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Course Project Overview: Ethics In Leadership
Objective
The objective of the course project is to assess ethical cases that can be challenging for those in leadership roles in healthcare. Ethical standards in healthcare are very important and should be handled according to organizational policies and procedures. When an ethical dilemma surfaces it deserves immediate attention to maintain the integrity of the organization.
Project Requirements
For the Course Project students will put themselves in the role of healthcare leadership to evaluate ethical case studies. Students will examine the provided ethical challenge case studies listed below. Following, students will conduct an assessment of these cases to determine if they meet ethical standards of practice. Students will be required to select three cases to compare and contrast and summarize your findings in a 2-3 page assessment. The assessment should include a full summary of the cases using full paragraphs written in APA format.
Assessment Findings
While conducting your assessment, answer the following questions for the three scenarios you have 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.
Ethical Case Studies (select three of the cases shown below)
Ethical Challenges in Leadership Case # 1
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?
Ethical Challenges in Leadership Case # 2
Medical Record Audit
You are the Release of Information Supervisor in the HIM Department. In this role, you are responsible for assuring appropriate disclosures of health information. This includes responding to medical record audit requests for Government oversight agencies. You’ve received a medical record request from CMS, requesting the entire medical record for several Medicare patients. The purpose of this request is to validate the medical necessity for the care and services provided during the patient stay.
Following procedure, after obtaining the requested medical records, you send the records over to the utilization review team, who is primarily responsible for coordinating patient treatment and services to maximize patient care. This team also reviews all medical records before being sent to an auditor for medical necessity review. This process helps assure that all required components are included in the medical record to support the medical necessity of the encounter.
Upon the utilization team’s review, they find documentation in several progress notes inferring that the patient’s actual condition didn’t require the intensity of services that were provided. In other words, this documentation could invalidate the medical necessity of each visit and may result in rejection of payment for each encounter. If discovered by the auditor, the hospital will lose a lot of money. The utilization review manager has asked you to omit these progress notes from your submission to CMS so that the information is not discovered by the agency. She has assured you that “no one has to know about this and it will save the hospital a lot of trouble later on”.
What will you choose to do in this situation?
Ethical Challenges in Leadership Case # 3
Coding Backlog
Mary is a coding supervisor at a community healthcare organization. Due to an increase in patient volumes and an increase in coding staff turnovers, the coding unit is experiencing a heavy backlog in outpatient accounts that need coded. This backlog is resulting in an estimated $8 million in unbilled accounts that the facility needs to seek reimbursement for. This is critical to the operations of the organization as they are potentially facing bankruptcy in the near future.
In order to quickly get caught up and obtain reimbursement, Mary’s manager, Sandy has directed all coders to code the first diagnosis seen on the first page of the chart, rather than reviewing all of the documentation in the encounter for additional diagnoses that may increase revenue for each encounter.
Mary voices her concerns to Sandy that this may result in under-coding. If the coders could take the time to review the full documentation, they could maximize the potential amount of reimbursement for each encounter. Sandy argues that the coders do not have time for that and need to focus more on getting the charts done rather than checking for additional diagnoses. Sandy accuses Mary of being disobedient to Sandy’s authority and threatens disciplinary action if Mary does not comply with her instructions.
What should Mary do?
Milestones
Week 2 Select three cases and submit a summary explaining the cases you selected for the course project.
Week 4 Develop a 2-4 minute video discussing why leadership should demonstrate ethical behavior.
Week 7 Course Project
