Ethics and Decision-Making in the VA Healthcare System

This article discusses the ethical issues related to decision-making practices in the VA healthcare system. It explores the problems at the VA relative to ethical decision-making practices, ethical issues related to 1,700 veterans who were not listed on the EWL, and the American College of Healthcare Executives Code of Ethics and the VA Health System case study. The article also discusses the reasons for the resignation of Secretary Eric Shinseki and alternative options to resolve the unethical decision-making practice.

Running head: ETHICS AND DECISION-MAKING IN THE VA HEALTHCARE SYSTEM
ETHICS AND DECISION-MAKING IN THE VA HEALTHCARE SYSTEM
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1ETHICS AND DECISION-MAKING IN THE VA HEALTHCARE SYSTEM
Problems at the VA relative to ethical decision-making practices
Maintain ethics is an essential part of healthcare management. It is important to provide
effective, ethical behaviour to the patient in order to avoid ethical issue regarding decision
making in the health care centre. One of the necessary skills of effective leadership in the health
care system is the ability to take decisions considering the ethical factors (Huber, 2017). Such
guidance helps to reduce ethical issues related to the management of the health care system. The
case study related to the VA health care system has led to enormous problems related to ethical
decision making practice. It has been reported that the veterans at the Williams Jennings Bryan
Dorn Veterans Medical Centre in Columbia were experiencing a delay in the care service
provided by the healthcare organization. Even the delay became so severe so that six veterans
have died during the time of waiting for care service related to the diagnostic of illness. Delay in
the primary care appointment is also noted in this case. Such incidents have indicated the lack of
effective leadership in the healthcare organization. In this case, one of the main problems is the
inability of the leader to understand the role of individual staffs. Due to this, the leader has failed
to provide adequate system process and program coordination in the healthcare organization. The
leader has failed to make an ethical decision regarding the veteran affairs in the healthcare
organization. It is the responsibility of the leader to provide important strategies to improve the
planning process in order to achieve the goal of the organization in an effective manner (Barr &
Dowding, 2015). According to the case study, the leader has introduced multiple types of
scheduling practices that have failed to comply with the Veterans Health Administration policy.
Such incidents have indicated that the leader has failed to take the effective ethical decision due
to which the majority of the patients have suffered, even resulted in deaths. Another problem

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related to ethical decision making is that the secretary has resigned from his post after the
investigation instead of introducing effective interventions to resolve the issue in the healthcare
organization. Such unethical decision has indicated lack of effective leadership in the healthcare
organization, which is a big problem for the organization and need to be mitigated with
significant initiatives (Harrison & Association of University Programs in Health Administration,
2010).
Ethical issue related to 1,700 veterans who were not listed on the EWL
According to the case study in the Phoenix VA, it was found that 1700 veterans were
waiting for the primary care appointment, but they were not listed in the EWL. Due to this, the
Phoenix leadership failed to recognize them, thus registered new patients in the EWL. Thus, the
patients that were not listed in the EWL have faced a significant delay in the primary care, and
many patients have died during this situation. The investigation has indicated that the average
waiting time for primary care appointment in the health care was 115 days and 84% of the
patient has waited for more than 14 days. In the organization, multiple lists of EWL has been
found that is different from the official EWL, which indicates the presence of a secret wait list in
the organization. Such activity is unethical and leads to the violation of the ethics in the
healthcare organization. The action related to the presence of secret wait list and let the patients
wait for primary care appointment without enlisted them in the official EWL could lead to the
violation of the human rights of the individual patient (Kangasniemi, Pakkanen & Korhonen,
2015). The incident has raised questions regarding omitting the names of the veterans from the
official EWL and deaths of the patients during the waiting period. Such a situation has led to

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ethical issues related to patient safety. The issues related to dignity and equal access to the
service is also present in this case.
It is important to introduce significant policies to ensure effective leadership considering
ethical factors. The administration must propose strategies to improve the coordination in the
EWL and primary care appointments in the healthcare organization (Epstein & Turner, 2015).
One of such policies may include the policy related to enabling the audit controls within
Veterans Health Information Systems and Technology Architecture (VistA). Such a policy
would help to identify the presence of malicious manipulation of the VistA. It would help to
ensure that the future oversight ability of the veterans is not neglected, thus could help to
improve the primary care appointment through EWL (Fernández-Alemán et al., 2013). Another
policy could be related to the open access scheduling. The process could help to reduce the wait
time of the patients through enabling telephone calls consultation, message consultation and e-
mail consultation (Ansell et al., 2017).
Reason for the resignation of Secretary Eric Shinseki and alternative options
to resolve the unethical decision making practice
The retired Army Chief of Staff, General Eric Shinseki has been appointed as the
secretary of the Veterans affair that provides healthcare and federal facilities to the veterans and
the dependents of the US. During his service, it was found that the veterans of Williams Jennings
Bryan Dorn Veterans Medical Centre in Columbia were facing a delay in primary care
appointment. The investigation has revealed that 1400 veterans lack the primary care
appointment still they were enlisted in the EWL, whereas, other 1700 veterans were waiting for
primary care appointment but they were not listed in the EWL system. The incident has revealed

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the presence of a secret wait list in the healthcare organization. Question related to omitting the
names of the veterans from the EWL has risen. It was found that many veterans have died during
the waiting period without a diagnosis of the illness. Due to such scandal in the organization, it
has been proved that the responsible authority has failed to fulfil the responsibilities. The lack of
effective leadership and ethical decision making power has been detected in this case. Thus the
secretary of Veterans affair, Eric Shinseki has resigned from his post.
The responsible authority must provide effective strategies to mitigate the ethical issues
in the organization (Shanks, 2016). The activity related to the resignation of the secretary of the
Veterans Affair is unethical. Instead of that, he might introduce significant steps to resolve the
issue in the organization. For example, the secretary could arrange a meeting and recruit an
investigational team to identify such ethical issues in the healthcare organization in order to solve
them in an effective manner. The secretary could communicate with the responsible authority
that is accountable for the unethical decision making in the healthcare organization and take
proper legal steps against the staffs that are responsible for the scam in the organization
(Langevin & Mendoza, 2013). Such effort of the secretary could help to mitigate the issue of
unethical decision making practice and ensure the quality of service provided by the healthcare
organization.
American College of Healthcare Executives Code of Ethics and the VA Health
System case study
The American College of Healthcare Executives (ACHE) provides a valid code of ethics
in order to maintain ethical behaviour in the healthcare organization. According to the preamble
of the ACHE code of ethics, it is the responsibilities of the healthcare executives to serve to the

5ETHICS AND DECISION-MAKING IN THE VA HEALTHCARE SYSTEM
people with need considering the standards provided by the code of ethics. The code of ethics
provides standards that help to maintain ethical behaviour in the professional relationship such as
colleagues, other members of the organization and the patients. It also provides the standard for
governing the behaviour of an individual in order to identify the role and responsibilities of the
individual in the health care system. It is essential for a healthcare executive to maintain such
standards in order to provide service in an effective manner (ACHE Code of Ethics, 2018).
According to the ACHE code of ethics, it is the responsibility of the professional
healthcare management team to provide service with honesty, integrity, respect and faith in order
to avoid ethical issues and meet the requirements of the patient. The healthcare executive in the
case study has failed to maintain such standards. They have ignored the integrity and the faith to
an extent. The incident mentioned in the case study such as “investigators found that 1,400
veterans did not have a primary care appointment but were listed on the EWL. It was also
determined that 1,700 veterans were waiting for a primary care appointment but were not listed
on the EWL” has proved that the healthcare executive in the healthcare organization has failed to
comply with the code of ethics. The code of ethics also states that, it is the duty of the healthcare
executive to serve to the patients efficiently to meet their requirements and do not exploit the
patients for personal gain, but the executives in the case study have misused their power and
create a secret wait list. Due to such situation, the veterans have faced problem related to primary
care appointment; even death has occurred during the waiting period. The code of ethics
provides standards to ensure patient safety. According to the code of ethics, it is important to
provide equal access to the service for all, but in the case study, it has been found that the
veterans lack equal access to the primary care appointment. Such an incident is an example of
the violation of the code of ethics (ACHE Code of Ethics, 2018).

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Reference:
ACHE Code of Ethics. (2018). Retrieved from https://www.ache.org/abt_ache/code.cfm
Ansell, D., Crispo, J. A., Simard, B., & Bjerre, L. M. (2017). Interventions to reduce wait times
for primary care appointments: a systematic review. BMC health services
research, 17(1), 295.
Barr, J., & Dowding, L. (2015). Leadership in health care. Sage.
Epstein, B., & Turner, M. (2015). The nursing code of ethics: Its value, its history. OJIN: The
Online Journal of Issues in Nursing, 20(2).
Fernández-Alemán, J. L., Señor, I. C., Lozoya, P. Á. O., & Toval, A. (2013). Security and
privacy in electronic health records: A systematic literature review. Journal of biomedical
informatics, 46(3), 541-562.
Harrison, J. P., & Association of University Programs in Health Administration.
(2010). Essentials of strategic planning in healthcare (Vol. 19, No. 3). Chicago, IL:
Health Administration Press.
Huber, D. (2017). Leadership and Nursing Care Management-E-Book. Elsevier Health Sciences.
Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an
integrative review. Journal of advanced nursing, 71(8), 1744-1757.
Langevin, P., & Mendoza, C. (2013). How can management control system fairness reduce
managers’ unethical behaviours?. European Management Journal, 31(3), 209-222.

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Shanks, N. H. (2016). Introduction to health care management. Jones & Bartlett Publishers.