Ethics of Healthcare Management:
Personal Reflection: Corporate Structure and Legal Issues
BUSI 506-B02
Legal and Ethical Issues for Health Professionals
Dr. Josefina Cruz-Melend
6/26/21
Joshua-Paul Johnian Sr.
Ethics of Healthcare Management:
Personal Reflection: Corporate Structure and Legal Issues
Due to my present professional role within the U.S. healthcare system, and in keeping within my
future professional aspirations, I requested permission from Dr. Melend to provide my personal
reflection on Chapter Nine of our class text: Corporate Structures and Legal Issues. Presently, I
am employed as an assistant administrator for a hospice provider serving approximately 420
patients and families in North Carolina. The particular hospice provider I work with is a national
hospice company that is a subsidiary of large hospital system located in the Midwest. As an
Assistant Administrator my roles and responsivities are primarily focused financial goals and
benchmarks along with internal and corporate quality control measures and CMS compliance
rules and regulations. Since the nature of my position is not focused on clinical patient care and
what most would consider the business side of the healthcare, I have also set my future
professional aspirations to work within the larger hospital system as director or administrator of
multiple departments that are essential to the daily workings of a medical system or healthcare
provider. Since the purpose of this discussion thread is to explore the possible legal and ethical
challenges within my scope of work, I will seek to provide insight on the following:
The roles and responsibilities of an administrator
Potential legal issues an administrator must address
Ethical challenges an administrator must reconcile
A Biblical foundation for administrators
In conclusion, I hope to provide further insight to future professional opportunities and how my
Judeo-Christian worldview can positively influence U.S. healthcare within the corporate
structure.
The Role of Administrators in Healthcare
The U.S. healthcare system is both diverse and extensive providing access to healthcare services
for approximately 87.6% of people living within the United States according to the CDC. While
most individuals personalize their healthcare in the relationship between themselves and their
doctor, or specialized health care provider, an intricate and multi-layered role of support and
management staff ensure the any medical provider is able to practice the necessary measure of
care safely, legally, ethically and efficiently. From the health informatics specialists that develop
patient portals, and smart-phone applications to transfer health information from the patient to
the provider and from the provider to the insurer, to the in-office personnel that process patient
information, scheduling and billing one's confidence in their health care provider is supported by
the role of administrators, office managers and department directors. Especially as healthcare is
consolidating into larger networks of medical systems the specialized role of various
administrators not only protects the patient's private health information but also ensures the
integrity of the healthcare organization in legal compliance and financial stability. In Legal
Aspects of Healthcare Administration Pozgar writes, "each corporation has a governing body
that has the ultimate responsibility for the operation of the organization. Pozgar expands the role
of governing bodies by saying, "in hospitals and systems, board members are fiduciaries because
they have been entrusted with overseeing the fulfillment of the organizations mission."
While Pozgar's text primarily focuses on the high-level role of corporate boards, CEOs and
specific committees these larger entities replicate this same model and structure on an agency
level that operate under the same premise and guidelines despite the size or location of the
agency.
To highlight the similarities between my present role, and our agency structure, with our larger
corporate structure I will explore the of the senior leadership structure. Within our local agency
there is a branch administrator, who acts as the agency CEO, and is ultimately responsible for
every action and outcome related to the specialized healthcare we provide. As our local agency
branch is the second largest in the nation, for our company, there is also an assistant
administrator that oversees specific departments of the agency. Additional layers of senior
leaders include the agency office manager, who is responsible for the finances, Directors of
nursing, clinical compliance nursing and two medical directors. Extending beyond the senior
leadership level are patient care managers, human resources generalists various expertise of
nursing, certified nursing assistants, ancillary services and team coordinators. Presently, our
agency requires a staff of 175 medical and administrative professionals to serve approximately
425 patients and families and daily there are multiple potential legal and ethical questions or
concerns. While it may seem, to some, as a logical progression from medical clinician to
administrator would make for a comprehensive leadership model the reality is very different.
Lazarus writes, "Physician executives may also clash with lay administrators who have
management goals other than medical standards. Relationships between physician executives
and non-physician executives have been rife with conflict for years, and these conflicts may not
dissipate easily given the broader scope of administrative responsibilities sought by and accorded
physician executives nowadays. The boundary- spanning roles of physician executives puts them
in direct competition for coveted CEO positions once considered the sole province of non-
physician executives. Also, physicians and non-physician executives have been trained
differently, and their personalities are often polar opposites.
Highlighted in Lazarus' article is the potential of different approaches to healthcare management
as clinically training executives and non-clinical executives may look at the medical business
model differently and potentially creating a disparity in management, scope of responsibility
long-term healthcare outcomes while also providing an essential balance in maintaining a
solvent, compliant and efficient organization.
Ethical Concerns
Since the management of provision of healthcare is faced daily with ethical and legal questions
the necessity of a highly qualified administrative system is essential. Further evidence of
potential issues within healthcare, and the need for training in understanding and application of
ethics for non-clinical leaders, has been highlighted Falkenstrom's research,”
Jormsri et al. (2005) have argued that ethical competence in healthcare consists of three
dimensions, namely, perception, judgement and behavior.
Perception
In this case means that the moral agent should possess the ability to identify ethical dimensions
and value conflicts that are at stake in a certain situation. Judgement is defined as the ability to
weigh pros and cons in relation to the identified value conflict, and behavior, finally, as the
ability to act on the judgement that has been performed. A somewhat different terminology is
used by Eriksson et al. (2007), who have argued that ethical competence should include aspects
of both virtue ethics and traditional action-guided reasoning, based in utilitarian and
deontological reasoning. Hence, ethical competence in their view is a matter of being (personal
character), doing (acting according to judgements made based on rules and principles) and
knowing (familiarity with moral traditions as well as laws and guidelines for one's work).
Compared to Jormsri et al. (2005), the concept of knowing relates to perception and judgement
and doing to the concept of behavior. What differs between these two positions is the virtue
aspect that is emphasized by Eriksson et al. (2007) and which has no direct equivalent in Jormsri
et al. 's (2005) position. In this study, ethical competence is related to the managers' tasks, which
are embedded in the context of healthcare organization and society."
Falkenstrom's research highlights the essential role a highly trained administrative team
demonstrates daily, and in some instances, on a patient by patient situation. Since the question of
how administrators define perception, judgement and behavior, from a certain ethical
application, can result in varying quality control outcomes and financial goals, as well as the
application of intentional barriers to promote a healthy work-life balance as part of a healthy
promotion of employee satisfaction and retention and care, the educated administrative staff
must adhere to a set standard of care, mission and goals to maintain a consistency of care.
While there will always be varying degrees of ethical interpretations established standards that
guarantee a system of integrity and accountability will maintain an ethical work culture and
environment.
Within my specific vocation there is little room for ethical debates or applications of different
approaches to care according to ones personal ethics. While I have heard of other hospice
providers utilizing certain practices that promote a different level of hospice care, than what we
provide, I am certain our practices always consider the medical needs of the patient while also
providing supportive services that care for the holistic care of the patient and caregivers.
Unfortunately, I am aware of certain providers that exclude medical care based on financial
models that are tied to higher levels of acuity of care; and I feel such decisions may pose an
ethical dilemma to patients and providers. The above cited research is further supported by such
real-life application when administrators may consider their healthcare model from a limited
scope of practice and care.
Legal Concerns
In my present role most legal concerns surround the application and limitations of HIPPA as it
relates to direct patient care, caregiver concerns and in some situations how employees may
violate corporate policies often related to attendance or protected patient information. While
most legal challenges are addressed on a corporate level often, on the agency level, our legal
concerns stem from requested patient health information from family members who are not
legally designated POA's. While my specific role and agency has not had to address legal
concerns than affect our company or agency the reality is office administrators and health
organizations often face an abundance of legal concerns as evidenced by recent legal rulings on
such polarizing topics of abortion and individual health care providers. In Healthcare
responsibilities and contentious objection, a ruling from the District of Columbia stated,"
The ruling that administrative officers cannot invoke conscientious objection to accommodating
abortion confirms that the claim that this amounts to complicity in abortion has no legal
substance. Objection is allowed to direct participation, such as by conducting surgery or writing
a prescription for medication abortion or rendering for instance nursing or anesthetic assistance
during surgery, but not for more remote acts of administration or service, such as postoperative
care. Some US legislatures have enacted widely-drawn immunities for those who claim
pposition to abortion, such as hospital admission staff and ambulance attendants, but these laws,
designed to prevent abortion, abuse defense of religion in order to restrict human rights to
healthcare, particularly of women."
The result of this ruling and the more recent ruling from the Supreme Court regarding Catholic
organizations and adoption practices to same-sex families highlight the following, "
The case that resulted in the seminal judgment of the Constitutional Court of Colombia shows
how powerful health facility administrators and physicians who enjoy a monopoly of service
delivery can violate their ethical duties by the abuse of vulnerable, dependent patients in denying
them their legal rights."
While I personally disagree with the conclusions of the authors, they do highlight the leverage
administrators and clinicians have in directing the policies and practices of their provider-based
organization and despite legal challenges, or cultural assumptions, the corporate by-laws and
articles of incorporation require the administrative team to adhere to these policies thereby
making it the responsibility of administrators, boards of directors and CEO's to ensure the
company remains complaint to its mission and values.
Biblical Perspective
While medical systems and administrators of multi-million-dollar organizations may seem far
removed from Biblical text the reality is ample Biblical principles exists equating the need for
administration and the dangers of poor administration. While it may be difficult to envision
oneself as being at the pinnacle of ministry, or medical administration, while laboring with over
spreadsheets, policies and quality assurance programs, the reality is good administration is
essential to an effective organization in its goal of ethical and legal compliance.
Most occupations have some tasks which may be labor intensive and lost in the weeds of policies
and procedures; but such toilsome work acts as a buffer against poor administration that will
comprise any organization morally and legally. In Daniel 2:49 and 3:12 Daniel was specifically
placed in the function of an empire administrator. While the Book of Daniel establishes by God
used his giftings, and call, for other Kingdom purposes his earthly role was to administer the
needs, demands and values of an empire he was captive to. From the earliest verses of Daniel his
level of skill and training was established and later validated as he served several larger empires
and kings over a lengthy period. Further adding to the role and value of administrators the
Biblical use of the word, administrator, in Hebrew is pequddah. The word "pequddah", as
applied in Scripture, means oversight and mustering. Therefore, from Daniel to the establishment
of the first century church administrators were responsible for the affairs of the general need of
the people as well as appointed to care for the oversight and responsibility of the office and
people they are assigned to.
Finally, just as there is a need for quality Church or business administration the same
expectations should be set for any healthcare system or provider. As with the church model the
healthcare system is an organism, and an organism is a complex structure of interdependent and
subordinate elements whose relations and properties are largely determined by their function in
the whole. Just as a church is of God administrators, of any healthcare system, should behave as
an essential partnership between a sacred oath between providers, patients and all individuals
who support such structures. Therefore, just as church administration concerns itself with
presenting the human element in the partnership equation as a disciplined, orderly, purposeful
instrument to be directed and used of God as He sees fit, healthcare administrators should act in
such a professional manner make healthcare ethically and leally sound, ordered, consistent and
true to their mission and values.
In Conclusion: My Goals and Personal Application
While I am currently working in the role of a hospice administrator my desire to pursue an
advanced education, within healthcare administration, is to equip myself to succeed, influence
and provide the highest levels of leadership in the ever-changing world of healthcare. While
much of our present healthcare system appears to limit the virtues and qualities of a Judeo-
Christian faith system I believe the values of life, identity, purpose, healing and dignity are best
modeled in the Christ-centered experience. Sadly, while our society is eager to legally challenge
such opinions and practices, I do believe there are ample opportunities for advanced
professionals to not only influence these organizations but also lead and possibly create new
opportunities for re-imagined healthcare. This was recently evidenced following the adoption of
"Obamacare" and the creation of Biblically based healthcare sharing programs to provide
medical coverage while also remaining affordable, effective and legally compliant. Finally, while
the ethics of godless society attempt to re-define healthcare and the timeless principles of science
and ethics, the immutable nature of God compels Christians to remain actively engaged in all
segments of society and I believe especially in portions of society that effect life, death and
decency. It is my professional goal to be a future influencer at some of the highest levels of
healthcare or hospital administration with the long-term goal to be a CEO and perhaps have the
opportunity to pave a new and re-imagined application of healthcare.
Works Cited
Cook, R., Arango Olaya, M., & Dickens, B. (2008). Healthcare responsibilities and
conscientious
objection. International Journal of Gynecology and Obstetrics, 249-252.
Falkenström, E., Ohlsson, J., & Höglund, A. T. (2016). Developing ethical competence in
healthcare management. Journal of Workplace Learning , 17-32. Hebrew Aramaic Dictionary.
(1998). La Habra: The Lockman Foundation.
Lazarus, A. (2009). Professional and career issues in administrative medicine. Journal of
Healthcare Leadership, 1-5.
Pozgar, G. (2019). Legal aspects of healthcare administration. Annapolis: Jones and Bartlett
Learning.
Statistics, C. C. (2021, March 1). National Center for Health Statistics. Retrieved from CDC.gov:
https://www.cdc.gov/nchs/fastats/access-to-health-care.htm
