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Chapter 5

Chapter 5
Ethical Conflicts: System & Interest of Others

HUS 1020

Marietta Miller-Jones, MSEd

Unit 5: Ethical Conflicts
Objectives:

To discuss what is meant by “system culture”

To discuss how system culture impact ethical decision-making?

To review examples of ethical conflict when working in a managed- care environment

To review examples of ethical conflict when working with 3rd-party payees

What does the term “System Culture” mean?

The Ethical Culture of Social Systems consists of:

An organization that develops their own values or standards to guide decision making within the culture of that organization

An organization that values their own system’s view of what’s important as it relates to goals, activities, relationship, and feelings

Organizational
Systems of Culture Consists of:

A pattern of basic assumptions that is taught to members in a new setting, culture, environment, etc.

An invented or developed way a group should adopt to rules, regulations, policies An integration, adaption, acceptance, & expectation to comply w/the organization’s internal/external system because the company’s mottos is: “it works for us” thus, it’s valid to us—there’s no need to change; this can also lead to “group think” i.e., going along to get along

Systems of Culture Cont’d…

A company’s perceived correct way to think and feel in relation to internal/external problems

An organization develops & maintains its system’s culture which is not to be questioned or challenged i.e., “this is the way we’ve always done it”; “if-it-ain’t-broke-don’t-fix-it” mentality

Ethical Conflicts:
The System’s Goals vs. The Helper’s Values

When making ethical decisions w/in an organization’s system (ex: Kaiser, BC/BS), a helper must be mindful of their values when making a “good-faith” effort to treat their client’s needs

Helpers practicing counseling w/in an organization who uses 3rd-party managed- care systems to fund their client’s services, should be aware of the subtle influence their organization may have when setting goals and/or making decisions for the needs of clients (ex: the services may be limited to a certain number of sessions), this means you have a limited amount of time to spend counseling your client (i.e., 4 sessions for 45 mins. each)

The System’s Goals-The Helper’s Values Cont’d …

Thus, the helper who accepts a position with an organization will have to sign a contract agreeing (and embracing) the values & standards of practice within that organization!

Who is the Client?

According to ALL professional organization guidelines, the needs of the client are the primary concern thus, thus this may conflict with the institution/organization’s systems of culture

However, helpers must be accountable & responsive to both the organization’s system AND to the clients, they service within that system; this is what is meant by “Multiple Masters”

Multiple Masters:
Manage Care System & The Client

What is a manage care system?

A cost-effective systems designed for Health Maintenance Organization (HMO) are to provide equal or better care to patients

It is designed to be a cost-saving for clients to pay for their mental health counseling through their employer’s managed care system i.e. Blue Cross/Blue Shield, Kaiser Permanente, Aetna, etc.

A professional counselor may work with clients who pay for their sessions through an HMO, but may be limited to the # of sessions their client may need

A managed care organization challenges a professional to provide ethical treatment according to the needs of the client

Financial Incentives in Managed Care Systems

Financial incentives benefit HMO’s & the Practitioner BUT:

Denies and limits the clients’ access to long-term therapy

Narrows the clients’ choice of a therapist

Disrupts the continuity of care

Sometimes relies on less-qualified practitioners to service clients

Ethical Issues in Managed Care

Confidentiality – does restrict some access to client’s records which threatens the fundamental concept of “confidentiality, but some access may be required on an as-needed-basis ex: a client using his/her Employee Assistance Plan (EAP)

Informed consent – ethical practitioners will need to discuss w/the clients what will be covered through their insurance which may affect the type of treatment available to them, # of sessions, the amount of time per session, etc.

Client’s limited by their insurance may be undertreated, underdiagnosed, or receive no follow-up care

Abandonment – it is unethical for a helper to abandoned a client! it is imperative that helpers understand the ethical standards of practice within the manage care’s system & the guidelines of their professional organization

Group Case Study Practice

You are treating clients insured under their company’s HMO; however, you billed the HMO and received a letter stating that “Due to COVID-19 reimbursements will be delayed because state funding is being allocated to hospitals providing mental health counseling to Covid patients at this time” however, you’re treating two clients who are depressed and grieving because they’ve lost family member(s) due to the virus…

Poll Questions:

Would you continue treating your clients not knowing when you will be paid for your services with

the same quality of care? Yes or No

2) Would you limit the amount of time you would normally spend with your clients to take on more

clients who can pay out of pocket? Yes or No

Chapter 5

 

Read Chapt 5: Ethical Conflicts: The System & the Interest of Others (p.88-99)

  • Do Ex 5.2 (p. 88) Goals–Value & Decisions
  • Carefully read the 4 scenarios. The first one is done for you.
  • Identify which Human Services System’s Goals & Preferred Decisions are in Conflict or Parallel (aligned) with the Practitioner’s Goals & Preferred Decisions by stating Parallel or Conflict? Explain why you chose that answer

CHAPTER 5

CHAPTER 5

eHR and PerformanceManagementA Consideration of PositivePotential and the Dark SideRobert L. CardyJanice S. Miller

Technology seems to offer us boundless possibilities and hope.Somehow, technological advances seem to bring with them visionsof increased ease, efficiency, and fairness, while reducing the needfor labor and providing more time for leisure. Technology, in theform of improved appliances and chemistry, is taking the drudgeryout of housework. Similarly, the advent of the automobile affordedsafe, convenient, and economical travel to virtually everyone. Fur-ther, the personal computer offered to level the playing field andbring instantaneous information to everyone, even those whomight be housebound or in remote areas.

While there can be little doubt that technological advances,such as those described above, have improved our lives, they maynot have lived up to their initial promises. Further, the advanceshave brought with them negative aspects that may not have beenanticipated. For example, technological advances would beexpected to reduce the time we spend doing housework. Whileover the years there has been a reduction in average time spent onhousework for women, the figure has increased for men (Green-

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wood, Seshadri, & Yorukoglu, 2004; Institute for Social Research,2002;). Changes in the amount of time spent in housework appearto have more to do with the labor market than with labor-savingdevices. Further, technological advances in the form of labor-savingdevices can actually increase the time spent in housework. At leastin part, a reason for the counterintuitive relationship between tech-nological advances and time spent in housework is that appliancesbring with them their own set of tasks. They also make possible ahigher level of performance and therefore change the standardsfor performance. For example, an “automatic” dishwasher mayinvolve rinsing or pre-washing dishes. Since the dishwasher makespossible storage and daily washing of dishes, dirty dishes left in asink is no longer acceptable in many households. The level ofperformance made possible by technological advancement haschanged the standard for acceptable performance. Similarly, theautomobile has made travel easier and more accessible to millionsof people. However, auto accidents maim and kill drivers, passen-gers, and pedestrians on a daily basis. Further, auto advancementssuch as four-wheel drive and traction control hold forth the possi-bility of horrific accidents when the performance envelope isextended beyond its boundaries. As another example, personalcomputers offer information and communication, but we are farfrom paperless and viruses and spam now seem to be permanentfixtures on the computer landscape.

In sum, technology offers great positive possibilities, but neg-ative outcomes, often unintended, can be part of the advancement.Further, technology now permeates our lives, and its role in per-formance management in the workplace is no exception.

Our purpose in this chapter is to consider the role of technol-ogy in performance management. We will consider the promiseand potential of technology in this important area of management.We will also consider the sometimes not-so-obvious negative possi-bilities that technology can bring to performance management.Our hope is that a review of positive possibilities as well as the “darkside” can identify potentially beneficial applications of technologyto performance management and identify potential costs and howthey might be avoided.

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140 THE BRAVE NEW WORLD OF EHR

The Positive Potential for Technology in Performance ManagementIn view of the fact that HRM centers on an organization’s uniquehuman and “inimitable” component, whereas technology is morestandard and replicable, incorporating technology into HRM intro-duces some interesting and relevant concerns for practitioners. Forexample, to what extent is it productive to invest in technology rel-ative to investments in employee development, mentoring, orcareer management? Or can technology actually support or accel-erate positive outcomes in these areas? Does success depend lesson how firms manage their technology than on how they managetheir human assets? In short, the contrasts between “content” con-cerns and “process” concerns confronting HRM are intriguingissues to explore, as these contribute uniquely to the way organi-zations manage and develop their members.

The use of technology in performance management has thepotential to increase productivity and enhance competitiveness.We believe that appraisal satisfaction is a key concept that is cen-tral to any discussion of technology and performance manage-ment. Clearly, gains technology makes are Pyrrhic victories ifappraisal satisfaction does not improve as well. Contemporaryattention to psychological variables such as appraisal satisfactionthat underlie the appraisal process and user reactions to the per-formance management system have supplanted previous preoccu-pations with appraisal instrument format and rater accuracy (Cardy& Dobbins, 1994; Judge & Ferris, 1993; Waldman, 1997). In viewof the uniqueness and competitive advantage that human re-sources provide, it is appropriate that organizations pay greaterattention to questions of employee satisfaction and with how firmsevaluate their performance.

We believe that appraisal satisfaction will remain a relevant con-cern, even when technology is a primary mechanism for the feed-back process. Beyond this, appraisal satisfaction is also a criticalconcern when technology actually becomes the appraisal process.This is because an important link exists between satisfaction withappraisal processes and technology’s potential as an effective forcefor change and improved performance.

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Gueutal, H., Stone, D. L., & Stone, D. L. (Eds.). (2005). The brave new world of ehr : Human resources in the digital age. ProQuest Ebook Central <a onclick=window.open(‘http://ebookcentral.proquest.com’,’_blank’) href=’http://ebookcentral.proquest.com’ target=’_blank’ style=’cursor: pointer;’>http://ebookcentral.proquest.com</a>Created from apus on 2021-06-17 01:30:46.

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Given that high-quality performance feedback should be onefactor that helps organizations retain, motivate, and develop theiremployees, these outcomes are more likely to occur if employeesare satisfied with the performance appraisal process, feel they aretreated fairly, and support the system. Conversely, if ratees are dis-satisfied or perceive a system as unfair, they have diminished moti-vation to use evaluation information to improve their performance(Ilgen, Fisher, & Taylor, 1979). In the extreme, dissatisfaction withappraisal procedures may be responsible for feelings of inequity,decreased motivation, and increased employee turnover.

Furthermore, from a reward standpoint, linking performanceto compensation is difficult when employees are dissatisfied withthe appraisal process. Noting this difficulty, Lawler (1967) sug-gested that employee opinions of an appraisal system might actu-ally be as important as the system’s psychometric validity andreliability. The question of appraisal satisfaction is a relevant con-cern in discussions of how technology interacts with performancemanagement systems since, absent user satisfaction and support,technological enhancements are likely to be unsuccessful.

Technology as Content

Technology may contribute to performance management and thusto appraisal satisfaction in two primary ways. First, technology mayfacilitate measuring an individual’s performance via computermonitoring activities. This frequently occurs as an unobtrusive androte mechanical process that relies on minimal input from indi-viduals beyond their task performance. Jobs that incorporate thistype of appraisal technology are frequently scripted or repetitiousand involve little personal judgment or discretion. Working in acall center or performing data entry are examples. In this instance,the very act of performing a job simultaneously becomes the mea-sure of how well a jobholder accomplishes it. Keystrokes, time ontask, or numbers of calls made are recorded and at once becomeboth job content and appraisal content.

A second approach to technology and performance manage-ment changes the emphasis so that technology becomes a tool tofacilitate the process of writing reviews or generating performance

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142 THE BRAVE NEW WORLD OF EHR

feedback. Examples here include multi-rater appraisals that super-visors or team members generate online, as well as off-the-shelfappraisal software packages that actually construct an evaluationfor a manager. This particular technological approach occurs moreoften in the context of jobs that involve personal judgment, highdiscretion, and open-ended tasks for which real-time performancemonitoring is not an option. Again, it is critical to consider theseaspects of technology use in performance management within aframework of appraisal satisfaction. We will address the secondapplication of technology to performance management in the nextsection of this chapter.

In 1993 computerized performance reports evaluated the workof approximately ten million workers in the United States (Hawk,1994). Although estimates vary, by the end of the twentieth cen-tury this number may have reached at least twenty-seven millionworkers (DeTienne & Abbot, 1993; Staunton & Barnes-Farrell,1996). Computerized performance monitoring (CPM) technologyfacilitates data collection by counting the number of work unitscompleted per time period, number and length of times a termi-nal is left idle, number of keystrokes, error rates, time spent onvarious tasks, and so forth. The resulting data are attractive toemployers who may opt to use the technique for workforce plan-ning, evaluating and controlling worker performance, and pro-viding employee performance feedback, our focus here.

Clearly, this use of technology in performance managementhas positive features from a manager’s perspective. For one, CPMpermits greater span of control because it facilitates accurate col-lection of performance data without requiring managers to spendsignificant time observing each individual worker’s actual job per-formance. Similar to technology implemented in other organiza-tional processes (purchasing or manufacturing, for example),when firms apply technology to performance management theystand to benefit from prized gains in efficiency.

Trust is a critical issue that arises in connection with the use ofCPM. Some describe trust as the essence of social exchange. Thatis, when mutual trust flourishes, so also does the extent of theexchange. Earley (1988) empirically demonstrated that computer-generated performance feedback enhanced worker performanceif the individual trusted the feedback source. His study centered

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on telemarketers who either received CPM feedback that a super-visor provided or, in an alternate condition, accessed their CPMfeedback directly. Results showed that an individual’s performanceand trust in feedback was higher for the self-generated than for thesupervisor-generated condition. Although employees’ direct accessto feedback data had positive effects, the level of specificity of infor-mation available from CPM also led to performance improvements.The researcher found that specific information produced greaterperformance gains than more general performance feedback, asthe latter had only limited value in enhancing performance.

Another way to interpret these findings is that self-efficacyincreases when an individual takes control of generating his or herown feedback via technology rather than ceding this function to asupervisor. Enhanced control over one’s work that comes fromreceiving feedback directly from a computer may be preferable torelying on the supervisor to manage the feedback process as anintermediary. It may be that computer-generated feedback thatperformers access and interpret on their own is less threateningthan situations in which the person is a powerless and passive recip-ient of feedback from a supervisor.

More recently, Douthitt and Aiello (2001) approached CPMusing a procedural-justice framework. In a laboratory study, theyexposed participants to four feedback conditions in which partici-pants experienced varying levels of control over the feedback theyreceived. They found that the opportunity to participate in deter-mining how one received feedback positively affected perceivedprocedural justice, and that this was more effective than actuallyhaving an opportunity to control or turn off the computer moni-toring. One of the authors’ conclusions was that heightened per-ceptions of procedural fairness provide positive return for the costinvolved in establishing employee participation in a CPM envi-ronment. Thus, these researchers confirmed a growing awarenessof the importance of allowing workers to retain control over someaspects of computerized feedback generation.

Organizations that invest in technology for performanceimprovement have wasted their resources if employees are uncom-fortable with the system or are overwhelmed with the amount ofdata that is available. Therefore, formal training for users that willresult in comfort and confidence with the system should be an

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144 THE BRAVE NEW WORLD OF EHR

essential part of CPM implementation. This is especially importantif organizations allow employees access to their own CPM data.

To enhance perceptions of system fairness, practitioners shouldfind a way to balance quantitative performance data with acknowl-edgment of system factors. For example, an employee who delivershigh-quality customer service over the telephone could generatepositive responses from the public that would foster return business,even though objective call duration data alone might not capturethis fact, as more time spent on individual calls results in handlingfewer calls daily. A CPM system that monitors call volume could castthis individual’s performance in a negative light. However, a processthat also incorporates acknowledgment of system factors—such ascall complexity—would put work performance in perspective. Sincethis is the kind of performance that an organization seeks toencourage, finding an appropriate objective/subjective balancebenefits not only the performer in terms of fairness, but the orga-nization from an outcome standpoint.

In this vein, DeTienne and Abbot (1993) cautioned firms notmerely to measure quantity via CPM but also to find ways to mea-sure subjective aspects of job performance. A CPM process thatincludes provisions for acknowledging the situational constraintsor system factors affecting performance may greatly enhanceemployee satisfaction with an appraisal process. Examples of con-straints could include changes in workload based on fluctuationsin employment level, introduction of new work processes, thespecialized nature of some tasks, or shifting demand as a result ofmarketplace changes over which an employee has no control.

A system approach to CPM is appropriate because organiza-tional researchers now recognize that individual-level variables donot operate in isolation, but interact with situational factors thatsurround working individuals. The system approach to perfor-mance management hails from Deming’s (1986) assertion that 85percent of performance variation comes from organizational sys-tems. As most employee performance falls within a predictablerange of behavior or is within statistical control, Deming believedthat performance fluctuations were due to system inputs like poortraining, inadequate technology, or other factors under manage-ment control.

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In this framework, system factors may either facilitate or bedetrimental to performance (Cardy & Dobbins, 1994). For exam-ple, economic factors, computer crashes, or task complexity varia-tions could all influence CPM data. If firms find ways to incorporatesituational constraints and system factors into CPM practices, thensatisfaction with computer generated performance feedback neednot suffer.

One way to pursue objectivity, while acknowledging system fac-tors, is by incorporating CPM into a broader “Management byObjectives” (MBO) format. A key component of MBO programs isan emphasis on joint supervisor-subordinate determination ofgoals and performance indicators. As discussed above, employeesrespond with greater trust to an appraisal system in which theyhave had a voice. A CPM appraisal system does not preclude jointlyset goals and agreement on measurement tactics. Practitioners mayfind that the upside potential for heightened trust that can lead toloyalty and commitment more than compensates for the timespent engaging in the MBO process in conjunction with CPM.

An additional important consideration is follow-up and estab-lishment of a development plan after feedback delivery. AlthoughCPM provides accurate performance feedback in quantitative form,its role and function appear to end there. To have a positive effect,data delivery must also include a developmental aspect that includesdevising a plan for monitoring progress and achieving improvedperformance. Indeed, merely providing outcome measures withoutaddressing how to interpret them—or establishing a programdesigned to elicit subsequent performance improvements—fails tofulfill the goals of a well-administered appraisal process.

One effective way to administer CPM feedback may be to bor-row again from established MBO practices. For example, a super-visor might have a developmental meeting with an employee toreview the CPM data, discuss tactics for raising performance, andjointly solve problems regarding current procedures. To make CPMa more positive experience, practitioners might consider exploringhow to convey CPM data feedback in a way that involves interactionbetween supervisor and employee and is geared toward data inter-pretation and employee development, rather than simply over-whelming an employee with quantitative performance numbers.

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An attractive feature of CPM is that feedback is more clearlyrelated to work output and less to superiors’ biased impressions(Shamir & Salomon, 1985). This contrasts with performance-management processes that may be highly political or that en-courage individuals to practice impression management or othernonperformance tactics to improve appraisal outcomes. Despite awide range of impression-management behaviors that employeesmay engage in to influence appraisal results, these behaviors arelargely irrelevant in organizations that rely on objective CPM data.Certainly recipients of CPM performance feedback should feelconfident that data are unbiased by nonperformance factors orpolitical behaviors that can affect traditional performance appraisalin various ways (Longnecker, Sims, & Gioia, 1987). While this isclearly a positive feature of CPM from the standpoint of fairness,it does not tell the whole story.

There is growing research interest in CPM and its impact onemployees and their performance, but few conclusions about per-sonality and other individual-level variables such as demographicor biographical characteristics and their roles in CPM. There hasbeen a surprising lack of attention to individual differences in tech-nology acceptance, particularly in view of extant research on indi-vidual differences and technology implementation (Agarwal &Prasad, 1999). Both theory development and practice could ben-efit from discovering which personality traits or individual qualitiesprovide the best fit for a CPM environment. There are two ap-proaches organizations could use to explore this supposition.

First, the “Big Five” model of personality (Barrick & Mount,1991) may shed some light on the type of individual who prospersin a firm that uses CPM to evaluate his or her performance. A start-ing point for this discussion comes from Earley’s findings (1986,1988) regarding the importance of employee participation in CPMpractices. Along with increased trust and individual self-efficacyresulting from accessing one’s own CPM data, personality factorsmay enhance success in this environment. For example, one rele-vant factor might be the Big Five concept of “openness to experi-ence.” Individuals high in openness tend to be broad-minded,motivated to learn, imaginative, and interested in new ideas. Thiswillingness to try something new (that is, master the technology nec-

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essary to access one’s own CPM data and benefit from it) seems con-sistent with the kind of CPM procedures Earley (1988) advocated.

Second, recent work exploring the relationship betweenworker age and technology has disclosed that age significantlyinfluences workplace technology usage. In a recent longitudinalstudy, Morris and Venkatesh (2000) reported that, compared toolder workers, the ease or difficulty of technology usage stronglyinfluenced attitudes of younger workers toward a particular tech-nology. They also found that social pressure to use a technologywas a more important factor in determining older workers’ atti-tudes toward usage. Consideration of these findings could havepositive implications for satisfaction with performance manage-ment administered via CPM.

Technology as Process

In contrast to the performance management of routine or low-discretion jobs that CPM addresses, organizations also have theoption to use software that can both generate appraisal forms andtheir accompanying narrative. In this case, technology becomes anaid that facilitates delivering performance feedback, rather thangenerating the actual content or data, as CPM does. This broadenstechnology options to the remaining jobs in an organization whoseincumbents receive appraisals.

There are several ways to achieve technological enhancementof performance-management systems in these remaining jobs. Onemethod incorporates appraisal as part of an overall enterpriseresource planning (ERP) software system. Today many perfor-mance/competency management systems are part of ERP pack-ages. The advantage of this macro approach is that it comprises awide variety of enterprise data, including finance, operations, andsales/marketing. The ERP system permits viewing an organizationin ways that otherwise would not be feasible by exploring the enter-prise data and analyzing competencies for individuals, groups ofworkers, departments, and project teams. This allows HR practi-tioners to identify high performers, to spot skill and competencygaps, and to analyze pay relative to performance (Greengard,1999). The ERP creates a continuous process, providing managers

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with easy access to information. The ERP can also adapt to fluctu-ations in subordinates’ progress toward goals.

Once HR holds this information, it may provide training,coaching, and education so an organization remains competitive.The ERP methodology is also attractive from the standpoint of per-mitting a strategic approach to HRM—the HR practitioner canconcentrate on developing an organization’s unique human com-ponent, while the employees remain fully engaged in their work(Greengard, 1999).

Firm intranets or the Internet may also serve as key techno-logical enhancements of the performance-management process.Novell Inc., in San Jose, California, anticipates …