HCS 335 Week 3 Management and Ethical Decision Making Example

The Surgeon Who Brings In the Most Revenue: How a Hospital Administrator Decides What to Do About Disruptive Behavior, and What the Decision Says About the Culture

[Student Name]

University of Phoenix

HCS/335: Health Care Ethics and Social Responsibility

Week 3 Assignment

[Instructor Name]

[Date]

The hospital, the surgeon and the reports are composites written for a model paper; research findings and guidance come from the sources listed.

The ninth report arrived on a Monday. A scrub nurse at a composite 220-bed hospital wrote that a cardiac surgeon had shouted at her in front of the team and thrown a clamp that struck the instrument table beside her. The chief operating officer read it alongside a note from the finance office: the surgeon's cases account for nearly a third of cardiac revenue. The hospital's values statement lists respect, safety and integrity. This paper examines the decision the administrator faces and what it will reveal about the organization's culture.

Stated Values and Actual Culture

Every staff member signs the code of conduct each year. It promises a workplace free of intimidation and invites staff to report concerns without fear. Nine reports over 18 months, each answered with an informal word from the chief of surgery, suggest a different message: the code applies unless the person is valuable enough.

Why the Behavior Is a Safety Issue

The Joint Commission (2008) warned that intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and cause qualified staff to leave, and it called on accredited organizations to adopt a code of conduct and a process for managing such behavior. When nurses fear a surgeon, they hesitate to point out a missed count or an unclear order, and that hesitation reaches patients.

Why Silence Is Dangerous

Edmondson (1999) found that team psychological safety, the team's shared sense that members can take interpersonal risks without punishment, was associated with learning behavior, such as asking questions and discussing errors, and those learning behaviors were in turn linked with how well teams performed. An operating room where people are afraid to speak is one that has stopped learning, whatever the skill of the person at the table.

A Structured Decision

The chief operating officer followed a six-step process: gather facts, identify stakeholders, name the values at stake, list options, weigh consequences and decide.

The Facts

Interviews confirmed seven of the nine reports. Two nurses on the cardiac team had transferred out in the past year, citing the surgeon. Patient outcomes remained good. The surgeon, when asked, said the team was slow and that high standards save lives.

Stakeholders

Patients depend on a team that communicates. Nurses and technicians deserve a safe workplace. The surgeon deserves due process and a chance to change. Other physicians watch to see whether rules apply to the powerful. The hospital's finances and its accreditation are both at stake.

Values and Principles

Nonmaleficence applies to patients harmed by silence and to staff harmed by intimidation. Justice requires that the code apply equally. Respect for persons applies to the surgeon as well. Integrity, one of the hospital's stated values, means acting on what it says.

Options

Option one: another informal conversation. Option two: a formal, escalating intervention with clear expectations and consequences. Option three: immediate suspension of privileges.

Weighing Consequences

Another informal word would protect revenue in the short term but teach staff that reporting is pointless. Immediate suspension would skip the fair process medical staff bylaws require and could lose a skilled surgeon who might change. A formal intervention protects both fairness and safety.

What the Finance Office Argued

The finance director made a fair point: losing the surgeon would cut cardiac volume, and the revenue supports services, including charity care, that the community needs. The argument deserved an answer rather than dismissal. The answer is that the revenue is already at risk. Two experienced nurses have left, replacing each costs months of recruiting and orientation, and a serious error in a team afraid to speak would cost far more than any single surgeon earns. Protecting the culture also protects the program.

A Tiered Model

Hickson et al. (2007) described a pyramid for addressing unprofessional behavior: an informal conversation for a single incident, an awareness intervention by a respected colleague when a pattern appears, a guided intervention by an authority with a plan if the pattern continues and disciplinary action if it does not change. The surgeon's nine reports place him well past the first level.

The Decision

The chief medical officer and chief of surgery will meet the surgeon with the reports, the code of conduct and a written plan: coaching, no further incidents for 12 months and review at 90 days. The plan states that continued behavior will go to the medical executive committee for action on privileges. The surgeon keeps operating during the plan, and a respected senior colleague will serve as his coach.

If the Plan Fails

If the surgeon does not change, the matter moves to the medical executive committee under the bylaws, which may restrict or remove privileges after a fair hearing. The hospital will begin recruiting a second cardiac surgeon now, so that a future decision about privileges is not held hostage to revenue.

Protecting Those Who Reported

The nurse who wrote the ninth report will be told, within limits of confidentiality, that action has been taken. Retaliation of any kind will be treated as a separate violation.

Communicating the Decision

Without naming the surgeon, the chief operating officer will tell department leaders that the code of conduct applies to everyone and that reports lead to action. Leaders will repeat the message in their units, and the hospital will add a question on psychological safety to its annual culture survey.

Compliance Connection

The decision also meets accreditation expectations for a code of conduct and a process for managing disruptive behavior, which surveyors review. Here ethics and compliance point the same way.

Conclusion

The administrator's choice was never only about one surgeon. By using a structured process and a tiered model, the hospital acted on its stated values of respect, safety and integrity, protected staff who spoke up and gave the surgeon a fair chance to change, showing staff that its code of conduct means what it says.

References

Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350-383. https://doi.org/10.2307/2666999

Hickson, G. B., Pichert, J. W., Webb, L. E., & Gabbe, S. G. (2007). A complementary approach to promoting professionalism: Identifying, measuring, and addressing unprofessional behaviors. Academic Medicine, 82(11), 1040-1048. https://doi.org/10.1097/ACM.0b013e31815761ee

The Joint Commission. (2008). Behaviors that undermine a culture of safety (Sentinel Event Alert, Issue 40). https://www.jointcommission.org/resources/sentinel-event/sentinel-event-alert-newsletters/sentinel-event-alert-issue-40-behaviors-that-undermine-a-culture-of-safety/