J Steakley | PubMed Health

PubMed1999

Above reproach: developing a comprehensive ethics and compliance program.

How can a healthcare organization improve the public's confidence in the conduct of its business operations? What can it do to ensure that it can thrive despite being the subject of public and governmental scrutiny and doubt? Healthcare providers must establish standards of conduct that are above reproach and ensure that those standards are clearly articulated and strictly adhered to. This article describes the merits of a comprehensive ethics and compliance program, suggests five basic elements of such a program--organizational support/structure, setting standards, creating awareness, establishing a mechanism for reporting exceptions, and monitoring and auditing--and then demonstrates how those elements should be applied in several high-risk areas. Fundamentally, an ethics and compliance program has two purposes: to ensure that all individuals in an organization observe pertinent laws and regulations in their work; and to articulate a broader set of aspirational ethical standards that are well-understood within the organization and become a practical guideline for organization members making decisions that raise ethical concerns. Every ethics and compliance program should contain certain fundamental aspects. First, the effort must have the active support of the most senior management in the organization. To instill a commitment to ethics and compliance absent a clear and outspoken commitment to such purposes by organization leaders is simply impossible. Second, an ethics and compliance program is fundamentally about organizational culture--about instilling a commitment to observe the law and, more generally, to do the right thing. Third, ethics and compliance are responsibilities of operating management (sometimes called line management). Although staff such as compliance officers are obligated to provide the necessary resources for a successful program and to design the program, such staff officers cannot achieve implementation and execution. Only operating managers can do that. Fourth, an ethics and compliance effort should be about the conduct of individuals, not about "checking the boxes" in a model plan or generating attractive written or educational materials. Such an effort is about individuals on a day-to-day basis knowing what is expected of them and doing it and about never compromising integrity, regardless of pressures faced. A great deal of progress has been made in healthcare organizations in the development of increasingly sophisticated ethics and compliance programs. A particularly energetic focus has been placed on these programs since formal government guidance regarding compliance programs was first issued in the laboratory area about two years ago and as more sophisticated automated monitoring tools have been developed. As ethics and compliance programs have become more sophisticated, certain best practices have been established. This discussion will set forth approaches to ethics and compliance in the context of what are believed to be illustrative best practices. Much of what is described here is descriptive of the efforts of Columbia/HCA Healthcare Corporation from October 1997 to the present; however, this article has been presented not as a mere descriptive piece but rather as a set of normative guidelines. We hope that other healthcare providers will find this to be of practical use. Provider settings pose certain unique challenges that are specifically addressed in this discussion; however, many of the issues raised can be adapted to other healthcare organizations. For simplicity's sake, because the authors of this article all work on a daily basis primarily with hospitals, the article is written from a hospital perspective.

Ethics, Institutional↗

PubMed1995

Leftist sexual politics and homosexuality: a historical overview.

For almost a full century now, the revolutionary prospect of socialism has fuelled opening forays first of the homosexual emancipation and later of the gay liberation movements, both in Europe and in North America. It inspired Edward Carpenter and Magnus Hirschfeld at the turn of the century; André Gide and Richard Linsert in the post-World War I years; Harry Hay and Jim Kepner in the post-World War II era; and the British and American Gay Liberation Front, the Italian Fuori!, the French FHAR, the German "Rotzschwule," and the Dutch Red Faggots following the Stonewall rebellion. While the official socialist parties of Northwestern Europe may have made only limited contributions to homosexual emancipation, they certainly have a better record than conservative and Christian parties and even the liberals, who have consistently, if contradictorily, underlined the freedom of private life. Even so, parties across the entire political spectrum have gradually come to endorse at least some of the movement's goals. As it has advanced, the gay movement has changed as well, and it now finds itself pulled in divergent directions. Gay leftists who still subscribe to the ideals expressed in Marxist and utopian socialist writings now find themselves at demonstrations shoulder-to-shoulder with members of ACT UP and Queer Nation, to say nothing of gay conservatives and gay Christians. The successes achieved by the contemporary gay movement despite or precisely because of its diversity support Foucault's argument that "there is no single locus of great Refusal, no soul of revolt, source of all rebellions, or pure law of the revolutionary. Instead there is a plurality of resistances, each of them a special case...." At the close of the twentieth century, the welfare state has reached its apogee in Northwestern Europe. As blue-collar workers historically committed to class struggle have become relatively well-to-do and minoritarian, socialist parties have increasingly lost their traditional base of support and been forced into the defensive. Depending only on the socialists would mean relying on an ineffectual partner, for nowhere are they in a stable position of power. Long before the collapse of "really existing socialism" in Eastern Europe and the former Soviet Union, gay and lesbian movements began developing their own autonomous politics independent of parties. They moved in this direction in part because the coalition with leftism so frequently led to disappointment, particularly when gays and lesbians working within socialist parties were called upon to subordinate or abandon their own goals in favor of party platforms. In other cases the gay-left coalition failed to yield results because a single-minded reliance on one party placed limits on lobbying other parties and entering compromises. We have reached a time when inherited ideologies are no longer capable of laying claim to the undivided loyalty of the gay movement, if indeed they ever were. As it has developed autonomous theories and practices, the gay movement's choice of coalition partners has increasingly come to be based on pragmatism and success in advancing the gay agenda. Indeed, the roles of the gay movement and political parties have undergone a notable switch in recent years, with parties currying the support of the gay movement rather than vice versa. This signals a shift from the desire for politics to a politics of desire, going far beyond traditional socialist ideologies.

Europe↗