Problems at the VA relative to ethical decision-making practices

Maintain ethics is an essential part of healthcare management. It is important to provide effective, ethical behaviour to the patient in order to avoid ethical issue regarding decision making in the health care centre. One of the necessary skills of effective leadership in the health care system is the ability to take decisions considering the ethical factors (Huber, 2017). Such guidance helps to reduce ethical issues related to the management of the health care system. The case study related to the VA health care system has led to enormous problems related to ethical decision making practice. It has been reported that the veterans at the Williams Jennings Bryan Dorn Veterans Medical Centre in Columbia were experiencing a delay in the care service provided by the healthcare organization. Even the delay became so severe so that six veterans have died during the time of waiting for care service related to the diagnostic of illness. Delay in the primary care appointment is also noted in this case. Such incidents have indicated the lack of effective leadership in the healthcare organization. In this case, one of the main problems is the inability of the leader to understand the role of individual staffs. Due to this, the leader has failed to provide adequate system process and program coordination in the healthcare organization. The leader has failed to make an ethical decision regarding the veteran affairs in the healthcare organization. It is the responsibility of the leader to provide important strategies to improve the planning process in order to achieve the goal of the organization in an effective manner (Barr & Dowding, 2015). According to the case study, the leader has introduced multiple types of scheduling practices that have failed to comply with the Veterans Health Administration policy. Such incidents have indicated that the leader has failed to take the effective ethical decision due to which the majority of the patients have suffered, even resulted in deaths. Another problem related to ethical decision making is that the secretary has resigned from his post after the investigation instead of introducing effective interventions to resolve the issue in the healthcare organization. Such unethical decision has indicated lack of effective leadership in the healthcare organization, which is a big problem for the organization and need to be mitigated with significant initiatives (Harrison & Association of University Programs in Health Administration, 2010).

According to the case study in the Phoenix VA, it was found that 1700 veterans were waiting for the primary care appointment, but they were not listed in the EWL. Due to this, the Phoenix leadership failed to recognize them, thus registered new patients in the EWL. Thus, the patients that were not listed in the EWL have faced a significant delay in the primary care, and many patients have died during this situation. The investigation has indicated that the average waiting time for primary care appointment in the health care was 115 days and 84% of the patient has waited for more than 14 days. In the organization, multiple lists of EWL has been found that is different from the official EWL, which indicates the presence of a secret wait list in the organization. Such activity is unethical and leads to the violation of the ethics in the healthcare organization. The action related to the presence of secret wait list and let the patients wait for primary care appointment without enlisted them in the official EWL could lead to the violation of the human rights of the individual patient (Kangasniemi, Pakkanen & Korhonen, 2015). The incident has raised questions regarding omitting the names of the veterans from the official EWL and deaths of the patients during the waiting period. Such a situation has led to ethical issues related to patient safety. The issues related to dignity and equal access to the service is also present in this case.

Ethical issue related to 1,700 veterans who were not listed on the EWL

It is important to introduce significant policies to ensure effective leadership considering ethical factors. The administration must propose strategies to improve the coordination in the EWL and primary care appointments in the healthcare organization (Epstein & Turner, 2015). One of such policies may include the policy related to enabling the audit controls within Veterans Health Information Systems and Technology Architecture (VistA). Such a policy would help to identify the presence of malicious manipulation of the VistA. It would help to ensure that the future oversight ability of the veterans is not neglected, thus could help to improve the primary care appointment through EWL (Fernández-Alemán et al., 2013). Another policy could be related to the open access scheduling. The process could help to reduce the wait time of the patients through enabling telephone calls consultation, message consultation and e-mail consultation (Ansell et al., 2017).

The retired Army Chief of Staff, General Eric Shinseki has been appointed as the secretary of the Veterans affair that provides healthcare and federal facilities to the veterans and the dependents of the US. During his service, it was found that the veterans of Williams Jennings Bryan Dorn Veterans Medical Centre in Columbia were facing a delay in primary care appointment. The investigation has revealed that 1400 veterans lack the primary care appointment still they were enlisted in the EWL, whereas, other 1700 veterans were waiting for primary care appointment but they were not listed in the EWL system. The incident has revealed the presence of a secret wait list in the healthcare organization. Question related to omitting the names of the veterans from the EWL has risen. It was found that many veterans have died during the waiting period without a diagnosis of the illness. Due to such scandal in the organization, it has been proved that the responsible authority has failed to fulfil the responsibilities. The lack of effective leadership and ethical decision making power has been detected in this case. Thus the secretary of Veterans affair, Eric Shinseki has resigned from his post.

The responsible authority must provide effective strategies to mitigate the ethical issues in the organization (Shanks, 2016). The activity related to the resignation of the secretary of the Veterans Affair is unethical. Instead of that, he might introduce significant steps to resolve the issue in the organization. For example, the secretary could arrange a meeting and recruit an investigational team to identify such ethical issues in the healthcare organization in order to solve them in an effective manner. The secretary could communicate with the responsible authority that is accountable for the unethical decision making in the healthcare organization and take proper legal steps against the staffs that are responsible for the scam in the organization (Langevin & Mendoza, 2013). Such effort of the secretary could help to mitigate the issue of unethical decision making practice and ensure the quality of service provided by the healthcare organization.

Alternative options to resolve the unethical decision making practice

American College of Healthcare Executives Code of Ethics and the VA Health System case study

The American College of Healthcare Executives (ACHE) provides a valid code of ethics in order to maintain ethical behaviour in the healthcare organization. According to the preamble of the ACHE code of ethics, it is the responsibilities of the healthcare executives to serve to the people with need considering the standards provided by the code of ethics. The code of ethics provides standards that help to maintain ethical behaviour in the professional relationship such as colleagues, other members of the organization and the patients. It also provides the standard for governing the behaviour of an individual in order to identify the role and responsibilities of the individual in the health care system.  It is essential for a healthcare executive to maintain such standards in order to provide service in an effective manner (ACHE Code of Ethics, 2018).

     According to the ACHE code of ethics, it is the responsibility of the professional healthcare management team to provide service with honesty, integrity, respect and faith in order to avoid ethical issues and meet the requirements of the patient. The healthcare executive in the case study has failed to maintain such standards. They have ignored the integrity and the faith to an extent. The incident mentioned in the case study such as “investigators found that 1,400 veterans did not have a primary care appointment but were listed on the EWL. It was also determined that 1,700 veterans were waiting for a primary care appointment but were not listed on the EWL” has proved that the healthcare executive in the healthcare organization has failed to comply with the code of ethics. The code of ethics also states that, it is the duty of the healthcare executive to serve to the patients efficiently to meet their requirements and do not exploit the patients for personal gain, but the executives in the case study have misused their power and create a secret wait list. Due to such situation, the veterans have faced problem related to primary care appointment; even death has occurred during the waiting period. The code of ethics provides standards to ensure patient safety. According to the code of ethics, it is important to provide equal access to the service for all, but in the case study, it has been found that the veterans lack equal access to the primary care appointment. Such an incident is an example of the violation of the code of ethics (ACHE Code of Ethics, 2018).

Reference:

ACHE Code of Ethics. (2018). Retrieved from https://www.ache.org/abt_ache/code.cfm

Ansell, D., Crispo, J. A., Simard, B., & Bjerre, L. M. (2017). Interventions to reduce wait times for primary care appointments: a systematic review. BMC health services research, 17(1), 295.

Barr, J., & Dowding, L. (2015). Leadership in health care. Sage.

Epstein, B., & Turner, M. (2015). The nursing code of ethics: Its value, its history. OJIN: The Online Journal of Issues in Nursing, 20(2).

Fernández-Alemán, J. L., Señor, I. C., Lozoya, P. Á. O., & Toval, A. (2013). Security and privacy in electronic health records: A systematic literature review. Journal of biomedical informatics, 46(3), 541-562.

Harrison, J. P., & Association of University Programs in Health Administration. (2010). Essentials of strategic planning in healthcare (Vol. 19, No. 3). Chicago, IL: Health Administration Press.

Huber, D. (2017). Leadership and Nursing Care Management-E-Book. Elsevier Health Sciences.

Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an integrative review. Journal of advanced nursing, 71(8), 1744-1757.

Langevin, P., & Mendoza, C. (2013). How can management control system fairness reduce managers’ unethical behaviours?. European Management Journal, 31(3), 209-222.

Shanks, N. H. (2016). Introduction to health care management. Jones & Bartlett Publishers.