Please read the following case: Whistle blowing in healthcare: An organizational failure in ethics and leadership by P. Rolland (2009) from the The Internet Journal of Law and Ethics: http://www.ispub.com/journal/the-internet-journal-of-law-healthcare-and-ethics/volume-6-number-1/whistle-blowing-in-healthcare-an-organizational-failure-in-ethics-and-leadership.html
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After reading the case study consider and respond to the following questions (at least a paragraph each) using terminology and concepts studied in the course:
Were Phillip’s actions and reactions appropriate or were they an attempt on his part to avoid professional practice in his field?
If Phillip reported the incidences of “alleged” improprieties and was told to move on with the plan, is he now relieved of any liability that ensues due to his actions?
Should Phillip take his concerns to a level higher than his administration (CEO) if he feels there are still violations taking place? If so, who should he go to?
Is Phillip being disloyal to his company or acting on behalf of the professional community?
What is whistle blowing and can Phillip be considered a whistle blower? Please explain.
Provide justification for each of your explanations.
Abstract
Ethical behavior, decision-making and leadership are becoming increasingly important in the healthcare environment where the traditional “service orientation” is being replaced by an almost exclusive “profit orientation.” This fixation on the profit oriented business model has ominous implications for the ethical provision of healthcare services. Healthcare organizations have been in the process of restructuring for over a decade and practitioners, patients and society are questioning unethical practices in managed care including gag rules, lack of full disclosure and compensation plans that reward withholding of healthcare services. There has been very little information published about organizational and administrative ethics in the healthcare literature.Individuals employed by healthcare organizations have a very large diversity in moral ideology reflective of society at large. Under these circumstances it is necessary for the HCO to identify basic and common core values and beliefs. It is from this perspective that we will examine an organization’s responsibility to create, define, and manage ethical behavior for the organization.Key Words: Ethics, ethical decision making, health care administration, institutional leadership, managerial ethics, organizational culture, organizational ethics, health care workers and organizational values.
Introduction
I would like to start this article by citing Ralph Nader in response to the recent deceptive and unethical accounting practices at large companies such as Enron and World Com. “What amazes me is that there were thousands of people who could have been whistle-blowers, from employees to the boards of directors to corporate insiders to the accounting firms to the lawyers working for these firms to the credit-rating agencies. All these people! Would a despotic dictatorship have been more effective in silencing them and producing the perverse incentives for them all to keep quiet? The system is so efficient that there is total silence. I mean, at least the Soviet Union had enough dissidents to fill Gulags.”1
Nader’s comparison of these organizations to a despotic dictatorial regime is quite applicable and accurate. Essentially the mentality keeping “all those people” from reporting illegal, immoral and unethical behavior is the same mentality that prevented people from speaking up as dictatorial regimes such as Nazi Germany and Soviet Russia swept across the world stage oppressing millions. “For evil to triumph it is only necessary for good men to remain silent.”2
And so, in silence, the cancer of moral depravity eats away at corporate America. Some examples from this cancer in the healthcare industry include:
The Allegheny Health, Education and Research Foundation (AHERF) declared bankruptcy and its former CEO was sentenced to prison for using restricted assets to keep the not-for-profit organization afloat.1
Columbia/HCA paid more than $840 million in criminal fines and civil penalties and damages after a whistle-blower brought allegations of unlawful billing practices to the attention of the federal government.1
HealthSouth officers have been charged with accounting fraud and conspiracy to commit wire and securities fraud. The company agreed to pay the government $7.9 million to settle allegations of Medicare fraud. The company faces shareholder lawsuits.1
These examples in healthcare can be added to those from the “business world” like Enron, WorldCom and others. What is glaringly apparent is that corporate America is suffering from a “moral meltdown”. Good men and women in these organizations are remaining silent in droves. Many employees have a misplaced loyalty to their organization. They fail to see the hidden costs of their inaction and the organizations lack of reciprocal loyalty to the employee. These organizations have created an environment of fear, intimidation, punishment and retaliation so effective that it prevents almost anyone from speaking out when illegal, immoral or unethical behavior is observed in the organization. This “culture” created and fostered by these organizations is a living testimony to the failure of these organizations to provide ethical and morally responsible leadership. These organizations have lost their way.
Ethics is defined as: “A systematic process of reflection in which issues of what one morally ought to do are analyzed, decided, and evaluated through moral reasoning that encompasses, but is not limited to, ethical principles and theories.”3 Ethical behavior, decision- making and leadership are becoming increasingly important in the healthcare environment where the traditional “service orientation” is being or has been replaced by an almost exclusive “profit orientation.” This fixation on the profit oriented business model has ominous implications for the ethical provision of healthcare services. “Ethical work environments are both multidimensional and multi-determined. There is variance in the ethical climate within organizations by position, tenure, and workgroup membership and significant differences both across and within firms.”4 “For employees to engage in ethical behavior, Brown (1990) proposed that conditions of power, trust, inclusion, role flexibility, and inquiry must be present.”5 “Workers should have the right to receive relevant information (inclusion), to be free to say what is needed to be said about an issue (power), and to be free to disagree with one another in order to increase their understanding of issues (trust).”6
Often individuals are identified as the source of ethical failure. However, one of the most important aspects of creating ethical behavior is the culture and environment of the organization in which these individuals function. “Managerial ethics assume a position of profound consequence here in the form of organizational policies and processes, culture, espoused vs. enacted values, leadership behavior, rewards and punishments, social networks, and treatment of employees.”7-15 Organizational policies and procedures dictate actions that may have ethical content.16 Organizational cultures create in employees a perception of the levels and limits of trust and integrity, two domains nearly synonymous with ethics.6,8,9,17-22
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