Nelson William, Rosenberg Marie-Claire, Weiss Julie, Goodrich Martha
Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire, USA.
J Healthc Manag. 2009 Jul-Aug;54(4):273-83; discussion 283-4.
Research into the importance of organizational healthcare ethics has increasingly appeared in healthcare publications. However, to date, few published studies have examined ethical issues from the perspective of healthcare executives, and no empirical study has addressed organizational ethics with an explicit focus on rural hospitals. For our study, we sought to identify the frequency of ethical conflicts occurring within 12 general categories (domains) of administrative activities. Also, we wanted to determine what ethics resources are currently available and whether additional resources would be helpful. We conducted a structured telephone interview of all 13 chief executive officers (CEOs) of critical access hospitals in New Hampshire. All the CEOs in the study indicated that they encountered ethical conflicts. On average, the three most frequently noted domains were organizational-professional staff relations, reimbursement, and clinical care. All CEOs indicated they would like to have additional ethics resources to address these conflicts. This study verified that CEOs encounter a broad spectrum of ethical conflicts and need additional ethics resources to address them. Because this study used a small sample of CEOs and represented only one New England state, further ethics-related research in rural healthcare facilities is warranted. Follow-up study would allow for (1) a higher level of generalization of the findings, (2) clarity regarding specific ethical dilemmas that rural healthcare executives encounter, and (3) an assessment of ethics resources and training that healthcare executives need to address the ethical conflicts.
关于组织医疗伦理重要性的研究在医疗出版物中越来越常见。然而，迄今为止，很少有已发表的研究从医疗管理人员的角度审视伦理问题，也没有实证研究明确聚焦农村医院来探讨组织伦理。在我们的研究中，我们试图确定行政活动的12个一般类别（领域）中发生伦理冲突的频率。此外，我们想确定目前有哪些伦理资源可用，以及额外的资源是否会有所帮助。我们对新罕布什尔州所有13家急救医院的首席执行官进行了结构化电话访谈。研究中的所有首席执行官都表示他们遇到过伦理冲突。平均而言，最常被提及的三个领域是组织与专业工作人员的关系、报销和临床护理。所有首席执行官都表示希望有更多的伦理资源来解决这些冲突。这项研究证实，首席执行官们面临广泛的伦理冲突，需要额外的伦理资源来应对。由于本研究仅使用了一小部分首席执行官作为样本，且仅代表新英格兰的一个州，因此有必要在农村医疗设施中开展进一步的伦理相关研究。后续研究将能够（1）对研究结果进行更高程度的归纳，（2）明确农村医疗管理人员遇到的具体伦理困境，以及（3）评估医疗管理人员应对伦理冲突所需的伦理资源和培训。
