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Ethics in a Healthcare Forensic Environment

Ethics in a Healthcare Forensic Environment. Paul Vincke Managing Director EHFCN BHF HFMU FRAUD, WASTE AND ABUSE WORKSHOP 26 August 2014. CONTENT . Morality, ethics , values and beliefs Integrity management Introduction to Dilemma training with cases. The enigma of moral beliefs….

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Ethics in a Healthcare Forensic Environment

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  1. Ethics in a Healthcare Forensic Environment Paul Vincke Managing Director EHFCN BHF HFMU FRAUD, WASTE AND ABUSE WORKSHOP 26 August 2014

  2. CONTENT • Morality, ethics , values and beliefs • Integrity management • Introduction to Dilemma training with cases

  3. The enigma of moral beliefs….. Whatmakesusdistinguish • Right fromWrong ? • GoodfromBad ? • JusticefromUnjustice ? and more important…..

  4. …..and of (im-)moral practice What makes us act accordingly ?

  5. Religion ?

  6. The Law ?

  7. Our Mother in Law ?

  8. Or is it our sub-conscience ?

  9. Objectivisme vs. Relativisme • There is one true morality binding us (Divine Command , Human Nature and Reason) vs. • Morality is a culturally conditioned response and is emotionally based

  10. Bad ? Opportunity – I am a cashierworkingfor a richbanker Stealing money frombanker Rationalization – He stole his money from others Incentive – I am no longer a poordevil

  11. Good ? Opportunity – I am no longer a poordevil Donating money Rationalization – I want to help other poor devils Incentive – I willearn a tax cut andmyheaven

  12. Bad ? Opportunity – I am a dentist workingalone Up-coding Incentive – I willfinancially benefit andmanypoorpatientswillcometomypractice Rationalization – I want to help my poor patients

  13. Good ? Opportunity – I caninterrogatepatients as a healthcarefraud investigator Intimidate patientstoadmitupcodingfraud Rationalization – They stole money from health insurance Incentive – I willbepromoted

  14. Integrity Management (1) in a Healthcare Forensic environment • Definitions • Mental barriers • 2 Approaches • 3 Pillars (1) Prof. J. Maesschalck, Leuven Institute of Criminology, K.U.Leuven, Belgium EHFCN Conference, Malta, 2008

  15. Let’s get our semantics right: • Morality: beliefs about what is right behavior and what is wrong behavior • Ethics = generally accepted values and norms that guide daily behavior • Acting with integrity = acting in accordance with these generally accepted values and norms but is more than avoiding fraud and corruption: integrity also refers to loyalty, objectivity, transparency etc. • Integrity Management = the aggregate of management instruments that are aimed at stimulating and enforcing integrity within an organization

  16. Mental barriers to integrity management • “There are no ethical problems in our organization” • “Integrity management will only increase the scandalous atmosphere and the distrust of citizens” • “Corruption and other integrity violations are so deeply embedded in our culture that we should accept them” • “Our staff will feel attacked or accused”

  17. 2 Approaches to integrity management Rules-based • To avoid unethical behaviour • To emphasize external control • Typical instruments • Legislation • Strict codes of conduct • Strict procedures Values-based • To stimulate ethical behaviour • To emphasize internal control • Typical instruments • Workshops, training sessions • Ambitious ethics codes • Individual coaching

  18. 3 Pillars of an integrity management framework • Instruments • Ethics code or code of conduct • Training • Personnel management • Integrating integrity in daily discourse • Risk analysis • Structural measures • Whistle-blowing arrangements • Ethical leadership • Processes • Structures

  19. Instruments: The ethics code or code of conduct • Types of codes • Why codes? • Some decisions concerning a code • Some guidelines

  20. Instruments: training • Training in ethical decision making (or dilemma-training) • Integrate ethics into existing training • Provide training in specific instruments of integrity management

  21. Instruments: Personnel management • Focus on integrity in selection and recruitment • Integrity as a criterion in staff evaluation • Integrity as a competence in competence management

  22. Instruments:Integrating integrity into daily discourse • Announce integrity policy through external communication • Regular discussions of ethical dilemmas in official internal communication • Institutionalize discussion of integrity issues • Create an open culture of communication

  23. Instruments: Risk analysis • Risk analysis sensu stricto • To map vulnerable spots • To map the organisation’s resistance • To propose improvements • Inventory of dilemmas

  24. Instruments: Structural measures • A policy concerning conflicts of interest • A policy concerning the acceptance of gifts • Splitting up functions • Rotating functions • Well-developed procedures for “vulnerable” activities • Post-employment arrangements

  25. Instruments:Whistle-blowing arrangements • Aim: to solve problems before they become a scandal • Is a technical minefield: should be well-developed • Should contain arrangements for cases of false accusations and retaliations • Is not the core element of integrity management, but an essential safety net

  26. Instruments: Ethical leadership • Active leadership concerning integrity management • “Moral manager” • “Moral person”

  27. Processes Importance • to overcome implementation deficit • to survive after initial enthusiasm has waned • to ensure the framework remains up-to-date • To ensure coordination 2 types • Continuous development process • One-off projects

  28. Structures: the “integrity actor” • Institutionalization in one place is essential • Can take many forms • An separate office • An individual • A committee or working group • But: maintain co-ownership among all staff of integrity management! • Combination of centralized and decentralized steering

  29. Conclusion: two main challenges for integrity management • Integrity management should go beyond hollow rhetoric and window dressing • Instruments should have an actual impact on the work-floor • Integrity management should go beyond compliance • Do not only prevent integrity violations • Also support staff in dealing with ethical dilemmas

  30. Dilemma training session Mentalbarrierstoethics training: • “You’d better train our managers, because they are the problem, not we” • “We do not have time to address ethical dilemmas in our daily practice” • “Dilemma training sessions are nice exercises but irrelevant for daily practice” • “Integrity is not something you can learn; you either have it or you don’t”

  31. Training in ethical decision making: • Ethical dilemma: • situation where values are at stake and where a choice has to be made between several alternatives, while good arguments can be given for each of these alternatives. • intuition and rules are not sufficient to find a solution. • Aim of the training: improving the capacity for moral judgment: • knowing the values • skill in ethical decision making (applying the values) • Structure of the training: • The code Ethics code MEID/NIHDI and BHF values • Model for ethical decision making Model of Terry Cooper

  32. Model for ethical decision making(Terry Cooper, The Responsible Administrator) • Describe the situation  Drawing a picture of the situation as objective as possible • Define the problem in ethical terms  Defining the problem as a tension between values, not in practical terms

  33. Model for ethical decision making(Terry Cooper, The Responsible Administrator) • Identify the alternative possible actions  Suppressing the tendency to only see two possible solutions • Project the probable consequences of each of the actions (i.e. the “scenarios”)  Essential is “moral imagination”: the skill to imagine the different scenarios as lively as possible

  34. Model for ethical decision making(Terry Cooper, The Responsible Administrator) 5. Choose among the possible actions  In this last step, the process is not linear anymore. It is now a simultaneous balancing of three elements: • Identifying and making explicit the values that support each of the respective alternatives • “Rehearsal” by justifying the respective alternatives • Testing of actions with “anticipatory self-appraisal” : imagine which feelings (e.g. guilt, pride,…) would manifest themselves when one of the alternatives would be implemented

  35. Conclusion It can be useful to use explicit methods when dealing with ethical dilemmas • Checklist with possible solutions • Look beyond the law • Model for ethical decision making • Define the problem in terms of values, not in practical terms • Transgress the dichotomy • Use “moral imagination” • Model for the implementation of the decision in a non-cooperating environment • Only expand the reach and intensity of the conflict if really necessary

  36. Visual for Ethical Decision Making

  37. Join the fight against fraud, waste and corruption in healthcare CONTACT EHFCN AT: office@ehfcn.org OR CALL +32 2 739 7982 www.ehfcn.org

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