Ethical and legal aspects of medical laboratory management

Ethical and legal aspects of medical laboratory management Presented to: Dr. Zaid Al-Hamdan Presented by: Ruba Abd Al-Jawad Bara’ah Azaizeh

Ethics • A branch of philosophy that seeks to determine how human actions may be judged right or wrong. – Code of moral principles. – Set standards of “good” and “bad”.

Ethics • Ethical behavior – What is accepted as good and right in the context of the governing moral code. • Law, values, and ethical behavior: – Legal behavior is not necessarily ethical behavior. – Personal values help determine individual ethical behavior.

Ethics and law • Law often represents an ethical minimum ( Law is not the same as Ethics). • Law reflects society’s codified ethics. • Ethics often represents a standard that exceeds the legal minimum.

Main ethical approaches • Normative: involves supplying and justifying moral systems. – Focuses on “what should be”. • Descriptive: involves describing, characterizing and studying morality. – Focuses on “what is”.

Factors influencing ethical behavior include: – The person • Family influences, religious values, personal standards, and personal needs. – The organization • Supervisory behavior, group norms and behavior, and policy statements and written rules. – The environment • Government laws and regulations, societal norms and values, and competitive climate in an industry.

Cultural issues in ethical behavior: – Cultural relativism • Ethical behavior is always determined by cultural context. – Cultural universalism • Behavior that is unacceptable in one’s home environment should not be acceptable anywhere else.

Ethical philosophy • There are three different ethical philosophies that individuals follow under different situations in an organizational set-up. • These are- utilitarianism, individual rights, and justice.

Ethical philosophy • The individual rights philosophy deals with safe guarding the rights of individuals, such as the right to be informed, right to free consent, and the right to privacy. • Utilitarianism recommends that a course of action that achieves the greatest good for the greatest number of people is ethical.

Ethical philosophy • Justice requires that the rules of the organization be enforced fairly and impartially. • Utilitarianism is the most commonly followed ethical philosophy

Ethical decision ideology • Ethical decision ideologies can be classified based on two dimensions: one is • Idealism – the belief that behaving ethically ensures positive results; and the other is • Relativism – the belief that moral values depend on circumstances.

Ethical decision ideology • Based on these two dimensions, there are four classifications of ethical decision ideologies • Absolutist, • Exceptionist • Situationist, and • Subjectivist.

Ethical decision ideologies Matrix Relativism low I D E A L I S M low high Exceptionist Subjectivist Absolutist Situationist

Ethical decision ideologies Matrix • An Absolutist believes in strictly following the universally accepted ethical principles. • An Exceptionist refers to universally accepted ethical principles for broad guidance rather than for strict adherence.

Ethical decision ideologies Matrix • A Situationist takes a decision on a case to case basis by studying and comprehending the situation at hand. • A Subjectivist prepare to abide by their respective individual ethical principles rather than adhering to universally accepted ethical principles.

Codes of ethics ( Employee role): • Formal statement of an organization’s values and ethical principles regarding how to behave in situations susceptible to the creation of ethical problems.

Code of Ethics (IFBLS) International Federation of Biomedical Laboratory Science • Maintain strict confidentiality of patient information and test results within the limits of the law. • Safeguard the dignity and privacy of patients. • Be accountable for the quality and integrity of clinical laboratory services.

Cods of ethics • Treat patients and colleagues with respect, care and thoughtfulness. • Perform duties in an accurate, precise, timely and responsible manner. • Prudently use laboratory resources.

Three models of management ethics • Immoral management: a style devoid of ethical principles and active opposition to what is ethical. • Moral management: conforms to high standards of ethical behavior. • Amoral management: causal or careless about ethical factors.

Ethical role models: – Top managers serve as ethical role models. – All managers can influence the ethical behavior of people who work for and with them. – Excessive pressure can foster unethical behavior.

Manager role • Assure implementation of results • Reward employees who perform and deliver on values. – Reward systems should be integrated with the performance measurements systems. • Provide ethical training. – Structured programs that help participants to understand ethical aspects of decision making.

Manager role • Dealing with poor performance by disciplinary action or discharge. – Traditional discipline systems don’t make the job any easier. – A good manager replaces traditional punitive employee discipline measures such as warnings, probations and unpaid suspensions with the requirement that people take personal responsibility for their performance and behavior and commit to doing the job right.

Manager role – Creates dramatic reductions in disciplinary incidents, while producing major improvements in recognition and commitment. – For those employees who never become involved in any type of disciplinary issue provides specific procedures to help managers recognize and reinforce the performance of their good, solid performers. • Track employees attendance and job performance.

Manager role • View and approve staff leave records. – The employer has the right where the employee is sick or injured for three or more calendar days to require the employee to provide proof, such as a medical certificate, of the injury or illness.

Manager role • Develops standards of performance so that the employee knows how he or she will be judged when rated in job performance (job appraisal). – Provide the employees with written job description. – Annual merit raises are often linked to job performance.

Manager role – Gives the employees feedback throughout the year on how they are doing so that they have an opportunity to correct poor performance.

Manager role • Organize personnel records that should and contain all the information required by regulatory bodies: • Name • Colleges attended • Specialized laboratory training • Laboratory certification • Job description signed by employee • Record of job training at present job • Record of continuing education • Record of medical test

Employee role • Report anything that interferes with day to day activity. • Violation of policy. • Unusual event resulting in harm. • Equipment malfunction. • Employees are required to inform the employer at the earliest opportunity of the intention to take sick leave – preferably before they are due to start work, but otherwise as early as possible.

Accrediting agencies • All laboratories must be accredited (licensed) under (CLIA) Clinical Laboratory Improvement Act. – which means that every laboratory must register with (CMS) Centers for Medicare and Medicaid Services for every test it performs and must meet certain minimum quality standards. • Laboratories are monitored by inspections which include a review of a laboratory’s procedures, quality control program, documentation, and patient management.

Common areas of government regulations and laws: • Occupational safety and health. • Fair labor practices. • Environmental protection.

Laboratory regulations • The Environmental Protection Agency (EPA) – Regulates the disposal of toxic chemicals and biohazardous waste. • Occupational Safety and Health Administration (OSHA) – Regulates employee safety in the workplace.

Lab regulations • The office of the inspector General (OIG) – Monitor laboratories for fraud and abuse in the billing Medicare. • The Health Information Portability and Accountability Act (HIPAA) – legislates the need to maintain security and privacy of information found in patient records.

Lab regulations – This means having secure phone and faxes for transmission of laboratory data and limiting access to patent data to only those individuals needing to know the results.

Health Sciences Authority • Providing legal and regulatory advice and support. • Ensure regulatory compliance with related legislations and regulations. • Assist in formulating policies, procedures to ensure compliance with applicable laws and regulations.

• paid the minimum wage as well as any overtime, the right to a safe workplace, the right to take leave to care for your or a family member's illness, birth, or adoption, and the right to privacy in personal matters.

Jordanian labor law of 1996 • Jordanian Labor law number (8) was issued in 1996 to regulate the relationship between the Employer and the Employee, which means that any contract or any term in any contract between both parties that contradicts the labor law is considered invalid.

• Hours of work: • The average number of working hours for men and women is 8 hours a day. Breaks are not part of working time. If the employee accepts to work more than the working hours specified in the law, then he will be entitled for overtime. • Article 4 forbids the employment of women in night work, with exception in certain fields: hospitals, clinics, medical institutions ……

• Dismissal: • Article 28 states that workers can be discharged without notice, if they assault or beat or humiliate any worker or other person. • Article 29 states that if a worker is assaulted by the employer or his representative, the worker may quit work without notice, and still retain his legal rights.

• Leave: • Article 67 states that when the number of workers in an establishment is equal to, or exceeds ten, women workers in such an establishment have the right to take one year of leave without pay in order to look after their children. However, if the employee works in another establishment during this leave, the employer can dismiss her. Article 68 states that an employee (man or woman) may take a non-paid leave that does not exceed two years, in order to accompany his or her spouse who works abroad. • Article 70 states that the maternity leave is 10 weeks with full pay. Women, who go on maternity leave, cannot return to work until six weeks after the delivery.

• Article 71 states that upon their return from a maternity leave, mothers are entitled to a daily nursing break of one hour, for one year after giving birth. • Article 72 states that: • The owner of an establishment which employs 20 or more married women with at least 10 children under 4 years old, should provide a nursery and hire a qualified governess to take care of the children. • An employer must not dismiss a pregnant employee from the sixth month of pregnancy or during maternity leave.

• Paid leave: • Every worker is entitled to annual leave with full pay for a period of fourteen days for every year of employment. This leave is extended to twenty one days where the worker has been in the employment of the same employer for five consecutive years. Official and religious holidays and weekly rest days shall not be counted as part of a worker's annual leave unless they fall in its course. • If a worker's employment is terminated for any reason before he uses up his annual leave, he shall be entitled to receive his remuneration for all remaining leave days. Any agreement by which a worker relinquishes his right to annual leave in full or in part shall be null and void.

• Termination of the Contract: • Labor law verifies the cases that gives the employer the right to terminate the employment contract without paying any compensation due to termination. Other than these cases verified in the labor law, the termination will be considered unlawful. The termination of the employment contract for any reason – with or without cause - does not have an effect on the other rights enjoyed by the employee such as annual leave, unpaid salaries, overtime, or any other benefits.

• The foreigner workers: • According to labor law, it is not allowed to employ any foreigner workers without prior consent from the Ministry of Labor. The work permit should not exceed one year and can be renewed for extra years. Any employer who uses any foreign employee without obtaining a work permit will be liable for a fine between 100 – 150 Jordanian Dinar for each month until the employer meets the legal requirements.

THANK YOU