Question
Review the following 3 scenarios and answer each one in at least 150 words.
Scenario 1: Medical coding in a physician practice. Imagine you work in a high-pressure cardiology physician office and you are one of two medical coders. Your supervisor is very focused on the greatest reimbursement to satisfy revenue projections for the physician practice. As a result, you are asked to “up-code” billing. How can the pressure of acquiring the maximum repayment for services lead to manipulating or falsifying documentation?
Scenario 2: Administration of patient medications in the hospital setting. Imagine you are a new graduate nurse working nights on a busy medical unit. You just received a new patient who needs to be admitted to your unit, and you just finished medicating a patient with a narcotic injection with a dose greater than ordered. Clearly understanding medication errors may lead to patient injury and even death, explain why a clinician may choose to NOT report the incident.
Scenario 3: Not hiring a qualified individual because of discrimination. Imagine you are a new human resources director in a nonprofit organization and pressured to not hire Middle Eastern candidates by the organization’s CEO. In the United States, discrimination against people based on their ethnicity, race, or cultural orientation is strictly forbidden under federal and state laws. Ethical discrimination may result in the breeding of ill feelings at work, as well as reduced productivity. To eliminate these ramifications, organizations need to put forth increased effort in curbing ethical discrimination in the employment sector. What are some interventions organizations can put in place to prevent discrimination?
Answer
Ethics Scenarios
Scenario 1: Medical coding in a physician practice
The pressure for acquiring maximum repayment for services in healthcare settings can lead to fraudulent acts such as “up-code” billing. In order to gain maximum benefits, healthcare practitioners may fall in the trap of using fraudulent acts to inflate bills. The management may set unrealistic financial goals and put pressure on workers to attain the goals. This may lead to an increase in malpractices involving medical bills as the workers may see this as the easy way to achieve the unrealistic targets. The pressure for acquiring maximum repayments can also force health workers to disregard the ethical code of conduct. The pressure may be so great that health workers opt to do anything even if ethically wrong just to fulfill the supervisor’s expectations. Continued “up-code” billing may lead to “normalization” of the practice. This normalization process involves an unacceptable practice that slowly transcends to being an acceptable practice with time. Health workers may no longer feel uneasy while “up-code” billing after some time.
Scenario 2: Administration of patient medications in the hospital setting
Even with the apparent health risks associated administration of wrong dose to patients, some nurses may decide not to report such incidents. There are a number of reasons why clinicians may fail to report the incident. The major reason is fear of the hospital management’s reaction towards the reported error. Clinicians fear that once the error is reported, tough action will be taken against them such as discrediting their qualifications. The other reason why the incident may not be reported relates to the bureaucracy of error reporting procedures in most hospitals (Hughes & Blegen, 2008). In most cases, it may take long for a clinician to fully document the error. This discourages reporting of the incidences. The third reason is that the hospital’s organizational structure may not have developed appropriate error reporting mechanisms at the hospital. For instance, there may be lack of a clear definition of what a medical administration error constitutes and the necessary steps that a clinician can take to document the error. Fourth, there could be a culture of ignoring the hospital’s ethical code of conduct. If there exists such a culture, the employee may not feel obliged to report such incidences.
Related: Veterans Administration Medical Center Ethical Analysis
Scenario 3: Not hiring a qualified individual because of discrimination.
Organizations can put in place a number of interventions that can help curb incidences of discrimination. The first intervention is to develop an antidiscrimination policy (Schneid, 2016). This policy is only meant for internal uses since there are state and federal laws which prohibit discrimination. The policy should outline expected behaviors and establish sound hiring practices to prevent discrimination during the recruitment process. For example, the recruitment process can be outsourced to private HR companies. The second intervention is training of staff. Training can significantly reduce discrimination in the workplace. Training sessions should be mandatory and should cover issues ranging from diversity of human beings and equality. The third step is to ensure there is quick follow up of any discrimination complaints raised by employees and other stakeholders. Discriminatory complaints should be given priority to ensure that the behavior is curtailed. Fourth, it is important for the organization to develop a concrete action plan that can be used to tackle discrimination. An action plan may be a long-term measure of ensuring that the organization eliminates any forms of discrimination.
Reference
Hughes, R. G., & Blegen, M. A. (2008). Medication Administration Safety. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US). Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK2656/
Schneid, T. D. (2016). Discrimination law issues for the safety professional. Boca Raton: CRC Press.
