Understanding the Ethical Challenges in Healthcare Management

It’s the very first rule of healthcare writ large: “First, do no harm.” A maxim first expressed by physician-philosopher Hippocrates in 400 B.C., the Hippocratic oath has been part of the healthcare field about as long as there’s been a field to speak of.

Still, some of the most pressing ethical challenges in healthcare, particularly for higher-level management professionals, can fly under the radar. 

In order for all parties involved in healthcare services to uphold that important promise to patients, no ethical stone should go unturned. Here are three areas where healthcare management professionals should stay vigilant to ensure that the best possible outcome for patients comes first, despite competing interests.

Patient privacy and confidentiality

One of the most important and sensitive roles for healthcare managers is their responsibility to maintain patient records. Access to this highly personal information is a privilege that can easily be overlooked in the day-to-day duties of shuffling patient files. 

But in truth, every staff member who has access to patient files, even if only for medical scheduling, is being entrusted with confidential information — and has a duty to keep that information private. Even health information that is used for research purposes must first be divested of any items that can identify not only the patient themselves, but also their family members, household members or employers.

The importance of patient confidentiality is a legal one, thanks to the Health Insurance Portability and Accountability Act (HIPAA), which was originally passed in 1996. But HIPAA is far from the only reason to keep patients’ medical findings secret. Doing so also increases trust between patient and provider and empowers patients in their ability to make medical decisions for themselves, as well as preventing them from experiencing potential stigma or discrimination related to certain ailments. 

While technology like encryption has made maintaining confidentiality easier in some ways, vast medical data sets also create their own vulnerabilities in their ease of access and permanence. In any case, all personnel who interact with patient information should be subject to stringent — and regularly revisited — training in this area.

Maintaining financial integrity

In some ways, finances may seem like the least important aspect of running a medical facility — which, after all, exists for the primary purpose of healing people. But in other ways, finances are one of the most important parts of the job: Without proper funding, that all-important healing work can’t happen.

Of course, at the same time, healthcare professionals of all stripes remain acutely aware of how medical expenses can affect patients. Even while the vast majority of patients are covered by some form of medical insurance, many Americans report debt related to medical bills or express financial strain related to the cost of prescription medications. And that means healthcare managers overseeing money matters have something of a tightrope to walk.

In medical billing and coding, it’s imperative to ensure all treatments and procedures are correctly billed, which can both help avoid revenue leak and ensure patients aren’t overcharged for services. Consider enacting a pre-bill audit policy, which can help ensure every bill is correct — from the start. Not only will this help avoid under- or over-billing, but it can also stave off costly and time-consuming legal entanglements or appeals.

Healthcare managers who work in medical office accounting and finance will have better insight into the overall cash flow of the operation — and, of course, are ethically obligated to maintain integrity when recording and reporting earnings and expenditures. If a provider is commingling business and personal expenses, bookkeepers must stand up to and prohibit this behavior, which not only is morally questionable but also can put your business at risk of an IRS audit.

Allocating limited medications

It’s an unfortunate truth that prescription medications, even life-saving ones, aren’t unlimited in supply. And in fact, many basic and critical drugs, including chemotherapy drugs and painkillers, have been subject to shortages in recent years.

While prescribing medication falls to front-line medical professionals like physicians, behind-the-scenes healthcare management professionals are responsible for resource allocation, which includes drugs and medical equipment. It’s their responsibility to keep those drugs stocked — and, in some cases, to make difficult decisions when there’s not enough to go around. 

Working one-on-one with physicians and other prescribing professionals in order to understand their (and their patients’) needs is a critical step, as is keeping abreast of the changing landscape of medication shortages. The American Society of Health-System Pharmacists (ASHP) offers resources that can help keep you apprised of drugs no longer available or not available in commercially prepared form, as well as resolved shortages, which can help make this part of the job considerably easier. 

Healthcare management professionals have taxing — but important — jobs, and these ethical responsibilities are part and parcel with such roles. In keeping an eye toward ethical considerations and working together to prioritize such challenges, medical facilities can work to create a culture of integrity — which is a more healing environment for staff, physicians and patients alike.