Joint Commission," he says. "There might be basic requirements set by the Joint Commission, but we’re trying to look at what the perception of those needs are as well." The ultimate goal for the ethics committee is to have a code of ethics from which to operate, he says. (For more advice, see story, p. 29.)

"We are defining the issues and then passing them on to the ethics committee. The committee may then decide to adapt the definitions to the various departments within the organization. We are not charged with developing an actual code of ethics but will establish the groundwork for the ethics committee to build upon," Persaud says.

At first, the group had trouble determining what to look for, he admits. "It was a slow process at first because no one on this team majored in this in college."

Persaud’s first step was to search the Internet for existing codes of ethics. "There’s a lot out there, but most, if not all, deal with other industries and professions, so we’re having to adapt what we find to the health care setting." (For help in beginning your Internet search, see box at right.)

Developing a corporate or organizational code of ethics goes beyond having a written policy, Persaud says. A framework that helps staff understand the expected ethical business conduct can eliminate barriers between staff and top management. "There must be an ethical climate within the institution. Most importantly, there can’t be any barriers or blocks between individuals and top management. That leads to the perception that top management tolerates unethical behavior," he advises.