Ethical Case Study: Ethical Challenges in Leadership

by | Jul 24, 2024 | ethics

Ethical Case Study:
Ethical Challenges in Leadership
Quality Documentation
Billy is a medical record abstractor at a prestigious hospital, well known for their quality of care. In his role, he is responsible for reviewing the medical record and inputting data from the medical record into a quality measures database. The quality measures database is then used to report specific quality measures as mandated for accreditation. As an abstractor, Billy must fully input data exactly as it is stated in the chart. The motto “If it wasn’t documented, it wasn’t done”, applies to his job. When inputting the data, Billy notices that the facility is about to fail one of the quality measures due to lack of documentation. The quality measure indicates that all patients who are admitted with a stroke diagnosis must be given clot-prevention medication unless there is a contraindication noted in the chart. If the patient is not given the medication and a contraindication is NOT noted, then the chart fails the quality measure. Billy searches the chart and finds no documentation, therefore, the chart fails the quality measure. Upon review, he notices several charts with the same issue (No documentation to help support the decision of the care team.) He makes note to notify the Quality Committee so that improvements can be made to the documentation templates in the electronic health record. Billy continues with his work and submits his abstracted data into the database.
John works in the quality department as a quality measure reviewer. His job is to double check the submissions from the quality database and review all measures that fail. John notices that several of Billy’s abstractions come back as failures for “lack of documentation”. Not wanting to fail the upcoming accreditation, John requests Billy to go back and change all of the abstracted data so that it passes the measure. When Billy informs John that the quality measure specifically states that the information must be clearly documented, John says “It is my job to assure our organization is compliant with quality measures. In the big scheme of things, this is just a small task that will benefit our organization”.
Billy, feeling conflicted between helping the organization and doing the right thing, takes the issue to you as his leader.
What should be done in this situation?

Answer the following questions for the scenario selected:
Scenario 1:
1. Identify whether there is an ethical concern, and if so, what the ethical concern is.
2. Determine how the scenario should be handled. For instance, if you were the leader in the selected situation, how would you manage the issue?
3. Recommend course(s) of action to be taken.
Scenario 2:
1. Identify whether there is an ethical concern, and if so, what the ethical concern is.
2. Determine how the scenario should be handled. For instance, if you were the leader in the selected situation, how would you manage the issue?
3. Recommend course(s) of action to be taken.
Scenario 3:
1. Identify whether there is an ethical concern, and if so, what the ethical concern is.
2. Determine how the scenario should be handled. For instance, if you were the leader in the selected situation, how would you manage the issue?
3. Recommend course(s) of action to be taken.
Conclusion
1. Compare/contrast the three cases selected. In what ways are the ethical concerns similar? Different?
2. Interpret/discuss the ethical theory or theories that would best apply to the recommended courses of action for each scenario.
3. Develop steps for a leader to follow to assist with the ethical-decision making process.

 

Sample solution

Dante Alighieri played a critical role in the literature world through his poem Divine Comedy that was written in the 14th century. The poem contains Inferno, Purgatorio, and Paradiso. The Inferno is a description of the nine circles of torment that are found on the earth. It depicts the realms of the people that have gone against the spiritual values and who, instead, have chosen bestial appetite, violence, or fraud and malice. The nine circles of hell are limbo, lust, gluttony, greed and wrath. Others are heresy, violence, fraud, and treachery. The purpose of this paper is to examine the Dante’s Inferno in the perspective of its portrayal of God’s image and the justification of hell. 

In this epic poem, God is portrayed as a super being guilty of multiple weaknesses including being egotistic, unjust, and hypocritical. Dante, in this poem, depicts God as being more human than divine by challenging God’s omnipotence. Additionally, the manner in which Dante describes Hell is in full contradiction to the morals of God as written in the Bible. When god arranges Hell to flatter Himself, He commits egotism, a sin that is common among human beings (Cheney, 2016). The weakness is depicted in Limbo and on the Gate of Hell where, for instance, God sends those who do not worship Him to Hell. This implies that failure to worship Him is a sin.


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God is also depicted as lacking justice in His actions thus removing the godly image. The injustice is portrayed by the manner in which the sodomites and opportunists are treated. The opportunists are subjected to banner chasing in their lives after death followed by being stung by insects and maggots. They are known to having done neither good nor bad during their lifetimes and, therefore, justice could have demanded that they be granted a neutral punishment having lived a neutral life. The sodomites are also punished unfairly by God when Brunetto Lattini is condemned to hell despite being a good leader (Babor, T. F., McGovern, T., & Robaina, K. (2017). While he commited sodomy, God chooses to ignore all the other good deeds that Brunetto did.

Finally, God is also portrayed as being hypocritical in His actions, a sin that further diminishes His godliness and makes Him more human. A case in point is when God condemns the sin of egotism and goes ahead to commit it repeatedly. Proverbs 29:23 states that “arrogance will bring your downfall, but if you are humble, you will be respected.” When Slattery condemns Dante’s human state as being weak, doubtful, and limited, he is proving God’s hypocrisy because He is also human (Verdicchio, 2015). The actions of God in Hell as portrayed by Dante are inconsistent with the Biblical literature. Both Dante and God are prone to making mistakes, something common among human beings thus making God more human.

To wrap it up, Dante portrays God is more human since He commits the same sins that humans commit: egotism, hypocrisy, and injustice. Hell is justified as being a destination for victims of the mistakes committed by God. The Hell is presented as being a totally different place as compared to what is written about it in the Bible. As a result, reading through the text gives an image of God who is prone to the very mistakes common to humans thus ripping Him off His lofty status of divine and, instead, making Him a mere human. Whether or not Dante did it intentionally is subject to debate but one thing is clear in the poem: the misconstrued notion of God is revealed to future generations.

 

References

Babor, T. F., McGovern, T., & Robaina, K. (2017). Dante’s inferno: Seven deadly sins in scientific publishing and how to avoid them. Addiction Science: A Guide for the Perplexed, 267.

Cheney, L. D. G. (2016). Illustrations for Dante’s Inferno: A Comparative Study of Sandro Botticelli, Giovanni Stradano, and Federico Zuccaro. Cultural and Religious Studies, 4(8), 487.

Verdicchio, M. (2015). Irony and Desire in Dante’s” Inferno” 27. Italica, 285-297.

Sample Answer

Sample Answer

 

Ethical Case Study: Ethical Challenges in Leadership

Scenario 1

1. Ethical Concern

The ethical concern in this scenario revolves around the integrity and accuracy of medical documentation. Billy discovers that the lack of documentation for critical care measures—specifically, the administration of clot-prevention medication for stroke patients—could lead to a failure in quality measures reporting. John’s request for Billy to alter the abstracted data to show compliance undermines ethical standards of honesty and transparency in healthcare. It poses a risk to patient safety and the hospital’s reputation, as misleading documentation could mask deficiencies in care.

2. Handling the Scenario

As a leader, I would first acknowledge Billy’s ethical dilemma and commend him for bringing this issue forward. It is vital to create an open environment where employees feel safe to report unethical practices. I would then arrange a meeting with John to discuss the implications of his request on patient safety, organizational integrity, and accreditation standards.

3. Recommended Courses of Action

– Educate: Provide training sessions on the importance of accurate documentation and ethical standards in quality reporting.
– Review: Conduct a thorough review of all relevant documentation processes within the department.
– Escalate: If John insists on altering the data after discussions, escalate the issue to higher management or the ethics committee within the organization to ensure accountability.
– Implement Changes: Work with the Quality Committee to improve documentation templates in the electronic health record system.

Scenario 2

1. Ethical Concern

The ethical concern here involves the potential for misrepresentation of care provided to patients. By altering data to meet quality measures, John would be compromising the ethical principle of beneficence, which emphasizes doing good and ensuring patient safety. Moreover, it raises questions about accountability and transparency within the organization.

2. Handling the Scenario

In my role as a leader, I would address John’s approach directly. This requires a firm stance on maintaining ethical practices in reporting. Open dialogue about the implications of unethical behavior on patient care and institutional credibility is essential.

3. Recommended Courses of Action

– Reinforce Ethical Standards: Reiterate the organization’s commitment to ethical practices and quality care.
– Gather Data: Collect detailed information about any other charts affected by similar issues and begin a root cause analysis.
– Support Billy: Ensure Billy feels supported in his decision not to change the data inappropriately.
– Collaboration: Facilitate a meeting between Billy, John, and other stakeholders to collaboratively find solutions that adhere to ethical standards.

Scenario 3

1. Ethical Concern

Here, the ethical concern is centered around whistleblowing and the fear of retaliation that may arise when employees report unethical practices. Billy’s predicament highlights the conflict between personal integrity and organizational pressures, which can lead to moral distress.

2. Handling the Scenario

As a leader, it is critical to provide reassurance to Billy that his concerns will be taken seriously and handled confidentially. Establishing a culture that encourages ethical behavior without fear of retribution is essential.

3. Recommended Courses of Action

– Create Safe Reporting Mechanisms: Develop anonymous reporting channels for employees to voice concerns without fear.
– Encourage Dialogue: Promote open discussion among staff regarding ethical dilemmas and responses to unethical requests.
– Policy Review: Review existing policies regarding documentation and quality reporting to ensure they promote ethical standards.

Conclusion

1. Comparison of Ethical Concerns

All three scenarios share common ethical concerns regarding documentation integrity, patient safety, and the importance of adhering to ethical standards in healthcare. However, while Scenario 1 focuses on the immediate impact of falsifying data, Scenario 2 emphasizes misrepresentation of care quality at an organizational level. Scenario 3 highlights the personal struggle of an employee facing potential retaliation for speaking out against unethical practices.

2. Ethical Theory Interpretation

The ethical theories best aligning with these scenarios include:

– Deontological Ethics: Upholding duties and responsibilities towards truthfulness in documentation (Kantian ethics).
– Consequentialism: Evaluating actions based on their consequences for patient safety and organizational integrity.
– Virtue Ethics: Emphasizing character traits such as honesty, integrity, and professionalism in healthcare practice.

3. Steps for Ethical Decision Making

1. Identify the Ethical Dilemma: Understand the specific situation and its implications.
2. Gather Relevant Information: Collect all pertinent facts and perspectives from involved parties.
3. Evaluate Alternatives: Consider possible courses of action and their potential outcomes.
4. Consult Ethical Guidelines: Refer to organizational policies and professional codes of ethics.
5. Make a Decision: Choose the course of action that aligns with ethical principles.
6. Implement Action: Execute the decision while ensuring transparency among stakeholders.
7. Reflect on the Outcome: After implementation, assess the results and learn from the experience for future decisions.

By establishing a clear framework for ethical decision-making, leaders can foster an environment where integrity and patient care are prioritized over compliance pressures.

 

 

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