Business Perspective Module 1: Ethics and Healthcare

 Blog Entry Module 1

Module 1 was predominantly focused on ethics and applying ethical standards to business.  Business ethics can be defined as the “study of moral (ethical) matters pertaining to business, industry or related activities, institutions or practice and beliefs” (Karri, 2021). Our lecture also emphasized that strong moral values should be integrated into daily business workflow and practices. When individuals, including leaders, are regularly reminded of the significance of ethical conduct, they are more inclined to behave as such (McCombs School of Business, The University of Texas at Austin, 2019)  

I am a nurse manager in utilization review over three hospitals.  Ethics and healthcare go hand in hand, probably more so than the average business.  In healthcare, there are significant ethical components.  The patient side with care being rendered vs the financial capture.  There are several workflows/escalation paths to ensure the most ethical and responsible patient outcomes when there is a conflict between fiscal responsibility and patient advocacy.  For example, we have daily care conferences with patients, families, and physicians to help the patients understand the plan of care when they are resistant.  We are also very connected to risk when the POA makes questionable patient decisions.  If needed, we will also send real-time cases to the ethics committee if none of the above render successful.  On the opposite side of healthcare is finance; most people do not think of the hospital as a business; however, in utilization review, I am responsible for ensuring the hospital receives payment for the services rendered.  For example, the hospital will profit more from inpatient versus observation status patients, roughly a $6K difference in payment.  Thus, there is an incentive to keep the observation patients low and inpatients high. 

There is an incentive to capture the higher payment, i.e., inpatient, and keep the observation numbers low.  The hospital has set an aggressive observation metric goal, based on financial gain and is tied to the bonus structure of the executives.  This is not a nationally based number, nor is this number defined by the payer, i.e. Medicare, Medicare Advantage, or commercial.  The hospital has set the goal based on financial incentives rather than true medical necessity.

My direct leader was also incentivized to hit this metric; she demanded that we follow a clock vs medical necessity to convert patients.  This posed an ethical dilemma for me and my team.  Goals were set that were unrealistic and impossible to meet, and I had executives, including my current leader, demanding that we meet the metrics despite not operating with integrity.  Not only was this an ethical dilemma, but it was also concerning from a legal perspective, converting patients without true medical necessity.  According to Pressler, in the Wall Street Journal post, Building an Ethical Culture: Leadership’s Role in Corporate Integrity, “corporate scandals tend to spring from systemic failures in corporate culture, specifically around ethics” (Pressler et al., 2025).  I found this article and quote very applicable to my situation, systematic failure, strong and true. 

This ethical dilemma put me in a challenging position: hit metrics and “succeed” in the institution, whistle blow and be worked out, lose my job, or address head-on while continuing to support my team.  I opted for option three, address head-on.  I attempted to discuss this issue with key members of the executive team; however, I was met with resistance.  Pressler stated in the Wall Street Journal post “organizations may not be giving ethical risk the attention it deserves, particularly from the top down” (Pressler et al., 2025). Pressler goes on to say, “In ethical leadership, the CEO sets the tone. The rest of the C-suite amplifies it. Then business unit leaders, supervisors, and managers instill it in employees. The result: an ethical culture” (Pressler et al., 2025). 

 I decided to go directly to the source and confronted my director, stating that what we were doing was unethical and possibly had legal implications.  She was astonished I confronted her.  I asked if I could attempt to run the team using medical necessity and attempt to hit metrics, knowing I was setting myself up for potential failure.  She agreed, but again said I would be held personally accountable.  This was not an easy discussion, but I felt morally and ethically I had no other option.  I refuse to run a team and tell them to operate unethically; as a leader, I hold myself to a high moral standard.

In our lecture, Karri states that ethics can be viewed looking at ones “personal moral norms apply to the activities and goal of commercial enterprise.  It is not a separate moral standard, but the study of how the business context poses its unique problems for the moral person who acts as an agent of this system” (Karri, 2021).   My moral compass is strong; however, it takes more than one person to make change.  According to the Wall Street Journal post, Building an Ethical Culture, “ Organizations need to be proactive, sense risks before they emerge, and move quickly to head off potential crises. The capabilities needed to effect and enforce ethical behavior cannot be developed overnight; they must be modeled by leaders and embedded into the fabric of the organization” (Pressler et al., 2025). It takes more than one person to make this level of ethical change in a large corporation; it takes like-minded people who all have a strong ethical commitment with a strong moral compass.  I will continue to lead the department with integrity and push others by leading by example. 

 

References

Karri, R. (2021). Lecture on business ethics. University of Illinois Springfield. https://docs.google.com/presentation/d/1gCC10O-RCIvBgU2GalPfoMlnFJ_tI28j-bWiDUyerk0/edit?usp=sharing

McCombs School of Business, The University of Texas at Austin. (2019). Being your best self, part 1: moral awareness [Video]. youtube. https://www.youtube.com/watch?v=snm01IG_PHU

Pressler, L., Rossen, M., & Velia, M. (2025). Building an ethical culture: leadership's role in corporate integrity. Wall Street Journal. Retrieved June 5, 2025, from https://deloitte.wsj.com/cfo/building-an-ethical-culture-leaderships-role-in-corporate-integrity-fc008c9f?gaa_at=eafs&gaa_n=ASWzDAgxYUtCjwlnAt0qWyvYSIxk6JlwH453lQLTqj26fnidmbl75Id1RjqGQsfoWF0%3D&gaa_ts=68422b1d&gaa_sig=GbImMlAlcETpKpnxJE6LKhk6PnhXjTXNCjRNKwOToiGUxBiPywEYh4JxrdYiKUYP2u_ruY_nWzZlfl6iPMfxrg%3D%3D