STRATEGIES OF MORAL DECISION - MAKING PROCESS

-Moral decision making is having the ability to decide which the right course of action is once we have
spotted the ethical issue. Sometimes this can be very difficult, as multiple options may seem morally
defensible (or, perhaps, no options seem morally acceptable)
-Ethical decisions generate and sustain trust; demonstrate respect, responsibility, fairness and caring; and
are consistent with good citizenship. These behaviors provide a foundation for making better decisions by
setting the ground rules for our behavior.
ETHICAL (MORAL) DECISION – MAKING PROCESS
1. Identify the Ethical Problem – A process in which the decision maker must be able to determine:
 If there is a possible violation of an important ethical principle, societal law, or
organizational standard or policy
 If there are potential consequences that should be sought or avoided that emanate
from an action being considered to resolve the problem.

2. Collect Relevant Information – A process in which the decision maker should seek to gather as
much information as possible about which rights are being forsaken and to what degree.
 A consequential focus would prompt the decision maker to attempt to measure the
type, degree, and amount of harm being inflicted or that will be inflicted on others.

3. Evaluate the Information - Once the information has been collected, the decision maker must
apply some type of standard or assessment criterion to evaluate the situation.
 The decision maker might use one of the predominant ethics theories-utilitarianism,
rights, or justice.

4. Act or Implement - The decision maker needs to generate a set of possible action alternatives,
such as:
 Confronting another person's actions
 Seeking a higher authority, or
 Stepping in and changing the direction of what is happening.

5. Make a Decision - The decision maker should seek the action alternative that is supported by the
evaluation criteria used in Step 3.
 A decision maker selects a course of action that is supported by all the ethics theories
or other evaluation criteria used in the decision- making process.

6. Consider Alternatives - The decision maker, if truly seeking to resolve the problem being
considered, must take action. .
 Once the action alternatives have been identified in Step 4 and the optimal response
is selected in Step 5, the action is taken in Step

7. Review the Action - Once the action has been taken and the results are known, the decision maker
should review the consequences of the action.
  If the optimal resolution to the problem is not achieved, the decision maker may need
to modify the actions being taken or return to the beginning of the decision-making
process

Four Stages of Moral Decision Making

 Moral Awareness- Moral awareness is the ability to detect and appreciate the ethical
aspects of a decision that one must make. Moral awareness is the first step to acting
ethically.

 Moral Judgement - Moral judgment is the evaluation of a certain behavior as good or

bad, or as right or wrong. The goal of moral psychology is to clarify why individuals
make the judgments they do about moral issues

 Moral intention - Moral intent is the desire to act ethically when facing a decision and
overcome the rationalization to not be ethical “this time.” Even if a person sees the
ethical aspects of a decision and has the philosophical tools to make the right choice,
he or she still needs to want to do the right thing.

 Moral Action - Moral action involves taking the necessary steps to transform the
intent to do the right thing into reality. This includes moral ownership, moral
efficacy, and moral courage.

Strategies of Moral Decision – Making process

 RECOGNIZING PERSONAL CIRCUMSTANCES

Example: Thinking about origins of problem, individuals involved, and relevant principles, goals
& values; considering one’s own role in causing and/or resoling the problem

 ANTICIPATING CONSEQUENCES
Example: Thinking about many possible outcomes such as consequences for others, short & long
term outcomes based upon possible decision alternatives

 CONSIDERING OTHERS' PERSPECTIVES

Example: Being mindful of others’ perceptions, concerns, and the impact of your actions on
others, socially and professionally

 SEEKING HELP
Example: Talking with a supervisor, peer, or institutional resource, or learning from others’
behaviors in similar situations

 QUESTIONING YOUR OWN JUDGMENT

 Example: Considering problems that people often have with making ethical decisions,
remembering that decisions are seldom perfect

 DEALING WITH EMOTIONS

Example: Assessing and regulating the emotional reactions of any situation

 EXAMINING PERSONAL VALUES

Example: Considering one’s own biases, effects of one’s values and goals, how to explain/justify
one’s actions to others, & questioning ability to make ethical decisions

Strategies of Moral decision-making is required when the healthcare executive must address a conflict or
uncertainty regarding competing values, such as personal, organizational, professional and societal
values.
All of this involved in this decision-making process and we must consider ethical principles including:
Justice, Autonomy, Beneficence and Nonmaleficence, as well as Professional and Organizational
Ethical standards and Codes.
Many factors have contributed to the growing concern in healthcare organizations over clinical,
organizational and societal ethical issues, including issues of equitable access and affordability, quality,
value-based care, patient safety, disclosure of medical errors, allocation of limited resources, mergers
and acquisitions, financial and other resource constraints, and advances in medical treatment that
complicate decision-making near the end of life.
Healthcare executives have a responsibility to recognize and address the growing number of complex
ethical dilemmas they are facing, but they cannot and should not make such decisions alone or without a
sound decision-making process that considers diverse viewpoints. The application of a systematic
decision-making process can serve as a useful tool for leaders, staff and stakeholders in addressing
ethically challenging situations.

 MEANING AND SERVICES VALUE OF MEDICAL CARE

Value-based healthcare, also known as value-based care, is a payment model that rewards healthcare
providers for providing quality care to patients. Under this approach, providers seek to achieve the triple
aim of providing better care for patients and better health for populations at a lower cost.
Value-based care focuses on care coordination that ensures patients are given the right care by the right
provider at the right time. Thus, in a value-based healthcare model, physicians may collaborate with each
other on a patient's care, rather than making decisions separately that can lead to gaps or overlaps in care.
Example:
1. Hospital Value-Based Purchasing Program, - which rewards acute care hospitals with incentive
payments for the quality of care they provide to Medicare patients. This program is designed to
improve the patient experience during hospital stays.
 2. Hospital Readmission Reduction Program, - which lowers payments to Inpatient Prospective
Payment System hospitals that have too many readmissions. This program incentivizes hospitals
to improve their communication, care coordination and how they work with patients and
caregivers on post-discharge planning.
3. Value Modifier Program or Physician Value-Based Modifier, - which measures the quality and
cost of care for Medicare patients. This program determines the amount of Medicare payments
physicians will receive based on their performance on certain cost and quality measures.
4. Hospital Acquired Conditions Program,- which encourages hospitals to reduce the number of
infections or illnesses that patients receive while admitted. This program reduces payments for
hospitals that rank the worst for how often patients get hospital-acquired conditions.
By comparison, under the value-based care model, healthcare providers are pushed to provide quality care
that improves patient outcomes. Options exist for bundling payments or alternative payments that give
added incentives for high-quality and cost-effective healthcare.