The future promises to be even more challenging to health services managers than the past has been. The types of problems noted above are likely to continue, both in their present forms and in new permutations. New or exacerbated problem areas include terminal illness and futility care, advance directives, serving the underserved, marginal practitioners, multiculturalism (especially the differing meanings of life, death, disease, and treatment held by American subcultures), corporate compliance, employment practices, and whistleblowing. Three of these areas are noteworthy.
FUTILITY CARE. Futility care has been discussed since the early 1990s, but remains inadequately addressed. Acute care hospitals face families (and, less often, patients) who demand that care offering no hope of benefit be continued.
Fear of legal action and bad publicity have prevented hospitals from acting to withhold or withdraw services in such situations.
MULTICULTURALISM. Effectiveness in a multicultural society requires that the HSO's values are clearly communicated to patients, lest the HSO be pulled in many directions with inconsistent demands. Patient interests must be accommodated when possible, but not in contravention of the organization's values.
CORPORATE COMPLIANCE. Corporate compliance is the hot button issue of the new millennium. An organization whose culture and values include honesty, respect, and fair dealing will require little attention to corporate compliance, even though compliance officers are mandated by law. Its values already encourage staff to act honestly. Managers must assure that the organization's culture has no incentives for staff to do otherwise.
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