Wild Card Blog- 11/29

Wow almost the last assignment this semester! I has been a great semester and a wonderful class. Human resources is my subject of choice and I hope to work in this area, so i always enjoy the material. For this wild card post I will do my usually and review a current article.
One of the topics on this weeks readings was benefits, including insurance. The article I choose to review is titled, "Caution:High deductible plans might be bad for your health." This article comes from Kaiser Health News, and was written by Julie Rovner on November 24, 2010. In this article they consider s high deducible plan one which is over $1,000 before services. in 2009 about 23% of adults were paying this high deductible. This percentage is for an employer based insurance. The percentage rises to 50% for individuals who purchase insurance on the open market.

A study done by Archives of Internal Medicine, aimed to analyze this issue. The sample was patients in Harvard-Pilgirms high deducible plan. The survey results are as followed; 60% of low income groups delayed or went without care due to high cost, 42.5% of those with income over 300% of the poverty line also reported going without care, those who went without care also reported stress increase, 35% of low income group and 31% of high income group. In conclusion the article states the people may be more likely to go for high deductible plans due to the new health insurance laws. This is because the law puts limits on what the insurance companies can charge for monthly premiums. Finally the author states that policy makers should consider strategies to support patients facing high levels of cost sharing.

This article is interesting to me because I am a young adult who doesn't have health insurance. I work full time and go to school full time, my current employer does not offer health insurance and i can not afford Private insurance. I hope that the passing of the health reform will make it possible for me to obtain insurance as soon as possible. My significant other and I fall into that category of people who forgo or delay care because they can not afford to pay and at times it can be stressful when you are unsure of how serious something could be. I agree that policy makers should develop a strategy to support patients who are apart of these plans. I assume that those who are enrolled in these plans are those who really need continual care and probably that which is costly. By focusing on these types of issues policy makers can tackle one of the biggest issues, outrageously costly care, which effects the cost of care for all individuals. I believe that by addressing the biggest issues, the smaller ones will solve themselves.

Blog 3:Wild Card Module 5

For this blog I went to Kaiser Health New in order to review what is currently happening in health care news. This weeks readings included a discussion on job design. An article I found related to that subject is about nurses pushing for expanded roles. The article talks about nurses with advanced degrees receiving more authority. A study from the institute of medicine reported that nurses should take on a large and more independent role in providing health care in America. Specify to remove state and federal restrictions on what advanced practice nurse, with maters degrees, can do. In support of this movement, the new federal health care law will provide more funding for nurse education . Those in support of this issue say that it is the only way to increase the quality of care currently being provided. Opposed say that the advanced degrees do not include the same training and education as physicians which could put patients safety at risk. The report is asking for nurses to be paid the same wages if they are doing the same jobs as the physicians, as well as allowing them to admit patients to the hospital or a hospice(Villegas, 2010).

In this article nurses with advanced degrees are fighting to change their job design. to broaden their scope of responsibilities and authority. This article is a perfect example of how the changing environment is calling for a job analysis. Shortages in health care professionals now and in the future are the basis for this change. These nurses are asking for job enrichment in the form of vertical expansion of duties. They want to add autonomy and responsibility to the scope of their duties (Fottler, 2008 p.179).

The Federal Trade Commission and the Department of Justice are set to review this issue and examine the existing scope of the practice provisions to decide whether the changes should be made. If the decision poses no threat to patients safety and the quality of care then these changes could enhance productivity, job satisfaction, and patient satisfaction (Fottler, 2008 p.179).

Fottler, Myron D. Friend, Bruce J. (2008). Human Resources In Healthcare:Managing For Success. Chicago, IL: Health Administration Press.

Villegas A. & Carey M. (2010). Nurses Push for Bigger Roles Get Powerful Ally. Retrieved October 25, 2010, from Kaiser Health News Website www.Kaiserhealthnews.org/stories/2010/october/05/iom-report-on-nurses.aspx

Human Resources- Wild Card

This week the assignment is a wild card blog entry. So I decided to look to the libraries database and found an interesting journal article which i will summarize and then give my opinion on.

The article I choose is the journal, The Health Care Manager and is titled, "Examining Human Resources efforts to develop a culturally competent Workforce." The article defines cultural competency as,"the ability of health professionals and organizations to provide services to patients with diverse beliefs, values and practice in a manner that meets patients cultural, social and linguistic needs." The importance of this topic is due to the increased prevalence of the minority population. If health professionals are not able to effectively meet the need of a diverse customer base then they will hinder the quality and access of service they provide and will lose a competitive edge in the market. Their is also a second part of cultural competency which deals with the recruitment and selection of a diverse workforce. The article states that studies show that a diverse workforce helps an organization overcome sociocultural barriers.

Increasing the diversity of a workforce can foster innovation, improve cooperation, increase and performance levels. These benefits will lead to improved quality, increased access, decreased costs and improved patient safety and health care outcomes. In order for an organization to be culturally competent they must have effective diversity management. Meaning, they must have policies and procedure which complement a diverse workforce and population. The focus of the article in on the efforts of the human recourse department to recruit and train staff in a way that fosters cultural competency.

For this article a questionnaire was sent out to 101 hospitals in the southeast region. The purpose was to inquire about the hospitals recruitment efforts, training practices and other efforts related to developing a culturally and linguistically competent workforce. Some of the interesting results obtained are as followed: 77% actively recruit employees from various ethnic backgrounds, 74% have persons from different ethnic backgrounds in leadership positions, 87% of staff are provided with training to care for patients with cultural difference, 44% have trained interpreters on staff.

Overall the findings indicated that most human resource departments focus their efforts on recruiting ethically divers individuals and training clerical and nursing staff to deal with diverse patients. The article suggest that HR focus on identifying the demographics pf the area they serve, to ensure groups are adequately represented. One way to ensure that diverse individuals are recruited properly is to partner with statewide or community based organization that support culturally diverse groups.

I found this article very informative. I like how in the survey they not only asked about the staff diversity but whether there were diverse leaders in the organization. The study showed that those with diverse leaders were more focused on diversity and seemed to realize the importance of providing patients with a more comfortable environment, one where their ethnicity was represented. It is important to keep the patient comfortable not only for cooperation's and satisfaction but for a positive word of mouth.

What does Human Resources mean to you and what is their role in hc orgnizations?

Human Resources to me is managing the key asset of the organization,the employees. The employees of an organization need to be managed separately from other asset of the organization because they have specific needs unlike the other tangible assets of and organization. The human resources department of an organization is responsible for designing and implementing strategies to manage the employees of an organization. This department is responsible for recruitment and the hiring and firing of individuals, performance reviews and management, training and development of employee's skills and the management of compensation and benefits as well as rewards.

Human Resources play a large role in a health care organization. Since a Health care organization's main purpose is to serve individuals who need health related services as a result of an injury, ailment or prevention of the two, the success of the organization depends on the skills of the employees. Therefore it is especially important for a health care organization to have a fully functioning and capable human resource team. This department will need to be able to hire, train, and retain quality employees to provide superior customer service, ensure patient safety and to produce successful outcomes for patients. Employees will need to stay motivated through proper compensation, benefits and rewards. Finally to achieve successful outcomes for patients and improve employee skills human resources will need to conduct performance reviews to inform employees of what they are doing right and what they are doing wrong.

H.C. Quality:Wild Card

This is my last assignment for this class. I just finished posting my responses to other students quality improvement projects. I am happy that it was an assignment. I enjoyed looking at other students work. It almost works as a comparison to understand what I may have done wrong or misinterpreted. This helps me to do higher quality work in the future.

For my wild card I am going to do a current event in the news related to health care quality. The article is titled, Doctors critize insureres over ranking and it from the wallstreet juornal. The raticle talks about how doctos are critizing insurers for ranking groups based on cost or quality. They say it is swaying the popion of paients on where they seek care. Insurers say they are working to ensure that the rating are accurate and transparent. Consumers can get lower out of pocket charges if they see a doctor in a preferred ranking. Doctors are saying that these rankings are unreliable and often inaccurate. Doctors can be ranked higher is they order less "questionable" tests or if they have more favorable patient outcomes.

I think it is a good thing that insurance companies are doing this. Not only does it help to control costs overall for health care but it also helps the patient make a more informed decision on where they seek health care. If the rating are accurate and reliable then they are serving a purpose. This is something that could be regulated by a third party to ensure that the rating are not bias. I can see a few flaws in this. Doctors may be more inclined to order less test if they re being rated on the fact that they may have ordered a questionable test. This could result is less quality of care for the patient. This could also reduce access to care if the Doctor began to refuse the type of insurance all together. The Doctor may decide to switch to accepting a different insurance in place that doesn't use ranking. This could hinder access for the patient.

Ethics Week 8

Yeah last blog! I'm happy to be almost done with this semester. I finished my third mini paper, which actually ended up being my favorite. I wrote the paper on patient autonomy for end of life decision making. The Great Debate is all finished up. It was fun and way different from doing a face to face debate. It was much easier to respond to the opposition when you have time to write a well thought out response. The only assignments I have left to do are three more decision board response which I will finish up over the next two days. I am going to follow the same trend for my blog this week and reflect on the interesting points in the reading for the week.

In the Perry book we didn't have a case to read but just a general section titled the ethics of managing people. It was a good conclusion to the book. Ethical dilemmas involve people making decisions and managers must support their employees and provide them with the tools necessary to make ethical decisions. Employees are a resource that is essential to the success of an organization and they should have a safe work environment. They should be protected from harassment and discrimination. It is the Managers job to make sure this thought becomes a realization. It must be extremely difficult for managers to not only work about their duty to the organization to perform financially and productively but to also protect employees and support them emotionally. This section make me think about the case in this book where the female intern worked with a male mentor and CEO. The CEO was trying to protect himself and the intern from potential wrongful actions associated with a sexual attraction. His actions back fired and he was accused of discrimination. It must be like walking on egg shells. This class has almost scared me to take a management position. I am an indecisive person in nature and i picture myself stressing my life away trying to figure out ethical dilemmas. I am sure when put in the actually situation it will come more naturally to make decisions. I think I have thus far prepared myself through education.
The rest of the chapter is almost like a handbook for ethical behavior in the day to day duties of a manager. I think I will keep this book to help alleviate my stress when trying to make ethical decisions.

The chapters in the Hofmann book are similar in topic to those of the Perry book. I was going to write my third mini paper on accountability but in the end switched to autonomy. I think accountability is an important topic. Accountability seems to be addressed in several ways. First organizations are accountable for their actions and should report their performance and errors to the public. This ensure that the public is well informed and able to make decisions for their best interest. Organizations are also accountable to their employees, as addressed in the first section of the Hofmann reading. Organizations are accountable for setting ethical and moral standards for employees to follow. These standards require explicit attention, articulation, education, practice, re informant and rewards. Basically you cant ask employees to act ethically and morally if you, the health care organization or executive, are not doing the same. This seems simple and seems to make sense, however some organizations find it difficult, or they just choose not to follow. Which ever the case it is important for any organization, especially a health care organization to set an ethically example for their employees and the community. If the health care organization which is utilized for saving lives and treating people, isn't ethical then who is?

Ethics Week 7

This weeks readings reminded me of my debate discussion. The first section Hofmann book talks about civic responsibility, and how it is difficult to manage limited resources under ethical and economic challenges while still aiming to improve community health. In my debate I am the affirmative side and the topic is whether health care organizations should be able to refuse demands for futile treatments. As one of my main points I talk about limited resources and the fact that health care organizations have a duty to promote overall community health and ensure that the proper resources are there when patients need them. Meaning they should not be "wasted" on futile treatments. We just finished our Q&A session and I will be writing my closing statement in the next few days. I found the debate enlightening. It was interesting to see both points of view, and that both points of view could be considered right. Which actually confuses me even more about ethical decision making. It is difficult to understand where to draw the line and what can be justified. Especially when talking about the life of a human being. Is it ethical to demand resources when then is no positive outcome and they would benefit another? How can you possible make that decision! I am very glad I am not a doctor, because I don't think anything would get accomplished. I would never be able to make a decisions. From a managements perspective I think it is easy to look at facts and analysis the situation for what its worth, without emotions. When you have that one on one connection with the patient and you can actually see and feel their pain, then it can be hard to do what is right for the overall community, not just that individual patient.

The next two sections in the reading for Hofmann discuss advertising in health care and its ethical implications. I actually watched another group debate this during my last semester. This too is also a difficult subject, one where the complexity of the situation is highlighted. Health care is a business and therefore has an objectives to produce revenues. However health care also has an objective to serve the patients best interest, which can be saving a patients life. Typically other businesses do not have this sort of complexity. Trying to meet both objectives and do it in an ethical manner is the real challenge. In regards to advertising the message can be bias and can be twisted. To ensure the organization is advertising to the consumer in an ethical way all relevant data must be presented in order to ensure the consumer is well informed. The consumer should not be persuaded to do purchases a medical product, medication, procedure or visit a certain health care organization if it is not in their best interest. Consumers should be able to make well informed decisions on what is best for them. Health care organizations should make themselves visible to the public. Knowledge is the key.

Titled post wrong

I titled my post wrong and I do not know how to fix it. The last post titled, ethics week 4 should be tilted ethics week 6- due on 6-29

H.C. Ethics Week 4

This week my boyfriend had a knee surgery, so I wanted to wait until it was over so I could write about it on my blog. My boyfriend had a torn muscle in his knee, his surgery was to repair the muscle and remove scar tissue and build up associated from the injury. His surgery took place in an ambulatory surgery center. We were scheduled to be there at 7:45am. We were in the car on the way home by 11:00am. The surgery itself was about an hour. The facility was easy to walk around in, lots of signs directing the patients and visitors where to go. The employees at the facility were very friendly, informative and caring. I was very pleased with the way I was treated as well as my boyfriend. When discharged we received detailed directions on how to care of the injury, we also received a follow up phone call to check in. Although I do not have many experiences at a health care facility to compare this one to, I believe the service was excellent and my boyfriend and I are satisfied with the outcome. I did encounter one ethical situation. When the doctor finished surgery he came out to the waiting room to talk to me. Due to patient confidentiality the doctor asked me to follow him into a room to update me on the situation an discuss the outcome of the surgery and the state of the patient. The doctor upheld his ethical duty of respecting a patients privacy by bringing me into a different room to keep our conversation private.

I noticed something interesting while sitting in the waiting room. A older couple entered the facility and had a hard time hearing the receptionist. Therefore the receptionist spoke very loudly with the patient. During the conversation the receptionist made it a point to tell the patient that the facility was an ambulatory setting and that her advanced directive, living will, could not be honored there because it was not a hospital. The interesting part was the receptionist did not mentioned this to my boyfriend during check in. I wondered whether this was an issues of equality. Was the receptionist treating the patients differently because they were older or my boyfriend because he was younger? Then I wondered why the organization did not honor advanced directives, why would they not give the patients the choice , why was the organization was not interested in the values and the wishes of the patient.

H.C. Quality:Patient Perceptive

Explain Why or Why not the perceptive of the patient is the most important determinate of an adverse event.

I believe that the patient perceptive is important in determining an adverse event, however I don't believe it is the most important determinate. The text defines an adverse event as a patients experience of harm or injury from a medical intervention. The text further explains how there are different types of adverse events. The different types include, ones that are a result of an error and are consider preventable, and those that are not a result of an error but occur as a result of a careful planned and executed medical intervention. The later type is out of the control of the medical interventionist and results as an unpreventable consequence of the medical intervention itself. Patent's perspective is not one that is backed by medical knowledge and clinical experience and therefore is bias. Patients are emotional while receiving any type of medical intervention. Feelings of fear, anxiety, discomfort, pain, discrimination, anger, and denial can typical cloud the judgement of a patient. Patients may feel differently after having a procedure done and can contribute the abnormal feeling to an adverse event, when really it may just be a side effect of the recovery process. Trained medical professionals or other knowledgeable third parties should analyze the process and procedure to determine whether an adverse event has taken place. The analyze should be conducted using guidelines which are organization wide and widely accepted in the medical community. Evidence based medicine can help determine whether a preventable error may have caused an adverse event or whether a unpreventable adverse event has occurred. Patients are not qualified to analyze these types of situations or to conclude whether an adverse event has occurred.
Patients should however be included in the process. Communication should be open and flowing between the patients and those involved in the medial intervention. If the patient is not able to articulate their feelings after a medical intervention, then an adverse event may not be discovered. When this happens, an error can be repeated and harm can be brought upon other patients.

Ethics Week 5

Wow already on week 5... We are moving right along. Usually I write about the Track's We Leave book. This is because I always find the stories interesting and relatable, as well as something I can learn from. This week the reading was about graduate medical education. The chapter was full of information and very educational but didn't leave me with much to reflect on. This week I therefore will concentrate on the Manging Ethically readings. This should also help me think of a topic for my second mini-paper.

The first reading really stood out to me, it stated that clinical activity of health care executives should be limited to recruitment and retention of the best qualified staff and to then be responsive to legitimate requests for essential resources. The author then states that the executive have a moral obligation to ensure that patients receive the highest possible quality care. I completely agree with this. I think that in order to understand who is the best staff for your organization, you need to know who your patients are, what their expectations are and then monitor that your staff is meeting desired expectation. The author suggests making frequent patient rounds so that the opportunity for communicating with patients, physicians and nurses will arise. This could be very difficult for an executive to efficiently achieve. Any health care facility is very busy and the executive would not want to interfere with the activities already in process. However if the executive is knowledgeable about the way the organization is run, then they may be able to proper identify a reasonable time to effectively interact with those in the organization. This could be during the patient wait time before a procedure or their wait time associated with discharge. I also like the suggestion that the executive interact with the ethics committee on a daily basis. By doing this the executive will be able to easily identify any issues going on within the organizations that may need to be more closing monitored. This would have give the executive expert insight on the ways he can ethically deal with any situations he may have observed.
The next reading was about end of life decisions. This reading was interesting to me because it is similar to the topic in which my team will be debating, futile treatments. The author states that the decision to withhold or discontinue extraordinary or disproportionate means of medical intervention must be made with the judgment that the treatment itself is excessively burdensome or that the treatment is useless(not whether a persons life is not worth living). The topic for my debate is whether health care organizations should be able to refuse demands for futile treatments. I believe yes that health care organizations, maybe a specific panel designed for these types of situations, should be able to make the decision. Patients and their families may not be rationale in there thinking during these types of situations. Health care organization have the education to make informed decisions on whether a treatment is necessary, and with the help of an ethics committe they can determine if that decsion is also moral.

Ethics Week 4

This week was especially interesting to me because the reading in the tracks we leave book was about gender discrimination. I am a woman and these types of situations and their consequences are important for me to understand. The issue at Rolling Meadows hospital was tricky. When I graduate I hope to receive a fellowship opportunity in an acclaimed health care institution and this type of situation would not be one I would like to see myself in. In my own opinion I think it is not only the responsibility of the male to ensure he does not discriminate against a female but it also the females responsibility to keep her guard up. Whenever you are working closing with people, whether they are of the same gender or different gender, you will develop a relationship. That relationship can come in any form. It is a professionals or future professionals personal responsibility to maintain a productive and healthy relationship with the other people that they work with. This can often become hard when attractions, physical and not, have the opportunity to develop. My current job is a waitress and I work with several members of the opposite sex. The environment in which I work is fairly casual and professionalism is not a big issue. For me I think it may be difficult to transition into a different environment, one where gender discrimination and sexual harassment issues can become prevalent. Therefore this chapter in the book was highly enlightening and I aimed to absorb all the information presented. This is because I am beginning to mentally prepare myself to properly act in any situations that may arise in the future.
My first opinion in response to this chapter is I am completely against subordinate/ supervisor relations in an organization. As the book stated these types of relationships cause a hostile environment for workers. An environment where feelings of jealously, favoritism, and fear of expression can arise. Most jobs in themselves are stressful and the supervisor should be there to ensure that the employee isn't distracted while trying to perform at their best. Women should keep their guard up and not be vulnerable to put themselves in situations, such as the one stated in the text.
I also think that this situation may have been avoided had the protege keep in communication with the mentor and vice verse. The mentor had a responsibility to prepare the protege for the future and be emotionally secure. The moment that he may have felt inappropriate attractions were at play he should have communicated this with the protege. Being emotionally secure and rational may have saved the mentor from putting himself in this type of situation.
Personally I would like my mentor to be a female, one who has dealt with these types of situations first hand. As the text stated CEO's are predominantly male, but what the text didn't state was whether mentors are predominately CEO's. I would assume that most mentors are not the CEO's of an organization. I would assume that they are more time mangers of departments and positions such as that.
In out managing ethically book the readings were about leadership and ethics programs and committees. These reading kind of went hand and hand with the tracks we leave reading. The tracks we leave book gave the situation and then the manging ethically book gave examples of solutions that may have been implemented to avoid the problem. The solution being exemplary leadership and clearly defined ethics in an organization.

H.C. Quality Post 2- Wild Card

This week is a wild card blog entry, meaning a topic of my choice. It always seems harder for me to think of something to write about when it is my choice. It always seems easier to me to receive directions and then follow them. So this week for the sake of brain drain I am going to do a current event from the news. In my other class I have been reading and researching in the area of Managed care. One of the positives sides of managed care is that patients have shown to have fewer admissions and shorter lengths of stay at the hospital. One of the studies showed that Managed care patients spent 35% less time in the ICU (Hofmann, 2001,p.45 ). The quality of care received in a manged care environment can become an ethical issue. This is because in a traditional managed care setting you do not use a fee-for-service system, which can promote less treatments resulting in lower quality of care.

An article in relation to this issue, was in the news this week. The article is titles, the revolving door at the hospital. It talks about how patients over length of stay is shortening but the readmission rates are rising. This specific article is about Medicare patients with heart-failure. The study indicated that death rates for patients during hospitalization for heart-failure have decreased but rose after discharge. The article also quoted the vice president for quality and patient safety policy at American Hospital Association saying, "a reduction in 30-day overall death rates showed hospitals are doing better in caring for these types of patients." Studies presented in the article also show that 1 in 4 patients are readmitted for heart failure within 30 days of discharge. The factors contributed to these problem is a fragmented delivery system and conflicting reimbursement incentives (Winslow, 2010).

A fragmented delivery system and conflicting reimbursement incentives are great examples of quality issues in today health care. The health care reform legislation is attempting to control these issues. What I wonder is if these issues are controllable without a complete realignment of the overall health care delivery system. With so many different ways in which reimbursements are handled and health care is delivered, how can one be sure that quality service is given. I personally believe that a standard should be developed and mandated for all organizations, health care is not a typical business, it is essential to out population and their health and quality should be the most important outcome, not profit.

Hofmann, P.(2001). Managing Ethically: An Executive's Guide. Chicago: Health Administration Press

Winslow, R. (2010). The Revolving Door at the Hospital. Retrieved June 7,2010, from the Wallstreet Journal Web Site: http://online.wsj.com/article/SB1000014240527487039612045752809

H.C. Ethics Week 3

It's week three and we are moving right along!!! A lot of the reading this week had to do with managed care, which is a great topic to touch one when talking about ethical decisions. I plan on writing my mini-paper on manged care. I have not yet decided the actually topic but I feel that managed care relies heavily on providers and insurance companies making ethical decisions to benefit patients. This week another big portion of the reading was related to the importance of ethical programs, performing effective audits and creation of compliance boards and ethics committees. Having an effective and well defined system for ethics in an organization is very important to ensure that not only employees are making everyday ethical decisions but also top level executives. This is also extremely important for a managed care system, which is naturally suspect to unethical decision making. In the "Tracks we Leave" text, 6 principles of medical ethics are presented, which are in direct relation to manged care environments. Autonomy, Beneficence, Nonmalefice, Fidelity, Veracity and Justice and the 6 principles talked about in this chapter. The real question presented here is whether health care should be treated as just another business or should its own set of ethical principles and guidelines. Whether you answer yes or no, would determines where the loyalty of the physicians, and managers lies. This decision bring about ethical dilemmas for the physicians and managers.

Personally I think of my self as an ethical person and I do sincerely care about individuals. If i were a physician my loyalty would lye with my patient and their well being. In that situation I would think of health care as not just another businesses, it would mentally be separate. This decision might be too easy for me to make since I am not trained in this area, one might feel completely different when they are actually working the profession. For example my undergrad degree is in Business management so when I think of being put into the situation as a manger I might feel more inclined to look at health care from a business perspective. Stakeholders are different and the patient is not the only important outcome. When profits come in to play the game changes. Business can be cold hearted to the customer. The text specifically talks about marketing and in a manged care system how the optimal customer is young and healthy. So is it ethically to market to the young and healthy and exclude others if that is what is profitable to the business??? I would not like to be the one who makes that decisions. It is seems difficult to decipher what is appropriate. The book says no this is not appropriate ethical behavior, and calls this "cherry picking." In this situation the loyalty lies with the community and a duty to provide optimal health care for all, not just provide the highest profits for the organization.

H.C. Ethics Week 2

So this week we were assigned chapter 1 and 1a in "The Tracks We Leave" text. I LOVED this reading. Last week the reading was straight definitions and I had a hard time trying to piece things together in my mind what exactly ethical dilemmas implied. This week was so much different. The chapter starts out with a real life example of a typical ethical dilemmas that could happen. The situation itself, at Paradise Hill, was interesting and relatable. I wasn't sure if this was a real life example or a fictional one. After the situation was presented then the definitions were introduced, the different types of ethical issues. The explanation of the ethical issues was presented in the form of the questions you would ask yourself if you were encountering that ethical issue. Giving the question rather then a definition gave the explanation more meaning and made it more relatable to the reader. Next the ethical issues were related directly
to the situation at Paradise Hill, and backed up further through details of other documents related to the issue of medical errors, patients rights and ethical standards and codes.
All in all it was a great way for me to make a mental connection of the definitions. This connection will make it easier to apply the definitions to different situations by using this example as a reference.
Chapter 1a was also insightful and made me think of my values. This is something else hard for an individual to define. It is not something i often sit down and reflect upon. In the situation at Paradise Hill i would have had a hard if i were any one of the different people that were part of the situation. If i were the CEO it would be hard for me not to listen to my employees and their perceptive on the issue when I have different stakeholder such as the board members who felt a different way. In one section of the chapter the question of whether values are separable from facts. Facts are easier to defend, they are concrete and hard to argue against. However someone may value one fact's important over another. So does your role in life determine what your values are? and if that is the case, since our roles are ever changing and expanding are also our set of values?

Healcare Ethics- Post week 1

FYI: After I wrote my whole post in Microsoft Word, I realized that you cannot paste text into this blog, this is highly frustrating. I have been racking my brain trying to think of something interesting for my blog posting. I wanted to think of a time where I experienced an ethical dilemma i have encountered however it has been difficult. so mu first ideas was to review the material and try and form an understanding. First I know what ethics is not. Is is not the same as feelings or religion, or as breaking the law or a culturally accepted norm, and it is not science. Thinking of what ethics isn't defiantly didn't make it easy to decide what it is.
The next was to try and think about ethics is by examine the different sources of ethical standards. I looked at the different approaches and pulled out a few notable parts. First I liked how the utilitarian view talks about consequences and how they should do more good then harm. The rights approach talks about dignity and a duty to respect others rights. I particularly found the perceptive of common good approach interesting. To think that just being part of the community is reason enough to respect others. When thinking about this approach, the first thing that came to my mind was garbage pickup day. I started to wonder whether i was offending my neighbors when i forget to take out my trash on one day, resulting in double the trash on the next pickup day. Then quickly it was easy to realize this situation is more likely breaking a cultural norm.
Next in my notes is the framework for ethical decisions making. As part of the framework. the first think you have to do is recognize your ethical issue. So now i am back to square one and just frustrated that i am still have trouble identifying an ethical issue i have encountered. The rest of the framework seems to be the easy part, get the facts, evaluate the alternatives, make a decision and test it and finally act and reflect on the outcome. So in conclusion my plan is to make a conscious effort to put myself through this decision making process and to recognize a typical ethical issue i encounter. I think this important because if i cannot identify my ethical dilemmas how will i be able to make ethical decision and how will I be able to know if I lead an ethical life.

H.C. Quality:Module 1: What does quality mean to you?

I think the best way to start a reflection on this topic is to begin with what I learned from the reading this week. In my notes I complied a few points under my definition of quality,"Balance of health benefits and harm, the degree to which health services for individuals and populations increases the likelihood of desired health outcomes and are consistent with current professional knowledge, how care is provided should reflect appropriate use of the most current knowledge about scientific, clinical, technological, interpersonal, manual, cognitive and organizational management." This is the definition of quality health care, not just quality in general. Since this is a health care class I feel it is appropriate to center my decision on quality of care. I would like to think that this is a decent definition of quality of care, given from a health care professionals view, but from a patient view I don't know if this would be the best way to define quality. From a patients point of view, quality care will be tailored around their knowledge of their health status before and after treatment, the actual condition being treated, and how the service they have received compares with other patients and/or other personal past experience. This definition is similar in nature that that given in the text but i think that quality is a perception and should be defined on a personal level. One can not assess whether they believe the care they were given was quality unless they have a way to measure that care in relation to something that was not quality.
I am a waitress in a restaurant and I do enjoy my job most of the time. I try and give quality service because it is important to the reputation of the establishment in which I work. I work in a family owned restaurant which was been in operation for 30 years. I have worked their for 7 years, and have always made good money. I would not be able to keep my job if i did not give quality service. Now when i go other places to eat sometimes i am amazed at the lack of quality service I receive and I think about about would happen to me in my job if i were to give the customer poor quality service in the restaurant which I work. The conclusion that I am trying to make here is that I measure the quality of service in which I receive based off a perception of a standard in which I have created. I have a desired outcome.

The problem here lies in the fact that not everyone in the service industry values the level of services or the quality of service they provide. Not everyone aims to reach that desired outcome. For example last semester during a debate in class, I was in debate with a technician who worked in a hospital. We were debating the issue of how the health reform will affect quality of care. I presented more or less the example i have provided early on how I try and give the greatest quality of service because it is my job for one and for two because that is what i would like in return. Then i asked the technician whether she also felt this way. Whether she thought that nurses, technicians, etc. valued their jobs and would aim to provide the highest quality service possible. She didn't agree with me and basically called me naive.

So the next part of the reading talks about the six dimensional aims for improvement and the one that most service provides are lacking in terms of quality is being patient centered. So what makes me so naive to think that this is a achievable? The definition states that the system of care should revolve around the patient, respect the patients preference and put the patient in control. Being patient centered will create that perception of quality, along with the other 5 aims you can achieve actual quality.

Week1

I guess I am just trying this out right now.....I am very excited to start this semester and creating a blog seems interesting and fun. I am waiting on the confusion of the books to settle, as well as my book to arrive before i begin doing school work and posting my actually first assignment blog. I am in hopes of completely it by Sunday, so see ya then!