1. © 2010 Jones and Bartlett Publishers, LLC A Practical Approach For Decision Makers SECOND EDITION EILEEN E. MORRISON

2. © 2010 Jones and Bartlett Publishers, LLC Class Ten: Organizational Culture

3. © 2010 Jones and Bartlett Publishers, LLC Agenda Discussion of the macro view of organizational culture Discussion of the macro view of organizational culture Review of the impact of subcultures Review of the impact of subcultures Overview of ethics committees and ethicists Overview of ethics committees and ethicists Use of decision making models Use of decision making models Application of case material Application of case material Summary Summary

4. © 2010 Jones and Bartlett Publishers, LLC Macro View: Who are we? ¾ live in cities, 1 in 5 householders are over 65. ¾ live in cities, 1 in 5 householders are over 65. Diversity is the norm, Diversity is the norm, Is there just one American culture? Is there just one American culture? What concerns does the American culture bring to health care? What concerns does the American culture bring to health care?

5. © 2010 Jones and Bartlett Publishers, LLC Organizational Culture Need to determine the definition of organization (Daft, 2001) Need to determine the definition of organization (Daft, 2001) –Organizations are social. –Organizations have goals and do activities. –Organizations are linked to the outside world.

6. © 2010 Jones and Bartlett Publishers, LLC Organizational Culture Organization culture is like an iceberg. Organization culture is like an iceberg. Members of a culture need to adapt to the organization and the external environment. Members of a culture need to adapt to the organization and the external environment. Culture expects certain things from the organization. Culture expects certain things from the organization. Ethics is a cultural issue for the organization. Ethics is a cultural issue for the organization.

7. © 2010 Jones and Bartlett Publishers, LLC Subcultures in Health Care What subcultures exist in HCOs? What subcultures exist in HCOs? Culture clashes are common and always possible. Culture clashes are common and always possible. Cultures have different values, stories, traditions etc. Cultures have different values, stories, traditions etc.

8. © 2010 Jones and Bartlett Publishers, LLC Exercise: What do they say about… Aquinas: Male nurses Aquinas: Male nurses Kant: Housekeeping staff Kant: Housekeeping staff Mill: Psychiatrists Mill: Psychiatrists Rawls: HCA interns/residents Rawls: HCA interns/residents Brainstorm as many examples of what might be said about your topic. Brainstorm as many examples of what might be said about your topic. Debrief Debrief

9. © 2010 Jones and Bartlett Publishers, LLC Did Stereotyping Happen? What is a stereotype? What is a stereotype? Stereotypes are lazy behavior. Stereotypes are lazy behavior. Stereotypes exist by gender, ethnicity, physical characteristics, age, economic status, health condition, etc.. Stereotypes exist by gender, ethnicity, physical characteristics, age, economic status, health condition, etc.. Why do you care? Why do you care?

10. © 2010 Jones and Bartlett Publishers, LLC Administration Subculture Administration has its own subculture. Administration has its own subculture. Ethical temptations exist. Ethical temptations exist. Watch out for managerial malpractice. Watch out for managerial malpractice. In extremes, administration can use its power for evil. In extremes, administration can use its power for evil. Ethics needs to be the norm as a business practice. Ethics needs to be the norm as a business practice. You are the role model; your actions need to match your words. You are the role model; your actions need to match your words.

11. © 2010 Jones and Bartlett Publishers, LLC Ethics Committees Technology and other challenges make ethics decisions difficult. Technology and other challenges make ethics decisions difficult. Functions include education, advice, and patient case review. Functions include education, advice, and patient case review. Should be given a important place on the organizational chart. Should be given a important place on the organizational chart. Can assist with policy development. Can assist with policy development. Membership composition varies. Membership composition varies. Training and commitment is a must. Training and commitment is a must.

12. © 2010 Jones and Bartlett Publishers, LLC Pediatric Ethics Committees Also called infant care review committees (ICRC). Also called infant care review committees (ICRC). Issues of infant end of life, disability, and child abuse and neglect addressed. Issues of infant end of life, disability, and child abuse and neglect addressed. Members may include pediatricians, pediatric oncologists, nurses and social workers. Members may include pediatricians, pediatric oncologists, nurses and social workers. May be on 24-hour call. May be on 24-hour call.

13. © 2010 Jones and Bartlett Publishers, LLC Institutional Review Boards Research brings special ethics issues, Research brings special ethics issues, Roots of IRBs were in the Nuremburg Code of 1949, Roots of IRBs were in the Nuremburg Code of 1949, Abuses have occurred in the U.S. Abuses have occurred in the U.S. IRB protects humans subjects from researchers IRB protects humans subjects from researchers –Informed consent –Proposal/protocol review.

14. © 2010 Jones and Bartlett Publishers, LLC Ethicists Specialist in ethics. Specialist in ethics. Usually hired as a consultant. Usually hired as a consultant. Have doctorates in ethics, bioethics, etc.. Have doctorates in ethics, bioethics, etc.. Serve as a resource for ethics committee. Serve as a resource for ethics committee. Assists with decision making through facilitation. Assists with decision making through facilitation.

15. © 2010 Jones and Bartlett Publishers, LLC Decision Making Models Need tools to assist with making decisions Need tools to assist with making decisions Committees should review existing models and choose one. Committees should review existing models and choose one. Model must be well understood Model must be well understood Training is needed especially when new members are added. Training is needed especially when new members are added.

16. © 2010 Jones and Bartlett Publishers, LLC Organizations need Assistance Many organizations use check sheets and forms to help with ethics decisions. Many organizations use check sheets and forms to help with ethics decisions. ACHE uses the Nelson (2005) model to assist committees. ACHE uses the Nelson (2005) model to assist committees. Work the model exercise. Work the model exercise.

17. © 2010 Jones and Bartlett Publishers, LLC Debriefing What was your decision? What was your decision? Conclusions from the class. Conclusions from the class. How helpful was it it have a model? How helpful was it it have a model? What else did you need? What else did you need? How easy or difficult was it to come to a decision? How easy or difficult was it to come to a decision?

18. © 2010 Jones and Bartlett Publishers, LLC In summary… Why will you need to know about ethics committees as a health care administrator? Why will you need to know about ethics committees as a health care administrator?