This document discusses codes of ethics and institutional ethics structures in healthcare organizations. It begins by outlining the key learning objectives which focus on understanding the importance of codes of ethics and how they reflect an organization's values. It then discusses the role of codes of ethics in shaping an organization's moral identity and standards of conduct. The document provides examples of codes from the American Medical Association and Trinity Health. It emphasizes that codes of ethics should apply to all healthcare workers and cover areas like cultural competence, privacy, and nondiscrimination. Institutional ethics committees and review boards also help address ethical issues.
Ethics and Corporate Social ResponsibilityLearning Objec.docxhumphrieskalyn
Ethics and Corporate Social
Responsibility
Learning Objectives
After reading this chapter, you should be able to:
• Discuss the differences among ethics, morals, and values.
• Describe the purpose of the American College of Healthcare Executives code of ethics.
• Demonstrate an understanding of ethical issues and behavior.
• Analyze the various unethical behaviors that tempt managers and HSOs.
• Identify ethical dilemmas and an approach to coping with them.
• Discuss the nature of corporate social responsibility (CSR) and the role of HSOs in being econom-
ically, legally, ethically, philanthropically, and environmentally responsible.
Chapter 10
Boris Lyubner/Illustration Works/Getty Images
spa81202_10_c10.indd 279 1/15/14 3:51 PM
CHAPTER 10Section 10.1 Ethics, Morals, and Values
Ethics and socially acceptable ethical behavior should be embedded into the way people
are brought up and the way healthcare business and clinical students are trained. But the
sad fact is that unethical behavior does occur in HSOs more than it should. This chapter
will clarify the distinctions between ethics, morality, and values, what unethical behavior
is and is not, situations that make it difficult to be ethical and how to cope with them, and
the degree to which ethics can be taught.
The chapter also discusses corporate social responsibility (CSR)—what it is and the
extent to which HSOs have a duty to be socially responsible. Finally, the physical envi-
ronment (air, land, water) is—or should be—an important stakeholder for HSOs. What
does the responsibility to safeguard the environment mean, and what role should orga-
nizations play?
10.1 Ethics, Morals, and Values
The terms ethics, morals, and values are often confused or used interchangeably in every-
day speech. Before discussing ethics in more detail, it is important to establish definitions
of what each means and the differences among them. A traditional definition of ethics is
the art and discipline of applying principles to analyze and resolve moral dilemmas
(Rossy, 2011).
The Josephson Institute of Ethics, a
nonprofit organization based in Los
Angeles, defines ethics differently
but perhaps more aptly for the busi-
ness world: “Ethics is about how we
meet the challenge of doing the right
thing when that will cost more than
we want to pay” (quoted in Maxwell,
2003, pp. 23–24).
This definition gets to the heart of
why “doing the right thing” is some-
times so difficult: We are unaware
of the associated cost. The Institute
breaks down the definition into two
parts: (1) the ability to discern right from wrong and (2) the commitment to do what is
right and good (Maxwell, 2003). People and organizations need to develop a standard to
follow and possess the will to uphold it, an ongoing struggle for both. This struggle is
evidenced by recent studies suggesting that hospitals aggressively pursuing programs to
reduce surgical complications could experience a ne.
Ethics and Corporate Social ResponsibilityLearning Objec.docxhumphrieskalyn
Ethics and Corporate Social
Responsibility
Learning Objectives
After reading this chapter, you should be able to:
• Discuss the differences among ethics, morals, and values.
• Describe the purpose of the American College of Healthcare Executives code of ethics.
• Demonstrate an understanding of ethical issues and behavior.
• Analyze the various unethical behaviors that tempt managers and HSOs.
• Identify ethical dilemmas and an approach to coping with them.
• Discuss the nature of corporate social responsibility (CSR) and the role of HSOs in being econom-
ically, legally, ethically, philanthropically, and environmentally responsible.
Chapter 10
Boris Lyubner/Illustration Works/Getty Images
spa81202_10_c10.indd 279 1/15/14 3:51 PM
CHAPTER 10Section 10.1 Ethics, Morals, and Values
Ethics and socially acceptable ethical behavior should be embedded into the way people
are brought up and the way healthcare business and clinical students are trained. But the
sad fact is that unethical behavior does occur in HSOs more than it should. This chapter
will clarify the distinctions between ethics, morality, and values, what unethical behavior
is and is not, situations that make it difficult to be ethical and how to cope with them, and
the degree to which ethics can be taught.
The chapter also discusses corporate social responsibility (CSR)—what it is and the
extent to which HSOs have a duty to be socially responsible. Finally, the physical envi-
ronment (air, land, water) is—or should be—an important stakeholder for HSOs. What
does the responsibility to safeguard the environment mean, and what role should orga-
nizations play?
10.1 Ethics, Morals, and Values
The terms ethics, morals, and values are often confused or used interchangeably in every-
day speech. Before discussing ethics in more detail, it is important to establish definitions
of what each means and the differences among them. A traditional definition of ethics is
the art and discipline of applying principles to analyze and resolve moral dilemmas
(Rossy, 2011).
The Josephson Institute of Ethics, a
nonprofit organization based in Los
Angeles, defines ethics differently
but perhaps more aptly for the busi-
ness world: “Ethics is about how we
meet the challenge of doing the right
thing when that will cost more than
we want to pay” (quoted in Maxwell,
2003, pp. 23–24).
This definition gets to the heart of
why “doing the right thing” is some-
times so difficult: We are unaware
of the associated cost. The Institute
breaks down the definition into two
parts: (1) the ability to discern right from wrong and (2) the commitment to do what is
right and good (Maxwell, 2003). People and organizations need to develop a standard to
follow and possess the will to uphold it, an ongoing struggle for both. This struggle is
evidenced by recent studies suggesting that hospitals aggressively pursuing programs to
reduce surgical complications could experience a ne.
Chapter 4
Healthcare Marketing Ethics Considered
Healthcare ethics refers to moral standards of clinical and administrative conduct that affect healthcare stakeholders. Stakeholders are people, groups, and organizations that “hold a stake” in an enterprise and are affected by the conduct of people in that enterprise. In the case study, stakeholders included the patients who underwent the hand therapy, the coder who was told to bill for the treatment, other salaried providers and staff at the SportsMed clinic, the three physicians who had previously owned the clinic, the clinic’s leadership team, the employees of AMU, AMU itself, and the general public.
In everyday life, individuals’ personal moral codes guide their behaviors and actions. At times, people must seriously consider whether actions they are contemplating violate those codes. Exhibit 4.1 categorizes example behaviors/actions in one of four quadrants to illustrate their legal/ethical status. (While Exhibit 4.1 is substantively in the public domain, it is possibly based on ethics professor and management consultant Verne Henderson’s (1982) concentric circle model, which illustrates how ethics may be conceptualized in business.) Behaviors/actions may be unethical and illegal, ethical and legal, unethical but legal, or ethical but illegal. Stealing drugs is wrong; providing a patient with expert care is right. However, controversial topics, such as assisted suicide and expediting a celebrity’s organ transplant, provoke debate. Whether these latter two examples are right or wrong is not as clear.
Beginning with the Hippocratic Oath, healthcare is governed by ethical codes of clinical conduct. Each of the clinical professions has a specific professional code of eth- ics that spells out ethical/professional standards of conduct/behavior for its members. Examples include:
the American Medical Association’s (AMA) Code of Medical Ethics for physicians (www.ama-assn.org), and
the American Physical Therapy Association’s (APTA) Code of Ethics for the Physical Therapist (www.apta.org).
Administrative and managerial professionals in the healthcare environment also have specific professional codes of ethics. Coding and marketing professionals are two examples:
◆ For coders, the American Health Information Management Association (AHIMA) not only has a code of ethics but also outlines expectations for ethical decision making in the workplace (www.ahima.org). AHIMA’s framework is reproduced in Exhibit 4.2. Moreover, AHIMA provides case studies to assist its members’ ethical decision making in the workplace. The case studies illustrate work situations in which ethics had a role and show how the professional addressed the situation.
◆ For healthcare marketers, the American College of Healthcare Executives (ACHE) provides a code of ethics and a process to assist with ethical decision making (www.ache.org).
While AMA and APTA focus on clinical behaviors and AHIMA and ACHE center on administrative an ...
2DOING THE RIGHT THINGEthical Behavior and Social Responsi.docxgilbertkpeters11344
2
DOING THE RIGHT THING
Ethical Behavior and Social Responsibilities
in Today’s Health Care Workplace
Starting Point
Go to www.wiley.com/college/Lombardi to assess your knowledge of the
basics of ethics in health care.
Determine where you need to concentrate your effort.
What You’ll Learn in This Chapter
▲ Common types of ethical dilemmas
▲ Four ways to respond to ethical dilemmas
▲ Common rationalizations for unethical behavior
▲ Three influences on a person’s ethics
▲ Three ways to encourage high ethical standards
▲ Socially responsible responses to difficult situations
After Studying This Chapter, You’ll Be Able To
▲ Demonstrate ethics and socially responsible behavior
▲ Analyze typical ethical dilemmas
▲ Practice health care-specific ethical considerations
▲ Use the seven-step process for ethical decision making
▲ Compare the three common influences on an individual’s ethics
▲ Distinguish between ethics and social responsibility
▲ Examine ways to incorporate social responsibility into today’s workplace
Goals and Outcomes
▲ Master the terminology related to ethical and socially responsible behavior
▲ Recognize common ethical dilemmas and responses
▲ Compare the four views on ethical behavior
▲ Analyze the reasons behind an ethical choice
▲ Formulate ethical responses
▲ Propose ways to encourage high ethical standards and behavior
▲ Evaluate ethical dilemmas and possible responses
2061T_c02_032-051.QXD 7/20/06 7:24 PM Page 32
2.1.1 IDENTIFYING ETHICAL DILEMMAS 33
INTRODUCTION
Often ambiguous and unexpected, ethical dilemmas are part of the challenge of
working in today’s health care organization. While individuals approach ethical
questions differently and generate their own unique responses, a basic framework
for ethical decision making does exist and can be a useful tool for health care man-
agers. Throughout the decision-making process, managers need to be aware of what
influences their ethics. Proactive managers can establish and encourage high ethi-
cal standards. Socially responsible behavior extends beyond ethics, encouraging
health care managers to make a difference in patients’ lives and the world at large.
2.1 Acting Ethically
Ethics are a collection of moral principles that set standards of good or bad, or
right or wrong, in one’s conduct and thereby guide the behavior of a person or
group within an organization.1 Ethics help people make choices among alterna-
tive courses of action. Ethical behavior is what is accepted to be “good” and
“right” as opposed to “bad” or “wrong” in the context of the governing moral
code. For example, is it ethical to
▲ take longer than necessary to do a job?
▲ make personal telephone calls on company time?
▲ call in sick and then take the day off for leisure activities?
▲ fail to report rule violations by a co-worker?
None of these acts is strictly illegal, but many people consider one or more of
them to be unethical. Indeed, most ethical problems arise when people are asked
to do .
READINGSIntroductionUnit II examines ethical, legal, and .docxsedgar5
READINGS:
Introduction
Unit II
examines ethical, legal, and legislative issues affecting leadership and management as well as professional advocacy. This chapter focuses on applied ethical decision making as a critical leadership role for managers.
Chapter 5
examines the impact of legislation and the law on leadership and management, and
Chapter 6
focuses on advocacy for patients and subordinates and for the nursing profession in general.
Ethics
is the systematic study of what a person’s conduct and actions should be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person’s life and relationships should be, not necessarily what they are. Ethics is a system of moral conduct and principles that guide a person’s actions in regard to right and wrong and in regard to oneself and society at large.
Ethics is concerned with doing the right thing, although it is not always clear what that is.
Applied ethics
requires application of normative ethical theory to everyday problems. The normative ethical theory for each profession arises from the purpose of the profession. The values and norms of the nursing profession, therefore, provide the foundation and filter from which ethical decisions are made. The nurse-manager, however, has a different ethical responsibility than the clinical nurse and does not have as clearly defined a foundation to use as a base for ethical reasoning.
In addition, because management is a discipline and not a profession, its purpose is not as clearly defined as medicine or law; therefore, the norms that guide ethical decision making are less clear. Instead, the organization reflects norms and values to the manager, and the personal values of managers are reflected through the organization. The manager’s ethical obligation is tied to the organization’s purpose, and the purpose of the organization is linked to the function that it fills in society and the constraints society places on it. So, the responsibilities of the nurse-manager emerge from a complex set of interactions.
Society helps define the purposes of various institutions, and the purposes, in turn, help ensure that the institution fulfills specific functions. However, the specific values and norms in any institution determine the focus of its resources and shape its organizational life. The values of people within institutions influence actual management practice. In reviewing this set of complex interactions, it becomes evident that arriving at appropriate ethical management decisions can be a difficult task.
In addition,
nursing management ethics
are distinct from
clinical nursing ethics
. Although significant research exists regarding ethical dilemmas and moral distress experienced by staff nurses in clinical roles, less research exists regarding the ethical distress experienced by nursing managers.
Nursing management ethics are also distinct from other areas of m.
4.1 EXPLORING INCENTIVE PAY4-1 Explore the incentive pay a.docxlorainedeserre
4.1 EXPLORING INCENTIVE PAY
4-1 Explore the incentive pay approach.
Incentive pay
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/bm01#bm01goss212) or
variable pay
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/bm01#bm01goss462)
rewards employees for partially or completely attaining a predetermined work objective.
Incentive or variable pay is defined as compensation, other than base wages or salaries that
fluctuate according to employees’ attainment of some standard, such as a preestablished
formula, individual or group goals, or company earnings.
Effective incentive pay systems are based on three assumptions:
Individual employees and work teams differ in how much they contribute to the
company, both in what they do as well as in how well they do it.
The company’s overall performance depends to a large degree on the performance of
individuals and groups within the company.
To attract, retain, and motivate high performers and to be fair to all employees, a
company needs to reward employees on the basis of their relative performance.
Much like seniority and merit pay approaches, incentive pay augments employees’ base pay,
but incentive pay appears as a one-time payment. Employees usually receive a combination
of recurring base pay and incentive pay, with base pay representing the greater portion of
core compensation. More employees are presently eligible for incentive pay than ever before,
as companies seek to control costs and motivate personnel continually to strive for exemplary
performance. Companies increasingly recognize the importance of applying incentive pay
programs to various kinds of employees as well, including production workers, technical
employees, and service workers.
Some companies use incentive pay extensively. Lincoln Electric Company, a manufacturer of
welding machines and motors, is renowned for its use of incentive pay plans. At Lincoln
Electric, production employees receive recurring base pay as well as incentive pay. The
company determines incentive pay awards according to five performance criteria: quality,
output, dependability, cooperation, and ideas. The company has awarded incentive payments
every year since 1934, through prosperous and poor economic times. In 2014, the average
profit sharing payment per employee was $33,984.
Coupled with average base
pay, total core compensation for Lincoln employees was $82,903. Over the past 10 years,
Lincoln’s profit-sharing payments averaged approximately 40 percent of annual salary.
1
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end1)
2
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end2)
3
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end3)
4
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end4)
4.1 Exploring Incentive Pay
4/15/20, 8:49 PM
Page 1 ...
More Related Content
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Chapter 4
Healthcare Marketing Ethics Considered
Healthcare ethics refers to moral standards of clinical and administrative conduct that affect healthcare stakeholders. Stakeholders are people, groups, and organizations that “hold a stake” in an enterprise and are affected by the conduct of people in that enterprise. In the case study, stakeholders included the patients who underwent the hand therapy, the coder who was told to bill for the treatment, other salaried providers and staff at the SportsMed clinic, the three physicians who had previously owned the clinic, the clinic’s leadership team, the employees of AMU, AMU itself, and the general public.
In everyday life, individuals’ personal moral codes guide their behaviors and actions. At times, people must seriously consider whether actions they are contemplating violate those codes. Exhibit 4.1 categorizes example behaviors/actions in one of four quadrants to illustrate their legal/ethical status. (While Exhibit 4.1 is substantively in the public domain, it is possibly based on ethics professor and management consultant Verne Henderson’s (1982) concentric circle model, which illustrates how ethics may be conceptualized in business.) Behaviors/actions may be unethical and illegal, ethical and legal, unethical but legal, or ethical but illegal. Stealing drugs is wrong; providing a patient with expert care is right. However, controversial topics, such as assisted suicide and expediting a celebrity’s organ transplant, provoke debate. Whether these latter two examples are right or wrong is not as clear.
Beginning with the Hippocratic Oath, healthcare is governed by ethical codes of clinical conduct. Each of the clinical professions has a specific professional code of eth- ics that spells out ethical/professional standards of conduct/behavior for its members. Examples include:
the American Medical Association’s (AMA) Code of Medical Ethics for physicians (www.ama-assn.org), and
the American Physical Therapy Association’s (APTA) Code of Ethics for the Physical Therapist (www.apta.org).
Administrative and managerial professionals in the healthcare environment also have specific professional codes of ethics. Coding and marketing professionals are two examples:
◆ For coders, the American Health Information Management Association (AHIMA) not only has a code of ethics but also outlines expectations for ethical decision making in the workplace (www.ahima.org). AHIMA’s framework is reproduced in Exhibit 4.2. Moreover, AHIMA provides case studies to assist its members’ ethical decision making in the workplace. The case studies illustrate work situations in which ethics had a role and show how the professional addressed the situation.
◆ For healthcare marketers, the American College of Healthcare Executives (ACHE) provides a code of ethics and a process to assist with ethical decision making (www.ache.org).
While AMA and APTA focus on clinical behaviors and AHIMA and ACHE center on administrative an ...
2DOING THE RIGHT THINGEthical Behavior and Social Responsi.docxgilbertkpeters11344
2
DOING THE RIGHT THING
Ethical Behavior and Social Responsibilities
in Today’s Health Care Workplace
Starting Point
Go to www.wiley.com/college/Lombardi to assess your knowledge of the
basics of ethics in health care.
Determine where you need to concentrate your effort.
What You’ll Learn in This Chapter
▲ Common types of ethical dilemmas
▲ Four ways to respond to ethical dilemmas
▲ Common rationalizations for unethical behavior
▲ Three influences on a person’s ethics
▲ Three ways to encourage high ethical standards
▲ Socially responsible responses to difficult situations
After Studying This Chapter, You’ll Be Able To
▲ Demonstrate ethics and socially responsible behavior
▲ Analyze typical ethical dilemmas
▲ Practice health care-specific ethical considerations
▲ Use the seven-step process for ethical decision making
▲ Compare the three common influences on an individual’s ethics
▲ Distinguish between ethics and social responsibility
▲ Examine ways to incorporate social responsibility into today’s workplace
Goals and Outcomes
▲ Master the terminology related to ethical and socially responsible behavior
▲ Recognize common ethical dilemmas and responses
▲ Compare the four views on ethical behavior
▲ Analyze the reasons behind an ethical choice
▲ Formulate ethical responses
▲ Propose ways to encourage high ethical standards and behavior
▲ Evaluate ethical dilemmas and possible responses
2061T_c02_032-051.QXD 7/20/06 7:24 PM Page 32
2.1.1 IDENTIFYING ETHICAL DILEMMAS 33
INTRODUCTION
Often ambiguous and unexpected, ethical dilemmas are part of the challenge of
working in today’s health care organization. While individuals approach ethical
questions differently and generate their own unique responses, a basic framework
for ethical decision making does exist and can be a useful tool for health care man-
agers. Throughout the decision-making process, managers need to be aware of what
influences their ethics. Proactive managers can establish and encourage high ethi-
cal standards. Socially responsible behavior extends beyond ethics, encouraging
health care managers to make a difference in patients’ lives and the world at large.
2.1 Acting Ethically
Ethics are a collection of moral principles that set standards of good or bad, or
right or wrong, in one’s conduct and thereby guide the behavior of a person or
group within an organization.1 Ethics help people make choices among alterna-
tive courses of action. Ethical behavior is what is accepted to be “good” and
“right” as opposed to “bad” or “wrong” in the context of the governing moral
code. For example, is it ethical to
▲ take longer than necessary to do a job?
▲ make personal telephone calls on company time?
▲ call in sick and then take the day off for leisure activities?
▲ fail to report rule violations by a co-worker?
None of these acts is strictly illegal, but many people consider one or more of
them to be unethical. Indeed, most ethical problems arise when people are asked
to do .
READINGSIntroductionUnit II examines ethical, legal, and .docxsedgar5
READINGS:
Introduction
Unit II
examines ethical, legal, and legislative issues affecting leadership and management as well as professional advocacy. This chapter focuses on applied ethical decision making as a critical leadership role for managers.
Chapter 5
examines the impact of legislation and the law on leadership and management, and
Chapter 6
focuses on advocacy for patients and subordinates and for the nursing profession in general.
Ethics
is the systematic study of what a person’s conduct and actions should be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person’s life and relationships should be, not necessarily what they are. Ethics is a system of moral conduct and principles that guide a person’s actions in regard to right and wrong and in regard to oneself and society at large.
Ethics is concerned with doing the right thing, although it is not always clear what that is.
Applied ethics
requires application of normative ethical theory to everyday problems. The normative ethical theory for each profession arises from the purpose of the profession. The values and norms of the nursing profession, therefore, provide the foundation and filter from which ethical decisions are made. The nurse-manager, however, has a different ethical responsibility than the clinical nurse and does not have as clearly defined a foundation to use as a base for ethical reasoning.
In addition, because management is a discipline and not a profession, its purpose is not as clearly defined as medicine or law; therefore, the norms that guide ethical decision making are less clear. Instead, the organization reflects norms and values to the manager, and the personal values of managers are reflected through the organization. The manager’s ethical obligation is tied to the organization’s purpose, and the purpose of the organization is linked to the function that it fills in society and the constraints society places on it. So, the responsibilities of the nurse-manager emerge from a complex set of interactions.
Society helps define the purposes of various institutions, and the purposes, in turn, help ensure that the institution fulfills specific functions. However, the specific values and norms in any institution determine the focus of its resources and shape its organizational life. The values of people within institutions influence actual management practice. In reviewing this set of complex interactions, it becomes evident that arriving at appropriate ethical management decisions can be a difficult task.
In addition,
nursing management ethics
are distinct from
clinical nursing ethics
. Although significant research exists regarding ethical dilemmas and moral distress experienced by staff nurses in clinical roles, less research exists regarding the ethical distress experienced by nursing managers.
Nursing management ethics are also distinct from other areas of m.
4.1 EXPLORING INCENTIVE PAY4-1 Explore the incentive pay a.docxlorainedeserre
4.1 EXPLORING INCENTIVE PAY
4-1 Explore the incentive pay approach.
Incentive pay
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/bm01#bm01goss212) or
variable pay
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/bm01#bm01goss462)
rewards employees for partially or completely attaining a predetermined work objective.
Incentive or variable pay is defined as compensation, other than base wages or salaries that
fluctuate according to employees’ attainment of some standard, such as a preestablished
formula, individual or group goals, or company earnings.
Effective incentive pay systems are based on three assumptions:
Individual employees and work teams differ in how much they contribute to the
company, both in what they do as well as in how well they do it.
The company’s overall performance depends to a large degree on the performance of
individuals and groups within the company.
To attract, retain, and motivate high performers and to be fair to all employees, a
company needs to reward employees on the basis of their relative performance.
Much like seniority and merit pay approaches, incentive pay augments employees’ base pay,
but incentive pay appears as a one-time payment. Employees usually receive a combination
of recurring base pay and incentive pay, with base pay representing the greater portion of
core compensation. More employees are presently eligible for incentive pay than ever before,
as companies seek to control costs and motivate personnel continually to strive for exemplary
performance. Companies increasingly recognize the importance of applying incentive pay
programs to various kinds of employees as well, including production workers, technical
employees, and service workers.
Some companies use incentive pay extensively. Lincoln Electric Company, a manufacturer of
welding machines and motors, is renowned for its use of incentive pay plans. At Lincoln
Electric, production employees receive recurring base pay as well as incentive pay. The
company determines incentive pay awards according to five performance criteria: quality,
output, dependability, cooperation, and ideas. The company has awarded incentive payments
every year since 1934, through prosperous and poor economic times. In 2014, the average
profit sharing payment per employee was $33,984.
Coupled with average base
pay, total core compensation for Lincoln employees was $82,903. Over the past 10 years,
Lincoln’s profit-sharing payments averaged approximately 40 percent of annual salary.
1
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end1)
2
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end2)
3
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end3)
4
(http://content.thuzelearning.com/books/Martocchio.7916.16.1/sections/ch04lev1sec11#ch04end4)
4.1 Exploring Incentive Pay
4/15/20, 8:49 PM
Page 1 ...
38 u December 2017 January 2018The authorities beli.docxlorainedeserre
38 u December 2017 / January 2018
T
he authorities believe he slipped across the United States-Mexico
border sometime during the summer of 2016, likely deep in the
night. He carried no papers. The crossing happened in the rugged
backcountry of southeastern Arizona, where the main deterrent to
trespassers is the challenging nature of the terrain—not the metal
walls, checkpoints, and aerial surveillance that dominate much of the border.
But the border crosser was des-
ert-hardy and something of an expert
at camouflage. No one knows for cer-
tain how long he’d been in the United
States before a motion-activated cam-
era caught him walking a trail in the
Dos Cabezas Mountains on the night
of November 16. When a government
agency retrieved the photo in late Feb-
ruary, the image was plastered across
Arizona newspapers, causing an imme-
diate sensation.
The border crosser was a jaguar.
Jaguars once roamed throughout
the southwestern United States, but
are now quite rare. A core population
resides in the mountains of northern
Mexico, and occasionally an adventur-
ous jaguar will venture north of the bor-
der. When one of these elusive, graceful
cats makes an appearance stateside,
Mrill Ingram is The Progressive’s online media editor.
‘The Border Is
a Beautiful Place’
For Many, Both Sides of the
Arizona-Mexico Border Are Home
B
O
R
D
ER
A
R
TS
C
O
R
R
ID
O
R
By Mrill Ingram
Artists Ana Teresa Fernández in Agua Prieta, Mexico, and Jenea Sanchez in Douglas, Arizona, worked with dozens of community members to paint sections
of the border fence sky blue, “erasing” it as a symbolic act of resistance against increasing violence and oppression of human rights along the border.
https://apnews.com/79c83219af724016b8cfa2c505018ac4/agency-reports-rare-jaguar-sighting-mountains-arizona
The Progressive u 39
usually via a motion-triggered camera,
it may get celebrity status.
“We’ve had positive identifications
of seven cats, alive and well, in the last
twenty years in the United States,” says
Diana Hadley of the Mexico-based
Northern Jaguar Project, which works
with people in both countries to pro-
tect the big cat. One of those cats be-
came known as El Jefe, after he took
up residence in 2011 in the Santa Rita
Mountains south of Tucson, Arizona.
His presence was proof that the United
States still had enough wild habitat to
support a jaguar.
The new cat was especially excit-
ing because, based on size and shape,
observers initially thought it might
be female. “A lot of people in Arizona
would be very happy to have jaguars
from Mexico breeding in Arizona,” re-
marks Hadley.
In September 2017, the Arizo-
na-based Center for Biological Di-
versity released new video of the cat,
apparently a male, caught on a mo-
tion-triggered camera ambling through
the oak scrub forest in the Chiricahua
Mountains. He’s been named Sombra,
or Shadow, by schoolkids in Tucson.
Such things will no longer ...
3Prototypes of Ethical ProblemsObjectivesThe reader shou.docxlorainedeserre
3
Prototypes of Ethical Problems
Objectives
The reader should be able to:
• Recognize an ethical question and distinguish it from a strictly clinical or legal one.
• Identify three component parts of any ethical problem.
• Describe what an agent is and, more importantly, what it is to be a moral agent.
• Name two prototypical ethical problems.
• Distinguish between two varieties of moral distress.
• Compare the fundamental difference between moral distress and an ethical dilemma.
• Describe the role of emotions in moral distress and ethical dilemmas.
• Describe a type of ethical dilemma that challenges a professional’s desire (and duty) to treat everyone fairly and equitably.
• Discuss the role of locus of authority considerations in ethical problem solving.
• Identify four criteria to assist in deciding who should assume authority for a specific ethical decision to achieve a caring response.
• Describe how shared agency functions in ethical problem solving.
NEW TERMS AND IDEAS YOU WILL ENCOUNTER IN THIS CHAPTER
legal question
disability benefits
ethical question
prototype
clinical question
agent
moral agent
locus of authority
shared agency
moral distress
moral residue
ethical dilemma
Topics in this chapter introduced in earlier chapters
Topic
Introduced in chapter
Ethical problem
1
Integrity
1
Interprofessional care team
1
Professional responsibility
2
A caring response
2
Accountability
2
Social determinants of care
2
Justice
2
Introduction
You have come a long way already and are prepared to take the next steps toward becoming skilled in the art of ethical decision making. The first part of this chapter guides you through an inquiry regarding how to know when you are faced with an ethical question instead of (or in addition to) a clinical or legal question. A further question is raised: How do you know whether the situation that raised the question is a problem that requires your involvement? This chapter helps you prepare to answer that question too. You will learn the basic components of an ethical problem and be introduced to two prototypes of ethical problems. We start with the story of Bill Boyd and Kate Lindy.
 The Story of Bill Boyd and Kate Lindy
Bill Boyd is a 25-year-old soldier who lives in a large city. Bill served in the U.S. Army for more than 6 years and was deployed to both Iraq and Afghanistan for multiple military missions in the past 4 years. During his final deployment, Bill suffered a blast injury in which he sustained significant shoulder and neck trauma and a mild traumatic brain injury (TBI) and posttraumatic stress. He was treated in an inpatient military hospital and transitioned back to his hometown, where he moved into his childhood home with his mother.
Kate Lindy is the outpatient psychologist who has been treating Bill for pain and posttraumatic stress. Bill is in a structured civilian reentry program. This competitive program is administered by a government subcontractor; its goal is to help in ...
4-5 Annotations and Writing Plan - Thu Jan 30 2111Claire Knaus.docxlorainedeserre
4-5 Annotations and Writing Plan - Thu Jan 30 21:11
Claire Knaus
Annotations:
Bekalu, M. A., McCloud, R. F., & Viswanath, K. (2019). Association of Social Media Use With Social Well-Being, Positive Mental Health, and Self-Rated Health: Disentangling Routine Use From Emotional Connection to Use. Health Education & Behavior, 46(2_suppl), 69S-80S. https://doi.org/10.1177/1090198119863768
It seems that this source is arguing the effect of social media on mental health. This source uses this evidence to support the argument: Provided studies focusing on why individuals use social media, types of social network platforms, and the value of social capital. A counterargument for this source is: Studies that focus more on statistical usage rather than emotion connection. Personally, I believe the source is doing a good job of supporting its arguments because it provides an abundance of study references and clearly portrays the information and intent. I think this source will be very helpful in supporting my argument because of the focus on emotional connection to social media and its effects on mental health.
Matsakis, L. (2019). How Pro-Eating Disorder Posts Evade Filters on Social Media. In Gale Opposing Viewpoints Online Collection. Farmington Hills, MI: Gale. (Reprinted from How Pro-Eating Disorder Posts Evade Filters on Social Media, Wired, 2018, June 13) Retrieved from https://link-gale-com.ezproxy.snhu.edu/apps/doc/UAZKKH366290962/OVIC?u=nhc_main&sid=OVIC&xid=2c90b7b5
It seems that this source is arguing that social media platforms are not doing enough to eliminate harmful pro-ED posts. This source uses this evidence to support the argument: Information about specific platforms and what they have done to moderate content, links for more information, and what constitutes as harmful content. A counterargument for this source is that it is too difficult for platforms to remove the content and to even find it. In addition, it is believed there may be harmful effects on vulnerable people posting this type of content. Personally, I believe the source is doing a good job of supporting its arguments because it provides opposing viewpoints as well as raising awareness of some of the dangers of social media posts. I think this source will be very helpful in supporting my argument because it provides information on specifically what is being done to moderate this type of content on social media, and what some of the difficulties in moderating are.
Investigators at University of Leeds Describe Findings in Eating Disorders (Pro-ana versus Pro-recovery: A Content Analytic Comparison of Social Media Users' Communication about Eating Disorders on Twitter and Tumblr). (2017, September 4). Mental Health Weekly Digest, 38. Retrieved from https://link-gale-com.ezproxy.snhu.edu/apps/doc/A502914419/OVIC?u=nhc_main&sid=OVIC&xid=5e60152f
It seems that this source is arguing that there are more positive, anti-anorexia posts on social media than harmful, pro-ED content. ...
3NIMH Opinion or FactThe National Institute of Mental Healt.docxlorainedeserre
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NIMH: Opinion or Fact
The National Institute of Mental Health (NIMH) was formed in 1946 and is one of 27 institutes that form the National Institute of Health (NIH) (NIMH, 2019). The mission of the NIMH is “To transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure.” (NIMH, 2019). There are many different mental illnesses discussed on the NIMH website to include Attention-Deficit/Hyperactivity Disorder (ADHD). The NIMH website about ADHD is effective at providing the public general information and meets the criteria of authority, objectivity, and currency.
The NIMH website about ADHD provides an overview of ADHD, discusses signs and symptoms, and risk factors. The NIMH continues with information about treatment and therapies. Information provided by the NIMH is intended for both children and adults. The NIMH concludes on the page with studies the public can join and more resources for the public such as booklets, brochures, research and clinical trials.
As described by Jim Kapoun authority can be identified by who or what institution/organization published the document and if the information in the document is cited correctly (Cornell, 2020). The information on the website is published by the NIMH which is the lead research institute related to mental health for the last 70 plus years (NIMH, 2019). On the page related to ADHD the NIMH references the program of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) and provides a hyperlink to access the resources available with the agency (NIMH,2019). This link can be found under the support groups section in the treatment and therapies. On the website to the right of the area describing inattention the NIMH has a section on research. In this block there is a link to “PubMed: Journal Articles about Attention Deficit Hyperactivity Disorder (ADHD)” which will take you to a search of the National Center for Biotechnology Information (NCBI) published by PubMed on ADHD (NIMH, 2019). Throughout the entire page the NIMH provides sources and hyperlinks to the sources as citations. Based on the reputation of the NIMH and the citations to the source material the website meets the criteria of authority.
According to Kapoun objectivity can be identified looking for areas where the author expresses his or her opinion (Cornell, 2020). Information provided on the NIMH page about ADHD does not express the opinion of the author. The author produces only factual information based on research. The NIMH makes it a point not to mention the names of medications when discussing treatments and only explains the medications fall in two categories stimulants and non-stimulants (NIMH, 2019). In this same area the NIMH provides hyperlinks to the NIMH Mental Health Medication and FDA website for information about medication. The extent at which the NIMH goes to not provide an opinion on the website meet ...
4.1
Updated April-09
Lecture Notes
Chapter 4
Enterprise Excellence
Implementation
ENTERPRISE EXCELLENCE
4.2
Updated April-09
Learning Objectives
• Management & Operations Plans
• Enterprise Excellence Projects
• Enterprise Excellence Project decision Process
• Planning the Enterprise Excellence Project
• Tollgate Reviews
• Project Notebook
4.3
Updated April-09
MANAGEMENT AND OPERATIONS PLANS
• The scope and complexity of the
implementation projects will vary from the
executive level, to the management level, to
the operational level
• Each plan, as it is developed and deployed,
will include projects to be accomplished
• Conflicts typically will occur amongst
requirements of quality, cost, and schedule
when executing a project
4.4
Updated April-09
ENTERPRISE EXCELLENCE PROJECTS
• An Enterprise Excellence project will be one of three
types:
1. Technology invention or innovation
2. New product, service, or process development
3. Product, service, or process improvement
• Enterprise Excellence uses the scientific method
• The scientific method is a process of organizing
empirical facts and their interrelationships in a
manner that allows a hypothesis to be developed and
tested
4.5
Updated April-09
ENTERPRISE EXCELLENCE PROJECTS
• The scientific method consists of the
following steps:
1. Observe and describe the situation
2. Formulate a hypothesis
3. Use the hypothesis to predict results
4. Perform controlled tests to confirm the hypothesis
4.6
Updated April-09
ENTERPRISE EXCELLENCE PROJECTS
• Figure 4.1 shows the project decision process
4.7
Updated April-09
ENTERPRISE EXCELLENCE PROJECT
DECISION PROCESS
• Inventing/Innovating Technology:
Technology development is accomplished using
system engineering
This system approach enables critical functional
parameters and responses to be quickly transferred
into now products, services, and processes
The process is a four-phase process (I2DOV):
Invention & Innovation – Develop – Optimize – Verify
4.8
Updated April-09
ENTERPRISE EXCELLENCE PROJECT
DECISION PROCESS
• Development of Products, Services, and
Processes
The Enterprise Excellence approach for developing
products, services, and processes is the Design for
Lean Six Sigma strategy.
This strategy helps to incorporate customer
requirements and expectations into the product
and/or service.
Concept – Design – Optimize - Verify (CDOV) is a
specific sequential design & development process
used to execute the design strategy.
4.9
Updated April-09
ENTERPRISE EXCELLENCE PROJECT
DECISION PROCESS
• Improving Products, Services, and Processes:
Improving products, services and processes usually
involves the effectiveness and efficiency of operations.
A product or service is said to be effective when it meets
all of its customer requirements.
Effectiveness can be simply expressed as "doing the
right things the first time ...
3Type your name hereType your three-letter and -number cours.docxlorainedeserre
3
Type your name here
Type your three-letter and -number course code here
The date goes here
Type instructor’s name here
Your Title Goes Here
This is an electronic template for papers written in GCU style. The purpose of the template is to help you follow the basic writing expectations for beginning your coursework at GCU. Margins are set at 1 inch for top, bottom, left, and right. The first line of each paragraph is indented a half inch (0.5"). The line spacing is double throughout the paper, even on the reference page. One space after punctuation is used at the end of a sentence. The font style used in this template is Times New Roman. The font size is 12 point. When you are ready to write, and after having read these instructions completely, you can delete these directions and start typing. The formatting should stay the same. If you have any questions, please consult with your instructor.
Citations are used to reference material from another source. When paraphrasing material from another source (such as a book, journal, website), include the author’s last name and the publication year in parentheses.When directly quoting material word-for-word from another source, use quotation marks and include the page number after the author’s last name and year.
Using citations to give credit to others whose ideas or words you have used is an essential requirement to avoid issues of plagiarism. Just as you would never steal someone else’s car, you should not steal his or her words either. To avoid potential problems, always be sure to cite your sources. Cite by referring to the author’s last name, the year of publication in parentheses at the end of the sentence, such as (George & Mallery, 2016), and page numbers if you are using word-for-word materials. For example, “The developments of the World War II years firmly established the probability sample survey as a tool for describing population characteristics, beliefs, and attitudes” (Heeringa, West, & Berglund, 2017, p. 3).
The reference list should appear at the end of a paper (see the next page). It provides the information necessary for a reader to locate and retrieve any source you cite in the body of the paper. Each source you cite in the paper must appear in your reference list; likewise, each entry in the reference list must be cited in your text. A sample reference page is included below; this page includes examples (George & Mallery, 2016; Heeringa et al., 2017; Smith et al., 2018; “USA swimming,” 2018; Yu, Johnson, Deutsch, & Varga, 2018) of how to format different reference types (e.g., books, journal articles, and a website). For additional examples, see the GCU Style Guide.
References
George, D., & Mallery, P. (2016). IBM SPSS statistics 23 step by step: A simple guide and reference. New York, NY: Routledge.
Heeringa, S. G., West, B. T., & Berglund, P. A. (2017). Applied survey data analysis (2nd ed.). New York, NY: Chapman & Hall/CRC Press.
Smith, P. D., Martin, B., Chewning, B., ...
3Welcome to Writing at Work! After you have completed.docxlorainedeserre
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Welcome to Writing at Work! After you have completed the reading for the week, write an email to introduce yourself to your peers. The name of your thread should be what you would include in the subject of the email.
As you compose your email, keep in mind the following:
· You are addressing a group you will work with in a professional capacity for at least 15 weeks. Let us know something about you, but don't share anything you wouldn't want repeated.
· You should include what you perceive to be your relative strengths with regard to writing at work. What types of tasks would you feel most comfortable taking on?
· You should also include what aspects of writing at work make you feel least comfortable. What types of tasks would you not be as suited for?
· What do you hope to learn in the next several months?
Next, in an attachment, choose one of the following two prompts and write a letter, taking into account the purpose, audience, and appropriate style for the task.
1. Your organization has been contracted to complete a project for an important client, and you were charged with managing the project. It has unfortunately become clear that your team will not meet the deadline. Your supervisor has told you to contact the client in writing to alert them to the situation and wants to be cc'd on the message. Write a letter, which you will send via email, addressing the above.
2. After a year-long working relationship, your organization will no longer be making use of a freelancer's services due to no fault of their own. Write a letter alerting them to this fact.
Name:
HRT 4760 Assignment 01
Timeliness
First, you will choose one particular organization where you will conduct each of your 15 different observational assignments. Stick with this same organization throughout your coursework. (Do not switch around assignment locations at different organizations or locations.) The reason for continuing your observational assignments at the same organization is to give you a deeper understanding of this particular organization across the 15 different assignments. As you read on, you will get a more complete understanding as to how these 15 assignments come together.
Tip: Many students choose the organization where they are currently working. This works particularly well. If you are working there, you have much opportunity to gain access to the areas that will give you a more complete understanding of the quality of entire service package (the 15 different elements) that the organization offers to its customers.
This is one of a package of 15 different assignments that comprise the Elements of Service, which you will study this term. For this assignment, you will observe elements of service in almost any particular service establishment. A few examples of service establishments would include, but not be limited to these: Hotel, resort, private club, restaurant, airline, cruise line, grocery store, doctor’s office, coffee house, and scores of oth ...
3JWI 531 Finance II Assignment 1TemplateHOW TO USE THIS TEMP.docxlorainedeserre
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JWI 531 Finance II Assignment 1Template
HOW TO USE THIS TEMPLATE:
This is a template and checklist corresponding to your Assignment 1 paper: Enterprise Risk Management and Moat Strength. See below for an explanation of the color-coding in this template:
· All green text includes instructions to support your writing. You should delete all green text before submitting your final paper.
· All blue text indicates areas where you need to replace text with your own information. Replace the blue text with your own words in black.
· Headings and subheadings are written in black, bold type. Keep these in your paper.
TIPS:
· Write in the third person, using “he” or “she” or “they”, or using specific names. Do not use the second person “you”.
· The body of this paper has one-inch margins and uses a professional font (size 10-12); we recommend Arial or Times New Roman fonts.
· The Assignment template is already formatted with all needed specifications like margins, appropriate font, and double spacing.
· Before submitting your paper, use Grammarly to check for punctuation and usage errors and make the required corrections. Then read aloud to edit for tone and flow.
· You should also run your paper through SafeAssign to ensure that it meets the required standards for originality.
FINALIZING YOUR PAPER
Your submission should be a maximum of 4 pages in length. The page count doesnotinclude the Cover Page at the beginning and the References page at the end. The final paper that you submit for grading should be in black text only with all remaining green text and blue text removed. Assignment 1: Enterprise Risk Analysis and Moat Strength
Author’s Name
Jack Welch Management Institute
Professor’s Name
JWI 531
Date
Introduction
An Introduction should be succinct and to the point. Start your Introduction with a general and brief observation about the paper’s topic. Write a thesis statement, which is the “road map” for your paper - it helps your reader to navigate your work. In your thesis statement, be specific about the major areas you plan to address in your paper.
The headings below should guide your introduction, since they identify the topics to be addressed in your paper. The introduction is not a graded part of your rubric but it helps your reader to understand what your assignment will be about. We recommend that you write this part of your Introduction after you complete the other sections of your paper. It only needs to be one paragraph in length.
Analysis and Recommendations
You must answer each of the following questions in your paper. Keep your responses focused on the topic. Straying off into additional areas, even if they are interesting, will not earn additional marks, and may actually detract from the clarity of your responses.
I. Where is each company in its corporate lifecycle (startup, growth, maturity or decline)? Explain.
Before writing your response to this question, make sure you understand what characterizes ea ...
3Big Data Analyst QuestionnaireWithin this document are fo.docxlorainedeserre
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Big Data Analyst Questionnaire
Within this document are four different questions. Each question is structured in the following manner:
1) Premise
- Contains any needed background information
2) Request
- The actual question, what you are to solve
3) Notes
- A space if you feel like including notes of any kind for the given question
Please place your answer for each question in a separate file, following this naming convention:
Name_Qn.docx, where n = the question number (i.e., 1, 2 ...). So the file for the first question should be named ‘Name_Q1.docx’.
When complete, please package everything together and send email responses to the designated POCs.
Page | 1
Premise:
You have a table named “TRADES” with the following six columns:
Column Name
Data Type
Description
Date
DATE
The calendar date on which the trade took place.
Firm
VARCHAR(255)
A symbol representing the Broker/Dealer who conducted the trade.
Symbol
VARCHAR(10)
The security traded.
Side
VARCHAR(1)
Denotes whether the trade was a buy (purchase) or a sell (sale) of a security.
Quantity
BIGINT
The number of shares involved in the trade.
Price
DECIMAL(18,8)
The dollar price per share traded.
You write a query looking for all trades in the month of August 2019. The query returns the following:
DATE
FIRM
SYMBOL
SIDE
QUANTITY
PRICE
8/5/2019
ABC
123
B
200
41
8/5/2019
CDE
456
B
601
60
8/5/2019
ABC
789
S
600
70
8/5/2019
CDE
789
S
600
70
8/5/2019
FGH
456
B
200
62
8/6/2019
3CDE
456
X
300
61
8/8/2019
ABC
123
B
300
40
8/9/2019
ABC
123
S
300
30
8/9/2019
FGH
789
B
2100
71
8/10/2019
CDE
456
S
1100
63
Questions:
1) Conduct an analysis of the data set returned by your query. Write a paragraph describing your analysis. Please also note any questions or assumptions made about this data.
2) Your business user asks you to show them a table output that includes an additional column categorizing the TRADES data into volume based Tiers, with a column named ‘Tier’. Quantities between 0-250 will be considered ‘Small’, quantities greater than ‘Small’ but less than or equal to 500 will be considered ‘Medium’, quantities greater than ‘Medium’ but less than or equal to 500 will be considered ‘Large’, and quantities greater than ‘Tier 3’ will be considered ‘Very Large’ .
a. Please write the SQL query you would use to add the column to the table output.
b. Please show the exact results you expect based on your SQL query.
3) Your business user asks you to show them a table output summarizing the TRADES data (Buy and Sell) on week-by-week basis.
a. Please write the SQL query you would use to query this table.
b. Please show the exact results you expect based on your SQL query.
Notes:
1
Premise:
You need to describe in writing how to accomplish a task. Your audience has never completed this task before.
Question:
In a few paragraphs, please describe how to complete a task of your choice. You may choose a task of your own liking or one of the sample tasks below:
1) How to make a p ...
3HR StrategiesKey concepts and termsHigh commitment .docxlorainedeserre
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HR Strategies
Key concepts and terms
High commitment management •
High performance management •
HR strategy •
High involvement management •
Horizontal fi t •
Vertical fi t •
On completing this chapter you should be able to defi ne these key concepts.
You should also understand:
Learning outcomes
T • he purpose of HR strategy
Specifi c HR strategy areas •
How HR strategy is formulated •
How the vertical integration of •
business and HR strategies is
achieved
How HR strategies can be set out •
General HR strategy areas •
The criteria for a successful HR •
strategy
The fundamental questions on •
the development of HR strategy
How horizontal fi t (bundling) is •
achieved
How HR strategies can be •
implemented
47
48 Human Resource Management
Introduction
As described in Chapter 2, strategic HRM is a mindset that leads to strategic actions and reac-
tions, either in the form of overall or specifi c HR strategies or strategic behaviour on the part
of HR professionals. This chapter focuses on HR strategies and answers the following ques-
tions: What are HR strategies? What are the main types of overall HR strategies? What are the
main areas in which specifi c HR strategies are developed? What are the criteria for an effective
HR strategy? How should HR strategies be developed? How should HR strategies be
implemented?
What are HR strategies?
HR strategies set out what the organization intends to do about its human resource manage-
ment policies and practices and how they should be integrated with the business strategy and
each other. They are described by Dyer and Reeves (1995) as ‘internally consistent bundles of
human resource practices’. Richardson and Thompson (1999) suggest that:
A strategy, whether it is an HR strategy or any other kind of management strategy must
have two key elements: there must be strategic objectives (ie things the strategy is sup-
posed to achieve), and there must be a plan of action (ie the means by which it is pro-
posed that the objectives will be met).
The purpose of HR strategies is to articulate what an organization intends to do about its
human resource management policies and practices now and in the longer term, bearing in
mind the dictum of Fombrun et al (1984) that business and managers should perform well in
the present to succeed in the future. HR strategies aim to meet both business and human needs
in the organization.
HR strategies may set out intentions and provide a sense of purpose and direction, but they are
not just long-term plans. As Gratton (2000) commented: ‘There is no great strategy, only great
execution.’
Because all organizations are different, all HR strategies are different. There is no such thing as
a standard strategy and research into HR strategy conducted by Armstrong and Long (1994)
and Armstrong and Baron (2002) revealed many variations. Some strategies are simply very
general declarations of intent. Others go into much more detail. ...
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Implementing Change
Construction workers on scaffolding.
hxdbzxy/iStock/Thinkstock
Learning Objectives
After reading this chapter, you should be able to do the following:
Summarize the nine steps in Ackerman and Anderson’s road map for change.
Analyze Cummings and Worley’s five dimensions of leading and managing change.
Describe how to align an organization with its new vision and future state.
Explain how roles/relationships and interventions are used to implement change.
Examine ways to interact with and influence stakeholders.
Change is the law of life and those who look only to the past or present are certain to miss the future.
—John F. Kennedy
Alan Mulally was selected to lead Ford in 2006 after he was bypassed as CEO at Boeing, where he had worked and was expected to become CEO. Insiders and top-level managers at Ford, some of whom had expected to become CEO, were initially suspicious and then outraged when Mulally was hired. They questioned what someone from the airplane industry would know about the car business (Kiley, 2009).
Chair William (Bill) Clay Ford, Jr.—who selected Mulally as CEO—told Ford’s officers that the company needed a fresh perspective and a shake-up, especially since it had lost $14.8 billion in 2008—the most in its 105-year history—and had burned through $21.2 billion, or 61%, of its cash (Kiley, 2009). Because Ford knew that the company’s upper echelon culture was closed, bureaucratic, and rejected outsiders and new ways of thinking, he was not surprised by his officers’ reactions. However, Ford’s managers had no idea that the company was fighting for its life. To succeed, Mulally would need Chair Ford’s full endorsement and support, and he got it.
The company’s biggest cultural challenge was to break down the silos that various executives had built. As we will discuss more in Chapter 4, silos are specific processes or departments in an organization that work independently of each other without strong communication between or among them. A lack of communication can often stifle productivity and innovation, and this was exactly what was happening at Ford.
Mulally devised a turnaround strategy and developed it into the Way Forward Plan. The plan centralized and modernized plants to handle several models at once, to be sold in several markets. The plan was designed to break up the fiefdoms of isolated cultures, in which leaders independently developed and decided where to sell cars. Mulally’s plan also kept managers in positions for longer periods of time to deepen their expertise and improve consistency of operations. The manager who ran the Mazda Motor affiliate commented, “I’m going into my fourth year in the same job. I’ve never had such consistency of purpose before” (as cited in Kiley, 2009, “Meetings About Meetings,” para. 2).
Mulally’s leadership style involved evaluating and analyzing a situation using data and facts and then earning individuals’ support with his determinatio ...
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Assignment Three: Purpose of the study and Research Questions
RES 9300
Recently, Autism has become a serious health concern to parents. According to Center for Disease Control and Prevention (2018), about one in fifty nine United States children has been identified with autism spectrum disorder with one in six children developing developmental disability ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism (CDC,2018). World Health Organization (2019) estimates that 1 in 160 children globally has autism making it one of the most prevalent diseases. Despite the disease prevalence, most population has little knowledge about the disease. Many health practitioners have proposed early care as a means to control the disease effects.
Purpose Statement
The purpose of this study is to determine whether early intervention services can help improve the development of children suffering from autism. This study also aims to explore the general public awareness and perception about autism disorder.
Research Questions
(1) How should service delivery for autistic patients be improved to promote their health? (2) What impact does early intervention services have on development of children suffering from autism? (3) How can public knowledge on autism improve support and care for autistic patients? (4) What effect will early intervention have on patient’s social skills?
References
Center for Disease Control and Prevention. (2018). Autism Spectrum Disorder (ASD). Data & Statistics. Retrieved From https://www.cdc.gov/ncbddd/autism/data.html
World Health Organization. (2019). Autism Spectrum Disorders. Fact Sheet. Retrieved From https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders
3
Assignment Two: Theoretical Perspective and Literature Review
RES 9300
Literature Map
Parenting an Autism Child
(Dependent Variable)
9
Mothers/Father Role
Education
Religious Beliefs
Gender/Age
Financial Resources
Maternal Relationship
Region
Public Awareness
Support
Ethnicity
Independent Variables
Secondary Source I Will Be Using In My Literature Review
Mother/Father Roles
Glynn, K. A. (2015). Predictors of parenting practices in parents of children with autism spectrum disorder.
Religious Beliefs
Huang, C. Y., Yen, H. C., Tseng, M. H., Tung, L. C., Chen, Y. D., & Chen, K. L. (2014). Impacts of autistic behaviors, emotional and behavioral problems on parenting stress in caregivers of children with autism. Journal of Autism and Developmental Disorders, 44(6), 1383-1390.
Education
Brezis, R. S., Weisner, T. S., Daley, T. C., Singhal, N., Barua, M., & Chollera, S. P. (2015). Parenting a child with autism in India: Narratives before and after a parent–child intervention program. Culture, Medicine, and Psychiatry, 39(2), 277-298.
Financial Resources
Zaidm ...
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380067.docxby Jamie Feryll380067.docxORIGINALITY REPORT380067.docxWRITECHECK REPORT
380067
by Jamie Feryll
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380067by Jamie Feryll380067ORIGINALITY REPORT380067WRITECHECK REPORT
Interpretations of Iron Age Architecture Brochs in Society/Social Identity
Archaeology is a historical field which has advanced over the years based on more discoveries still being experienced by the archaeologists who seek them. According to Kelly and Thomas (2010; p.5), the concession that life existed in more ancient times than stipulated by biblical scholars and human culture allowed the archaeologists to dig deeper into genealogical data. Iron Age architecture and social/society identity relate to one another. For instance, the population, based on their identity and perception will construct buildings that directly reflect their beliefs. This essay will discuss these archaeological concepts of Iron Age architecture and society/social identity. Need a paragraph on brochs and how many and where they are across Scotland with patcialur focus on the atlantc region, this is not relevant for masters essay. Must define broch from its architecture and how long it would take to build and note famous ones and note the ones that will be referred to in this essay – this could be Perhaps incorpated into the next paragraph.
Iron Age architecture has over the years been dominated by differing archaeological concepts and debates. It was defined by settlements and settlement structures such as duns, brochs, wheelhouses, hillforts, stone-built round houses and timber. The social and societal identity which is identified through material remains indicates aspects of differentiation, regional patterns and segregation. According to Kelly and Thomas (2010; p.28), people who existed in Iron Age Scotland were isolated. This is demonstrated by the presence of a burial followed by an assembled chariot at Newbridge. Northern and western Scotland have been the source of the well-structured developments that have provided cultural, architectural and social data over time. Maes Howe, which is the largest Orkney burial cairn, located between Stromne ...
39Chapter 7Theories of TeachingIntroductionTheories of l.docxlorainedeserre
39
Chapter 7
Theories of Teaching
Introduction
Theories of learning are typically only useful to adult learning practitioners when they are applied to the facilitation of learning—a function assigned usually in our society to a person designated as teacher or trainer.
A distinction must be made between theories of learning and theories of teaching. Theories of learning deal with the ways in which people learn, whereas theories of teaching deal with the ways in which one person influences others to learn (Gage, 1972, p. 56).
Presumably, the learning theory subscribed to by a teacher will influence his or her teaching theory.
Early on, Hilgard resisted this fragmentation of learning theory. He identified 20 principles he believed to be universally acceptable from three different families of theories: Stimulus–Response (S–R) theory, cognitive theory, and motivation and personality theory. These principles are summarized in Table 7.1.
Hilgard’s conviction in his belief that his 20 principles would be “in large part acceptable to all parties” was grounded in his limited verification process. The “parties” with whom he checked out these principles were control-oriented theorists. In spite of their differences about the internal mechanics of learning, these theorists are fairly close in their conceptualization of the role of the teacher.
Table 7.1 Summary of Hilgard’s principles
Teaching Concepts Based on Animal and Child Learning Theories
Let’s examine the concepts of a variety of theories about the nature of teaching and the role of the teacher. First, we’ll look at the members of Hilgard’s jury. These include Thorndike, Guthrie, Skinner, Hull, Tolman, and Gagné.
Thorndike
Thorndike essentially saw teaching as the control of learning by the management of reward. The teacher and learner must know the characteristics of a good performance in order that practice may be appropriately arranged. Errors must be diagnosed so that they will not be repeated. The teacher is not primarily concerned with the internal states of the organism, but with structuring the situation so that rewards will operate to strengthen desired responses. The learner should be interested, problem-oriented, and attentive. However, the best way to obtain these conditions is to manipulate the learning situation so that the learner accepts the problem posed because of the rewards involved. Attention is maintained and appropriate S–R connections are strengthened through the precise application of rewards toward the goals set by the teacher. A teacher’s role is to cause appropriate S–R bonds to be built up in the learner’s behavior repertoire (Hilgard and Bower, 1966, pp. 22–23; Pittenger and Gooding, 1971, pp. 82–83).
Guthrie
Guthrie’s suggestions for teaching are summarized as follows:
1. If you wish to encourage a particular kind of behavior or discourage another, discover the cues leading to the behavior in question. In the one case, arrange the situation so that the desired be ...
38 Monthly Labor Review • June 2012TelecommutingThe.docxlorainedeserre
38 Monthly Labor Review • June 2012
Telecommuting
The hard truth about telecommuting
Telecommuting has not permeated the American workplace, and
where it has become commonly used, it is not helpful in reducing
work-family conflicts; telecommuting appears, instead, to have
become instrumental in the general expansion of work hours,
facilitating workers’ needs for additional worktime beyond the
standard workweek and/or the ability of employers to increase or
intensify work demands among their salaried employees
Mary C. Noonan
and
Jennifer L. Glass
Mary C. Noonan is an Associate
Professor at the Department of
Sociology, The University of Iowa;
Jennifer L. Glass is the Barbara
Bush Regents Professor of Liberal
Arts at the Department of Sociol-
ogy and Population Research
Center, University of Texas at
Austin. Email: [email protected]
uiowa.edu or [email protected]
austin.utexas.edu.
Telecommuting, defined here as work tasks regularly performed at home, has achieved enough
traction in the American workplace to
merit intensive scrutiny, with 24 percent
of employed Americans reporting in recent
surveys that they work at least some hours
at home each week.1 The definitions of
telecommuting are quite diverse. In this ar-
ticle, we define telecommuters as employ-
ees who work regularly, but not exclusively,
at home. In our definition, at-home work
activities do not need to be technologically
mediated nor do telecommuters need a
formal arrangement with their employer to
work at home.
Telecommuting is popular with policy
makers and activists, with proponents
pointing out the multiple ways in which
telecommuting can cut commuting time
and costs,2 reduce energy consumption
and traffic congestion, and contribute to
worklife balance for those with caregiving
responsibilities.3 Changes in the structure
of jobs that enable mothers to more effec-
tively compete in the workplace, such as
telecommuting, may be needed to finally
eliminate the gender gap in earnings and
direct more earned income to children,
both important public policy goals.4
Evidence also reveals that an increasing num-
ber of jobs in the American economy could be
performed at home if employers were willing
to allow employees to do so.5 Often, employees
can perform jobs at home without supervision
in the “high-tech” sector, in the financial sector,
and many in the communication sector that are
technology dependent. The obstacles or barriers
to telecommuting seem to be more organiza-
tional, stemming from the managers’ reluctance
to give up direct supervisory control of workers
and from their fears of shirking among workers
who telecommute.6
Where the impact of telecommuting has
been empirically evaluated, it seems to boost
productivity, decrease absenteeism, and increase
retention.7 But can telecommuting live up to its
promise as an effective work-family policy that
helps employees meet their nonwork responsi-
bilities? To do so, tel ...
%38
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SafeAssign Originality Report
Computer Security: Foundations - 201950 - CRN163 - Zavgren • Week Eight Assignment
%51Total Score: High riskSanthosh Muthyapu
Submission UUID: febbc9ef-e6b9-70f0-6bf0-fe171274dcc9
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51 %
Santhosh Muthyapu week 8.docx
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Submitted on
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10:16 AM EDT
Average Word Count
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Highest: Santhosh Muthyapu week 8.docx
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Running Head: INDUSTRIAL ESPIONAGE ALLEGED BY DAVID 1
INDUSTRIAL ESPIONAGE ALLEGED BY DAVID DOE 2
INDUSTRIAL ESPIONAGE ALLEGED BY DAVID Name: Santhosh Muthyapu Course: Computer Security: Foundations Date of Submission: 08/20//2019
The steps ought to have been taken in detecting Industrial Espionage Alleged by David Doe
David Doe was a network administrator for the ABC company. The ABC company ought to have taken various steps in detecting Industrial Espionage alleged by
David Doe. First, it should evaluate threat and risk data as well as log data from numerous sources, intending to acquire information about security that would
enhance instant response to security incidents. The manager should be in place to detect any warning signal. An instance is when David is unhappy since he is
passed over for promotion three times. The vital warning signs that a representative may have incorporates bringing home materials having a place with the
organization, being keen on things outside their duties, mainly that are related to the contender of the organization. However, David is alleged to have duplicated the
company’s research after quitting the company and starting his own consulting business (Ho & Hollister, J2015) To predict risks in the network traffic, and dangerous
malware, the company should install signature and behavior-based detection devices. Advanced Cyber Intrusion Detection enhance this. To enable immediate
response as soon as the alerts of faults, attacks, or misuse indications, there should be a correlation, analysis, and collection of server clients’ logs. For the
integrity of local systems, it is essential to ensure regular checks. It was necessary for intrusion finding (Jin & van Dijk, 2018). This involves an outline of possible
security liabilities in software and operating systems applications. Us ...
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
2. institutional review boards play an
important role in shaping and reinforcing a health care
organization’s moral identity. In this
chapter we will discuss how codes of ethics align with and
direct an organization’s moral
identity. We will also explore the parameters of codes of ethics,
as well as how to create and
implement them. Finally, we will examine some of the ethical
dilemmas that led to the cre-
ation of committees designed to deal proactively, as well as
reactively, with ethical issues that
health care organizations face.
3.1 Codes of Ethics
Codifying the behavior of individuals within a community has
ancient roots. The oldest dis-
covered physical evidence of a code of ethics was a rock
fragment containing the Code of
Hammurabi, the edict of King Hammurabi of Babylonia dating
back to around 1772 BCE.
The American Medical Association’s (AMA) first code of
ethics, established in 1847, defined
uniform standards for professional education, training, and
conduct, as well as established
that a physician’s main purpose was to obey the calls of the sick
(Baker & Emanuel, 2000).
The code was created with physicians and medical personnel in
mind and provided strict
guidelines on how these employees should conduct themselves
with patients, with fellow
physicians, with the public, and within their profession in
general (American Medical Asso-
ciation [AMA], 2017).
While an institutional code of ethics, or code of conduct, should
ideally be prescriptive in its
4. resale or redistribution.
Section 3.1Codes of Ethics
• Communicate respectfully—whether in agreement or
disagreement.
• Create an environment which values diverse points of view
and experience.
• Foster an environment of openness without fear of reprisal.
We are fully present.
• Set aside distractions to be present.
• Seek first to understand, then be understood.
• Openly appreciate the gifts and contributions of others.
• Create a healthy balance between personal and professional
life.
• Contribute to a positive, optimistic and fun environment.
We are all accountable.
• Focus on finding solutions, not blame.
• Lead by positive, motivating example.
• Accept responsibility for his or her decisions and actions.
• Hold self accountable for the success of the larger
organization—across boundaries.
• Focus on the high payoff items.
• Follow through on commitments.
We trust and assume goodness in intentions.
• Talk directly to an individual when there is a concern or
problem, avoid triangle conver-
sations or hidden agenda.
6. resale or redistribution.
Section 3.1Codes of Ethics
The principles of medical ethics represent an attempt to balance
the tension between pro-
fessional standards and legal requirements. Therefore, the code
of ethics was created with
three sections: the principles of medical ethics, ethical opinions
of the council on ethical and
judicial affairs, and reports of the council on ethical and
judicial affairs (Riddick, 2003). The
AMA established the Council on Ethical and Judicial Affairs
(CEJA) to “maintain and update
the Code of Medical Ethics and promote adherence to the
Code’s professional and ethical
standards” (AMA, 2018). The principles of medical ethics
established by the AMA and the
opinions of CEJA make up the AMA Code of Medical Ethics.
CEJA’s opinions focus on scenarios
in which ethical issues may arise, such as abortion, capital
punishment, and genetic testing.
Many of these scenarios cover patient-physician relationships,
hospital relations, and profes-
sional rights and responsibilities, and are used to periodically
update the Code of Medical
Ethics (the most recent update having been published in 2017).
These updates occur depend-
ing on the numerous changes in health care over the years, such
as the evolution of medical
technology.
The AMA’s code of ethics covers many
areas and provides important require-
7. ments for physicians and health care
workers; however, the main focus is
patient welfare. Physicians must keep
patients’ best interests in mind and be
honest when treating patients. They
should also be involved with their com-
munities by serving as many patients as
possible, regardless of their ability to pay.
Physicians must also show they are com-
petent enough to treat and communicate
treatment plans with their patients. Com-
petence is key in developing trust with
patients, and it is important for physicians
to be able to communicate clearly so
patients are well-informed about poten-
tial or ongoing treatment. Even physicians
at the top of their fields will have a tough time gaining patient
trust if they lack skills in com-
petence and communication.
Professional Considerations
Ultimately, the AMA Code of Medical Ethics acts as a guiding
document to help health care
facilities develop their own codes of ethics. Though the AMA’s
code originally focused on
physicians’ treatment of patients, adherence to ethical codes
should be mandatory for reg-
istered nurses, nurse practitioners, administrative personnel,
management personnel, and
even allied health care workers. Indeed, any group that is
involved with patient care should
be held to the same ethical standards as physicians, even health
care workers who are not
clinical, such as those in health information management,
billing, and compliance depart-
ments. The following sections cover in more detail ethical
9. Nurses
Nurses typically spend more time with their patients than
physicians do; therefore, it is just
as, if not more, important that nurses follow their organization’s
code of ethics. Nursing care
can include both physical and mental interventions, and nurses
must protect any information
a patient provides during all types of care. According to Mylott
(2005), nurses are account-
able to their patients to make ethically sound health care
decisions, and guidelines for doing
so should be included in all health care organizations’ codes of
ethics. The field of nursing
covers such a broad spectrum that nurses may often work
outside of direct patient care. How-
ever, no matter the capacity in which they work, nurses are
responsible for advocating for
their patients and following a strong code of ethics.
Administrative Personnel
The health care system has evolved over decades into a
multifaceted industry. Advancements
in information technology in particular have not only changed
how patients purchase and
manage their health care, they are also responsible for an
increase in the amount of informa-
tion available to patients prior to visiting their physicians.
Patients can go online and gain
insight into myriad health care issues before ever setting foot in
a doctor’s office. Similarly,
health care facilities are now able to retrieve a patient’s medical
records from anywhere in
the world with the click of a button. However, the growth of
information technology also gives
rise to new risks regarding the privacy and protection of these
12. Section 3.1Codes of Ethics
Cultural Considerations
Since all institutions serve their own unique communities, a
code of ethics should also take
the culture of the community it serves into consideration.
Therefore, many institutions pro-
mote cultural competence, an awareness of and ability to
function “effectively . . . within
the context of the various cultural beliefs, behaviors, and needs
presented by consumers and
communities” (U.S. Department of Health and Human Services,
Office of Minority Health,
2001). Although cultural competence training programs have
become customary in many
health care organizations, the definition of these programs and
terms remains imprecise. The
Department of Health and Human Services’ Office of Minority
Health has defined some of the
terms necessary for a robust implementation of cultural
competence training. While many of
these concepts remain open to debate, for the purposes of our
discussion we will adopt the
Office of Minority Health’s definitions.
Defining Culture and Cultural Competence
The Office of Minority Health makes the following statement
about what culture is and how
it influences health care:
The thoughts, communications, actions, customs, beliefs,
values, and institu-
tions of racial, ethnic, religious, or social groups. Culture
defines how health
care information is received, how rights and protections are
exercised, what
13. is considered to be a health problem, how symptoms and
concerns about
the problem are expressed, who should provide treatment for the
problem,
and what type of treatment should be given. In sum, because
health care is
a cultural construct, arising from beliefs about the nature of
disease and the
human body, cultural issues are actually central to the delivery
of health ser-
vices treatment and preventive interventions. (U.S. Department
of Health and
Human Services, Office of Minority Health, 2001, p. 4)
Web Field Trip: Maimonides Medical Center Code of
Mutual Respect (continued)
Instructions
1. Listen to “Paging Dr. Jekyll,” a 2008 episode of The Brian
Lehrer Show: https://www
.wnyc.org/story/28252-paging-drjekyll/
2. Read Maimonides Medical Center’s (2018) complete Code of
Mutual Respect: https://
www.maimonidesmed.org/about-us/core-principles/code-of-
mutual-respect
3. Write a short critical paper (less than one page) in which you
critique the Code of
Mutual Respect. Assess whether there are any potential gaps or
missing elements
that might be helpful to include in future versions, and try to
identify any ethical
problems that the code might not be well suited to handle. If
appropriate, come up
15. 3. minimization of the negative
consequences arising from cul-
tural differences (Paasche- Orlow,
2004, pp. 347–348).
Generally, cultural competence promotes two of the four
principles of health care ethics:
respect for patient autonomy and justice. However, in most
cultural competence materials,
the reasons given for its importance are practical; among the
most popular reasons are that
it helps to (a) eliminate health disparities in the population, (b)
meet legislative or regulatory
guidelines, and (c) decrease the likelihood of medical
malpractice claims (Paasche-Orlow,
2004). However, the most important reason to be a culturally
competent professional is the
intrinsic good that arises from having a moral commitment to a
culturally responsive, patient-
centered practice. In this context, cultural competence is not
only characteristic of good health
care professionals and the organizations to which they belong,
but is perfectly aligned with
the goals of practicing medicine.
There are cultural competence guides and programs available
that support students’ aware-
ness of cross-cultural health care and foster an interpretive
method of understanding patients.
These guides state explicitly that any descriptions of cultures
found in cultural competence
materials are never the final word but rather a constructive
starting point for the dialogue
with particular patients and their families. Such materials can
be found, for example, at the
Office of Minority Health website:
17. laws, mores, norms, and guide-
lines of the clinical context. (Figure 3.2 shows the levels of
competencies that people possess
in working with other cultures.)
A Peek at Practice: Cultural Competence in Action
Despite its importance, it may not always be clear to
institutions and health care profes-
sionals what they can do on a regular basis to practice cultural
competence. In her arti-
cle “Why More Hospitals Should Prioritize Cultural
Competency,” law professor Olympia
Duhart (2017) suggests that professionals keep the following
practices in mind as they are
providing care:
• Be creative and expansive about addressing language barriers.
• Be alert for, and responsive to, mental health challenges.
• Be mindful of stereotypes.
Visit https://hbr.org/2017/05/why-more-hospitals-should-
prioritize-cultural
-competency to read the full article, then answer the following
questions.
Discussion Questions
1. Based on what you have read in this chapter and the
discussion of competence
training in the article, what types of cultural competence
training do you think
would be effective in the hypothetical case Duhart presents?
2. Now consider patients who come from third-world or non-
English-speaking countries.
20. officers, risk management officers,
and officers of general counsel provide a broad range of
oversight. Working alongside these
officials are institutional committees such as ethics committees
and review boards.
Institutional Ethics Committees
In 1976, the New Jersey Supreme Court decision regarding
Karen Ann Quinlan paved the
way for the establishment of institutional ethics committees in
hospitals around the country.
Soon after returning home from a party, the 21-year-old Quinlan
experienced two 15-minute
periods of respiratory arrest. She was rushed to a hospital,
where she lapsed into a persis-
tent vegetative state. Her father, Joseph Quinlan, approached
the court with a request to be
appointed Karen’s guardian so that he might consent to remove
her from life support. Karen’s
physicians, the local prosecutor, and the state attorney general
opposed the request. Until
the Quinlan case, the nation’s appellate courts had not decided a
termination-of-life-support
issue. Therefore, this was a case of first impression for the New
Jersey Supreme Court. Quot-
ing Karen Teel’s article from the Baylor Law Review, “The
Physician’s Dilemma: A Doctor’s
View: What the Law Should Be,” the court in its opinion stated:
I suggest that it would be more appropriate to provide a regular
forum for
more input and dialogue in individual situations and to allow
the responsibil-
ity of these judgments to be shared. Many hospitals have
established an Eth-
ics Committee composed of physicians, social workers,
22. In 1992, the Joint Commission, an independent, non-profit
organization, provided accredi-
tation and certification to more than 20,000 health care
organizations in the United States.
The Joint Commission required that hospitals institute a
mechanism to resolve ethical issues
such as that of Karen Ann Quinlan and others that had proved so
vexing and contentious in
the 1970s and 1980s. Today this requirement is usually met by
having some variation of an
institutional ethics committee. These committees are designed
to deal proactively, as well
as reactively, to ethical issues that the organization faces. Joint
Commission standards and the
reaccreditation process constitute a form of oversight of such
committees. In many facilities,
the oversight of bioethics committees is the responsibility of the
medical staff.
There are a variety of institutional ethics committees used
today. Some focus on clinical eth-
ics issues (including offering clinical ethics consultation), while
others look at research ethics
(see discussion of institutional review boards later in this
chapter), and still others confront
administrative ethical or legal issues. There are also specialized
committees (or subcommit-
tees) that look at a subset of the issues mentioned above. Some
institutions have multiple
ethics committees, while others have a single general-purpose
one, and still other health care
organizations may have none. When a particular health care
ethics committee is required by
accreditation standards or law, its membership composition is
usually prescribed by mini-
mum standards in order to foster diversity of views and avoid
24. resale or redistribution.
Section 3.2Institutional Structures That Foster and Support
Moral Identity
on an understanding of disease processes and physiology. The
issues also generally involve
the patient, the patient’s family, and the nursing and physician
staff. These issues are quite
different than those in health care administration, which take
the form of deciding whether
to purchase certain equipment or end a certain program. The
participants are usually admin-
istrative and management personnel and can include the
governance of, and representatives
from, the public. Unfortunately, it is still relatively rare to see
an administrative ethics com-
mittee that is specifically devoted to meeting regularly and
discussing administrative ethical
issues (Darr, 2011).
Clinical ethics committees may be involved in policy
development, ethics case review and
consultation, and advisory opinions upon request. Their policy
development role can range
from reviewing or developing the informed consent forms and
policies of the institution, to
making large-scale resource allocation policies for emergencies
or natural disasters. As we
will see in Chapter 6, institutional ethics committees have also
been called on to provide over-
sight (along with the institution’s risk-reduction mechanisms)
for cases of medical mistakes
and to establish and maintain a culture of patient safety in an
25. organization (Meaney, 2004).
A growing concern is that both clinical ethics consultation and
institutional ethics commit-
tees reflect the diversity of modern health care contexts and
develop the competence and
sensitivity to effectively and respectfully deal with cross-
cultural clinical affairs. In 2014, the
American Society for Bioethics and Humanities (ASBH)
published its “Code of Ethics and Pro-
fessional Responsibilities for Healthcare Ethics Consultants”
and is considering a certification
process for clinical ethical consultants, so the role of
institutional ethics committees in clini-
cal ethics consultation may yet again be changing in the near
future (Fox, 2016).
Institutional ethics committees are now largely seen as
necessary and essential components
of ethical health services organizations. Both clinical and
administrative ethical issues are
often better dealt with through committees, rather than through
unilateral decisions made by
executives or directors. However, committees should be
evaluated from time to time to assure
that groupthink or institutional allegiances are not biasing the
committee’s ethics decisions,
and to assure that the institution is continually helping foster an
ethical environment that
helps the organization better achieve its stated goals.
Institutional Review Boards
On the heels of the Nazi medical “research” atrocities of World
War II, the Nuremberg
Code (1947), along with the later Declaration of Helsinki
(World Medical Association,
27. which include the voluntariness of the subjects and the
requirement of informed consent,
also suggest the principles of respect for persons,
nonmaleficence, and the virtues of justice
and honesty. All are integral parts of our regulatory frameworks
(Public Welfare Protection of
Human Subjects, 2004; FDA, 2013).
The Belmont Report and subsequent regulations set the legal
standard for the protection of
subjects involved in clinical research in the United States. To
implement the regulations and
oversee research, an organizational structure called the
institutional review board (IRB)
was established. As a result, to conform to the regulations and
to protect human subjects
in clinical research, health care organizations conducting
research with any level of federal
funding must establish IRBs. IRBs are independent committees
with diverse memberships
that authorize and review most research that falls within the
government’s definition of
research involving human subjects (Public Welfare Protection
of Human Subjects, 2004; FDA,
2013). IRBs must follow processes and guidelines set forth by
the U.S. Department of Health
and Human Services as well as the U.S. Food and Drug
Administration (for trials that are likely
to produce products or drugs meant for public sale). The
processes and guidelines embody
the principles set forth in The Belmont Report, such as informed
consent documentation and
periodic compliance review. IRBs must contain both scientific
and nonscientific members and
at least one representative from the community (Public Welfare
Protection of Human Sub-
28. jects, 2004). Although the direct effect of the regulations is
limited to government-funded
research, the indirect effect is that such research is so pervasive
that the regulations establish
the standard of practice for civil torts.
As a result, if a drug company, a medical device manufacturer,
or even a college professor
seeks to perform federally funded or FDA-approved research
that involves human subjects,
the research, and particularly the protection of the human
subjects, must be approved and
overseen by an IRB. Although found in other organizations,
IRBs are part of many educational
organizations and health care facilities. An IRB’s mandate is to
ensure ethical clinical research
and minimize risks to subjects. This is done by determining
whether the risks to potential
subjects are reasonable relative to any anticipated benefits to
subjects or society. IRBs must
also make sure that informed consent is obtained from subjects,
or their legally authorized
proxies, as well as monitor the trial’s safety, equity, and
confidentiality. Additional safeguards
are necessary when the proposed subjects are likely to be
especially vulnerable to coercion
or undue influence; in fact, the bulk of the regulations
concerning IRBs are focused on the
requirements for informed consent.
Other Structures
To support its Code of Mutual Respect, Maimonides Medical
Center has established a “respect
hotline” telephone line, along with an e-mail account where
behavior that is inconsistent with
its Code of Mutual Respect can be reported. Maimonides has
30. support the moral identity
of health care organizations, including the now nearly universal
institutional ethics
committees and review boards that resolve ethical disputes,
ensure compliance,
consult with clinicians, and form ethical policies in health
services organizations.
Case Study: Preventative Ethics
Instructions: Identify the potential ethical dilemma in each of
the scenarios below. Think
about ways in which a change in policy or in the behavior of
staff or employees of the health
care organization could either help avoid the potential ethics
issue or prevent similar dilem-
mas from occurring in the future.
Scenario A: After taking stock of your hospital’s inventory, you
calculate that the number
of working mechanical ventilators, while sufficient for the
regular daily requirements of
a hospital such as yours, are dangerously below the number
suggested to keep on hand
in case of emergencies such as an influenza epidemic. While
some of the costs involved in
stockpiling this kind of equipment are covered by the federal
and state governments, pur-
chasing the additional ventilators would still mean a sizable
investment by your organiza-
tion. You did not plan for this in this year’s budget, which has
already been approved by the
board of directors. If you choose to purchase the ventilators in
the unlikely event that they
will be needed this year, you will have to seek special
permission from the board to amend
32. 1. Why is it necessary for a health care organization to establish
a code of ethics?
2. What role does the Council on Ethical and Judicial Affairs
(CEJA) play in regard to the
American Medical Association’s (AMA) Code of Medical
Ethics?
3. What three elements of the AMA’s Code of Medical Ethics
do you believe are most
important?
4. What institutional structure oversees human subject research
that is at least par-
tially federally funded?
Key Terms
code of ethics A compilation of rules for
ethical conduct for a community or society.
Although the values that codes are aim-
ing to protect, endorse, or foster are often
implied in the language used, codes gener-
ally focus on specific behaviors and actions
that are forbidden or state the minimal
behavior necessary to avoid incurring a
punishment.
cultural competence The ability of a
health care provider to effectively tend to
consumers and communities with particu-
lar cultural beliefs, behaviors, and needs.
institutional ethics committee A group
whose task is to deal proactively and reac-
tively with ethical issues that its organiza-
tion faces. Also called a bioethics committee.
34. 630
Student Class Registration System Individual Project
Phase 1: Requirements Analysis
1. Problem Definition
ABC University needs a new student registration system for
classes. The current registration method is time consuming and
inefficient for the growing student base. In order to cope with
the demand, ABC university has decided to move forward with
the implementation of a fully automated system for class
registration. The registration system in use now requires
students to meet with their advisors prior to the semester and
decide upon class requirements for the coming term.
Afterwards, the advisors register the student for their classes.
ABC University hopes that this new system will limit the
advisors to an advisory role and students can move forward with
registration on their own.
2. Issues
35. ABC University currently does not have a portal for students to
register for classes on their own. The current system access is
limited to advisors and it is incumbent upon the advisors to
register students for classes. With a growing student population,
ABC University is not able to respond to the rising need for
advisors during class registration time. In order to provide a
solution to this issue, ABC University is looking to implement a
fully automated online portal system that allows students to
select and register for classes on their own; advisors would
continue to serve in an advisory capacity. The only advantage
currently provided by the existing method is that each student
would get advisor time and the school can maintain a high level
of customer service. The consequence of the current method is
that the school is very limited to how many students they can
have because class registration is a long, drawn out procedure.
The goal of the new system is to automatically provide all
necessary information for students to be able to register on their
own. The system will be connected to the ABC University
database and be able to report on class availability, class
schedules, and professors for the class. The student will still
have the ability to visit their advisor on an as needed basis but
if the need is not there, the student will be able to register on
their own. The benefit of this new system is that the school can
now aggregate data such as:
· Class popularity,
· Wait lists for classes,
· Professor popularity,
· And class descriptions.
Should the new system be successful, university faculty will
experience a rise in time, work, and money. A fully functioning
system can help a student stay on track from the beginning of
their college career to the end. The users of the portal will be
full time and part time students of ABC University. Besides
helping university faculty free up more time, the new system
will also help in increasing student satisfaction by being a great
service to students in ways such as:
36. · Allow students a better chance to register for desired classes,
· Allow students to register for classes based upon their
schedule,
· And drastically decrease the time spent on the registration
process.
3. Objectives
The creation of a student registration portal for classes would
serve a number of objectives.
The most important objectives are:
· Log in process to ensure security,
· Display of detailed courses required for student’s degree,
· Virtual schedule before registration is finalized,
· Linked to university database to accurately report class
availability,
· Registration confirmation,
· And student advisement report for progress tracking purposes.
It is crucial for the student to be able to access the portal from
any location so they can register at their convenience. Should a
student choose to not visit their advisor in person, the
advisement report will aid in helping a student stay on track in
terms of which classes they need to take and which they have
completed. With the virtual schedule, a student will be able to
get a visual representation of what their semester will look like
so they can have a better foundation for planning their
extracurricular activities.
The advantages of these achieving these objectives for the
university are incredibly practical. Since one of the major
concerns was that the student population was stunted due to
lack of advisors available, this frees up university advisors to
be able to meet with students that need the extra support.
Additionally, it allows the university to track and monitor
37. students’ progress in their degree.
4. Requirements
The design of the student registration portal for ABC University
has functional, non- functional, hardware, and software
requirements. They are broken down below.
4.1 Functional Requirements
The portal functional requirements are detailed below:
· The system proposes possible schedules to the student during
registration;
· Search function;
· Student degree progression tracking;
· Integration with university database;
· Administrative report generation;
· Administrative override functionality;
· Administrative action tracking;
· Override reversal;
· Course detail display including class capacity, professor,
waitlist, seats remaining, and description;
· Staggered access for registration to prevent overload and
allow priority;
4.2 Non-Functional Requirements
4.2.1 Appearance Requirements
ABC University’s logo and the existing basic design of
university should be displayed. The system should achieve basic
web design standards similar to ones proposed by the US Digital
Service. The design and the color should make users feel
comfortable when using the portal. The design should also
reflect the seriousness of the university environment.
4.2.2 Usage Requirements
The overall design of the portal ensure ease of access, usability
and maintain user efficiency. The portal design should ensure
that the user will have an easy learning curve so the portal can
be seamlessly adopted by the stakeholders. Stakeholders should
have the option of undoing any changes made to their own
38. records as well as offer redundancies in checking and
confirming their selections.
4.2.3 Accessibility Requirements
The portal should follow national guidelines such as 508
Accessibility requirements to ensure accessibility by all
stakeholders. The portal design should take into consideration
stakeholder disabilities and the design should allow for them to
access as well. In order to maintain accessibility, the portal
design should also be
4.3 Software Requirements
In order to be scalable and user friendly, the proposed system
has the following requirements:
· Responsive in design,
· Browser agnostic,
· Maintain acceptable speed and latency for use;
· Maintain data reliability;
· Allow for access through any device with web access;
· Maintain easy of administration so university IT will have
· Accessibility compliant (example: 508 compliant)
4.4 Hardware Requirements
Since the solution is web based, the hardware requirements will
be limited for the proposed system. However, there are some
needs and they are listed below:
· Function on a minimum of 2GB RAM
· Functional on basic graphics hardware (example: video card,
device display, etc)
· Operating system agnostic
· Device processor compatibility (example: intel i5 chip or
higher)
5. Constraints
In order to have a clear understanding of the design constraints,
it is necessary to understand the environment in which the
system will be implemented. The portal will have to interact
with the university’s current environment. Therefore, it is
important in maintaining
39. control the adjacent systems such as the university database(s)
and/or the computerized environment. The development of this
portal will not require any increase in physical space. Due to
the need for accessibility, it is important that the portal remain
device and browser agnostic because it is to be expected that
stakeholders will try to access the portal remotely from
anywhere. Lastly, it is important that the solution takes into
consideration user and administrator technical abilities. The
portal should be capable of being updated to follow
standardized compliance regulations and not interfere with
stakeholder performance.
6. Proposed System
To combat the difficulties of student registration at ABC
University, a student registration portal has been presented as a
potential solution. The ultimate goal of this portal is to increase
the efficiency of student class registration and allow ABC
university to grow their student population so it is important
that the solution remains scalable.
Armed with a comprehensive understanding of ABC
University’s environment, the proposed solution is a web-based
portal that pulls data from the university’s database and
displays information for the stakeholder regarding classes, class
details, class schedules, etc. Aside from IT, the two
stakeholders are students and administrators. Both groups of
stakeholders will have their own log in to utilize the portal. The
student will have access to the following information in the
portal:
· Student ID
· Name
· Date of birth
· Password
· Mailing address
· Registration date
· Student status
40. · Contact information
· Image
As a user, a student can perform the following tasks:
· Registration
· Branch selection
· Scheduling
· Search
· View class details
· Generate advisement reports.
Available to stakeholders is the log in portal. This portal allows
for authentication of user accounts. All stakeholders will have
their own unique credentials for the portal. Once logged in,
stakeholders have the ability to search the university database
for the data they need. Students will be able to search for the
classes they register, see the details for the classes, create a
mock schedule prior to confirmation, and finalize their
selections. Administrators will be able to see class details,
reverse changes to student schedules, and create priority
registration for students
that are allowed that. User management is limited to be used by
administrators such as IT and/or university faculty. Students
will not see or have access to this part of the portal.
6.1 Data Flow Diagram
After the student requests a log in to the registration portal and
access is granted, the student is able to request information
from the portal in terms of class information, class schedule,
and make edits. This information is pulled from the ABC
41. University database. For administrators, the format is very
similar. The administrator is submits a log in request and once
it is granted, they are able to view the student data, class data,
and make edits to the data in the portal. Similarly, the
information is also retrieved from the ABC University database.
Data input into the registration portal is transferred to the ABC
University database.
Phase 2: System and Database Design
7. User Interface
The user interface design for students and administrators are
shown below.
Student registration portal log in
Each student and administrator will have their own unique
credentials to log into the portal on this interface. Once they log
in, they will be able to view the information available to them
in the next page.
Student portal interface
This is the student class registration portal. This is where a
student will be able to access their class registration by
following the “add/drop class” link. The other options available
to them is their class schedule, their personal information, their
advisor information, an ability to sign up for graduation, and an
advisement tool should they feel they do not need to meet with
an advisor in person.
42. Administrator portal interface
As an administrator, their main job has been to aid the students
in registering for their classes. Once an administrator logs in,
they will be able to see their own calendar that typically
displays meetings with the student. Since administrators have
no need to add/drop classes for themselves, their registration
portal will be slightly different from a student’s.
Student course search interface
When a student navigates to their add/drop class portal, this is
the interface they are presented with. They will have the ability
to search for a specific school term and search using keywords
or course numbers to find the classes they intend to take.
Student Course Search Results
Once a student searches for the class they would like to take,
the portal than directs them to a results list of the results. These
results include classes that have reached capacity and are
identified with the letter F under status, and classes that have
not reached capacity. Once a student selects the class, they click
“add” to include it in their schedule.
Student Registration Portal Class Registration Completion
Upon completion of registration, the student home interface of
the registration portal will display the class that the student
registered for.
7.1 Logical Model Design
8. System Architecture
43. The student registration portal is a web-based portal that
interacts with an existing database of information. Once a
stakeholder (student or administrator) accesses the web portal,
the web portal pulls information from the ABC University
database and displays the information requested.
8. Conclusion
With the implementation of a student class registration portal, it
will allow for ABC University to more efficiently process class
registration. The shift from manual registration by student
advisors to a more automated solution has been long awaited.
With the implementation of a student registration portal, the
university can grow their student population and advisors would
have more free time devoted to other tasks. The class
registration process would not take as long and it would become
a more efficient process. The initial roll out of the portal will
have to be monitored but the potential to build upon the student
registration portal will be great.
1The Evolution of Health Care Ethics: Overview, Theories,
and Methods
Travel Pictures Ltd./SuperStock
Learning Objectives
After reading this chapter, you should be able to
1. Summarize major factors that contributed to the interest and
importance of medical ethics in
the mid-20th century.
2. Identify the major factors associated with the rise of
45. each situation requires unique considerations and each outcome
may be different as a result
of those considerations.
As an academic study, ethics refers to a systematic analysis of
the rightness and wrongness of
actions, along with the theoretical basis and methods used in
deciding which course of action
to take. Ethics also encompasses a very practical application: It
seeks to provide a guide to
behaviors. How people behave toward one another is based on
their personal morals as well
as on societal ethics. There is some universal agreement about
what is right and wrong; for
example, murder and incest are almost always considered
wrong. However, there is much
variability in what an individual or particular society considers
ethical behavior, depending
on its laws and norms. This is in part due to the fact that
different peoples regard different
situations as posing an ethical dilemma, or a situation in which
they are uncertain about the
correct course of action. The goal of applied ethics is to identify
and resolve such dilemmas.
Given that Western societies, particularly the United States,
comprise many communities,
cultures, and languages, it is not surprising that there is
difficulty formulating concise and
coherent language to describe a comprehensive set of ethical
standards that can be applied to
society at large. Similar challenges arise within organizations.
These challenges are particu-
larly pronounced in health care organizations, where
communities, cultures, and languages
intersect on a daily basis, sometimes under critical and urgent
47. significant technology or capa-
bility other than simple procedures and a great deal of
compassion. For example, sterile tech-
niques and anesthesia were unknown until the beginning of the
20th century, and antibiotics
were not developed until World War II. In cases where effective
treatments were not readily
available (or not yet invented), paternalism, or the belief that
the doctor knew best, was not
significantly challenged, and, according to Cotler (2013),
“kindness and caring were indeed
the best medicine” (p. 4).
Beginning around the 1950s and 1960s, advents in both
medicine and medical technology
increased choices and costs, which complicated medical
decisions. In the 1960s, the invention
of dialysis, ventilators, and intensive care units vastly improved
patient health; the advent of
dialysis, for example, meant that patients could now be
maintained on machines that essen-
tially function as kidneys by mixing and monitoring the fluid
that removes unwanted waste
products from a patient’s blood. Such advancements in
knowledge and technology were mak-
ing it clear that age-old applications of medical ethics were no
longer sufficient, and with that
realization the field of bioethics was born. Drawn from the
combination of the words biology
and ethics, bioethics became the health care community’s
answer to the question of how to
study ethical issues arising from advances in biology and
medicine.
Coinciding with a rise of technology were social
justice movements calling for increased civil lib-
48. erties and women’s rights. As part of these move-
ments, individuals and interest groups also agi-
tated for the right to make health care decisions
(Cotler, 2013). On occasion, patients, their fami-
lies, and their physicians disagreed about
whether to continue treatment. In those cases it
was not clear what to do, who should decide, and
what basis to use for decisions. Given the plural-
istic society of the United States and the fact that
the nation lacks a common ethos, these decisions
fell to the courts. New technology also required
capital-intensive hospitals, specialization, and
new financing mechanisms. Specialists who often
did not have any relationship with the patient or
the family replaced the old family doctor who had
the luxury of knowing his or her patients. This
affected the physician-patient relationship, and
new forms of health care delivery developed.
In addition to court decisions that influence prac-
tice, heightened public expectations sometimes
result in malpractice suits. In turn, many physi-
cians practice defensively. Practice is also regu-
lated by third-party payers, including the state
and federal governments and insurance compa-
nies. Many health care organizations incorporate peer review
for their physicians, and many
hospitals are accredited through an independent, non-profit
organization known as The Joint
Commission.
Exactostock/SuperStock
Advancements in medical technology,
especially in life-support systems, have
given rise to new ethical dilemmas for
doctors, patients, and family members.
50. ethical pitfalls” (Cotler, 2013,
p. 14). The following are examples of structural differences that
could potentially pose a con-
flict of interest:
• Physicians may work independently of the organization in
their own office, but they
will usually also be a member of the medical staff, which has its
own bylaws. They
are thus constrained by rules with which they may not agree or
which they may not
respect.
• Administrators may have loyalty to their institution, but as
part of a corporation,
they are also required to comply with financial and managerial
demands. Potential
financial and clinical conflicts are part of their daily lives.
• The board of directors has differing power, authority, and
functions, depending on
whether the facility is independent or part of a corporation. Its
philosophy of care
may diverge from the corporation or from administration. In
addition, the boundar-
ies of the board’s authority may not be clear.
Human Subjects Research
Another historical influence on the rise of bioethics was the
realization, which began around
World War II, that persons all over the world had been forced to
become subjects in clini-
cal research; in other cases, research subjects were mistreated
or abused. Perhaps the best
known example in the United States of grievous research
misconduct was the Tuskegee
54. of human subjects . . . This is a soft paternalistic approach
justified by a long
and widespread international history of abuse of human subjects
and by the
complexity of proposed trials which require highly regulated
review by insti-
tutional review boards (IRBs). (p.13)
The true differences between clinical care and research,
however, are in their goals. In clini-
cal care, the goal is to heal and care for; in research, it is to
discover and increase knowledge.
Possible research ethics issues include:
• how research subjects are selected
• access to studies
• use of placebos
• international trials
• compliance
• relationships with outside vendors (Cotler, 2013, p. 14)
Another potential dilemma can occur when patients are asked to
participate in clinical trials
being run by their personal physician. While a patient must give
consent to take part in a clini-
cal trial, even if it is being conducted by their personal
physician, both parties may be wary of
the potential conflict when the researcher and the clinician are
the same person. For instance,
a patient may wonder if the physician is acting as the researcher
or as the treating doctor
who places the patient’s interests above all. Some ethical
dilemmas are not easily resolved by
regulation, and so require extra careful attention from both
55. professionals and organizations.
Bioethics Committees
According to Cotler (2013), bioethics committees (BECs) “have
grown as a response to
demands raised by exploding medical technology, diversity
among the population, directives
from the courts, and health-care systems attempting to address
ethical conflicts in health-
care organizations” (p. 6). Technology has increased choices
and thus raised questions about
what medical decisions to make, who should make them, and
when they are appropriate.
Ideally, BECs can prevent some of the many ethical dilemmas
posed by these developments.
Preventive ethics implies that the best resolution to a dilemma
is to prevent it from arising
in the first place.
Global diversity means that people of different cultures and
beliefs bring an array of perspec-
tives and values to the table when they make critical health care
decisions. In some countries
religion plays a strong enough role that it provides direction,
and possibly resolution, to ethi-
cal issues through consistent moral authority. Examples include
the Catholic Church’s prohi-
bition of elective abortions and the Islamic prohibition of male
physicians touching female
patients. Most countries lack a single authority, however, and
many developed nations have
various multicultural communities. Thus, particularly in diverse
regions that lack a unified
religion, language, or culture, there is confusion over how to
universally address or resolve
ethical dilemmas.
57. which included life-sustaining equipment and complex
organizational structures, required
ethical study and explicit practice standards. Thus, in the
United States, the 1960s and 1970s
saw the birth of freestanding and university-affiliated entities
devoted to the study and reflec-
tion of bioethics. Early prominent examples are the Hastings
Center, which is freestanding,
and the Kennedy Institute of Ethics, which is affiliated with
Georgetown University. Several
professional organizations (now largely subsumed under the
American Society for Bioeth-
ics and Humanities) also developed within philosophy, law, and
medicine. The field is still
very new, and it continues to struggle with creating an identity,
determining its own code
and structural requirements, forming a unified theory and
method, and determining whether
such a multidisciplinary field should even have a unified theory
or method.
1.2 Theories and Methods of Contemporary Bioethics
Before turning to the specific ethical issues health care
practitioners face, an introduction to
ethical theory is helpful. The goal of this section is to discuss
ways to think about the rightness
or wrongness of actions that have been historically important.
In particular, we will focus on
principlism, an approach commonly used in health care, and
how it is applied by practitioners
to resolve bioethical problems.
Ethical Theory
Traditionally, ethical theory has been the purview of
philosophers, including Immanuel Kant,
John Rawls, and John Stuart Mill. Today, ethics, or moral
59. and philosophers emphasized principlist ethics, which stresses
the application of general
principles, in a top-down fashion, to serve as the basis for rules
or guides to action. These
general principles include autonomy, nonmaleficence,
beneficence, and justice. The princi-
plist approach has mainly been associated with Tom Beauchamp
and James Childress (2009),
the authors of the canonical text on principlism, Principles of
Biomedical Ethics. Figure 1.1
provides a diagram to help visualize the four principles.
Case Study: Rationing the Antidote
You are a hospital administrator. One afternoon, the director of
your emergency department
notifies you that six patients have been brought to your
emergency room, all of whom are
dying after ingesting a rare poison. Unfortunately, your facility
does not have a large enough
supply of the antidote on hand to save the lives of all six
patients. There is also no way to
acquire more antidote in time to save all the patients. The
patients must be treated within
one hour of ingestion of the poison for the antidote to be
effective, and time is already run-
ning out. The director informs you that one of the patients has
ingested a much larger dose
of the poison than the others. If the antidote on hand is divided
five ways, there will be
enough antidote to save the five who ingested a small dose. In
order to save the patient who
ingested the large dose, however, all the antidote on hand would
have to be administered.
How should the emergency department staff distribute the
antidote?
62. Everyone has aspirations and
dreams, and yet everyone encounters reality. In health care, for
example, providing what the
patient wants must be contrasted with what he or she gets; this
is limited by the physician,
who is responsible for clinical judgment and determining
medical necessity.
According to Cotler (2013), the autonomy maxim “Do not do
unto others that which they
would not have you do, and keep your promises” has been such
a misunderstood concept
that Englehardt (1996) renamed it the principle of permission.
Autonomy forms the rationale
for informed consent. If one may not touch another without
permission, informed consent
provides a mechanism to obtain the permission by declaring
risks, potential benefits, and
alternatives. Note that the maxim includes the mandate to keep
promises. Autonomy is par-
ticularly confusing to providers and patients in that the
principle grants the right to accept
or reject recommended treatments, but decisions about
appropriateness and effectiveness
are the domain of the physician. Many cultures value
community over individual choice, and
autonomy may not be the most important value for such
communities. It may not even be
considered. In all cases practitioners need to discuss decisions
with the patient to discern the
relative value he or she places on autonomous choice. Does the
patient want information?
Does the patient want to be involved in decisions, or does he or
she delegate to family? These
are autonomous choices, and health care practitioners have a
duty to assure they are stable
63. and authentic.
As noted above, informed consent derives from the principle of
autonomy, and it is discussed
in detail in Chapter 2. However, note that informed consent
requires a conversation between
the physician and the patient or surrogate engaged in shared
decision making. Informed con-
sent requires that the patient be an active participant in the
process, necessitating well-docu-
mented notes in the medical records. It is much more than a
signature on a form.
Though court decisions tend to favor patient autonomy, “the
repeated lack of a clear mech-
anism to resolve conflicts between and among the principles at
the bedside demonstrates
weakness in the principalist approach” (Cotler, 2013, p. 6). For
example, consider a case in
which, based on medical necessity and the physician’s clinical
judgment, surgery is recom-
mended for a particular patient. However, the patient refuses
based on his or her own com-
plex reasons, preferences, and values. This collision between
the patient’s choices or refusals
causes dilemmas at the bedside and in setting policy. Before
life-sustaining technology, such
dilemmas were precluded by old paternalistic methods in which
the physician decided. Crit-
ics ask how principles help resolve conflicts in a given case.
Beauchamp and Childress address
the question in their later editions by recommending specifying
and balancing approaches in
specific cases.
Nonmaleficence
65. patients is the responsibility of the admin-
istrator, in collaboration with the medical
staff. In addition to the physical, psycho-
logical, and economic ways that health
care managers can affect patients or staff, those in leadership
roles also have the ability to
affect the culture of the organization in critical ways. The duty
of nonmaleficence not only
involves not causing harm, but also actively choosing the least
harmful alternatives. Nonma-
leficence requires that managers actively minimize or eliminate
workplace hazards and risks
that could harm employees and patients. It is prudential as well
as practical for administrators
to regularly review relevant policies, make rounds, meet with
practitioners and employees,
and attend meetings in which the topic is preventing or
responding to error and other harms.
Beneficence
Beneficence is the principle that guides health care
professionals to do good. It provides
the grounding for charitable duty to others. At the bedside,
patients define their own good;
this may present a conflict with a health care provider’s
recommendations, which are based
on the physician’s clinical judgment about the best medical
good. Problems may occur when
patients refuse recommended treatments. Conversely, they may
occur when patients or their
surrogates demand care that physicians deem inappropriate or
nonbeneficial. Misunder-
standings about patient and provider rights lead to many of the
requests for bioethics con-
sultation. In the case of refusal, autonomy usually trumps.
However, it is critical to evaluate
67. responsible. How this duty is put into practice depends upon the
nature of the organization
and its mission. For example, if a practitioner’s organization
has an explicit mission to serve
the health needs of a particular population or community, then
those commitments should
give shape and substance to the practitioner’s duty of
beneficence.
Justice
The justice principle can be broadly defined as “fairness.” It is
exemplified by the Aristotelian
ideal that people in similar situations ought to be treated
similarly, and people in different
situations should be treated differently. A distinction is
sometimes made between distribu-
tive justice, which refers to the allocation of resources, and
procedural justice, the fair-
ness and transparency of processes by which decisions are
made. The Belmont Report: Ethical
Principles and Guidelines for the Protection of Human Subjects
of Research, prepared by the
National Commission for the Protection of Human Subjects of
Biomedical and Behavioral
Research (1979), offers guidelines on ethical principles; it
states that “[a]n injustice occurs
when some benefit to which a person is entitled is denied
without good reason or when some
burden is imposed unduly” (p. 5). This may occur in the clinic
or in research. For example,
there is some evidence that persons who are poor and thus have
less access to care and infor-
mation about options may also have less access to clinical
trials. They also have less access to
the benefits of findings and to drugs that are approved as a
result of such studies. Charges of
68. injustice regarding access to research involving women have
also been made (Mastroianni,
1998); women have proportionately been less often represented
as research subjects. Data
also indicate that persons belonging to some racial groups are
treated differently when they
appear at an emergency department (James et al., 2005; Selassie
et al., 2003). Statistics have
consistently shown differences in life expectancy by
socioeconomic status (National Center
for Health Statistics, 2012).
In 1971, the leading American political philosopher of the 20th
century, John Rawls (1921–
2002), wrote A Theory of Justice, a highly influential book that
advances the idea that the best
principles of justice are those that we would all agree to if we
were all impartially situated
as equals. This he arrives at through his famous thought
experiment “the veil of ignorance,”
in which we are asked to imagine an “original position” from
which no one was better situ-
ated than anyone else (or at least that we’d be ignorant of any
inequalities in such a utopian
state-of-affairs).
A Rawlsian approach to distributive justice and health care
ethics is one based on fairness.
Therefore, even in cases where not everyone will have access to
a certain good because it is
scarce, there needs to be fair opportunity of access to the
benefit. For Rawls, fair access was
ensured by formal procedures that were themselves required to
be fair. This leads us to the
concept of procedural justice.
70. leave; such options could trigger a union dispute.
Justice is a fundamental principle for health care administrators
and practitioners—particu-
larly in their responsibilities to make resource allocation
decisions—and among those who
work toward eliminating health inequities. The justice principle
impacts many other day-to-
day decisions that health care managers make. Examples include
policies regarding unioniza-
tion, working conditions, and staffing patterns for employees;
hiring and promoting staff;
decisions about where and to whom the institution should be
marketed; and determining
whether promotion should be by merit, seniority, or favoritism.
In addition, hospitals that
undergo purchase or mergers often have to make choices about
their mission and values.
Strengths and Weaknesses of Principlism
Scholars continue to refine the principlist approach; with each
new edition, Beauchamp and
Childress refine the text to accommodate legitimate criticism.
Some bioethicist academics
turn to casuistry, a case-based method of resolving ethical
issues. Most practitioners use a
combined approach from different methods, depending
somewhat on the particulars of the
case. The several methods reflect the necessity of an
interdisciplinary approach. According
to Cotler (2013), “no single method has been successful in
addressing the varied and com-
plex dilemmas that arise in the clinic, the institution, or the
community” (p. 7). Principles
provide fundamental guidelines, but when they conflict with one
another, there is a lack of
71. clear instructions on how to prioritize. The courts have
consistently favored autonomy, but
that does not always seem correct in an acute health care
setting. It is also not always clear
whether a choice is consistent and authentic; in other words,
will the decision be the same
later today or tomorrow? Is it an accurate reflection of the
person’s narrative and the other
choices he or she has made?
Some argue that principlism fails to consider the complexities
of real-world situations, or
that it is too rigid in following prescribed formulas for making
ethical decisions (Pellegrino
& Thomasma, 1993). Other critics posit that principlism pays
too little attention to the char-
acter of the agent, opting instead to focus on actions that typify
the principle in question;
for example, asking if the decision was autonomous rather than
also looking at precedent
or important context (Bulger & Reiser, 1990). Does the way the
four principles are selected,
prioritized, and applied to ethical dilemmas depend on who gets
to do the selecting, prioritiz-
ing, and applying? Given that along with their great strengths,
principles have weaknesses in
application, leading proponents of principlism—especially
Beauchamp and Childress—con-
tinue to refine their text to include the necessity to specify and
balance in individual cases.
Whether in management, at the bedside, or in the community, it
has become clear that princi-
ples are important, but they are not to serve as a blind mantra.
They work when they are aptly
applied, usually along with other methods, and always in
conjunction with good judgment.
73. urgent, instead of those that are most important to the primary
goals of the institution or
practice.
The bulk of this textbook is devoted to helping cultivate in the
student the characteristics of
a moral leader capable of leading a moral organization. In this
section we will consider the
value of a flowchart method of resolving ethical dilemmas.
Introduction to the Sample Framework
Flowcharts, or decision-tree diagrams, such as the one seen in
Figure 1.2, help demonstrate
some of the important factors and norms that should be a part of
any thoughtful ethical deci-
sion. However, it is also important to remember that these
guides, when misused or relied
on too strictly, can serve as a crutch for bureaucrats and can
impede the kind of rigorous
and nuanced analysis that usually needs to happen in modern
health care ethics. Once you
become confident in applying the rules and norms covered in
this text, and become adept at
identifying the most important stakeholders and factors that
need to be addressed, then you
can use the diagram as a reference. It can be stored in a file
cabinet or on a computer so that it
is accessible when you need to make sure nothing important has
been overlooked. It can also
be used as a reminder of important questions to raise in an
ethics committee meeting.
Creatas/Thinkstock
Administrators routinely
face ethical dilemmas at the
institutional level.