Emerging Ethical Issues In A Changing Health & Human Service Landscape: A Group Discussion Session

Transcription

1 Emerging Ethical Issues In A Changing Health & Human Service Landscape: A Group Discussion Session The 2016 OPEN MINDS Executive Leadership Retreat September 22, :15am 12:45pm Kenneth Carr, Senior Associate, OPEN MINDS York Street, Gettysburg, Pennsylvania Phone: info@openminds.com 1

2 Agenda I. Overview Of Ethical Decision-Making Framework II. III. Case Studies Questions & Discussion 2

3 Overview Of Ethical Decision-Making Framework

4 Why A Discussion On Ethics? Behavioral health is in a time of turbulent change Expansion of managed care models Focus on reduction of health care costs and integrated care models Transition from volume to value payments for provider organizations Blurring of the role of payer and provider Increased competition and consolidation of provider organizations Technology changing the nature of service and competition 4

5 Turbulent Changes Require Decisions That Are Strategic & Ethical How we respond to the impacts of service delivery changes: Consumers Old services phased out New services begun New ways of delivering ongoing services Staff New leadership skill sets for a new behavioral health business paradigm Some positions no longer needed as the menu of services changes New skills sets needed by current staff Maintaining competitive wages in a time of changing reimbursement models Community Serving the public good and maintaining tax exempt status Working collaboratively with other providers 5

6 Fundamental Questions To Address When Facing An Ethical Decision On what do we base our ethical standards? What framework do we use and in what situations? How does that framework line up with the frameworks of others? How do our ethical standards get applied to specific situations we face? What process do we use to make decisions that are in line with our ethics? A Framework for Ethical Decision Making, Santa Clara University, Markkula Center for Applied Ethics, 6

7 On What Do We Base Our Ethical Standards? Five approaches to identifying our ethical standards: 1. Utilitarian Approach 2. Rights Approach 3. Fairness Approach 4. Common Good Approach 5. Virtue Approach A Framework for Ethical Decision Making, Santa Clara University, Markkula Center for Applied Ethics, 7

8 1. Utilitarian Approach Focuses on actions that do the most good (or the least harm) Considers impact on various stakeholders Identifies consequences of actions Strives to create balance between all stakeholders and consequences Example: The Just War Theory Last Resort Legitimate Authority Just Cause Probability of Success Right Intention Proportionality Civilian Casualties A Framework for Ethical Decision Making, Santa Clara University, Markkula Center for Applied Ethics, 8

9 2. Rights Approach Focuses on actions that protect and respect the rights of others Freedom of choice Self-determination Having rights implies respecting the rights of others Example: Declaration of Independence... unalienable rights, that among these are Life, Liberty, and the pursuit of Happiness. A Framework for Ethical Decision Making, Santa Clara University, Markkula Center for Applied Ethics, 9

10 3. Fairness Or Justice Approach Focuses on actions that treat all equally (or if unequally, by a defensible standard) Equal rights Cultural perspectives Unequal pay based on defensible standard that those who work harder should earn more Example: Gettysburg Address... dedicated to the proposition that all men are created equal. A Framework for Ethical Decision Making, Santa Clara University, Markkula Center for Applied Ethics,

11 4. Common Good Approach Focuses on actions that strengthen relationships and community Respect and compassion Care for the vulnerable Yielding independence for the welfare of others Example: Public Health & Safety A Framework for Ethical Decision Making, Santa Clara University, Markkula Center for Applied Ethics, 11

12 5. Virtue Approach Focuses on actions that lead to the full development of humanity Live up to our highest potential Good moral character Virtues: honesty, compassion, integrity, tolerance, etc. Example: Benjamin Franklin and Thirteen Virtues A Framework for Ethical Decision Making, Santa Clara University, Markkula Center for Applied Ethics,

13 How Do Our Ethical Standards Get Applied To Specific Situations We Face? Ethical decision-making requires a synthesis of framework Situation Impact on others Our role Sound ethical decisions require Understanding the cause and implications of the decision Understanding the framework for making the decision Dialogue A Framework for Ethical Decision Making, Santa Clara University, Markkula Center for Applied Ethics, 13

14 Steps For Ethical Decisionmaking Gather the facts Define the ethical issues Identify the options, and consequences of those options Weigh the options based on the impact on stakeholders, organizational obligations, and your ethical framework Dialogue with others (don t operate in a vacuum) Decide on an action make sure that it is defensible to others Steps Of The Ethical Decision-Making Process, International Center for Ethics in Business, Douglas May, 14

15 Case Studies

16 Case Study #1 Your organization faces the loss of a major service line. The state MCOs have decided to limit access to this service line, and incentive providers to participate in more cost effective services as a replacement. The change will have significant impact on organizational resources and may result in a reduction of staff. Assign roles in your group CEO, CFO, COO, CHRO, CMO What are potential options? Define the ethical issues. Identify points of opposing perspective on the team. How do you determine the right strategy based on consideration of the ethical issues? 16

17 Case Study #2 Your organization has been experiencing rate freezes and reductions over the last five years. Staff have not had a raise during that time. Your payers don t appear sympathetic to the needs of your organization. Turnover is increasing as staff go elsewhere, and service quality is beginning to be impacted. Assign roles in your group CEO, CFO, COO, CHRO, CMO What are potential options? Define the ethical issues. Identify points of opposing perspective on the team. How do you determine the right strategy based on consideration of the ethical issues? 17

18 Questions & Discussion

19 Chronic Care Management Disability Supports & Long-Term Care Mental Health Services Addiction Treatment Social Services Intellectual & Developmental Disability Supports Child & Family Services Juvenile Justice Corrections Health Care York Street, Gettysburg, Pennsylvania Phone: info@openminds.com