Frontiers of Health Services Management - Fall 2013 - (Page 19)

institutions as the best place for the treatment of a specific condition without reference or in contradiction to evidence. an ethically grounded marketing campaign supports such claims. Should an organization strive to be recognized as best in practice, or should it strive to achieve excellence in practice? focusing on being better than the competition, as opposed to achieving excellence, may result in unacceptable opportunity costs—for instance, the inability to provide an underserved community with excellent primary healthcare. What do healthcare organizations do with the results of performance measures? a commitment to achieving excellence requires that leaders consider not only performance targets but also performance floors—unacceptable performance levels at which clinical service lines might be exited or temporarily suspended pending full examination of root causes. take the case of a medical center renowned for cardiac care that has reported higherthan-expected risk-adjusted mortality for interventional cardiology procedures for three successive periods. Should care continue while potential causes are examined, or should interventional cardiology be suspended pending complete analysis? a commitment to truthfulness and transparency demands full and public sharing of performance measurement results as well as comparison with other institutions in the market, for better or for worse. in an article in The New Yorker, atul gawande (2004) provides a powerful and moving account of a healthcare system’s journey to achieve excellence for the care of persons with cystic fibrosis through full and public disclosure and a commitment to continuous improvement. John J. D onne l l a n Jr ., FAC H E • 19 f e a t u r e measured, be it to monitor achievement of internal performance targets or to meet the requirements of external monitoring groups and accrediting organizations. the measures are well intentioned and important clinical targets but are too often selected because they are easily quantified (e.g., number of vaccinations given, length of stay, number of hospital-acquired infections, laboratory tests performed). frequently lacking is sufficient thought as to how the measures relate to broader, mission-related objectives (e.g., community health). in my view, a decision about what should be measured is as much an ethical question as it is a performance management question. Do performance standards and metrics flow from mission, or have they become the mission? leaders can prevent a misalignment of mission and measures by considering the organization’s ethical responsibilities when selecting measures and reporting results. for example, an organization may identify specific HeDiS (Healthcare effectiveness Data and information Set) measures and set specific goals for improving performance above and beyond benchmark requirements on the basis of a strategic determination of need in the community it serves (e.g., improved screening for breast cancer, improved medical management for persons with asthma). and when deciding on which performance targets to emphasize, leaders need to consider the tools (e.g., training, data systems) and resources (e.g., staff) needed to achieve performance targets and recognize that failure to achieve these targets may point to a failed process design rather than a failure of individual execution. Marketing campaigns for healthcare organizations frequently promote those

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Fall 2013

Frontiers of Health Services Management - Fall 2013
Contents
Editorial
The Case for Values as a Basis for Organizational Culture
A Moral Compass for Management Decision Making: A Healthcare CEO’s Reflections
Ethics, Values, and Decision Making
Wanted: Morally Courageous Leaders
The Imperative of a Moral Compass–Driven Healthcare Organization

Frontiers of Health Services Management - Fall 2013