Ethics
An Article for ACHE Members, Both Actual and Potential
The ACHE (American College of Healthcare Executives) Code of Ethics is utilized in precisely the same manner as the code of ethics of any other professional body in that it is designed to lay down a series of rules and regulations by which the reputation, professionalism, and good name of the organization as a whole can be better protected, served, and enhanced as the case may be. The code of ethics helps guide the ultimate decisions of the healthcare executives, providing them with a focal point of reference to which they can rely upon in all times of doubt, difficulty, and moral ambiguity. A healthcare executive will have to make tough, emotionally draining decisions and there will be times when such choices may run counter to the personal feelings or politics of the healthcare executive in question.
The ACHE Code of Ethics is broken down into a number of different niches and subcategories, all of which seek to address specific issues that may arise during the commission and performance of the health care executive’s duties and functions. The Code imposes obligations upon the healthcare executive to be responsible for their own actions and decisions as the following excerpt shows:
“Disclose to the appropriate authority any direct or indirect financial or personal interests that pose potential or actual conflicts of interest.”
The Code also imposes a further duty upon the executive and that is to ensure that they supervise the actions and conduct of their subordinates in order to promote accountability and personal responsibility for their decisions:
“A member of the College who has reasonable grounds to believe that another member has violated this Code has a duty to communicate such facts to the Ethics Committee.”
The code is intended to be more than just a checklist for proper procedure, but also to promote the fundamental rights of the patients under their care:
“Work to ensure that all people have reasonable access to healthcare services.”
http://ethics.iit.edu/indexOfCodes-2.php?key=13_375_1321
Hospital of the Future: Achievement of Patient-Centered Care
There are many critical issues facing hospitals today. Among these are an increased demand for emergency care, an increased elderly population, more people suffering from chronic conditions, increased costs, and an increased need for access to care. In 2006, a roundtable of healthcare experts joined together to discuss these issues, make recommendations on these findings and trends, and to describe the hospital of the future.
The roundtable’s goal was to examine current healthcare issues such as socioeconomic trends, the physical care environment, technology, patient-centered care values, staffing challenges, and how those issues impact the hospital of the future. Following is a summary of the discussion and conclusion on the topic of achieving of patient-centered care:
It’s About the Patient
As a result of patient safety revelations, there is a a current emphasis and acceptance that the patient is the center of care. Since the patient has the greatest stake in the outcome of treatment and care, that patient should be respected as an equal partner. Family members are also influential in making healthcare decisions, thus becoming the third partner.
These partnerships have significant implications for the safety and quality of patient care. One large study showed that adult patients with chronic or serious conditions who were engaged in a collaborative care model had better control of their blood glucose levels, blood pressure, and serum cholesterol than patients who felt less confident of their doctors or in their own ability to care for themselves.
To further demonstrate the value of patient-centered care, in 2003, the MCG Health System in Augusta, Georgia redesigned its neuroscience intensive care unit to allow patients’ families to stay with them at all times. As a result of the increased insights and observations offered by family members and improved communication, medication errors decreased by 62%, the length of stay was reduced by 50%, and the staff vacancy rate fell from 7.5% to zero.
The Joint Commission’s National Patient Safety Goal 13 has a specific requirement for healthcare providers to encourage patients’ active involvement as a patient-safety strategy. It also requires healthcare staff to identify ways that a patient or family can report safety concerns and encourage them to do so. The foundation for the goal is the idea that when a patient knows what to expect, there is a greater awareness of possible errors and choices. When all aspects of care, treatment, and services are communicated, the patient can be an important source of information about adverse events and hazardous conditions to further engender a culture of safety.
Patients and families are driving momentum for the notion of “nothing about me, without me” with patient advocacy organizations such as Partnership for Patient Safety and PULSE. It is also likely to increase as a result of consumer-directed health plans and health savings accounts that increase consumer responsibility for value-based health care purchasing decisions.
The technology of personal health records (PHRs) that offers patients access to their own health records and increases communication with their healthcare providers will further drive momentum to patient-centered care. A higher level of home care increases the role of “partner” to a 24/7 responsibility.
Barriers to Patient-Centered Care
One of the barriers to patient-centered care is the need for increased patient education even when healthcare providers apparently have less time to spend with them, as in the 10-minute office visit. Health literacy is also an issue, with an estimate that almost half of the U.S. population lacks the skills required to make appropriate health decisions.
Hospital risk managers can be uneasy with the focus on transparency. However, several studies have shown that a collaborative relationship with open disclosure nurtures, rather than harms, the patient/caregiver relationship.
Half of all hospitalized patients today suffer from one or more chronic conditions and the prevalence of chronic conditions is expected to rise. More than 75% of adults over age 65 have at least one chronic condition such as diabetes, heart disease, or asthma, and many have multiple conditions. Those with multiple conditions often receive care from multiple providers and take numerous medications. Care is often fragmented, ineffective, and costly due to duplicative services and testing, avoidable hospitalization, and adverse drug events.
Patient-Centered Transformation
The hospital of the future will better meet the needs of all patients–including the underserved, the chronically ill, and the aged who will be filling its beds in greater numbers–with patient-centered care. Process improvement tools such as Six Sigma and Lean can be utilized by hospitals to increase the reliability of delivering patient-centered care.
An example of this transformation can be seen the ThedaCare hospitals of southern Wisconsin. The application of the patient-centered care methods to general medical units has resulted in a reduction of medication errors, a reduced average amount of time patients are hospitalized, and a reduction in fees for certain procedures. Other hospitals such as Virginia Mason Medical Center in Seattle and New York Presbyterian Hospital have used these tools to similar benefit.