Management Challenges of Private Healthcare Managers in Ethical Decision Making 2

N.1 Summary of Dissertation
Chapter 1 Summary
This chapter basically introduced the reader to the topic under discussion, that is, the management challenges faced by private healthcare managers in ethical decision making. The chapter first talks about human resource in general. It mentions the significance of human resource to the output if any organization. It also recognizes the fact that general human resource is closely related to management in the private health sector. As such, most of the challenges that face the human resource managers and the administrators of various industries also face the managers in the private health sector.
One of the biggest problems that are common to the management in the private health sector and the management of many other private or for-profit organizations is the need to make profits at the close of every business period. This need will guide the decision-making process of most managers and guide the choices they make on whether to hire or not, improve the quality or not, and whether to increase the cost of their goods and services or not. All these are quite vital when managers in the private health sector are arriving at ethical decisions. The other managerial issues that most managers, including the ones in the private health sector consider, are the size, composition, and distribution of a country’s workforce, and the cultural and geographical factors that influence the business environment in which they operate.
The level of training of the employable population of a country, the migration of skilled personnel, the nature of a country’s population, and the degree of reforms in the country’s health sector are some of the more specific factors that influence the ethical decision-making process of healthcare managers.

Other than discussing these specific issues, this chapter also brings the reader’s attention to the aim of the research which is to determine the management challenges faced by private healthcare managers in arriving at ethical decisions in the line of their duty. It also makes the reader aware of the specific objectives of the study, the research rationale, as well as the research approach.
Chapter 2 Summary
Chapter two is a review of the literature that is available on the dissertation topic. The analysis identifies the gaps in the literature talking about the issue and identifies the limitations of the previous researches that had been conducted on the same subject. It also identifies the various leadership styles available in professional healthcare and how they influence ethical decision making. The reviewed literature acknowledges that managers in the private health sector are faced with a number of challenges while making moral decisions, especially since they involve the care of patients. They are faced with the challenge of making ethical decisions that put the interests of the patients first while also making sure that they do not neglect the business element of their practice. The emergence of for-profit hospitals, dialysis centers, and other health delivery framework raises serious legal, sociological, administrative, political, and economic issues. Other than this, the phenomenon poses a challenge to some of the traditionally held presumptions about the healthcare and business communities.
The review reveals that there has always been an ambivalent relationship between professional healthcare and business. Organized medicine directed towards the generation of profits has been going on in nearly every country of the world for a while, and none of these nations have issued an outright condemnation of the practice. This chapter further discusses the global context of for-profit healthcare and gives a brief history of the practice as well as some of the common instances where the ethics of healthcare are likely to be compromised to allow for profit generation. From the literature reviewed, one of the cases where money or profits are likely to mar the ethical decision-making processes of healthcare providers, both in the private and public sectors, is the issue of patents. If physicians are allowed to hold the patents for any drug or surgical equipment, then that is likely to be derogatory to their professional conduct. This was the stand that was held in 1847; however, by 1981, this had changed, and the issue of patenting among doctors was allowed. The other act that put the professional ethics of healthcare professionals, including the managers in the private sector, was the act of receiving rebates for dispensing pharmaceuticals. Other developments that put healthcare providers in serious dilemmas while making ethical decisions concerning their profession are the practice of fee splitting and the ownership of health institutions. All these according to this chapter, need to be assessed in levels that most of the literature that was reviewed do not do.
Chapter 3 Summary
This chapter talks about the methods that were used in the research. The primary objective of this section is to show how the study arrived at all of its findings. In order to measure the ethical leadership styles of different healthcare managers, the research decided to utilize quantitative research. Quantitative research was preferred for this task because the reliability of data can be measured and the information or data obtained can be easily analyzed to come up with the kind of comparisons that this study intended to make. The researcher, therefore, used a questionnaire to collect the valuable information that was needed. The responses of the respondents were then received from both a Likert and an Ipsative scale. After collection, the data was analyzed using Excel sheets and the SPSS software.
Chapter 4 Summary
This chapter basically stated and discussed the findings of the study. From the questionnaire that was issued to twelve managers of the Mediclinic Middle East hospital, the study obtained valuable information. The sample of the managers that was used was found to have a managerial experience that ranged from two years to twenty years. Each manager in the sample was responsible for between 0 and 85 juniors who by the time of the research had given them an average of 15 reports in 2016. All of these managers were university graduates with only two being female. The chapter revealed that nearly every health administrator faced ethical challenges that were grounded in certain known moral principles. When asked to mention some of the common ethical challenges they meet while making decisions at work and how they would tackle them, all the managers stated the four issues that are discussed in the chapter. These are balancing ethics with fiscal responsibility, ethical mitigation of legal risks, privacy ethics, and the ethics of handling important relationships (Arnetz 209). The managers also displayed a varying degree to which each of the common managerial challenges they experienced impacted on their decision-making process.
N.2 Research Contributions
This study, like many other studies, is done to make a particular contribution to the field of academia and the related practice; for-profit medical practice in this case. The main contribution that the study brings to both academia and practice is the ethical differences between healthcare and business and how the differences pose ethical challenges to health professionals in the for-profit health sector. One of the major variations in the ethics of healthcare and business lies in the exclusion of the less efficient clients or customers. In business, it is both prudent and common to exclude customers whose service can only be achieved inefficiently. If a firm serves a big market and a part of the market is sparsely populated resulting in losses for the company, then they are expected to stop serving that portion. A business executive would be considered foolish or even unethical for squandering the resources of the stakeholders if he or she fails to wind up the operations on the portion of the market that is resulting in inefficiencies. In healthcare, any attempt to stop services to individuals in areas which can only be served at reduced profits is seen as suspect. If the government decides to move public health officials from regions that are sparsely populated or shuts down a rural clinic that would definitely stir up controversy. Private hospitals that are run to generate profits while providing medical services are faced with the conflict over these differing expectation patterns.
The other ethical difference between healthcare and business is the responsibility to the indigent. This ethic deals with the difference in what business people and physicians or other professionals in the health sector feel that they owe those who are unable to but the services at the set market rate. No regular businesspersons would feel that they have the duty of providing a Ford or a Mercedes to an individual who does not have enough money to buy one. Health care professionals, however, traditionally hold some wind of concern for the less fortunate in the society who are unable to afford the medical services they so desperately need. “Physicians have acknowledged both charity work and the principle of sliding-scale fee” (Gray par. 77). Although these are at times only recognized in theory and not in practice, some sense of individual or collective responsibility is still acknowledged. Hospitals that benefit from the Hill-Burton funds must provide services even to the indigent. It is highly likely that healthcare professionals operating in for-profit institutions will feel the pressures with their employers if indigent patients get to their facilities requiring services they cannot afford.
The other area that this research brings to light or contributes to both academia and practice is the issue that arises when one is required to supply products or offer services that are unprofitable. If people consider healthcare a right and not just a commodity, then this is one problem they are likely to face. No one in the for-profit health sector is likely to produce goods or services that do not have profit potential. This issue is already being faced with the manufacture of biologicals and drugs for uncommon conditions where the commercial manufacture is highly unlikely to generate any profits. A similar problem potentially exists for the services and goods in for-profit health facilities. Any strategy intervention that lacks profit potential, however useful, might be ruined by the profit-oriented health system of today. Of course, these issues have already been faced. Specific drug factories make pharmaceuticals which they are aware have no profit potential. They do this both for public relations and for the little sensed of altruism that probably exists in them. Nonetheless, the government bears a large fraction of the research and development burden where there is inadequate profit incentive. This means that if the commercially owned health facilities become widespread, the government will be forced to support the development and research, as well as the delivery networks of the services and products that lack the potential to produce profits. These and many other principles like that of professional and business self-regulation are the contributions that this research brings to both academia and practice.
N.3 Further Research and Development
One can expect several instances of ethical difficulties as profit-oriented health facilities change and make more direct relations between the healthcare profession with its set of ethics and the world of business also with its set of ethics unavoidable. One cannot yet tell clearly how the organized health professionals would respond to the developments in the profit-oriented health sector. One can anticipate that they might concern themselves with the elimination of professional regulation “from medical decision making and” will not be comfortable with an attack on their dignity would accompany a growth “in the image of commercialization of the role of the physician” (Gray par.80). Still, people have repeatedly witnessed the organized medical profession tolerate the change directed towards the business model. Shifts on aspects like advertising, ownership of hospitals, repetitive endorsement of the legality of the profit reason and changes to accommodate the act of lay organizations appointing professionals are all indicators of the profession’s flexibility on such topics. They are also indicators of the profession’s capability to put up with the truths of the health sector.
What the public should say regarding the commercial setting in which the for-profit medicine is being practiced nowadays. The traditional regard with which the public has for long viewed the healthcare profession makes most unwilling to see the doctor as part of a business process. It also makes them feel like, within certain reasonable limits, healthcare should be delivered on the basis of need and not just the ability of one to pay. On the flip side, one can make a case for greater “opening towards the practice of medicine in this way” (Gray par. 82). Most of the recent developments in the professional ethics of healthcare providers originate from the pressures from the lay bodies on the professional society to revert the traditional Western ethics. Both the lay people and the physicians may find it may find it appealing to be liberated from the unrealistic expectations of limitless altruism on the doctor’s part.
Such changes would make the private health sector more realistic one where both the professionals and the customers or patients get value for their money or investment in case of the owners of the private health facilities. Furthermore, if the society is drifting from the self-regulation of professionals towards more public control mechanisms similar to those in the business world, then for-profit healthcare might aid that change. Perhaps it is time that scholars explored in depth, the ethical dilemmas or tensions that might arise as the profit-oriented healthcare system run by non-professional money interests start to get a bigger portion of the society. Scholars need to do more study on the specific challenges that are likely to come up within the healthcare and healthcare management as these changes occur and how the people are likely to take them.
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