Professional Ethics Making Value-Based Decisions in the Conflicted World of MSPs

TH-08PD-1 Concurrent Session 9:15-10:15am Professional Ethics Making Value-Based Decisions in the Conflicted World of MSPs Rhonda M. Boyd, CPCS, CPMSM, VHA-CM

Professional Ethics Making Value-Based Decisions in the Conflicted World of Medical Services Professionals Historical Basis Thou shalt not steal. It is hardly too strong to say that the (American) Constitution was made to guard the people against the dangers of good intentions. Daniel Webster Doctrine Preserving the Core Principles Educating the People Guarding Virtue & Freedom

Rotten to the Core Expansion of professional ethics in the workplace over the past forty years. Enron, Ponzi, Politics Morals, Ethics, Professionalism Solid to the Core Vision, Mission, Values Integrity, Honesty, Respect, Beliefs Authenticity, Accountability Transparency, Trust Organizational Values Do no harm

Organizational Values Offer unparalleled strategic leadership, expertise and advocacy to promote the success of our members we are proactive, respect each other, and encourage creativity. Organizational Values Integrity, fiscal responsibility, teamwork, responsiveness, passion, and preparedness Personal Values 100 attributes that, when asked, people will use to describe themselves, usually with a great deal of pride in their voice. Do you really know yourself? Do these values play out in your actions every day?

Are you conflicted? Twenty-two attributes that, when asked, CEOs will use to describe their organizations, usually with a great deal of pride in their voices. Are you working for an organization that supports your values? Or, do their business values conflict with your personal values? A Code of Ethics Has to be understandable it can t be written in code. Unethical, unprofessional and/or illegal??? Human Factors Geography Religion Life Experiences

Generational Differences Baby Boomers 45-63 Generation X 30-44 Millennials 18-29 Personality Traits Boomers -- work-aholics, idealistic, harmony Gen X -- flexible, creative, question authority Minnies -- tech-savvy, multi-taskers, diversity Generational Workplace Attitudes Boomers long-term commitment to organization belief that hard work equals rewards Gen X Minnies life balance, multiple employers, less hierarchical, flexible schedules integrate technology, multiple careers, immediate feedback and recognition Mis-aligned Incentives MSPs are making decisions constantly, but are we acknowledging the conflicts involved and conscience of the values we call upon? Confidentiality v. regulatory disclosure rules Big admitter v. splitter Medical Staff President v. CMO Budget v. employee satisfaction Budget v. good work product

What would you do? Examples of everyday life situations for the MSP. What would you do? Why would you do that? You are a leader in your state association and are manning the registration table for your Spring conference. The breakfast and introductions are over and the speaker has begun her presentation. At the mid-morning break, you notice that Debbie has arrived and is looking for her name badge, so you go over to welcome her. Debbie then asks you if she can get the NAMSS CE credit certificate now because she will have to leave early today due to family flying into town, but she states that she really needs all the hours from today to get recertified. What would you do? You are a newly-hired Credentials Coordinator who is excited about your new job. About four months into the position, your Director comes to your desk and says, now don t tell anyone, but our Credentials Committee has been working really hard, so I used some money from the Dues account and got them these $15 gift cards, and if some of them don t make the meeting then you and she can split the leftover cards. You remember from your organization s orientation program and the corporate integrity statement which you signed, that all gifts to physicians must be registered due to limits provided for under Starke laws and gifts to employees must be logged in HR for tax purposes. What do you do?

You have just completed a two-year term with one of your favorite Medical Staff Presidents ever! Together, you two accomplished great improvements and closely dodged a fair hearing. Mutual respect is high and you now consider him a good friend. He arrives in your office one day, closes the door and presents you with a gift a new IPad, as well as movie tickets for your staff. What would you do? You are the peer of a newly-hired Medical Staff Coordinator. While completing your own re-certification application, the new MSC confides in you that he failed to complete his own re-certification last year. Yet, you notice that he included those credentials on his new ID badge and his business cards. What could you do? You are the treasurer of your state association. At the registration table for your Fall conference, Mary writes a check for the registration fee and complains that her employer won t support her educational efforts but she really needs these CE credits this year. A few days later, the Association s bank notifies you that Mary s account had insufficient funds. You have tried numerous ways for several weeks to contact Mary. What would you do?

Your Medical Executive Committee took significant adverse action against a new member of your Medical Staff at their meeting the night before. Coming into work the next day, you overhear your Chief Medical Office/supervisor telling the new member s partner all the details regarding the MEC s discussions. What do you do? Your Medical Staff President comes by your office late one day and asks you could please do her a favor. You say sure! Then, she asks you to misplace a referral of a case into your peer review process. You are surprised and ask why. She responds that the referral is just a petty complaint against one of her partners by a competing physician. What would you do? Your CEO of the hospital sends you an email asking you to send an Obstetrician the form to request case-specific temporary privileges. He goes on in the email to state that his niece is having her second child delivered by this Obstetrician, but he wants her to have this baby at his hospital. What do you do?

NAMSS Ethics Policy Preserving the Principles Creation of a more comprehensive Code of Professional Conduct Educating the People Providing Education and Consultation Guarding Virtue & Freedom Formation of an NAMSS Ethics Committee Role of Ethics Committee Education: NAMSS members will be required to attest annually, at time of initial or renewal of membership, to their commitment to the NAMSS Code of Professional Conduct. NAMSS will educate members on the NAMSS Code of Professional Conduct through the following activities among others: Webinars, Print Articles in NAMSS Publications and Live Presentations. Consultation: The Committee will serve in an advisory role on the principles of ethics, but not on individual ethical concerns and situations, to the NAMSS Board of Directors, state associations, NAMSS committees, and if requested by NAMSS, the public, members and employers. Evaluation of Professional Conduct of Members: The Committee will evaluate the professional conduct of NAMSS members following the administrative procedures outlined below. Purpose of Code The NAMSS Code of Professional Conduct shall apply to all persons holding membership in NAMSS, including the leadership/officers. The Code sets forth principles that connect the values and ideals of the profession to the work performed by Medical Services Professionals. The Code of Professional Conduct shall serve as the standard by which the NAMSS Ethics Committee will evaluate professional conduct and shall serve as the standards of minimally acceptable professional conduct for all members of NAMSS.

Violations Plagiarism Failure to protect confidential data Failure to share credit on a report Fabrication or holding back of data Criticize the integrity of colleague for personal gain Misuse of influence, manipulation of information Deliberately not reporting an incident Code of Professional Conduct Conducts self in a professional manner and provides appropriate quality credentialing support when requested by a peer or superior. Provides for patient safety and service unrestricted by the concerns of personal attributes and without discrimination on the basis of gender, sexual orientation, race, creed, religion, national origin or socioeconomic status. Uses technology consistent with the purposes for which it was designed, and employs procedures and techniques appropriately for credentialing best practices. Exercises care, discretion and judgment; assumes responsibility for professional decisions; and acts in the best interest of patients, his or her employers/healthcare providers and the public. Demonstrates expertise by protecting the safety of patients and other members of the health care team through credentialing processes that meet industry standards and understanding of regulatory requirements. Practices ethical conduct appropriate to the profession and protects the patient s right for quality healthcare. Respects and preserves confidences entrusted in the course of professional practice and reveals confidential information only as needed and in accordance with any applicable law. Continually strives to improve his/her knowledge, by participating in continuing education and professional development activities, and sharing his/her knowledge with colleagues.

Individual Accountability Employing fraud or deceit in our work or using authority for personal gain. Any conviction of a felony or gross misdemeanor involving fraud, crime against a person or negligent credentialing. Engaging in unprofessional conduct. Termination from any employment for conduct that is contrary to the ethical principles appropriate to the medical services profession. Inability to practice with reasonable skill and safety by use of alcohol, drugs, chemicals, or any other material. Adjudication by a court of competent jurisdiction, as mentally incompetent, or a person dangerous to the public. Engaging in conduct likely to deceive, defraud, or harm the public, an employer and/or healthcare workers; or demonstrating a willful or careless disregard for the medical services profession duties. Making false, fraudulent, deceptive, or misleading communications regarding the member s education, training, credentials, experience or qualifications, or the status of the individual s certification. Knowingly making a false statement or knowingly providing false information to NAMSS in any application or proceeding. Inappropriately using NAMSS copyright materials. Formal Process Possible actions by the Ethics Committee Letter of Concern Letter of Admonition Suspension or termination of Committee Assignment Recommend suspension/termination of Membership

Participation Hearings When action proposed, member has right to a hearing with a lawyer present if they so choose. Can be in person or web conference. Written response may be submitted in lieu of presence. Telephone hearing may be held. Appeals Appeal body is NAMSS Board of Directors. Member may appeal decision of the Ethics Committee within 30 days. Are you better equipped to make value-based decisions in the conflicted world of Medical Services Professionals? Questions? References American Dairy Foods Association American College of Healthcare Executives American Health Information Management Association American Marketing Association American Medical Association National Council of Architectural Registration Boards Mini-Monograph, 2008 Professional Hockey Players Association Ethical Decision-Making: the Link Between Ambiguity and Accountability, Ronald J. Scott, Jr. How the Mighty Fall, Jim Collins. Organizational Values Statements, William Nelson and Paul Gardent, Healthcare Executive, 2011 Professional Ethics- Session #714, by Dr. Peter Strahlendorf of Ryerson University Strategic Leadership and Decision Making, National Defense University Supplemental Research Brief-2009 National Business Ethics Survey, Ethics Resource Center

Thank you! On behalf of the NAMSS Ethics Committee and Task Force members, we thank you for your participation and interest in professional ethics. Bonnie Conley, CPCS Krista Eads, CPCS, CPMSM Samuel Evans, MD Bonnie Gutierrez, CPCS, CPMSM Kathy James, CPCS, CPMSM Diane Meldi, CPCS, CPMSM Joyce Moore, CPCS Valeigh Osborne, CPCS Brenda Schwab, CPCS, CPMSM Linda Waldorf, CPCS, CPMSM

PROFESSIONAL ETHICS A ROAD TO SELF DISCOVERY Self Assessment Tool The NAMSS Code of Professional Conduct sets forth principles that connect the values and ideals of the profession to the work performed by Medical Services Professionals. The Code serves as the standards of minimally acceptable professional conduct for all members of NAMSS. Members accept responsibility to observe and enhance ethical standards, in order to maintain the respect and credibility of the profession. Because the public, the healthcare providers and employers rely on each Medical Services Professional to be a Leader within this profession, it is essential to have a keen awareness of one s own ethics as demonstrated daily through their actions. The following self assessment is intended to be a useful tool, along this road to improvement, by understanding one s own ethics. This assessment is developed to help you identify your areas of strength in ethics and areas you might wish to strengthen. This tool is intended for personal use only, and should not be used to evaluate the behavior of others. There is no scoring mechanism for this assessment, which is intentional. The purpose of this assessment is to cause personal reflection. We are confident that everyone completing this assessment will uncover a few red flags for themselves. We encourage you to seek opportunities to seek out additional educational resources to learn more about professional ethics. Also, please use this information to initiate discussions with trusted friends and colleagues, as we all function within communities and are affected by those around us. Your willingness to better understand those areas that may be red flags is your key to enhancing your own ethical behaviors We hope that you will find this assessment useful, as well as stimulating for you in the areas of ethics, and we thank you for taking time to contemplate your personal characteristics. How to use the self assessment Take time to think about each question. Think about your work situations, your community affiliations, and your family dynamics. Once you have completed the entire assessment, review your responses noting those statements for which you answered occasionally or almost never. Do you conduct yourself differently in the settings noted above, and if so, do you understand why? In some situations, these answers are suitable; however, in other situations such an answer may raise an ethical red flag for further consideration. For those statements that you answered never, carefully review the wording of these statements. Is there a particular portion or phrase of the statement that you focused on? Do you disagree that the statement reflects actions that equate to ethical conduct? Would a discussion about the statement with a trusted colleague perhaps provide you with some insight? Remember, there are no right or wrong answers, just thought provoking statements to challenge yourself! We hope you find this exercise thought provoking and helpful. The NAMSS Ethics Committee has additional, valuable resources available to you as you enhance your awareness and knowledge regarding professional ethics. Several of these resources include these sites: Ethics.org; Knowledgeleader.com; and Nationalethicsresourcecenter.net. Further, the Ethics Committee is interested in using this self assessment as a tool for collecting aggregated data which might aid in our development of additional resources to meet Members needs. If you are willing to provide comments regarding either the effectiveness of this tool or specific educational deficits you identified through this exercise, please feel free to submit those to the NAMSS Executive Office. Any and all comments from Members regarding the Ethics Committee s efforts are greatly appreciated. Thank you for your investment in this important exercise. We hope you found it worthwhile.

Professional Ethics Self-Assessment Tool LEADERSHIP I take courageous, consistent and appropriate actions to overcome barriers to achieving my organization s mission. I place community, organization and patient benefit over my personal gain. I strive to be a role model for ethical behavior. I advocate for ethical decision making by the board, management team, medical staff and my work teams. I fulfill the promises I make. I thoughtfully consider decisions when making a promise on behalf of the organization to a person or a group of people. I openly support establishing and monitoring internal mechanisms (e.g., an ethics committee or program) to support ethical decision making. My personal expense reports are accurate and are only billed to a single organization. I make timely decisions rather than delaying them to avoid difficult or politically risky choices. I demonstrate my organization s vision, mission and value statements in my all actions. I demonstrate respect for my colleagues, superiors and staff. When an ethical conflict confronts my organization or me, I am successful in finding an effective resolution process and ensure it is followed. I use my authority solely to fulfill my responsibilities, and not for self interest or to further the interests of family, friends or associates.

Professional Ethics Self-Assessment Tool My statements and actions are honest, even when circumstances would allow me to confuse the issues. I initiate and encourage discussion of the ethical aspects of management/financial issues. I use an ethical approach to conflict resolution which encompasses sensitivity to cultural diversities. RELATIONSHIPS: Colleagues and Staff I foster discussions about ethical concerns when they arise. I expect and hold staff accountable for adherence to our organization s ethical standards (e.g., performance reviews). I demonstrate through personal actions and organizational policies zero tolerance for any form of staff harassment. I encourage discussions about and advocate for the implementation of the organization s code of ethics and value statements. I am respectful of views different from mine. I am respectful of individuals who differ from me in ethnicity, gender, education or job position. I demonstrate that incompetent job performance is not tolerated and make timely decisions regarding marginally performing employees. I am sensitive to employees who have ethical concerns and facilitate resolution of these concerns. I convey negative news promptly and openly, not allowing employees or others to be misled. I encourage the use of organizational mechanisms (e.g., an ethics committee or program) and other ethics resources to address ethical issues.

Professional Ethics Self-Assessment Tool I act quickly and decisively when employees are not treated fairly in their relationships with other employees. I assign staff only to official duties and do not ask them to assist me with work on behalf of my family, friends or associates. RELATIONSHIPS: Clinicians When problems arise with clinical care, to the extent of my involvement/authority, I ensure that the problems receive prompt attention and resolution by the responsible parties. When practice variations in care suggest quality of care is at stake, I encourage timely actions that serve patients interests to the extent of my authority. I expeditiously and forthrightly deal with impaired clinicians, and to the extent of my authority, I take necessary action when I believe a clinician is not competent to perform his/her clinical duties. I expect, and to the extent of my authority, hold clinicians accountable for adhering to their professional and the organization s ethical practices. RELATIONSHIPS: External Business Partners (buyers, suppliers and payors) I negotiate and expect my team to negotiate in good faith. I am mindful of the importance of avoiding even the appearance of wrongdoing, conflict of interest, or interference with free competition. I personally disclose, and expect board members, employees and clinicians to disclose, any possible conflicts of interests before pursuing or entering into relationships with potential business partners. I promote familiarity and compliance with organizational policies governing relationships with buyers, payors, and suppliers. I set an example for others in my organization by not accepting personal gifts from suppliers.

Professional Ethics Self-Assessment Tool NAMSS CODE OF CONDUCT I provide appropriate quality credentialing support when requested by a peer or superior. I provide for patient safety and services unrestricted by the concerns of personal attributes and without discrimination on the basis of gender, sexual orientation, race, creed, religion, national origin or socioeconomic status. I use technology consistent with the purposes for which it was designed, and employee procedures and techniques appropriately for credentialing best practices. I assess situations; exercise care, discretion and judgment; assume responsibility for professional decisions; and act in the best interest of patients, my employer and the public. I demonstrate expertise by protecting the safety of patients and other members of the healthcare team through credentialing processes that meet industry standards and understanding of regulatory requirements. I practices ethical conduct appropriate to the profession and protect the patient s right for quality healthcare. I respect and preserve confidence entrusted in the course of professional practice and reveal confidential information only as needed and in accordance with any applicable laws. I encourage innovation even when maintaining the status quo would be an easier choice. I submit complete and accurate information to maintain my continuing education requirements. I claim only those relevant professional credentials actually possessed and correct any inaccuracies occurring regarding my credentials. I advocate for the Medical Service Profession in all settings and participate in activities that promote and explain the mission, values, and principles of this profession to the public. I continually strive to improve my knowledge, skills and productivity by participating in continuing education and professional development activities, and sharing my knowledge with colleagues.

Professional Ethics Self-Assessment Tool I take precautions to ensure and maintain the privacy and security of information transmitted, transferred, or disposed. I take responsibility and credit, including authorship credit, only for work I actually developed or performed, or to which I contributed. I speak of, and on behalf of, my employer and those organizations to which I am affiliated (NAMSS) with appropriate respect and accurately represent their official positions on issues. I make clear distinctions between statements I make or actions I take as a private individual and as a representative of my employer and/or affiliated organizations. I seek the advice of the NAMSS Ethics Committee if there is a serious ethical challenge facing me or when making ethically challenging decisions. My statements and actions are consistent with professional and ethical standards, including the NAMSS code of professional conduct. This ethical self assessment was derived directly from a tool developed by the American College of Healthcare Executives (ACHE), and is being used with expressed permission of the ACHE. Additional materials have been added to reflect requirements of the NAMSS Code of Professional Conduct.

NAMSS Code of Conduct Attestation Membership in a professional organization, such as NAMSS, offers a wide variety of resources and opportunities; however, it also carries with it a certain level of responsibility. NAMSS is an association of MSPs who have voluntarily bound together with a defined mission. In 2008, the association established a Code of Professional Conduct to aid NAMSS members in our pursuit of this mission and to increase our level of accountability to the general public whom we serve and the healthcare community in which we participate. To that end, NAMSS members are asked annually to re-affirm their understanding of the Code of Professional Conduct. Please review the statements below and attest to your commitment. Should you have any questions or comments to share regarding the Code, please feel free to contact the NAMSS Executive Office. All NAMSS members are required to attest to this code of conduct upon joining NAMSS, and every year that they renew their dues. NAMSS CODE OF PROFESSIONAL CONDUCT: 1. The member conducts him/herself in a professional manner at all times and provides appropriate quality credentialing support when requested by a peer or superior. 2. The member provides for patient safety and service unrestricted by the concerns of personal attributes and without discrimination on the basis of gender, sexual orientation, race, creed, religion, national origin or socioeconomic status. 3. The member uses technology consistent with the purposes for which it was designed, and employs procedures and techniques appropriately for credentialing best practices 4. The member assesses situations; exercises care, discretion and judgment; assumes responsibility for professional decisions; and acts in the best interest of patients, his or her employers/healthcare providers and the public. 5. The member demonstrates expertise by protecting the safety of patients and other members of the health care team through credentialing processes that meet industry standards and understanding of regulatory requirements. 6. The member practices ethical conduct appropriate to the profession and protects the patient s right for quality healthcare. 7. The member respects and preserves confidences entrusted in the course of professional practice and reveals confidential information only as needed and in accordance with any applicable law. 8. The member continually strives to improve his/her knowledge, skills and productivity by participating in continuing education and professional development activities, and sharing his/her knowledge with colleagues.