NHS-FXP4000 | Applying Ethical Principals
School: Capella University
Topic:Case Analysis: Emergency Department Repeat Admissions
Summary of the Case Facts
Matt Losinski is the Chief Executive Officer of the County General Hospital. He is worried that the facility might be wasting its financial resources due to the overuse of the emergency department(ED) for minor, nonspecific medical issues. He decides to discuss the issue with Mary Scott, his Chief Financial Officer. However, Scott does not consider ED repeat admissions a matter of urgency because Medicaid pays for 75% of the expenses, and the remaining 25% are cross-subsidized from self-pay emergency admissions and privately insured individuals. Losinski gets bothered by the indifference reaction he receives from Scott. For this reason, he asks Aniysha Patel, the administrative resident, to furnish him with data regarding the use rates of individuals who were repeatedly admitted to the emergency department. The findings suggest that the issue is not as extreme as those from Central Texas hospital.
However, the results indicate that a few patients made hundreds of visits to the ED despite having minor, nonspecific medical problems. Losinski also found out that more than $200,000ED costs were not reimbursed to the facility annually. He felt that this money could be channeled towards promoting health initiatives for the community. Losinski also noted that repeated admissions to ED resulted in patients’ dissatisfaction, treatment delays, and crowding. He presented the findings to the executive committee, who were not interested in addressing the issue. Instead, they agreed that all patients meeting the active labor Act (EMTALA) and the federal emergency medical treatment requirements must be treated and stabilized. Losinski took upon himself to address ED overuse upon asking permission from the senior management.
The Ethical Dilemma in the Case Study
The overuse of the emergency department for minor issues is a significant problem at the County General Hospital. However, the primary stakeholders are not concerned because the emergency services are catered for by Medicaid, self-pay emergency admissions, and privately insured individuals. The facility incurs $ 200,000emergency department costs that are not reimbursed to the facility every year. The Chief Executive Officer feels that this money could be channeled to promoting the health and well-being of the patients and the community by addressing the overuse of the emergency department services. However, the Executive committee feels that the issue is not that important. Instead, they should continue providing emergency services for patients who meet the active labor Act (EMTALA) and the federal emergency medical treatment requirements.
Individuals Involved in the Ethical Dilemma
The primary stakeholders in the ethical dilemma include the Chief Executive Officer, The Chief Financial Officer, the Executive Committee comprising of the vice presidents, the director of development, and the elected president of the medical staff, and the senior management team. It is the role of these individuals to provide viable solutions to reducing the overuse of emergency departments for minor issues.
Analyzing the Case Using the Ethical Decision-Making Model
The ethical decision-making model is defined by three components, such as ethical behavior, moral judgment, and moral awareness. Moral awareness requires a person to note an ethical issue in a situation (Lincoln & Holmes, 2011). For instance, individuals must know when their actions or responses cause harm or are beneficial to the target audience. In the case study, it is evident that management failed to address the overuse of emergency department for minor issues, thus undermining patients satisfaction with the quality of services caused by overcrowding and treatment delays. Nonetheless, they are reluctant to address the issue, forcing the CEO to shoulder the burden of finding a viable solution.
Moral Judgment entails the identification of possible solutions to the issues affecting patient satisfaction and misuse of resources. A sound decision should be made after analyzing the repercussions of every alternative solution provided (Lincoln & Holmes, 2011). In the case study, the Executive Committee should identify possible solutions to reducing the overuse of emergency department services for non-emergent challenges. The answers might range from offering units for non-urgent primary care, redesigning primary care to enhance scheduling and access, and the use of financial disincentives and incentives for emergency department visits. Lastly, ethical behavior encompasses an individual course of action given the issue being faced. For instance, it was unethical for the Executive Committee to ignore the issue table before them because the costs were incurred by the Medicaid program, private insurance, and self-pay emergency admissions.
Effectiveness of the Communication Approaches in the Case Study
. In the case study, face-to-face communication was utilized among critical stakeholders. Face-to-face communication enables individuals to read facial expressions and body language to elicit meaning (Vermeir et al., 2015). From the case study, it is apparent that the facility exhibits a sound communication process. The chief executive officers communicated with the Chief Financial Officer before discussing the issue with the Executive Committee. The Chief Executive Officer asks permission from the senior management to address the case and provide appropriate recommendations because of the unwillingness of the committee to identify a course of action to mitigate the challenge. Also, the facility does not have ridged hierarchies that forbid frontline staff members from discussing health concerns with the top management.
Ineffective communication was evident among the executive committee members because they used “so what” to “wow” to address the ethical dilemma. They never resolved the issue instead suggested that patients should continue using ED services for non-emergent concerns. Additionally, the Chief Executive Officer did not gather information to find the seriousness of the issue before approaching the Chief Financial Officer. With facts, Mr. Scott might have reacted differently to Losinski claims. Losinski adhered to an informative rather than persuasive approach to communication. The persuasive technique would have changed the mind of the committee, who insisted that the facility should continue providing emergency department services to eligible candidates despite being costly to the facility.
The Effectiveness of the Approach by Professionals to Solve the Ethical Issue
According to the case study, minimal efforts were directed towards addressing the overuse of emergency services by patients. Since the services were catered for by Medicaid, insurers, and patients themselves, the concerned stakeholders were less interested in the issue. Instead, they agreed that eligible patients should continue to use the emergency department services despite their minor conditions. Therefore, the Chief executive officer considered it his duty to enhance patients’ satisfaction by identifying effective strategies to resolve the issue. The case study exhibits significant implications for healthcare providers. It highlights the importance of professional collaboration in solving healthcare issues. The reaction of various health professions suggested a lack of corporation, understanding, and negotiation (Morley& Cashel, 2017). In the future, the facility must take collective action to solve the problem rather than having a single person find solutions to issues affecting healthcare delivery.
The ethical principle of accountability requires health professionals to take responsibility for their actions. Nurses and allied health professionals must accept both personal and professional repercussions that emerge as a consequence of their actions (Registered Nursing.org, n.d). As per the case, medics’ failure to address the overuse of emergency services is causing patient dissatisfaction, overcrowding, and treatment delays. The best solution for the facility is to open urgent care clinics so that clients who had initially utilized the emergency department can use them for non-urgent issues. The use of these care clinics facilitates professional collaboration because of the partnership between the emergency department and these clinics. For instance, the ED will direct all patients with non-emergent issues to urgent care clinics.
- Lincoln, S.H., and Holmes, E.K. (2011). Ethical decision making: A process influenced by moral intensity. Journal of Healthcare, Science and the Humanities, 1(1), 55-61.
- Morley, L., and Cashel, A.(2017). Collaboration in health care. Journal of Medical Imaging and Radiation Sciences, 48, 207-216.
- Registered Nursing.org.(n.d). Ethical practice: NCLEX –RN. https://www.registerednursing.org/nclex/ethical-practice/
- Vermeir, P., Vandijck, D., Peleman,R., Verhaeghe, R., Mortier, E., Hallaert, G., Daele, S.V., Buylaert, W., and Vogelaers, D.(2015). Communication in healthcare: A narrative review of the literature and practical recommendations. International Journal of Clinical Practice, 69(11), 1257-1267. https:/doi.org/ 10.1111/ijcp.12686