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Role of Organisational Culture and Professional Ethics of Physicians and Nurses


The scope of this paper is to consider the quality and risk management for the healthcare professionals from the perspective of enhancing organizational culture as well as professional ethics of physicians and nurses.

The major reason for choosing this direction is the fact that ethical aspects of work create the strong basis for the quality improvement as well as for managing risk at the working place since ethical considerations of an individual set the standards of professional behavior at the sublime level.

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Organizational Quality Management Program

First, it is essential to note that there is a direct interrelation between organizational culture, structure, and overall organizational performance. The core reason for such interrelation is the fact that the approach towards human motivation within particular organization is mainly based on the organizational culture, attitude to the personnel, the rate of responsibility granted to each particular employee (Rowold & Schlotz, 2009). If the organizational structure implies clear and fair allocation of power and governance, and the employees are motivated for effective work, the overall organizational performance may be improved. Otherwise, the high rate of staff turnover, low morality, and ineffective work would occur, which is unacceptable for the healthcare entity (Foster, 2002).

The next issue to consider in the scope of this section is the factors, which influence individual behavior at working place and the way they relate to the quality of professional duties execution. Among the core factors, which influence the behavior of an employee at the working place, are the abilities and skills of each particular individual, demography, attitudes, personality, and perception (Schultz, 2010). While discussing the factors, influencing human behavior at the working place related to organizational culture and leadership, it is essential to make a detailed review of the attitude. In accordance with the psychological approach to the human resource management, attitude may be considered as the trend of responding favorably or unfavorably to certain persons, objects, or situations.

Such factors as society, organization, and culture influence the formation of attitude towards the professional activities execution (Wilkinson, 2006). Therefore, the top management of the healthcare entities should pay additional attention to the variables, which are related to job, and create a favorable work environment in order the employees form the positive attitude towards their professional activities. The reason is that the employees would perform better within a particular organization in the case if the positive attitude towards their professional activity in a particular organization is formed (Liu, Liu, & Zeng, 2011).

Effects of Social, Cultural, and Political Influences for the Health Care Services Delivery

It is worth noting that every organization has its unique organizational culture. The top management of the healthcare team possesses particular and unique experience in the healthcare services provision. The leaders of the healthcare establishment help this entity to exceed the expectations of its clients and patients as well as to balance the goals of this organization with the need to improve the community’s overall health. It is obvious that the healthcare services are impacted by the external factors, such as social, political, and cultural ones, but the major emphasis of the quality-controlling program should be placed on the internal factors, organizational culture in particular.

The first issue implied by the organizational culture of the health care entity, is the unity of its employees and of the entire organization within its departments. The shared organizational culture assists the top management of the health care entity in uniting the employees, who belong to different demographics. Therefore, the organizational culture at the health care entity provides its employees with the sense of unity and assists in understanding each other, promotes better communication, and minimizes occurrence of the conflict situations. Finally, the equality is promoted by the organizational culture, namely it ensures that nobody is neglected at the workplace and ensures the equal treatment towards each employee at the working place.

The next issue implied by the organizational culture of the health care entity is the loyalty. Employees are kept motivated and loyal towards the management of this entity. If the employees consider themselves as the part of the organization and its culture, they intend to make the contribution into the organizations’ development and prosperity (Cummings et al., 2004).

The competition, as a social factor, is the next issue of the organizational culture of health care entity. This means that the employees would perform their professional duties at their best in order to earn appreciation and recognition from their superiors. Such approach to the work improves the quality of work and, consequently, of the services provided to the clients. Direction of the organizational culture implies understanding of the roles and responsibilities as well as the ways of timely accomplishment of the particular duties.

The last issue implied by the organizational culture for the health care entity is identity of a particular employee. It is the way the business style of the organization is perceived both by its employees and by the patients and other clients. This way is mainly determined by the organizational culture of the health care entity providing the patients with the healthcare services of the highest quality. The brand image of the health care entity, which it is popular and respected among the population of a particular area, is mainly contributed by the values and beliefs of its employees and organization.

Finally, while considering the fact that the representatives of different cultures and social groups are employed in the health care entities (cross-cultural aspect), the shared organizational culture integrates them, creates the sense of unity and friendly environment for their work. Therefore, the organizational culture may be applied as the pattern of the organization’s development and functioning for the healthcare sector. The reason is that if the professional approach and personal values of the leader are combined with the friendly environment at the working place, they are the core contributing factors of success, high quality of services and improved healthcare while referring to the ethical code of an organization and to the ethical beliefs of each particular employee.

Health Care Professional and Stakeholder Roles and Responsibilities in Quality and Risk Management

While referring to the professional obligations of the healthcare workers it is essential to outline the following information. First, the employee of health care entity should be a competent professional and, consequently, he is required to master specific knowledge and skills. Secondly, the healthcare professional should be obligated to a service commitment, and current practice of such worker should imply lifelong learning due to scientific and technical development of medicine. The other obligations of healthcare professionals include protecting the patients from the unqualified practitioners and controlling the entrance of the colleges to the profession and “police the ranks”

Moreover, public safety should be protected by the professional experience of the employees of healthcare sector. Additional role in this aspect of professional activity of nurses and other healthcare professionals belongs to the government. The core reason for such trend is that these standards are established by the government regarding licensing and regulating practice.

Health Care Policy, Reimbursement and Regulatory Requirements

The next issue to be discussed is the core principles of ethics and legal issues in the nursing area from the perspectives of health care policy, reimbursement, and regulatory requirements. Therefore, the core principles of ethics and morality of the nursing area applied as the bases for the nursing legal issues will be outlined in this chapter. It is important to note that the ethics mainly deals with the standards of professional behavior and, consequently, with the moral judgment. Therefore, the core principles of the healthcare ethics imply upholding the ethics in all the situations, which are related to the autonomy, beneficence, non-maleficence, and justice. In this context, beneficence implies promotion.

The main purpose of nurses’ professional activity is promotion of their clients with the best interests and, in addition, desire to achieve the optimal outcomes of their professional activity. The next principle of the nurses’ work is the non-maleficence, which means that the nurse should put much effort in order to avoid harm to their patients. In other words, the competent practice level should be maintained by the medical in order to avoid causing suffering or injuries to their patients. In addition, the reporting suspected abuse issue is covered by the non-maleficence principle. The core objective of reporting suspected abuse implies prevention of further victimization of the client and his protection from the chemically impaired nurses as well as other practitioners in the healthcare area. Finally, the autonomy in the healthcare ethics and legislation implies the right of the patient to be independent and self-directed. In other words, the clients are provided with the right to be self-determinate and to get the complete information about their disease. Therefore, the competent adult patients have the right to decide whether the particular treatment may be applied to them or it should be refused completely or particularly. The employees of the healthcare establishment should respect the clients’ wish even if the professionals of the healthcare area do not agree with the omissions of their clients (White, 2010).

The last requirement of the justice is equal and fair treatment of all the clients regardless of their financial status, race, gender, religion, and other discriminative factors. The issues of justice are practically applied by the nurses in their daily activities. It is possible to outline the example when the nurses should allocate their time, required for each particular client while considering the needs of the client and making a decision in the fair distribution of available sources between the patients.

There is a need for the nurses to differentiate between the professional ethics and justice and their personal life values. The personal values cover the issues, which are true and significant, and the professional ethics implies the set of principles, which should be applied by the nurses in the process of their professional activity in various situations.

Moreover, it is important to note that the nurses should avoid the application of their personal judgments to the client care bias. The medicals are required to be fair and honest with their clients and, consequently, their professional activity and behavior should be mainly directed to meet the interests of their patients and show the respectful attitude towards them.

Legal, Ethical, and Risk Aspects inTotal Quality and Risk Management

In this chapter, the core aspects of the ethical problems, issues, and dilemmas will be discussed from the perspectives of legal, ethical, and risk aspects in total quality and risk management. In addition, the analysis of the differences between these concepts will be conducted.

Ethical dilemmas are the types of phenomena or behavior, which have the potential of becoming a problematic issue. As an evident example, it is possible to refer to the fact of avoiding the patient’s next of kin by the nurse if this relative is anguished or demanding regarding the situation of a patient.

It is possible to state that the most part of the health care professionals is aware of the obvious ethical issues such as euthanasia or abortion. In addition, there are issues, which occur in everyday professional activities of nurses and may be avoided, for example, the rights of vulnerable people, procedures of pain management, in-group conflicts, interaction and communication with demanding relatives, etc. In some cases, healthcare professional forget the fact that significant share of the ethical issues are relatively small, have the practical nature and are relevant to both the patents and their relatives.

Even if majority of people considers that they are aware of the core ethical issues and ethics in relation to the healthcare profession in particular, there is a high probability of the etiquette term confusion with ethics, while these terms have different concepts.

Hawley (2007) considers that the professional etiquette implies following codes of organizational policy, practice orders, and legislation. Therefore, etiquette is mainly dedicated to providing an individual with an advice about the appropriate behavior in the particular situations and under certain circumstances. It may be applied as the ‘good manners’ guideline for health professionals.

There is a significant difference between the ethical dilemmas or problems and etiquette. In majority of cases, the well-being of another person is involved into the ethical problems.

Individual is entitled to the certain privileges while engaging into a health profession, but there are corresponding obligations required to become a healthcare services’ provider. It is obvious that in order to become a healthcare professional, one should master the discrete body of knowledge. Both nurses and representatives of traditional health professions have the oaths that their members swear to follow after entering healthcare profession. Moreover, this oath implies certain virtues and essential qualities.

There is an identity of a healthcare processional, which is not limited only to the uniform. For example, this identity implies the set of the traits, which should be manifested by an individual in their actions. It is worth noting that over the significant period of time the respect from the public has been engendered by the healthcare professional identity. The ethical issues, their consideration and practical application is an essential component of the healthcare services provision within the relationship between the healthcare professional and the client. Healthcare professionals face the ethical conflicts, distresses, and uncertainties while executing their daily professional activities.

Such trend may be caused by several factors, such as the changes in the healthcare system, both in technologies and in the human values, which make their contribution to the ethical dilemmas. Understanding and integrating values and beliefs help the healthcare professionals to prevent ethical conflicts and to manage them in the case of their occurrence. While having the strong personal values, it is possible to understand the core reasons, the ways of managing the conflict situations and their minimization in the daily professional activities.

The core difference between the healthcare ethics and the professional ethics inherent to other areas of human activities is implied by the fact that the moral code of the doctors is the basic principle for their professional activities being common for the entire healthcare entities and healthcare professions.

As stated above, there are common values and beliefs of the public health professionals. They are reflected in Hippocratic Oath and in the Principles of the Ethical Practice of Public Health. The first one, which is in the Principles of the Ethical Practice of Public Health, is the right of humans for the resources, which are needed for their health care. It means that everyone has the right for the standard of living, which is adequate for the health and wellbeing of the individual and his family members.

The next values reflect the social perspective of the healthcare services provision. For example, the inherent feature of the humans is the fact that they live in the society and, consequently, are interdependent. Therefore, the value for the representatives of a particular social group is health, survival, safety, and well-being of their families, friends and other members of community.

The next integrative part of the healthcare professional ethics and values is the fact that there is a high correlation rate between the public’s trust and the effectiveness of the healthcare institution. In addition, the collaboration is one of the core elements of the public health and there is a need of integrative approach of the healthcare professionals towards the healthcare services provision. Therefore, the core professional values of the healthcare services’ provider should be high rate of responsibility and professionalism because the doctors’ failure has the cost of the human health or the end of the human life. In addition, the needs and the interests of the clients (patients) should be prior to the personal interests of the doctor.

While considering the fact that the complex human rights and ethical issues are addressed by the nurses on a regular basis, in 1985, the Code of Ethics for Nurses was initialed and addressed for the first time by Congress on Nursing Practice and American Nurses Association Board of Directors.

The main purpose of this code was to delineate the code of responsibilities and expected professional behavior of nurses in their daily practice. This code impels the responsibility of nurses to meet the standards of nursing practice and to monitor the way their colleagues meet these standards. The first revision of the code was done in 2001, and the main mission of the revision implied the practical implementation of the issues, related to the nursing science advancing. The revision was mainly based on the experience and professional opinions of the wide range of professionals in the nursing area (Schwab, 2005).

Consequently, there were nine provisions, which address the issues of ethical practice, approved by ANA. These issues were the following: patient advocacy, respect and compassion, the primary commitment of nurse to the patient, duties, responsibility and accountability, responsibility and accountability, participation in the healthcare environment and, finally, the collaboration.

The next issue, to be discussed implies the legal issues in the nursing area. Currently, in the US, there is a set of legal issues related to the nursing area, namely licensing, practice, standards of care, and the nurse practice acts. At the same time, the main emphasis of the legal issues in nursing imply the consideration of the career in nursing area as full of the malpractice and neglect one. The negligence implies both omission and commission. In the case of omission, the particular issues are undertaken, which should be practically implemented by the prudent person. While considering the commission as the form of the negligence, it is possible to say that some issues, which should have not been undertaken by the prudent person, are fulfilled.

While considering the malpractice in nursing, it implies the neglect of a professional. There are four issues are required by law to prove the malpractice, namely duty, breach, causation, damages.

It is essential to outline the core features of each of the above listed individually.

The first one is duty, which implies the legal obligation; this is owed by one person to another. In the cases of providing the patients with the nursing care, the obligation to care about the patients in a diligent and competent manner is assumed. Therefore, the clients expect to receive from the nurses the degree of care, which is also inherent to other medical workers, which operate in the same field. Consequently, the nurses should to meet the standards of care, which are imposed by the nursing practice act and the nurse’s state boards section, in particular. In addition, these core requirements are included into the following legal documents, namely national nursing specialty standards of care and scope of practice, nurse's hospital agency protocols.

Statistical Methodologies Used for Data Analysis

The risk and quality assessment programs involve the process of monitoring, where the patients would receive the questionnaires related to the quality of care provided to them. Afterwards, the rating of the employees would be created in accordance with their rank (physicians and nurses would have spate rating lists).

The risk management for the health care entity is mainly based on volition of basic norms and regulation for healthcare services provision and avoidance of malpractice.

For this purpose, the certain test would be developed for the personnel, where their awareness of principles would be periodically assessed.

Strategies for Administering the Quality Improvement and Risk-Management Processes within a Health Care Delivery System

In this section, it is essential to refer to the fact that the breach of the duty implies the failure in fulfilling obligations, which have been initially established in the form of the nurses’ responsibilities. In other words, it is possible to describe the breach of the nursing duties as not meeting the appropriate and generally established standard of the nursing care.

While considering the causation as an important component of the malpractice provision, it is important to rely on the following information. It is the most complex element to be proved due to the fact that it is the factual interrelation between the injury to the client and the actions of the nurse and, consequently, of their interrelation. Causation may be considered as the breach of the nurses’ duties or as the failure to meet the standard of care, which has been adopted for the nursing profession in the case this failure leads to the injury of the patient or to the adverse outcome.

Finally, while considering the damages, this notion implies the monetary compensation issued by the nurse to the client in the cases where the professional activity of a particular nurse caused the injury or the adverse effect. The monetary compensation should be provided to restore the plaintiff to the initial condition one was before the injury. In order to recover the damages, the is a need to state that the financial, physical, or emotional injury has been obtained by the client due to the nurses’ unprofessionalism or the violation of the care standards. There are two types of damages, namely compensative or punitive (Northrop, 1987).

To conclude, it is important state that the clients with the high level needs in combination with the short staffing may increase the risk and probability of failure. Moreover, it is possible to minimize nursing liability while applying the risk management. In addition, the continuing educational courses, related to the risk management, may be accomplished by the professionals of the healthcare area.

The nurses are required to accomplish the risk management courses in some states in order to be licensed for the first time or to renew the existing license. Additional advantages of the nursing risk management courses may also imply some monetary advantages for nurses, who have accomplished these courses.


After conducting general analysis of the health care entities, it is possible to state that the organizational culture makes a significant contribution to the development and prosperity of each healthcare entity.

One of the core reasons for such statement is the fact that each employee is motivated for work and development, both personal and organizational as well as its improvement through the personal contribution. In addition, the employees are motivated to provide the services of the highest quality not only because the vast majority of them have taken the Hippocratic Oath, but because the organizational values, reflected in its culture, imply the respectful attitude towards the clients and patients, high professionalism and constant development and improvement of the professional skills of physicians.