Organization ethics or compliance: which will articulate values for the United States' healthcare system?
There have been two major stimuli leading to the institution of compliance/ethics programs. One has been Justice Department attention and the need for a government approved compliance program. The other has been the JCAHO's promulgation of standards addressing organization ethics issues. Many healthcare organizations have seen the requirements imposed on them by JCAHO (and the necessity to have a mechanism to address federal compliance as separate issues) and have developed two compartmentalized programs. But the intensity with which the government has pursued and will continue to pursue its "fraud and abuse" program means that most healthcare organizations now support and encourage the institution of compliance programs, while allowing organization ethics initiatives to become marginalized within the organization. This approach may ignore consideration of the larger issue of what each of these activities means for a healthcare organization that is attempting to define itself based on its stated values. Although using two separate groups to focus on these particular issues may fulfill the letter of the law for both the Federal Government and the JCAHO, we believe attention to these issues is better accomplished under the umbrella of a single committee. This pathway for attention to accreditation and compliance issues within an HCO is one that may serve the HCO better than two committees working on similar issues but with separate agendas. Nothing here should be construed as a suggestion that the goal of developing a comprehensive values-oriented organization ethics program should be abandoned. Instead, we have offered an assessment of the current environment and current direction of the healthcare organization--an assessment that leads us to the conclusion that instituting organization ethics programs that are not linked to or incorporated somehow within compliance programs will probably fail. This is a frustrating position for those who believe that compliance programs may ultimately undermine the goals of an organization ethics program. Nevertheless, it is important to realize that the legal compliance of an HCO, like its compliance to high standards of ethics, are considerations that determine the ethical climate of an organization. In the absence of a consensus concerning the values that should inform the larger healthcare system, it may be the only consideration that all healthcare organization stakeholders can agree upon, and so may represent the only stable and consistent platform ethically to evaluate the activities of the healthcare organization at the present time. This can be the basis for each HCO to develop its values-oriented ethical program which will define and support the organization's ethical climate for the organization, its staff, its patients, and its community.
Mills
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Center for Biomedical Ethics, University of Virginia, Box 800758, Charlottesville, VA 22091, USA.
Spencer
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D000068:Accreditation; D003695:Delivery of Health Care / Q000592:standards*; D004991:Ethics, Institutional; D005607:Fraud / Q000517:prevention & control; D019983:Guideline Adherence; D006268:Health Facilities / Q000592:standards*; D007591:Joint Commission on Accreditation of Healthcare Organizations; D012945:Social Values; D014481:United States; D014483:United States Dept. of Health and Human Services