HA450 M5 Impact of Leadership and explore perception and Productivity

6

Ethics and Decision-Making in the VA Healthcare System

Marina Perez

Purdue Global University

HS450M5

July 18, 2021

Ethics and Decision-Making in the VA Healthcare System

1. From a leadership perspective, analyze the problems at the VA relative to ethical decision-making practices .

Based on the case study, the failure and shortage of caregiving evident in the Veteran Health Management might not be addressed by increasing various resources, including recruiting more nurses and new physicians. Ideally, there must be accessibility to money which would only be applicable after solving the problems aligned with ethical and cultural issues in the Veteran affairs' health administration. The leadership management available at the VAs does not guarantee responsiveness (D'Agostino, 2016). As a result, the leaders have incompetent management and communication strategies with their patients and staff. The entire organization does not have integrity, responsibility, and ethics because the administration puts more emphasis on performance and accountability measures. For instance, one of the key VA necessities required physicians to attend to patients in 14 days. Thus, such a requirement made the timeline one of the primary quality performance policies (Slade, 2017). Nonetheless, such a timeline could not be met accordingly. As a result, the caregivers decided to bribe local administrations, leaders, and managers to minimize the waiting period and falsifying patient records to deceive that it was accomplished.

Some claims attributable to manipulated patient wait time and patient deaths because of poor scheduling practices were reported. According to an investigation conducted in 2014 on the Phoenix VA Healthcare Center, numerous unsuitable scheduling practices were used in the facility. Such inappropriate practices resulted when the VA staff failed to comply with the Veteran Health Administration Policy. All medical workforce within the healthcare must recognize the role of a NEAR report as an essential tool in acquainting Primary Care Management Component coordinators and schedulers. However, they did not adhere to the ethics and guidelines enclosed in appointment scheduling.

2. Discuss the ethical issue of having 1,700 veterans, who were not listed on the EWL, wait for a primary care appointment at the Phoenix VA. Create at least two (2) policies/standards to ensure ethical leadership practices with respect to improving coordination of the EWL and primary care appointments.

While the HAS staff conducted their duties and responsibilities ethically, they did not adhere to the set laws and rules of the facility. They received screenshots and compiled them into PDFs rather than printing out such screenshots related to patient details and delivering them to Data Management Services. Such PDFs were forwarded electronically to the appropriate outpatient service staff daily (D'Agostino, 2016). Therefore, many workers could wait for primary care appointments without knowing that the HAS workers had not given the appointment date or filled NEAR reports on their behalf. The HAS staff also manipulated the patient waiting times since they used an inappropriate desired date of care. They did not adhere to the VHA planning system but generated their preferred dates for patient appointments, causing a wrong zero-day delay time.

There is a need to warrant ethical leadership practices to improve the harmonization of the EWL and primary care appointments. For instance, it is central to ensure that VA top facility leaders and HAS staff are trained properly against vast malpractice of Veteran Affairs matters or issues and criminal transgression. The HAS employees who fail to adhere to the proper primary care appointment scheduling would take compulsory training classes to educate and equip them with the required skills (Hodgson et al., 2013). There must be sanctions for these HAS employees who engage in criminal misconduct and gross mismanagement. In this case, the participants must get severe punishments concerning their malpractices. Additionally, it is critical to implement an approach to force the administration of various hospitals to ensure its audit or appraisal trail operates precisely and effectively. In this policy, the Veterans Administration Office must constantly monitor data and audit software to ensure transparency and restore confidence.

3. Explain why Secretary Eric Shinseki resigned his position. Identify at least two (2) alternative options that Secretary Shinseki could have taken to resolve the unethical decision-making practices in this case study.

From the 2014 investigation results on 1700 veterans who had not been placed on the EWL list, Secretary Eric Shinseki resigned his position as the Secretary for Veteran Affairs. Eric was attributed to various ethical issues accusations and was under pressure as the secretary. The investigation portrayed adverse ethnic decay among the HAS employees and other healthcare workers (Adeniran et al., 2012). This tainted Eric's image and depicted him as a corrupt and incompetent leader. Eric Shinseki did not want to be linked with a department that did not serve Veterans accordingly and managed the Veterans poorly.

Rather than quitting the position as the secretary, Eric could have resolved the unethical practices aligned with decision-making by ensuring that all VA employees are subjected to a compulsory training session on better techniques of enrolling new veterans and generating patient appointments. This implies that he should have subjected all the VA workers to practical assessments to ascertain their preparedness and qualifications in dealing with VA patients. They must also exhibit competence in making patient appointments according to the VHA scheduling system (Foglia et al., 2012). Moreover, Secretary Eric Shinseki could have imposed sanctions on all VA employees involved in malpractices within the facility. As a result, he should have introduced punishments and penalties for all employees who failed to do their duties and create patient appointments accordingly. A severe punishment could have been imposed on the staff who omitted veteran names in the electronic waiting list. Eric could also solve the unethical decision-making practices by implementing new leadership guidelines in all VA leadership and management policies.

4. Apply the American College of Healthcare Executives (ACHE) Code of Ethics to the VA Health System case study.

ACHE Code of Ethics is applicable in giving service and regulation of standards of conduct for employees. It contains standards regarding ethical characteristics that clinic executives within their professional connections can use. The major objective of all healthcare administration professionals includes maintenance and improvement of general well-being, dignity as well as life quality of every individual in search of healthcare facilities (D'Agostino, 2016). ACHE is also used to create effective, efficient, accessible, and equality in healthcare. It becomes easy for clinic leaders and workers to conduct themselves according to the accepted ethical code through the help of ACHE hence enhancing care administered to patients. It is the role of VA managers to guarantee their workers take the correct measures of using ethics in making decisions.

The application of the ACHE Code of Ethics in the VA health care system mostly proves support when it comes to morals. The management and executive use ACHE measures in improving patient care, incentives, and morals of workers. The administration is responsible for administering social beliefs regarding work ethics in a genuine manner (Fihn et al., 2014). The management ought to be transparent and accountable for ensuring care to patients and staff members. It is advisable that if one of the ACHE members is aware of their members violating ACHE codes, they should report to the ethics committee for further action. It is essential for VA managers and administrators to acknowledge the chance of position occupation using their powers to make the organization a good place for healthcare service administration (Hodgson et al., 2013). The Code of Ethics must be protected from being violated.

References

Adeniran, R. K., Bhattacharya, A., & Adeniran, A. A. (2012). Professional excellence and career advancement in nursing: A conceptual framework for clinical leadership development. Nursing Administration Quarterly, 36(1), 41-51.

D'Agostino, J. A. (2016). VA Pipeline for Future Nurse Leaders: an Exploration of Current Nurse Leadership Development in the Veteran's Health Administration. ARMY COMMAND AND GENERAL STAFF COLLEGE FORT LEAVENWORTH KS FORT LEAVENWORTH United States.

Fihn, S. D., Francis, J., Clancy, C., Nielson, C., Nelson, K., Rumsfeld, J., ... & Graham, G. L. (2014). Insights from advanced analytics at the Veterans Health Administration. Health affairs, 33(7), 1203-1211.

Foglia, M. B., Fox, E., Chanko, B., & Bottrell, M. M. (2012). Preventive ethics: addressing ethics quality gaps on a systems level. The Joint Commission Journal on Quality and Patient Safety, 38(3), 103-AP7.

Hodgson, M. J., Matz, M. W., & Nelson, A. (2013). Patient handling in the Veterans Health Administration: facilitating change in the health care industry. Journal of occupational and environmental medicine, 55(10), 1230-1237.

Slade, M. (2017). Implementing shared decision making in routine mental health care. World psychiatry, 16(2), 146-153.