Management Challenges of Private Healthcare Managers in Ethical Decision Making

Management Challenges of Private Healthcare Managers in Ethical Decision Making
4.1 Introduction
Decision making is a core function of management. It is the process of evaluating alternatives to lower uncertainties about attaining the desired result with the best impact on the institution. Timelines, money-value interpretations, considerations of methodologies, social values’ explications and accountability to reason are some of the key issues that affect decision making. The review of the organizational and social elements of context is key to the optimization of the decision-making process. The thought process of the managers includes tactics, vision, due diligence, strategy, and the need to manage possible risks. The ethical dimensions of the process include respect for diverging views, trust, and integrity, the effect of policies, democracy, respect to the public sendee, and conviction to do the morally correct thing.
Healthcare managers have to go through this process almost every day. While in the act, they often face dilemmas or challenges that make it difficult for them to arrive at sound ethical decisions. Being ready for these difficulties is the reason why decision making and moral leadership are desirable traits in healthcare management, especially in the private health sector where money or profits are the primary goals of the process. Both of these skills are essential for managers in the private healthcare sector to navigate the changing health sector. The previous chapters of the study were dedicated to determining the management challenges that healthcare administrators in the private sector face and evaluating the possibility of coming up with a system of measuring the ethical leadership styles of healthcare managers in the private sector.

This section of the study will put forth the results obtained from the quantitative study and relate them to the theoretical perspectives derived from the literature reviewed in the other chapters of the research.
4.2 Descriptive Findings
Mediclinic Middle East is the one company that agreed to take part in the study. The hospital is the largest privately owned medical center in Dubai. The company is a private hospital; therefore, those working in the institution are exactly the group that the interests the research. Twelve of the managers in the organization were approached and accepted to take part in the ethical leadership style survey.
This sample had management experiences that ranged from two years to twenty years. Meaning some of the participants were just starting out in the management scene and might not have encountered most of the ethical dilemmas that the seasoned managers have seen severally during their work years. Each member of this sample had a team made up of between 0 and 85 individuals working under them. On average, these managers had received approximately 15 reports in 2016. All of these people are university graduates, and they were very precise with their responses. The research determined that indeed these people faced numerous challenges every day while making ethical decisions in their work and they had an almost similar set of ideas that run through their minds while making moral decisions about their job in the private health sector.
4.2.1 Demographic Characteristics
The questionnaires that were used to collect the information that was needed to draw the necessary research conclusions were issues to twelve managers of the Mediclinic Middle East as mentioned before. Out of these managers, two were female, and ten were male. In the overall healthcare scene, women make approximately 73 percent of managers and 18 percent of chief executive officers. However, those who accepted to take place from Mediclinic Middle East were in the proportions mentioned; 16.67 percent female managers and 83.33 percent male managers. Aside from the gender, the questionnaire also inquired about the ages of the respondents.
The ages of the participants were seen to lie between 29 years and 59 years. According to the UN, youths are persons aged between 15 and 24 years. Therefore, none of the managers at the health facility were youths. When averaged, the ages of the twelve healthcare managers at Mediclinic Middle East came to 41 years. Two of the people who participated in the survey were found to be below the age of 35. Six of the respondents, which make 50% of the sample, were found to be between the ages of 30 and 39. The ages of two respondents fell between 40 and 49, and the remaining two were aged between 50 and 55 years. These figures indicate that all of the managers at Mediclinic Middle East were middle aged people.
4.2.2 Construct A: All administrators in the private healthcare sector face ethical decision-making challenges grounded in certain moral philosophies.
There are many codes of ethics depending on the time, place, and cultural beliefs of people. “According to the American Psychological Association (APA), there are six ethical principles:” integrity, competence, scientific and professional responsibility, respect for the dignity and rights of individuals, social responsibility, and concern for the welfare of others (Arnetz 206). Many other bodies and philosophers have a different but similar set of ethical principles. The research established that managers in the private healthcare sector too, have specific moral codes which they adhere to. Nonetheless, some scholars suggest the actions of these professionals cannot be judged by their ethical codes because those are likely to favor the healthcare manager more than any other person they interact with (Arnetz 208).
In that spirit, the study was designed to allow the healthcare providers name at least five ethical challenges they face while making decisions at their places of work. The responses had different wordings, but nearly all of them talked about a similar set of problems grounded within known moral philosophies like altruism, consequentialism, and deontology etcetera. Below were some of the most commonly mentioned challenges by the sampled healthcare managers:
Balancing Ethics with Fiscal Responsibility: Managers in the private healthcare are usually tasked with the duty of making financial decisions that have the potential of influencing both the profits made by their organization and the quality of service that they provide (Arnetz 209). Balancing these equal and demanding responsibilities can be quite challenging. Juggling the responsibilities at times sets ethics, budget, and quality against each other. At times a manager has to choose between repairing broken medical equipment and hiring more practitioners to reduce the patient-practitioner ratio. This challenge borders competence regards for the welfare of the patients and the nurses, and some of the ethical principles talked about in this chapter of the study. For this challenge, 70 percent of the respondents said that they would discuss with the board to determine what issue they prefer to solve first and which one can wait. The remaining 30 percent argued that they would just use their judgment to evaluate which of the two can cause a severe strain on the operations of the hospital if not solved, then solve that first.
Ethical Mitigation of Legal Risks: Medical lawsuits and malpractice can ruin any medical practice. Health managers are at times required to work with other staff members to resolve problems that arise in practice before they become severe enough to require a courtroom solution. In such a situation, the healthcare manager has to ensure that the practitioner involved is basing his decisions more on the needs of the patient than any other factors. If the employee of the organization seems not to be doing that, then his services can be terminated, or he can be put through any other disciplinary process prescribed by the organization. However, the fear of the possible legal action that may result from medical malpractices at times forces managers to allow the practitioners under them to perform certain treatments to avoid being sued by the unsatisfied clients. For this issue, all the respondents but one said that they would try their best to solve the situation in any possible manner before it got to court.
Privacy Ethics: Safeguarding the right to autonomy and confidentiality is also a vital ethical principle. Healthcare institutions are increasingly using technology like “electronic health records” to record, store, and relay sensitive information about the health of their clients. Managers in the healthcare sector have a role to play in ensuring that these records are kept safe and that the framework of the organization adheres to the relevant regulations like the Health Insurance Portability and Accountability Act (HIPPA). However, certain situations put the healthcare professionals in the awkward position of having to break these laws of confidentiality to prevent either a patient or an outside party from being unfairly harmed. A proper understanding of the rules that govern such provisions and the ability to evaluate the applicable ethical principle is important to healthcare managers as they make such decisions. All 12 of the respondents said that when it comes to the privacy of the client, other than a court order, the consent of the patient is the only thing that should govern how their records are kept. Any other situation that calls for the disclosure of a patient’s confidential information must be brought to his attention or the attention of the court.
The Ethics of Handling Important Relationships: Healthcare managers are also tasked with the important role of monitoring the relations between the organization and its employees with stakeholders like suppliers who provide the organization with medicine, software solutions, and diagnostic tools etcetera (Arnetz 210). The managers must ensure that healthcare providers do not favor certain prescriptions because the vendor of that particular drug promises them financial benefits for every prescription of the medicine that originates from the hospital. However, there are situations where these managers have shares in some of the provider organizations. In such cases, they might be tempted to overlook this duty; they might allow the provider to promise benefits to their doctors and do nothing to stop the doctors from prescribing the drugs supplied by the vendor affiliated with them. These situations are some of the situations that test the morality of a healthcare manager in the for-profit health sector. 50% of the respondents argued that they would just allow the healthcare provider to subscribe the drug provided it cures the condition even if there are other alternatives. 40% stated that employees should not be allowed to take part in any such dealings and those found must face disciplinary measures, while the remaining 10% said that they would just not allow any supplier that they are affiliated with to supply their organization with drugs so as to avoid any conflict of interests.
4.2.3 Construct B: All healthcare managers in the private health sector have widely varying extents to which the challenges mentioned above affect their decision-making process.
Out of the mentioned challenges, the table below shows the ratings that the participants gave the four common problems that were referred to by all of them. The ratings were based on whether the manager would seriously consider the ethical issue while making important decisions in his work.
Strongly Disagree Disagree neutral Agree Strongly Agree
A 0 0 0 4 8
B 0 0 0 1 11
C 0 0 1 8 3
D 0 0 1 10 1
From the ratings, one can see that although a majority of the doctors fall in the same category when it comes to the level at which certain healthcare challenges affect their decision-making process, some still fall into different categories. Therefore, it is true, according to the research, that managers in the healthcare sector have widely varying extents to which certain ethical dilemmas affect their decision-making process.
4.3 Correlation Findings
This study was meant to determine the management challenges that managers in the private healthcare sector face while making ethical decisions. Therefore the only significant correlation that can exist following the research design is one between the business aspect of private practice and ethical decision-making. From the responses of the respondents and the design of the study, using the formula below to calculate correlation becomes challenging.
However, from the responses and the secondary research done on the matter, one can conclude that there exists a correlation between ethical decision making and the money or the profit part of private healthcare practice. Just as in the reviewed literature, the results confirm that one of the things that put the professional ethics of healthcare managers in the private sector is the business element of the practice. All of these common management challenges that the 12 managers from Mediclinic Middle East mentioned are linked to the need to save a business or ensure more financial gains for one.
4.4 Conclusion
The problems that healthcare administrators in the private health sector face are most likely similar to those that other professionals face. The most significant ethical issue that these managers face that is different from the ones that other healthcare administrators in the public sector face is the incompatibility of the business world and the world of physicians. Many people hold the belief that it is right for a businessperson to go after their self-interests while executing their role as businessmen. However, there is a stereotype that the work of healthcare providers should put the welfare of the patients above any other interests. Therefore, when healthcare providers double up as businessmen, handling the two different ethical settings becomes challenging. As a result, healthcare managers in the private sector constantly need to devise ways in which they can handle the two roles without letting any side drop. From the responses, it is evident that the profit element of private healthcare practice indeed puts some strain on healthcare managers while making ethical decisions. They have to consider the impacts that those moral decisions are going to have on the profits at times more seriously than the impacts they are going to have on stakeholders.
References
Arnetz, Bengt B. “Psychosocial challenges facing physicians of today.”Social science &
medicine 52.2 (2001): 203-213.
Bagdasarov, Zhanna, et al. “Mental models and ethical decision making: The mediating role of
sensemaking.” Journal of Business Ethics (2015): 1-12.
Creswell, J. W. (2009) Research design: Qualitative, quantitative, and mixed
methods approaches (3rd ed.). Thousand Oaks, CA: Sage.
Detert, J. R., Treviño, L. K., & Sweitzer, V. L. (2008). Moral disengagement in ethical decision
making: a study of antecedents and outcomes. Journal of Applied Psychology, 93(2), 374.
Forsyth, D. R. (2006). Conflict. In D. R. Forsyth (Ed.), Group dynamics (5th ed.)
(pp.388–389). Belmont, CA: Wadsworth, Cengage Learning.
Hinkin, T. R. (1998). A brief tutorial on the development of measures for use in
survey questionnaires. Organizational Research Methods, 1(1), 104–121.
Hursthouse, R. (2013, Fall). Virtue ethics. In E. N. Zalta (Ed.), The Stanford encyclopedia of
philosophy. Retrieved from http://plato.stanford.edu/archives/fall2013/entries/ethics-virtue.
Lehnert, Kevin, Yung-hwal Park, and Nitish Singh. “Research note and review of the empirical
ethical decision-making literature: Boundary conditions and extensions.” Journal of Business Ethics 129.1 (2015): 195-219.
Martin, Mike W. Meaningful work: Rethinking professional ethics. Oxford University Press,
2000.
Northouse, P. G. (2011–2014). Personal interviews and correspondence.
Northouse, P. G. (2012) Leadership theory and practice (6th ed.). Thousand Oaks, CA: Sage.
O’Fallon, M. J., & Butterfield, K. D. (2005). A review of the empirical ethical decision-making
Literature: 1996–2003. Journal of business ethics, 59(4), 375-413.
Pitesa, Marko, and Stefan Thau. “Compliant sinners, obstinate Saints: How power and self-focus
determine the effectiveness of social influences in ethical decision making.” Academy of Management Journal 56.3 (2013): 635-658.
Rubens, Arthur J., and Edward T. Wimberley. “Contrasting the American College of Healthcare
Executives’ code of ethics with undergraduate health administration students’ values and ethical decision choices.”Hospital Topics 82.3 (2004): 10-17.
Schrempf-Stirling, Judith, Guido Palazzo, and Robert Phillips. “Historic corporate social
responsibility.” Academy of Management Review (2015): amr-2014.
Shaw, W. H. & Barry, V. (2010). Moral issues in business. Belmont, CA: Wadsworth
Cengage.
Tronto, J. (2005). An ethic of care. In A. Cudd & R. Andreasen (Eds.),
Feminist theory: A philosophical anthology (pp. 251–63). Malden, MA: Blackwell Publishing.
Valentine, Sean, et al. “Ethical context and ethical decision making: Examination of an
alternative statistical approach for identifying variable relationships.” Journal of Business Ethics 124.3 (2014): 509-526.
Yu, Yi-Ming. “Comparative analysis of Jones’ and Kelley’s ethical decision-making
models.” Journal of Business Ethics 130.3 (2015): 573-583.
Tronto, J. (2005). An ethic of care. In A. Cudd & R. Andreasen (Eds.),
Feminist theory: A philosophical anthology (pp. 251–63). Malden, MA: Blackwell Publishing.