A Comparison of Medical Ethics and Managerial Ethics in the Health Sector

<p>This multidisciplinary doctorate research draws on the disciplines of psychology and philosophy in its consideration and comparison of medical ethics and managerial ethics in the health sector. There is very little research which has compared the ethics of doctors and managers even though they work alongside each other in health organisations. Hence this thesis not only adds to the body of knowledge but also contributes a new perspective to applied ethics via the multidisciplinary approach. The empirical research was conducted in three phases. First, a pilot study which interviewed via the repertory grid method six doctors and managers from a Crown Health Enterprise (i.e. a public sector health provider organisation which manages a number of hospitals). Second, a series of repertory grid interviews conducted with nineteen doctors and managers from seven Crown Health Enterprises throughout New Zealand. In the third phase, the ethical constructs and role perceptions identified in the first and second phases were incorporated into a questionnaire which was distributed to 799 doctors and managers in three Crown Health Enterprises. The questionnaire posed a range of questions on role perceptions, ethical dilemmas faced, influences on ethically challenging decisions, ethical issues, and required respondents to rate an ethical manager, ethical doctor, unethical manager and unethical doctor on a range of constructs and rate which construct contributed the most to being an ethical manager and to being an ethical doctor. The main aim was to identify similarities and differences between doctors and managers. The questionnaire analysis revealed a complex three way interaction between doctor/manager raters and the ethical/unethical doctor/manager being rated. This interaction was best represented by seven of the bipolar constructs. Additionally it was found that a highly ethical doctor was seen as honest, focused on patients' best interests, and principled - has standards which are lived up to privately and publicly. The highly ethical manager was seen as honest, flexible and open to others' ideas, recognises and uses the skills of others for their good and the good of the health service, committed to and works hard for the public health service, and takes a long term/strategic view of issues and the wider implications of decisions. Overall it was concluded that the results showed that medical ethics and managerial ethics can be discussed within a general moral framework which allows for different priorities in each role. And that the fundamental difference in priorities between doctors and managers, lay in their basic role orientation - doctors focused on the patient, and managers focused on the organisation.</p>

A Comparison of Medical Ethics and Managerial Ethics in the Health Sector

<p>This multidisciplinary doctorate research draws on the disciplines of psychology and philosophy in its consideration and comparison of medical ethics and managerial ethics in the health sector. There is very little research which has compared the ethics of doctors and managers even though they work alongside each other in health organisations. Hence this thesis not only adds to the body of knowledge but also contributes a new perspective to applied ethics via the multidisciplinary approach. The empirical research was conducted in three phases. First, a pilot study which interviewed via the repertory grid method six doctors and managers from a Crown Health Enterprise (i.e. a public sector health provider organisation which manages a number of hospitals). Second, a series of repertory grid interviews conducted with nineteen doctors and managers from seven Crown Health Enterprises throughout New Zealand. In the third phase, the ethical constructs and role perceptions identified in the first and second phases were incorporated into a questionnaire which was distributed to 799 doctors and managers in three Crown Health Enterprises. The questionnaire posed a range of questions on role perceptions, ethical dilemmas faced, influences on ethically challenging decisions, ethical issues, and required respondents to rate an ethical manager, ethical doctor, unethical manager and unethical doctor on a range of constructs and rate which construct contributed the most to being an ethical manager and to being an ethical doctor. The main aim was to identify similarities and differences between doctors and managers. The questionnaire analysis revealed a complex three way interaction between doctor/manager raters and the ethical/unethical doctor/manager being rated. This interaction was best represented by seven of the bipolar constructs. Additionally it was found that a highly ethical doctor was seen as honest, focused on patients' best interests, and principled - has standards which are lived up to privately and publicly. The highly ethical manager was seen as honest, flexible and open to others' ideas, recognises and uses the skills of others for their good and the good of the health service, committed to and works hard for the public health service, and takes a long term/strategic view of issues and the wider implications of decisions. Overall it was concluded that the results showed that medical ethics and managerial ethics can be discussed within a general moral framework which allows for different priorities in each role. And that the fundamental difference in priorities between doctors and managers, lay in their basic role orientation - doctors focused on the patient, and managers focused on the organisation.</p>

Is it my job? Leaders' family-supportive role perceptions

PurposeDespite a burgeoning literature on family-supportive supervisor behaviors (FSSB), it is unclear whether supervisors view these behaviors as in-role or discretionary. We proposed a new cognitive motivational construct, FSSB role perceptions (FSSB-RP; that is the extent to which supervisors perceive FSSB as an expected part of their job) and evaluated it as a mediator of the relationship between supervisors' own work–family experiences and FSSB.Design/methodology/approachWe used an online survey of 245 US based supervisors.FindingsWe find that FSSB role perceptions is a unique but related construct to FSSB, and that approximately half of our sample of 245 supervisors either do not believe that FSSB is a part of their job or are unsure as to whether it is. Path analyses revealed that supervisors' own experiences of work–family conflict and enrichment are related to engaging in FSSB through role perceptions, especially when a reward system is in place that values FSSB.Practical implicationsThese results may influence the design, implementation and dissemination of leader family-supportive training programs.Originality/valueThe factors that drive supervisors to engage in FSSB are relatively unknown, yet this study suggests the novel construct of FSSB role perceptions and supervisors' own work–family experiences are important factors.

Serving Multiple Masters? Public Managers’ Role Perceptions in Participatory Budgeting

Participatory budgeting is fast becoming a popular form of public participation. Public managers play an important role in organizing and implementing participatory budgeting. Their role perceptions affect whether they use their discretion to limit or increase residents’ say in participatory processes. However, we know little about public managers’ role perceptions in participatory budgeting. In this study, we develop a typology of public managers’ role perceptions in participatory budgeting using a Q-methodological analysis of public managers in seven municipal participatory budgeting projects in Belgium. We find evidence for four distinct perspectives: a managerial, citizen-centered, technocratic, and skeptical perspective.

Impact of Relationship and Communication Variables on Ambulatory Blood Pressure in Advanced Cancer Caregivers

Background Cancer impacts both patients and their family caregivers. Evidence suggests that caregiving stress, including the strain of taking on a new role, can elevate the risk of numerous health conditions, including high blood pressure (BP). However, the caregiver’s psychosocial experiences, including their interpersonal relationship with the patient, may buffer some of the negative physiological consequences of caregiving. Purpose To examine the influence of psychosocial contextual variables on caregiver ambulatory BP. Methods Participants were 81 spouse–caregivers of patients with advanced gastrointestinal or thoracic cancer. For an entire day at home with the patient, caregivers wore an ambulatory BP monitor that took readings at random intervals. Immediately after each BP reading, caregivers reported on physical circumstances (e.g., posture, activity) and psychosocial experiences since the last BP measurement, including affect, caregiver and patient disclosure, and role perceptions (i.e., feeling more like a spouse vs. caregiver). Multilevel modeling was used to examine concurrent and lagged effects of psychosocial variables on systolic and diastolic BP, controlling for momentary posture, activity, negative affect, and time. Results Feeling more like a caregiver (vs. spouse) was associated with lower systolic BP at the same time point. Patient disclosure to the caregiver since the previous BP reading was associated with higher diastolic BP. No lagged effects were statistically significant. Conclusions Caregivers’ psychosocial experiences can have immediate physiological effects. Future research should examine possible cognitive and behavioral mechanisms of these effects, as well as longer-term effects of caregiver role perceptions and patient disclosure on caregiver psychological and physical health.

Working Within a System of Administrative Burden: How Street-Level Bureaucrats’ Role Perceptions Shape Access to the Promise of Higher Education

Utilizing a statewide survey and administrative data, we explore how state-imposed burdens are translated by street-level bureaucrats (SLBs) into frontline practices that may alleviate or exacerbate onerous experiences of the administrative state. First, we find that SLBs’ role perceptions shaped not only uses of discretionary power—as either a force of client empowerment or disentitlement—but also program access. Second, we find that the local agencies with the largest proportions of income-eligible clients often had the least capacity for alleviating administrative burden, suggesting decentralization may be a mechanism by which administrative burden perpetuates structural inequality.