Gathering her key players around a table in her office, Jane Fulton broke the news to them.
"Unfortunately, I'm your boss," Fulton told the physicians, nurses and hospital administrators. "I'm going to give legitimacy to your views, and you've got to give legitimacy to mine, because I have a job to do."
Fulton, a veteran ACHE speaker, will share this ethical framework for problem-solving she used as a Canadian health official at the ACHE congress in sessions titled "Good Ethics Make Good Business," to be held at 10: 30 a.m. and 2 p.m. Tuesday, March 3.
"I discovered there were a lot of problems in the healthcare industry when making tough choices," says Fulton, now president of the Healthcare Group, a consulting firm in Ontario, Canada. "I think this (seminar) is something that will light a fire under people living in the managed-care world."
Fulton drew from her nine years as an ethics professor at the University of Ottawa Business School to craft what she calls a moral decisionmaking process.
That process helped remedy the rifts caused by the cold, hard business calls she had to make in her role as deputy minister of health in the Canadian province of Alberta.
"I was running a $3.6 billion-a-year healthcare system," Fulton says, explaining that the Canadian government covers healthcare for all its citizens. "I was actually running a business and dealing with some difficult issues."
Fulton will talk about the three perspectives to be considered when trying to solve problems: pluralism, "contractarianism" and utilitarianism.
Pluralism means making decisions based on rules of practice or codes of ethics. This perspective applies mostly to physicians.
"Pluralists hold fundamental beliefs about their roles in society," Fulton says. "Physicians believe, and rightly so, that they are advocates for their patients."
Contractarianism refers to nurses and trade unions' representation of healthcare workers.
"In other words, if I have a contract or an agreement to work, you can't fire me if you run out of money, because there are still people who need care," she says.
Fulton herself took the utilitarian point of view, which is typically held by government bureaucrats.
"We want the most value for our money," she says. "It's a cost-benefit approach that doesn't always pay attention to the other two perspectives."
Giving each perspective equal consideration helped Fulton and her key players work through a laundry strike and a hospital closing.
"Communication is really important, and so is being trusted," Fulton says. "You want to make sure you can solve the next problem. This (process) is an intuitive behavior, not a recipe."