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Journal of evaluation in clinical practice
Jun, 2020;26 (3): 699-706.

Ethics in contemporary health care management and medical education.

Naci Balak, Marike L D Broekman, Tiit Mathiesen
Author Information
  1. Naci Balak: Department of Neurosurgery, Göztepe Education and Research Hospital, Medeniyet University, Istanbul, Turkey. ORCID
  2. Marike L D Broekman: Cushing Neurosurgical Outcomes Centre, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  3. Tiit Mathiesen: Department of Neurosurgery, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark, and Karolinska Institutet, Stockholm, Sweden.
PMID: 31975509 DOI: 10.1111/jep.13352

Abstract

RATIONALE: The health care landscape is changing: it has become the largest part of the economy and changes in public management systems will greatly affect how we practice medicine in the future. Medical education will be more important than ever to ensure patients get the best care with empathy. However, new public management systems implemented without thorough analysis might challenge medical education. An increasing number of public health care institutions provide services based on competitive market rules and express their goals in financial terms and have set financial gains as their main goal, which contradicts the fundamental nature of medical ethics and practice.
AIMS AND OBJECTIVES: To explore new public management to identify potential problems and offer possible solutions for medical education and health care institutions.
METHODS: A scoping review of the literature on public administration, hospital management, professionalism, ethics, and medical education was undertaken to map evidence on the topic and identify main concepts and knowledge gaps in the influence of management systems on the quality of medical educational practices.
RESULTS: If the accelerating changes in public management are cursorily analysed, medical education may lose the esteem in which it has long been held globally. Without precautions, the so-called new public management medical faculties will-at best-generate economic benefit, following a business model with strict quality rules, regulations, standardized products, and complex analysis and measurement systems. However, these faculties will function at a level far below the ideal of teaching institutions distinguished for their outstanding components, creativity, and ambience.
CONCLUSIONS: Patients and teaching values are not reducible to financial terms only and the acknowledgement of non-financial values is fundamental to achieve quality in health care and education. The most essential step could be selecting managers who will implement public management principles while taking into account both business requirements and medical ethics.

Keywords

health care health policy medical education medical ethics philosophy of medicine

References

  1. Karle H. Global standards and accreditation in medical education: a view from the WFME. Acad Med. 2006;81(12):S43-S48.
  2. Editorial. Universities challenged. Nature. 2014;514(7522):273.
  3. Caulfield T, Ogbogu U. The commercialization of university-based research: balancing risks and benefits. BMC Med Ethics. 2015;16(1):70.
  4. Osborne SP. The New Public Governance: Emerging Perspectives on the Theory and Practice of Public Governance. New York: Routledge Taylor & Francis Group; 2010.
  5. Agarwal N, Norrmen-Smith IO, Tomei KL, Prestigiacomo CJ, Gandhi CD. Improving medical student recruitment into neurological surgery: a single institution's experience. World Neurosurg. 2013;80(6):745-750.
  6. Jena AB, Seabury S, Lakdawalla D, Chandra A. Malpractice risk according to physician specialty. N Engl J Med. 2011;365(7):629-636.
  7. Ratcheson RA. Fast forwarding: the evolution of neurosurgery: the 2005 presidential address. J Neurosurg. 2005;103(4):585-590.
  8. Reulen H-J. Training in Neurosurgery in the Countries of the EU: A Guide to Organize a Training Programme. Wien: Springer-Verlag; 2004.
  9. Gillon R. Medical ethics: four principles plus attention to scope. BMJ. 1994;309(6948):184-188.
  10. Gregg D. The art and the science of medicine. Boston Med Surg J. 1923;189:438-440.
  11. Harbaugh RE. The 2015 AANS presidential address: neurosurgery's founding principles. J Neurosurg. 2015;123(6):1351-1357.
  12. Editorial. Promoting excellence: standards for medical education and training Manchester: General Medical Council; 2015. Available from: http://www.gmc-uk.org/education/standards.asp
  13. Groot T, Budding T. New public management's current issues and future prospects. FAM. 2008;24(1):1-13.
  14. Stienen MN, Netuka D, Demetriades AK, et al. Working time of neurosurgical residents in Europe-results of a multinational survey. Acta Neurochir. 2016;158(1):17-25.
  15. Crow M, Anderson D, Whitman K. Academic enterprise as a new institutional logic for public higher education. Places Engage. 2018;121.
  16. Natale SM, Libertella AF, Doran CJ. For-profit education: the sleep of ethical reason. J Bus Ethics. 2015;126(3):415-421.
  17. Wilson W. The study of administration. Polit Sci Q. 1887;2(2):197-222.
  18. Hood C. The “new public management” in the 1980s: variations on a theme. Account Organiz Soc. 1995;20(2):93-109.
  19. Morgan DF, Cook BJ. New Public Governance: A Regime-Centered Perspective. ME Sharpe Inc: Armonk, New York; 2014.
  20. Ryan S, Connell J, Burgess J. Casual academics: a new public management paradox. Labour Industry. 2017;1-17.
  21. Simonet D. Assessment of new public management in health care: the French case. Health Res Policy Syst. 2014;12(1):57.
  22. Butterfield R, Edwards C, Woodall J. The new public management and managerial roles: the case of the police sergeant. Br J Manag. 2005;16(4):329-341.
  23. Anderson G. Participatory action research (PAR) as democratic disruption: new public management and educational research in schools and universities. Int J Qualitat Studies Edu. 2017;30(5):432-449.
  24. Ball SJ. The teacher's soul and the terrors of performativity. J Educ Policy. 2003;18(2):215-228.
  25. Sklar DP, Hemmer PA, Durning SJ. Medical education and health care delivery: a call to better align goals and purposes. Acad Med. 2018;93(3):384-390.
  26. Hughes OE. Public Management and Administration. Hampshire. New York: Palgrave Macmillan; 2012.
  27. Vigoda E. New public management. Encyclopedia of Public Administration and Public Policy. 2003;2:812-816.
  28. Neil-Dwyer G, Lang D, Trojanowski T. Neurosurgical training programme director position and responsibilities. Training in neurosurgery in the countries of the EU. Acta Neurochir. 2004;90:13-16.
  29. Resnick AS, Corrigan D, Mullen JL, Kaiser LR. Surgeon contribution to hospital bottom line: not all are created equal. Ann Surg. 2005;242(4):530-539.
  30. Pollitt C, Van Thiel S, Homburg V, Van Thiel S. New Public Management in Europe: Adaptation and Alternatives. Basingstoke: Palgrave MacMillan; 2007.
  31. Editorial. Higher education: the university experiment. Nature. 2014;514(7522):287.
  32. Wachtel RE, Dexter F. Tactical increases in operating room block time for capacity planning should not be based on utilization. Anesth Analg. 2008;106(1):215-226.
  33. Macario A. The limitations of using operating room utilisation to allocate surgeons more or less surgical block time in the USA. Anaesthesia. 2010;65(6):548-552.
  34. Pandit J, Pandit M, Reynard J. Understanding waiting lists as the matching of surgical capacity to demand: are we wasting enough surgical time? Anaesthesia. 2010;65(6):625-640.
  35. Eibner C, Hussey PS, Ridgely MS, McGlynn EA. Controlling Health Care Spending in Massachusetts: An Analysis of Options. Santa Monica, CA: RAND Corporation; 2009.
  36. Goetghebeur MM, Forrest S, Hay JW. Understanding the underlying drivers of inpatient cost growth: a literature review. Am J Manag Care 2003;9(Spec No 1):SP3-SP12.
  37. Altman SH, Reinhardt UE, Research AHS. Strategic Choices for a Changing Health Care System. Chicago, IL: Health Administration Press; 1996.
  38. Cameron W. Informal Sociology: A Casual Introduction to Sociological Thinking. New York: Random House; 1963.
  39. Figueras J, Robinson R, Jakubowski E. Purchasing to improve health systems performance. Berkshire: Open University Press McGraw-Hill Education; 2005.
  40. Kelly N, Garvey J, Palcic D. Health policy and the policymaking system: a case study of primary care in Ireland. Health Policy. 2016;120(8):913-919.
  41. Houghton F. Hiding the evidence: the state and spatial inequalities in health in Ireland. Irish Geogr. 2005;38(1):96-106.
  42. van Ineveld M, van Oostrum J, Vermeulen R, Steenhoek A, van de Klundert J. Productivity and quality of Dutch hospitals during system reform. Health Care Manag Sci. 2016;19(3):279-290.
  43. Varkevisser M, van der Geest SA. Why do patients bypass the nearest hospital? An empirical analysis for orthopaedic care and neurosurgery in the Netherlands. Eur J Health Econ. 2007;8(3):287-295.
  44. Saultz A, Saultz JW. Measuring outcomes: lessons from the world of public education. Ann Family Med. 2017;15(1):71-76.
  45. Cruess SR. Professionalism and medicine's social contract with society. Clin Orthop Relat Res. 2006;449:170-176.
  46. Bustamante A, Morales L, Ortega A. Racial and ethnic disparities in health care. Changing the US Health Care System: Key Issues in Health Services Policy and Management. Jossey-Bass; 2014:103-134.
  47. Norheim OF. Ethical priority setting for universal health coverage: challenges in deciding upon fair distribution of health services. BMC Med. 2016;14(1):75.
  48. Alonso JM, Clifton J, Díaz-Fuentes D. Did new public management matter? An empirical analysis of the outsourcing and decentralization effects on public sector size. Public Manag Rev. 2015;17(5):643-660.
  49. Kocher R, Sahni NR. Hospitals' race to employ physicians-the logic behind a money-losing proposition. N Engl J Med. 2011;364(19):1790-1793.
  50. Shah DR, Bold RJ, Yang AD, Khatri VP, Martinez SR, Canter RJ. Relative value units poorly correlate with measures of surgical effort and complexity. J Surg Res. 2014;190(2):465-470.
  51. Haliasos N, Rezajooi K, O'neill K, Van Dellen J, Hudovsky A, Nouraei S. Financial and clinical governance implications of clinical coding accuracy in neurosurgery: a multidisciplinary audit. Br J Neurosurg. 2010;24(2):191-195.
  52. Olesiński B, Opala P, Rozkrut M, Torój A. Short-Termism in Business: Causes, Mechanisms and Consequences. UK: Ernst & Young Global Limited; 2014.
  53. Kuttner R. Market-based failure-a second opinion on US health care costs. N Engl J Med. 2008;358(6):549-551.
  54. Umansky F, Black PL, DiRocco C, et al. Statement of ethics in neurosurgery of the world federation of neurosurgical societies. World Neurosurg. 2011;76(3):239-247.
  55. World Federation of Neurosurgical Societies and European Association of Neurosurgical Societies (final version: August 1998). Good practice: a guide for neurosurgeons. Acta Neurochir. 1999;141(8):793-799.
  56. Wall S, Austin WJ, Garros D. Organizational influences on health professionals' experiences of moral distress in PICUs. HEC Forum. 2016;28(1):53-67.
  57. Austin W. Moral distress and the contemporary plight of health professionals. HEC Forum. 2012;24(1):27-38.
  58. Cobanoglu N. Hastane Yönetiminin Hekim-Hasta İlişkisine Müdahalesinin Etik Boyutları. [Ethical Dimensions of Hospital Administration's intervention to Physician-Patient Relationship] 1 Ulusal Uygulamalı Etik Kongresi Kitabı; Ankara. Ankara: ODTÜ Yayınları; 2001. p. 178 [In Turkish].
  59. Ausman JI, Shibuya T. Socioeconomics and politics affecting the Japanese neurosurgeon. Neurol Med Chir (Tokyo). 1999;39(6):409-415.
  60. Kolthoff E, Huberts L, Van den Heuvel H. The ethics of new public management: is integrity at stake? Public Adm Q. 2006;399-439.
  61. Kim R, The US. Hospital management from a strategic management viewpoint. J Hosp Med Manag. 2016;2(2):1-7.
  62. Castlen JP, Cote DJ, Moojen WA, et al. The changing health care landscape and implications of organizational ethics on modern medical practice. World Neurosurg. 2017;102:420-424.
  63. Ammar A, Bernstein M. Neurosurgical Ethics in Practice: Value-based Medicine. Springer Berlin Heidelberg; 2014.
  64. Broekman ML, Peerdeman S. Are happy residents better residents? Acta Neurochir. 2016;158(10):1835-1836.
  65. Aronson E, Wilson TD, Akert RM. Social Psychology. 7th ed. New Jersey: Prentice Hall; 2010.

MeSH Term

Delivery of Health Care
Education, Medical
Ethics, Medical
Health Services Administration
Humans
Journal Article Review

Word Cloud

Created with Highcharts 10.0.0medicalmanagementpubliceducationhealthcaresystemswillethicsnewinstitutionsfinancialqualitychangespracticemedicineHoweveranalysisrulestermsmainfundamentalidentifyfacultiesbusinessteachingvaluesRATIONALE:landscapechanging:becomelargestparteconomygreatlyaffectfutureMedicalimportanteverensurepatientsgetbestempathyimplementedwithoutthoroughmightchallengeincreasingnumberprovideservicesbasedcompetitivemarketexpressgoalssetgainsgoalcontradictsnatureAIMSANDOBJECTIVES:explorepotentialproblemsofferpossiblesolutionsMETHODS:scopingreviewliteratureadministrationhospitalprofessionalismundertakenmapevidencetopicconceptsknowledgegapsinfluenceeducationalpracticesRESULTS:acceleratingcursorilyanalysedmayloseesteemlongheldgloballyWithoutprecautionsso-calledwill-atbest-generateeconomicbenefitfollowingmodelstrictregulationsstandardizedproductscomplexmeasurementfunctionlevelfaridealdistinguishedoutstandingcomponentscreativityambienceCONCLUSIONS:Patientsreducibleacknowledgementnon-financialachieveessentialstepselectingmanagersimplementprinciplestakingaccountrequirementsEthicscontemporarypolicyphilosophy

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