Beyond financial incentives: Organizational ethics and organizational integrity

Abstract

We use the recent JCAHO standards on organizational ethics as a starting point for this paper. We briefly examining the existing JCAHO standards and highlight their emphasis on financial incentives. We then take up an in-depth discussion of a number of issues associated with implementing these standards. Our fundamental argument is that the standards, as currently presented, do not address the full scope of organizational ethics issues around clinical decisionmaking, particularly with respect to the impact of organizational initiatives to contain costs. We discuss how health care organizations might adopt an organizational integrity strategy to address in a more comprehensive manner organizational ethics issues associated with both financial incentives and organizational cost management initiatives, and offer some recommendations for how the standards might be revised and expanded in light of our discussion.