PCA Health Care has established a corporate culture in which it demands that the staff cut costs at the expense of the patients. Dawn was given no parameters in finding ways in which to save money; therefore, her decisions are making life miserable for the employees and eventually the patients. Her actions and suggestions for cutbacks are ethically and morally reprehensible. First, she fired employees and redistributed the work load, which in itself isn’t unusual in large corporations. Her list of suggestions contained many objectionable ideas, but the two most problematic are: replacing physicians with PA’s and charging the physician rate, the “one vendor” policy. PA’s are qualified to see patients, but they earn, on average, half of what a physician earns; therefore, PCA would save approximately $70,000 per physician replaced (Salary.com). Insurance companies are paying for their customers to see doctors, and lying to them is fraudulent. The “one vendor” policy means that they will buy everything from one company in order to take advantage of bulk discounts. The ethical dilemma is that the vendor chosen may not have the same level of quality in all of their products, and buying everything from one vendor may put patients at risk.
Dawn’s options in cutting costs are limited by two major factors. The first is that she needs to be careful not to alienate the employees. The act of firing four employees and redistributing their work instigates a hostile atmosphere – she is essentially adding to the workload without increasing pay. Next, if she replaces physicians with PA’s, than the physicians who are employed by PCA may start looking for work elsewhere. A patient who has a relationship with a particular doctor may follow the doctor rather than stay with the health care facility. Elderly patients especially require continuity of care in order to ensure that the doctor understands his or her needs. In that sense, Dawn’s plan could backfire. Nancy has now antagonized the nurses by destabilizing their union, and offering incentives to work faster can lead to a lack of attention to detail. Nancy once again may alienate the patients by allowing the nurses less time to tend to more needy patients. As nurses are on the front lines of patient care, this is the wrong place to cut costs. Finally, the presence of unions is limiting Dawn’s ability to cut hours and to fire or replace employees. The union’s purpose is to fight for their members, so Dawn has a battle ahead.
A health care facility that is for profit needs to balance its bottom line with its consideration for patient care. In Dawn’s case, the ideal outcome is to cut costs without alienating patients and employees. This goal is going to be difficult to attain; therefore, she must decide which is more important, the employees’ job satisfaction and ability to provide quality care, or patient satisfaction with the quality of care and value for their health care expenditures. A non profit health care facility can concentrate on their patients and the quality of care, but they must work within the restraints of the amount of money they’re able to bring in under their charter. Non profit facilities need to raise money through grants and donations, which means hiring additional staff to raise money.
If I were Dawn, the first piece of information I would require would be the names of the union stewards. I would need to meet with them, explain the situation and the need to cut costs, and find a way to work together on this. My next move would involve interviewing the staff to find out what they consider to be the most important costs and/or positions within the facility – if a certain individual is key to maintaining order, I must avoid firing them to save money. I would need to review ethical standards by our governing boards in order to find out if the categorization of patients (healthy, dying, etc.) is legal. Finally, I would investigate the causes of the accidents that began plaguing the facility in order to prevent future incidents and/or lawsuits. Even though my position would require me to cut costs, the most important thing I can do is find ways to cut costs ethically.
(2006 Sept). Average Physician Assistant Salary. Retrieved November 12, 2006, from Salary.com Web site: http://swz.salary.com/salarywizard/layouthtmls/swzl_compresult_national_HC07000009.html