Professional Ethics Making Value-Based Decisions in the Conflicted World of Medical Services Professionals

1
Professional Ethics Making Value-Based
Decisions in the Conflicted World of Medical
Services Professionals
2
Historical Basis

• Thou shalt not steal.
• It is hardly too strong to say that the
  (American) Constitution was made to guard the
  people against the dangers of good
  intentions. Daniel Webster

3
Doctrine

• Preserving the Core Principles
• Educating the People
• Guarding Virtue Freedom

4
Rotten to the Core

• Expansion of professional ethics in the workplace
  over the past forty years.
• Enron, Ponzi, Politics
• When an organization grows beyond its ability to
  fill its key seats with the right people, it has
  set itself up for a fall. Jim Collins

5
Solid to the Core

• Vision, Mission, Core Values
• Morals, Ethics, Professionalism
• Integrity, Honesty, Respect, Beliefs
• Authenticity, Accountability
• Transparency, Trust

6
A Code of Ethics

• Unethical, unprofessional and/or illegal ???
• A Code has to be understandable
• it cant be written in code.

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Human Factors

• Geography
• Religion
• Life Experiences
• Age/Generation

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Organizational Values

• Do no harm
• American Marketers Association

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Organizational Values

• Offer unparalleled strategic leadership,
• expertise and advocacy to promote the
• success of our members
• we are proactive, respect each other,
• and encourage creativity.
• International Dairy Foods Association

10
Personal Values

• 100 attributes that, when asked,
• people will use to describe themselves,
• usually with a great deal of pride in their
  voice.
• Do you really know yourself?
• Do these values play out
• in your actions every day?
•  .

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Are you conflicted?

• Twenty-two attributes that, when asked, CEOs will
  use to describe their organizations, usually with
  a great deal of pride in their voices.
• Are you working for an organization
• that supports your values?
• Or, do their business values
• conflict with your personal values?
• Can you see any of these values
• being played out each day in your organization?

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Mis-aligned Incentives

• Confidentiality v. regulatory disclosure rules
• Big admitter v. splitter
• Medical Staff President v. CMO
• Budget v. employee satisfaction
• Budget v. good work product

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What would you do?

• Examples of everyday life situations for the MSP.
• What would you do?
• Why would you do that?

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• You are a leader in your state association and
  are manning the registration table for your
  Spring conference. Breakfast is over and the
  speaker has begun her presentation. At the
  mid-morning break, you notice that Debbie has
  arrived and is looking for her name badge, so you
  go over to welcome her. Debbie then asks you if
  she can get the NAMSS CE credit certificate now
  because she will have to leave early today due to
  family event. She goes on to state that she
  really needs all the hours from today to get
  re-certified. What would you do? You would say
• Sure, let me just get that for you.
• Oh, Im sorry I dont know where those are, you
  will have to talk to the President.
• Sure, here it is, but oh, I see that the
  certificate already has the hours printed on it,
  lets figure out together how much you have
  already missed and how long you will be able to
  stay for.

15

• You are a newly-hired Credentials Coordinator who
  is excited about your new job. About four months
  into the position, your Director says to you,
  now dont tell anyone, but our Credentials
  Committee has been working really hard, so I used
  some money from their Dues account and got them
  these 15 gift cards. If some of the Committee
  members dont make the meeting then you and I can
  split the leftover cards! You remember from
  your organizations orientation program and the
  corporate integrity statement which you signed,
  that all gifts to physicians must be registered
  due to limits provided for under Starke laws and
  gifts to employees must be logged in HR for tax
  purposes. What do you do?
• a. Ask if the Medical Staff President knows
  about the gifts.
• Say nothing to her about reporting the gifts, but
  tell her you dont drink coffee so she can keep
  all the extra cards.
• Respectfully ask your Director how you should go
  about logging these gifts for reporting purposes,
  as you remembered from orientation that there is
  already a system place.

16

• You have just completed a two-year term with one
  of your favorite Medical Staff Presidents ever!
  Together, you two accomplished great improvements
  and closely dodged a fair hearing. Mutual
  respect is high and you now consider him a good
  friend. He arrives in your office one day,
  closes the door and presents you with a gifta
  new IPad, as well as movie tickets for your
  staff. What would you do?
• Explain to him that the hospital has a strict
  policy limiting the value of gifts to 50, so you
  wont be able to accept his generosity.
• Take the IPad, but report the gift to your CMO in
  hopes he will not make you give it back and hurt
  the Presidents feelings.
• Take the IPad and say nothing except thank you!

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• You are the peer of a newly-hired Medical Staff
  Coordinator. While completing your own
  re-certification application, the new MSC
  confides in you that he failed to complete his
  own re-certification last year. Yet, you notice
  that he included those credentials on his new ID
  badge and his business cards. What could you do?
• Express your concern to the peer and insist that
  he notify your mutual supervisor before you have
  to do so yourself.
• Say nothing to the peer, but later you report the
  information to your supervisor because you know
  that they considered the new employees
  certification as a key qualification for the
  position.
• Make an anonymous call to your organizations
  corporate integrity hotline.

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• You are the treasurer of your state association.
  At the registration table for your Fall
  conference, Mary writes a check for the
  registration fee and complains that her employer
  wont support her educational efforts but she
  really needs these CE credits this year. A few
  days later, the Associations bank notifies you
  that Marys account had insufficient funds. You
  have tried numerous ways for several weeks to
  contact Mary. What would you do?
• File away the notice and not mention the issue to
  anyone, as Mary is a ten-year member of the
  Association.
• Present the information to the Association Board
  and recommend banning her from future educational
  session until this cost is paid.
• Notify the NAMSS Certification Commission of this
  issue and, if in fact she used the CE for her
  recertification, file an ethics complaint with
  the CCN.

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• Your Medical Executive Committee took significant
  adverse action against a new member of your
  Medical Staff at their meeting the night before.
  Coming into work the next day, you overhear your
  Chief Medical Officer/supervisor telling the new
  members partner all the details regarding the
  MECs discussions. What do you do?
• Stop in your tracks and insert yourself into the
  conversation in order to re-direct the topic, but
  never raise the again with your CMO.
• Ask your CMO if you may speak to him immediately
  down the hall, then inquire about his purpose for
  sharing the confidential information.
• Keep walking but report the situation to your
  Medical Staff President.

20

• Your Medical Staff President comes by your office
  late one day and asks you to do her a favor. You
  say sure! Then, she asks you to misplace a
  referral of a case into your peer review process.
  You are surprised and ask why. She responds
  that the referral is just a petty complaint
  against one of her partners by a competing
  physician. What would you do?
• You carefully express that while you understand
  her concern, you can not misplace the referral
  and she should trust the system.
• You respond that you will meet her request, but
  the next day you meet with her again and state
  that her request is inappropriate and will not be
  fulfilled.
• You tell the President that you will misplace the
  referral, but then immediately notify your CMO.

21

• Your CEO sends you an email asking you to send an
  Obstetrician the form to request case-specific
  temporary privileges. He goes on in the email to
  state that his niece is having her second child
  delivered by this Obstetrician, but he wants her
  to have this baby at his hospital. What do you
  do?
• You respond to the CEO by stating that you arent
  sure if he is aware, but that the MEC has made it
  quite clear to you that temporary privileges are
  not for patient or physician convenience. So,
  you are concerned that this request will not be
  approved, or if it is, the story will tarnish his
  relationship with the MEC.
• You send the form, and when it is returned you
  fully explain the request as told to you by your
  CEO to your Department Chairman.
• You send the form to the physician and hope the
  Department Chairman doesnt ask any questions.

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NAMSS Ethics Policy

• Preserving the Principles
• Creation of a more comprehensive Code of
  Professional Conduct
• Educating the People
• Providing Education and Consultation
• Guarding Virtue Freedom
• Formation of an NAMSS Ethics Committee

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Role of Ethics Committee

•  Education
•  
• Consultation
•  
• Evaluation of Professional Conduct

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Purpose of Code

•  The NAMSS Code of Professional Conduct shall
  apply to all persons holding membership in NAMSS,
  including the leadership/officers. The Code sets
  forth principles that connect the values and
  ideals of the profession to the work performed by
  Medical Services Professionals.
• The Code of Professional Conduct shall serve as
  the standard by which the NAMSS Ethics Committee
  will evaluate professional conduct and shall
  serve as the standards of minimally acceptable
  professional conduct for all members of NAMSS.

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Violations

• Plagiarism
• Failure to protect confidential data
• Failure to share credit on a report
• Fabrication or holding back of data
• Criticize the integrity of colleague for personal
  gain
• Misuse of influence, manipulation of information
• Deliberately not reporting an incident

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• Are you better equipped to
• make value-based decisions
• in the conflicted world of
• Medical Services Professionals?
• Self-assessment

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Road to Self-Discovery

• Acknowledge areas of strength Core Values
• Identify areas of less commitment
• and determine the cause

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Professional Ethics Self-Assessment

• Leadership
• Relationships - Colleagues and Staff
• Relationships - Clinicians
• Relationships - External Business Partners
• NAMSS Code of Conduct

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Thank you!

• On behalf of the NAMSS Ethics Committee,
• we thank you for your participation and interest
  in professional ethics.
• Diane Meldi, CPCS, CPMSM, Chair
• Bonnie Conley, CPCS Kathy James, CPCS, CPMSM
• Samuel Evans, MD Valeigh Osborne, CPCS
• Bonnie Gutierrez, CPCS, CPMSM Brenda Schwab,
  CPCS, CPMSM