Do healthcare managers have an ethical duty to admit mistakes?

Healthcare Financial Management, Oct, 1998 by Michael Nowicki

It may be safe to assume that the number of mistakes admitted would exceed the number of mistakes not admitted that would lead to lawsuits. Therefore, by not admitting mistakes, healthcare organizations forgo the short-term costs associated with compensating patients. In some instances, healthcare organizations even bill a patient or a patient's insurance company for care needed to correct the mistake, sometimes justifying the billing by blaming the patient for his or her worsened condition through noncompliance with caregiver instructions. Under such circumstances, the healthcare organization may or may not incur the costs associated with ensuring that the mistake does not recur. The long-term costs of such a strategy, however, might be high.

For example, a healthcare organization normally would charge a patient for a readmission to clear up a postoperative infection that it contends occurred because the patient did not follow a prescribed regimen of antibiotic treatment following discharge. If the patient contests this claim and discovers that the postoperative infection was caused by an improperly sterilized instrument used during surgery, he or she could successfully bring suit against the organization. In this instance, punitive damages could be significantly higher.

Duties Owed by Managers

Most managers are taught that their primary duty is to represent the healthcare organization's interests and that in so doing, they also represent the interests of patients and the community. Taking into consideration the greatest good for the greatest number, some managers believe that admitting mistakes when they occur and compensating patients reduces the funds available for patient care.

It can be argued, however, that a manager's decision to admit a mistake is the only way to meet the organization's moral obligation to patients and the community. Not only should managers focus on individual patient interests, they argue, but also managers' duty to individual patients should take precedence over their duty to their healthcare organizations.

The managers' duty to themselves and their families, however, may affect the decision to admit mistakes. By admitting mistakes to patients, managers may risk losing their jobs if the organization disagrees with their choice regarding where their primary duty lies. Understandably, managers are not likely to risk their jobs by admitting mistakes to patients without the healthcare organization's approval.(g) Exacting such a price for doing the right thing is more than society can expect from most managers. Society can expect and even demand, however, that managers work to redirect their organizational cultures to reward, rather than punish, those who admit mistakes, fairly compensate patients for those mistakes, and ensure that similar mistakes do not occur.

Such organizational cultural changes may be easier to effect today than they were in the past because of the Federal fraud and abuse investigations that have been sweeping the healthcare provider industry in recent years. Increasing numbers of healthcare organizations are adopting comprehensive corporate compliance programs that emphasize, among other virtues, the importance of honesty and integrity in all of the organization's business dealings. For managers uncertain about where their ethical duty lies, such programs could provide the answer.