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Running head: HEALTH CARE QUALITY IMPROVEMENT
PROGRAMS
Ethics and Decision-Making in the VA Healthcare System
5
Ethics and Decision-Making in the VA Healthcare System
HS450: Strategic Planning and Organizational Development for
Health Care
Name
February 26, 2019
The Department of Veterans Affairs (VA) has had a tumultuous
time throughout its history with the processing of claims and
treatment of veterans. In 2009 President Barrack Obama put an
emphasis on fixing the issue. Current Army Chief of Staff
General Eric Shinseki was selected by President Obama as the
Secretary of the VA. General Shinseki’s primary role was to
implement 16 initiatives that would help alleviate the issues
within the VA. However under his leadership the VA had
different results than what was expected. In 2013 many major
news stations reported that veterans were experiencing delayed
care at the Williams Jennings Bryan Dorn Veterans Medical
Center in Columbia, SC. As a result of the delayed care six
veterans died. After an investigation many issues for found
including; low staff census, leadership turnover, lack of
understanding of roles, responsibilities and system processes,
and ineffective program coordination. In 2014, the Office of the
Inspector General (OIG) launched an investigation into these
allegations addressing two primary questions 1. Did the
facility’s electronic wait list (EWL) purposely omit the names
of veterans waiting for care and, if so, at whose direction? And
2. Were the deaths of any of these veterans related to delays in
care? The conclusion of the investigation resulted in the OIG
determining that there was evidence of improper scheduling in
the VA and the healthcare system. As a result of the
investigation General Shinseki resigned from office on May 30,
2014.
Ethical Decision Making Process
The ethical decision making process helps healthcare
professionals in making a sound judgment in regard to making a
proper ethical decision. Step one is to ask “What is the ethical
question?” In regard to issue at the VA the primary ethical issue
was the patients that were not listed on the Electronic Wait List
(EWL) but were still awaiting care. These individuals would be
waiting forever since their names were never on the actual list.
Step two is for you to ask yourself “What is your gut reaction?”
As an active duty U.S. Army Enlisted Soldiers my gut reaction
is pure disgust. There is no explanation for anyone not only
veterans but no one period to be waiting for care that they
would never receive. Step three is a research step and a point
where the facts are identified. The facts of the underlining
issues should have been identified at this point. The issues
should have been laid out and a plan to identify these issues
should begin at this moment. The fourth step is to ask “What are
the values at stake in the scenario?” This step should’ve been
one of the easiest in the VA case. Everyone has different values
but we all know what is right and what is wrong. In the VA case
it seems that everything was done wrong and to benefit
themselves and not the patients. Step five is to ask “What are
the options in this case?” The options were clear and that was to
find a solution that can provide veterans care in a timely
manner. In the sixth step you ask “What should I do?” This is
where an ethical decision should have been made by all
personnel who had a negative impact in the VA case. Many of
the people made the wrong choice for personal or professional
gain. Step seven is to ask “What justifies this choice?” Evidence
to support our choice is the proper way to support it. Without
the correct evidence an unethical decision is likely going to be
made. Finally step eight you ask “How could the ethical
problem have been prevented?” This is easier to ask after the
fact since we know the outcome. All healthcare professionals
should not have to decipher if something is right or wrong each
and every one of these individuals should be aware of what to
do and when to do it.
Two Policies/Standards
Upon researching about the issues in the VA more specifically
during the time that General Shinseki was the Secretary of the
VA many policies and procedure changes could have helped to
alleviate the issues. One of the policies I would have
implemented would have been to have one provider for a
specific number of patients. This would ensure there were
enough provider to care for the patients. When providers see to
many patients the providers begin to rush and that is when
mistakes begin to happen. This may not seem very cost effective
at first but the results of the policy would have outweighed the
cost associated with the policy. Additionally the second policy I
would have out in place would allow for the veterans to receive
care at another facility once they have been waiting for care for
an egregious amount of time. This would ensure that all patients
are receiving the appropriate amount of care in the appropriate
amount of time.
Two Alternative
Solution
s
At the time of his resignation General Shinseki made a quick
decision that may have seemed right in his mind but from the
outside looking in it seems as if he no longer wanted to be part
of the problem. He without a doubt could have done things
differently. I personally feel that he should have accepted
responsibility for the issues in the VA and then immediately
made changes within the VA. This would have been at the
healthcare administrator level. New administrator and leaders at
this pivotal positions could have without a doubt made a major
impact on the over success of the VA during his tenure. One of
the primary problems with the VA case is the focus on quantity
and not on quality. Healthcare quality cannot become collateral
damage when we are dealing with a large number of patients.
Another avenue that he could have approached is utilizing a
centralized Electronic Healthcare Records (EHR) this would
have provided everyone with oversight on how many patients
were being seen and how many needed to be seen going
forward.
ACHE Code of Ethics
The American College of Healthcare Executives (ACHE) Code
of Ethics can be applied to all healthcare systems including the
healthcare system of the VA Health System. Utilizing the ACHE
Code of Ethics will ensure that a centralized ethics system is
being shared across all of the healthcare professionals. The
ACHE Code of Ethics details the standards of all ethical
behavior for executives and administrators in the healthcare
industry. A clear cut code of ethics will undoubtedly lead to a
minimal number of unethical decisions made by healthcare
professionals. Ethics should be learned at the college level but
should also be refined as we progress into our professional
lives. Healthcare organization should be mandated to provide
ethical training on an annual basis in order to ensure the
mitigation of situation like that of the VA cases.
Overall the VA situation was a disaster for veterans, employees
of the VA, the VA, General Shinseki, President Obama and the
entire country. The whole situation could have been avoided if
the ethical decision making process was used. There were many
different tactics and techniques that could have been used by
General Shinseki in order to ensure these unethical decision
were avoided. Instead of putting in new policies and procedures
he decided to resign his position which I feel was the worst
thing he could have done. Many people quit or give up when
they are down, but a secretary of a major department within the
government should not do so. The ACHE is a great resource for
educating our current and future healthcare administrators on
ethics in healthcare. We should ensure we are utilizing all of the
resources to provide the patients not only of the VA but of all
healthcare with a good quality and ethical product. All of us as
future healthcare administrators should strive to learn from the
mistakes of the past and ensure we will be the best ethical
healthcare leaders of the future.
References
ACHE. 2017. ACHE Code of Ethics. Retrieved from
http://www.ache.org/abt_ache/code.cfm
Essentials of Strategic Planning in Healthcare, Harrison,
Jefferey P. retrieved from
https://purdueuniversityglobal.vitalsource.com/#/books/9781567
937916/cfi/0!/4/[email protected]:24.4
Ethical Decision-Making Guidelines and Tools, Jacqueline J.
Glover PhD retrieved from
http://samples.jbpub.com/9781284053708/Chapter2.pdf
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  • 1. Running head: HEALTH CARE QUALITY IMPROVEMENT PROGRAMS Ethics and Decision-Making in the VA Healthcare System 5 Ethics and Decision-Making in the VA Healthcare System HS450: Strategic Planning and Organizational Development for Health Care Name February 26, 2019 The Department of Veterans Affairs (VA) has had a tumultuous time throughout its history with the processing of claims and treatment of veterans. In 2009 President Barrack Obama put an
  • 2. emphasis on fixing the issue. Current Army Chief of Staff General Eric Shinseki was selected by President Obama as the Secretary of the VA. General Shinseki’s primary role was to implement 16 initiatives that would help alleviate the issues within the VA. However under his leadership the VA had different results than what was expected. In 2013 many major news stations reported that veterans were experiencing delayed care at the Williams Jennings Bryan Dorn Veterans Medical Center in Columbia, SC. As a result of the delayed care six veterans died. After an investigation many issues for found including; low staff census, leadership turnover, lack of understanding of roles, responsibilities and system processes, and ineffective program coordination. In 2014, the Office of the Inspector General (OIG) launched an investigation into these allegations addressing two primary questions 1. Did the facility’s electronic wait list (EWL) purposely omit the names of veterans waiting for care and, if so, at whose direction? And 2. Were the deaths of any of these veterans related to delays in care? The conclusion of the investigation resulted in the OIG determining that there was evidence of improper scheduling in the VA and the healthcare system. As a result of the investigation General Shinseki resigned from office on May 30, 2014. Ethical Decision Making Process The ethical decision making process helps healthcare professionals in making a sound judgment in regard to making a proper ethical decision. Step one is to ask “What is the ethical question?” In regard to issue at the VA the primary ethical issue was the patients that were not listed on the Electronic Wait List (EWL) but were still awaiting care. These individuals would be waiting forever since their names were never on the actual list. Step two is for you to ask yourself “What is your gut reaction?” As an active duty U.S. Army Enlisted Soldiers my gut reaction is pure disgust. There is no explanation for anyone not only veterans but no one period to be waiting for care that they would never receive. Step three is a research step and a point
  • 3. where the facts are identified. The facts of the underlining issues should have been identified at this point. The issues should have been laid out and a plan to identify these issues should begin at this moment. The fourth step is to ask “What are the values at stake in the scenario?” This step should’ve been one of the easiest in the VA case. Everyone has different values but we all know what is right and what is wrong. In the VA case it seems that everything was done wrong and to benefit themselves and not the patients. Step five is to ask “What are the options in this case?” The options were clear and that was to find a solution that can provide veterans care in a timely manner. In the sixth step you ask “What should I do?” This is where an ethical decision should have been made by all personnel who had a negative impact in the VA case. Many of the people made the wrong choice for personal or professional gain. Step seven is to ask “What justifies this choice?” Evidence to support our choice is the proper way to support it. Without the correct evidence an unethical decision is likely going to be made. Finally step eight you ask “How could the ethical problem have been prevented?” This is easier to ask after the fact since we know the outcome. All healthcare professionals should not have to decipher if something is right or wrong each and every one of these individuals should be aware of what to do and when to do it. Two Policies/Standards Upon researching about the issues in the VA more specifically during the time that General Shinseki was the Secretary of the VA many policies and procedure changes could have helped to alleviate the issues. One of the policies I would have implemented would have been to have one provider for a specific number of patients. This would ensure there were enough provider to care for the patients. When providers see to many patients the providers begin to rush and that is when mistakes begin to happen. This may not seem very cost effective at first but the results of the policy would have outweighed the cost associated with the policy. Additionally the second policy I
  • 4. would have out in place would allow for the veterans to receive care at another facility once they have been waiting for care for an egregious amount of time. This would ensure that all patients are receiving the appropriate amount of care in the appropriate amount of time. Two Alternative Solution s At the time of his resignation General Shinseki made a quick decision that may have seemed right in his mind but from the outside looking in it seems as if he no longer wanted to be part of the problem. He without a doubt could have done things differently. I personally feel that he should have accepted responsibility for the issues in the VA and then immediately made changes within the VA. This would have been at the healthcare administrator level. New administrator and leaders at this pivotal positions could have without a doubt made a major impact on the over success of the VA during his tenure. One of the primary problems with the VA case is the focus on quantity and not on quality. Healthcare quality cannot become collateral damage when we are dealing with a large number of patients. Another avenue that he could have approached is utilizing a centralized Electronic Healthcare Records (EHR) this would have provided everyone with oversight on how many patients
  • 5. were being seen and how many needed to be seen going forward. ACHE Code of Ethics The American College of Healthcare Executives (ACHE) Code of Ethics can be applied to all healthcare systems including the healthcare system of the VA Health System. Utilizing the ACHE Code of Ethics will ensure that a centralized ethics system is being shared across all of the healthcare professionals. The ACHE Code of Ethics details the standards of all ethical behavior for executives and administrators in the healthcare industry. A clear cut code of ethics will undoubtedly lead to a minimal number of unethical decisions made by healthcare professionals. Ethics should be learned at the college level but should also be refined as we progress into our professional lives. Healthcare organization should be mandated to provide ethical training on an annual basis in order to ensure the mitigation of situation like that of the VA cases. Overall the VA situation was a disaster for veterans, employees of the VA, the VA, General Shinseki, President Obama and the entire country. The whole situation could have been avoided if the ethical decision making process was used. There were many different tactics and techniques that could have been used by General Shinseki in order to ensure these unethical decision were avoided. Instead of putting in new policies and procedures he decided to resign his position which I feel was the worst
  • 6. thing he could have done. Many people quit or give up when they are down, but a secretary of a major department within the government should not do so. The ACHE is a great resource for educating our current and future healthcare administrators on ethics in healthcare. We should ensure we are utilizing all of the resources to provide the patients not only of the VA but of all healthcare with a good quality and ethical product. All of us as future healthcare administrators should strive to learn from the mistakes of the past and ensure we will be the best ethical healthcare leaders of the future. References ACHE. 2017. ACHE Code of Ethics. Retrieved from http://www.ache.org/abt_ache/code.cfm Essentials of Strategic Planning in Healthcare, Harrison, Jefferey P. retrieved from https://purdueuniversityglobal.vitalsource.com/#/books/9781567 937916/cfi/0!/4/[email protected]:24.4 Ethical Decision-Making Guidelines and Tools, Jacqueline J. Glover PhD retrieved from http://samples.jbpub.com/9781284053708/Chapter2.pdf