Jump out of the box

Steps to success for your committee

Public perception about managed care plans is changing, and ethics committees can either sit on the sidelines and wait to see what develops or play an expanded role in helping shape the future of health care delivery.

That’s how Steve O’Dell views the public’s criticism of managed care organizations (MCOs) and the role hospital ethics committees can play in the changing field of health care. O’Dell is vice president of Long Beach, CA-based First Consulting Group’s Denver office and serves as chairman of the board of Denver’s Rocky Moun tain Center for Healthcare Ethics.

He suggests ethics committees follow these steps to expand their roles with managed care organizations:

1. Review the organization’s code of ethics.

O’Dell recommends that hospital committees obtain a copy of the Rocky Mountain Center’s Colorado Code of Ethics for Healthcare and conduct a comprehensive discussion. (For information on the ethics code and how to order a copy, see Medical Ethics Advisor, October 1998, p. 112.) "The committee needs to look at the document’s seven principles and ask, Are we going to take this on?’ A fruitful discussion should occur, even if the committee decides not to do anything."

2. Determine if charter should be revised.

The ethics committee then should deter mine whether its charter should be expanded to accommodate a wider role in the health care delivery system, he suggests. "That needs to be put on the table as the central question. The committee then needs to determine if it does expand the charter, what should it include, or why it shouldn’t expand the charter," O’Dell advises.

The committee should not be limited by risk management and compliance issues, either, he warns. "The hospital’s attorney will say that changing the charter opens the hospital up to more liability, but that’s the mentality that’s kept health care locked in for the last 25 years," he explains.

"We’re attempting to change health care delivery in Colorado and make it a consumer process. Part of that is bringing the issue of ethics out of the darkened back room and having open discussions with all concerned parties. It’s ironic that health care is driven by other professionals, such as attorneys, and not consumers," O’Dell says.

3. Redefine what ethics is.

The issue of ethics is not easy to talk about within an organization, and that’s especially true in the field of health care, O’Dell says. "Once you start talking about what you consider unethical and ethical, the leadership or administration starts to worry that they may be held to those standards, and that’s not always a comfortable feeling," he adds.

The old definition of ethics relating to just one patient and one physician no longer works, he says.

"Maybe we haven’t quite reached what the new definition is yet, but getting the discussion started is the first step," O’Dell explains. "The demands from consumers and managed care require that resources be allocated and delivered to groups rather than individuals."