Ethical Decision-Making in Public Hospitals Management: Challenges and Models from Romania

Abstract

Ethical decision-making is essential in healthcare management, particularly in addressing challenges such as resource constraints, stakeholder conflicts, and legislative ambiguities. The aim of this study is to explore the ethical decision-making process in public hospital management, including its challenges and models. The research objectives are to identify the ethical decision-making models employed by public hospital managers in Romania, to investigate how the ethical dilemmas influence the decision-making process in Romanian public hospital management and to determine the role of ethical values in the decision-making process undertaken by Romanian public hospital managers. To this end, quantitative survey data were collected from hospital managers to assess how ethical considerations shape managerial choices. The main research results reveal that ethical dilemmas, especially in areas like resource allocation and strategic planning, delay decision-making and increase its complexity. Ethical values such as fairness, transparency, and trust are central to guiding decisions, yet the lack of formal ethics training among many managers limits their ability to address these dilemmas effectively. Structured frameworks like the PLUS and IDEA models, while valuable, are underutilized, further hindering consistent ethical decision-making. This study highlights the need for mandatory ethics training, institutionalized decision-making models, and strengthened organizational policies to improve decision-making efficiency and integrity. By addressing these gaps, healthcare organizations can align with global standards, foster ethical cultures, and better meet the needs of patients, staff, and communities. This research provides valuable insights into ethical management in resource-constrained healthcare systems.