1. Hader, Richard RN, CHE, CPHQ, NE-BC, PhD, FAAN

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Limited resources and a proliferation of requests place the healthcare leader in the position to make decisions that are often ethically challenging. As healthcare economics is becoming increasingly more complex, managers and administrators will need to make choices that can significantly impact the healthcare provided within the community. Should resources be added to the family health center with a negative contribution margin that serves a primarily indigent population or should an investment be made in a new hybrid OR that promises to provide a regional service and adds significantly to the financial margin of the hospital? Both can't be done, so what's the right decision?

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These types of situations garner more questions than answers. Do we add the resources to the profitable service because in the long run these revenues will help to offset the costs of providing charity care? Is it right to place the indigent patient at risk for not seeking preventive care, diagnostic tests, or treatments by not investing in a community service that could save lives?


To make these difficult decisions, you need to know and understand the mission of your organization and work to achieve it through strategic and operational practices. There are some healthcare organizations that focus on regional, profitable services, whereas others are more highly reliant on philanthropic activities to provide low- or no-cost healthcare services or may have a primary focus on academics and research.


Developing a priority grid to help rank order requests is one method you can use as you start the decision-making process. The priority grid should be developed to provide a high degree of objectivity in an effort to minimize the emotion in critical decision making. Categories of prioritization include internal and external resources; population served; use of technology; financial impact; relationship to mission, vision, and values; efficiency and effectiveness; and likelihood of achieving the outcome. Assigning a numeric value to each of these categories, which will provide an overall score, can be a first step in making a decision.


Once quantified, a proposed action needs to be qualified. What does your experience tell you to do? Are there politics involved? How will your decision be viewed by the constituents whom you lead? What are your emotions telling you? What are your fears and anxieties? Conducting a thorough SWOT (strengths, weaknesses, opportunities, and threats) analysis is an effective tool to utilize when attempting to make a difficult decision.


If you still aren't sure of the direction to take after various aspects of the decision are quantified and qualified, it's imperative to seek advice from colleagues who might have had to make a similar decision. The informality of "phoning a friend" might be the final ingredient necessary to make the right decision.


A critical-thinking, ethically responsible leader will answer both the quantitative and qualitative questions before rendering a decision. Spending the time to evaluate the pros and cons of a decision will give you a greater belief that you're making the correct choice for your organization and the community it serves.


We, as leaders, need to be prepared to make choices that will challenge our management ethics. Doing the right thing may not always be popular, but it will be sustained with vigilance and determination if due diligence is conducted fairly and accurately.


Richard Hader

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