Case Study

Case Study

In the course of its daily business, the hospital receives a diverse set of patients, with varying religious beliefs. These beliefs must be respected, according to the First Amendment to the Constitution of the United States, and out of simple respect. In cases where religious beliefs are at odds with the law, a patient's wishes should be respected. Jehovah's Witnesses, for example, are not allowed to accept blood transfusions, even if this would be a life-saving requirement (Muramoto, 1999).

At the same time, the medical practitioners themselves may have religious beliefs of their own. When these conflict with those of the patient, we find that discord results. For example, the CEO reported that multiple cases of heroic resuscitation efforts had taken place on the ward, even where DNR (Do Not Resuscitate) orders had been signed. This is very obviously against the wishes of the patient. The opposite was also reported to be true.

Uninsured patients are proving to be a heavy drain on the hospital's resources. While the medical center operates as a not-for-profit organization, it is nevertheless not a charity. The staff is paid Ð'- they are not volunteers, and operating costs must be met in order to stay open. There have been examples in which the on-site pharmacist has been accepting installment payments from low-income patients, and pro-bono work is on the increase.

At the other end of the scale, some patients are being turned away because they have no insurance coverage. According to the text, doctors and other medical practitioners have "a moral obligation to provide free medical care for those who cannot pay" (Browne et al., 2001, p. 159). However, this obligation must be balanced against the continued operation of the facility.

These are complex issues in themselves, but they are contributing to the third problem identified: per-patient costs are on the increase. With a lack of harmony in the facility's operation, inefficiency has crept in, which is costing the center a great deal of money. According to the hospital's financial analyst, patient population has decreased resulting in a higher proportion of fixed costs against variable costs. The population has most likely decreased due to the two main issues identified in this paper.

In considering solutions to these issues, it is important that the primary stakeholders are not neglected. This includes the patients, medical and administrative staff, and the board of directors. The community as a whole should also be considered as a stakeholder, as the hospital is a service organization.

In summary, then, there are two major problems at issue. Resolution of these would go a long way towards repairing the obviously tarnished reputation of the facility, which will in turn encourage more patients to return. That will enable the CEO to avoid a painful cost-cutting exercise. To redefine the problems, the first is the inability of the medical staff to act at all times in accordance to the letter of the law and the wishes of the patients. The second issue at hand is the excessive charitable work taking place at the expense of the hospital.

There are several alternatives to solving the problem with the medical staff. The most obvious of these is to adopt a policy that forces doctors and nurses to treat patients according to their wishes, whatever these may be, regardless of the practitioner's own religious beliefs. While simple to state, this would be difficult, if not impossible, to enforce. Most people of integrity place their religious beliefs above all else, and with good reason. It would be unfair to impose such a restriction on any person, and doing so would possibly encourage those doctors to leave the service of the hospital.

A second, more favorable, alternative might be to build a database of each doctor's and nurse's philosophy. Incoming patients could then be required to fill out a simple questionnaire in order to identify the measures that they would wish taken on their behalf. This would necessarily have to be in the form of a legally binding document. Once in place, this system would enable an administrative professional to match the patient to the care-givers. Like-minded doctors and nurses would be better able to form more permanent teams, and would have no qualms about treating the patients in the manner of their choosing. Although potentially costly and time-consuming to implement, this alternative would be the most beneficial in the long run. Any costs involved would be incurred during startup only, and could possibly be amortized.

The issue of excessive charitable work is more difficult to address, primarily due to the moral and legal obligations facing medical care givers. Part of the difficulty here is in judging the gravity of an indigent patient's complaint. While it should be possible to turn away patients that are not in dire need of medical assistance, that call is obviously for a medical professional to make. Sympathetic feelings and personal views and opinions are highly likely to interfere with an impartial judgment.

The options to solve this issue are very limited. The facility has little choice but to accept pro-bono cases. Not only is it the morally defensible, but in not doing so the hospital would leave itself open to expensive litigation.

Within the scope of this issue, two alternative, but similar, solutions have been identified. Doctors and nurses can be forced by policy to perform all pro-bono work on their own time, and at their own expense; or the hospital can allow a certain proportion of paid time and facility use to be utilized.

In the first case, the number of costly pro-bono cases would be dramatically cut, greatly improving the cost efficiency of the center. However, this would be very unpopular within the patient population and community. Doctors and nurses, while good people, do have families and personal lives to consider, and would be unwilling to spend a large proportion of their leisure time attending to these cases. Furthermore, by encouraging medical professionals to work longer hours, the management runs the risk of an increased error to patient ratio as fatigue starts to play a part.

The second option is far more attractive to all stakeholders: assigning a quota to the number of indigent cases that can be admitted. From the hospital's perspective, pro-bono work Ð'- while expensive Ð'- projects a caring image into the community, which in turn will drive up patient intake. Medical staff will feel able to accept such cases during normal hours, and will therefore be less prone to error due to fatigue. And, because this would be an officially sanctioned activity, more patients would be served.

In identifying potential solutions

...